{
  "abstract": "Evidence-based practices (EBPs) in supported employment (SE) improve vocational outcomes for individuals with serious mental health conditions, yet their implementation and sustainment at scale remain limited. Thinking Skills for Work (TSW), a cognitive remediation intervention, is an EBP that increases vocational outcomes for SE participants. This study evaluated the Integrated Scaling Approach (ISA), designed to increase adoption of EBPs, such as TSW, across service systems. A field trial of ISA was conducted across SE programs in a single U.S. state. ISA strategies addressed scale-up by building stakeholder engagement and staff-organizational-system capacity, across three phases (preparation, implementation, and sustainment). Using a concurrent mixed-methods design, quantitative data assessed TSW implementation, while qualitative interviews and focus groups examined facilitators and barriers to scaling and sustainment. Nine agencies, managing twelve SE sites, enrolled in the study. Eight completed all ISA phases. Nineteen staff achieved TSW certification, and sixteen completed a Train-the-Trainer program. Eighty-five clients received TSW during the trial. The state modified its evaluation process to monitor TSW implementation. Qualitative findings indicated that structured training, implementation team engagement, and intervention flexibility, facilitated adoption. Long term sustainment was not achieved due to workforce shortages, resource constraints, and the absence of sustained system-level support, exacerbated by the COVID-19 pandemic. The ISA promoted short-term adoption and workforce capacity for an evidence-based employment intervention across multiple organizations, but not long-term sustainment. These findings underscore the necessity of integrating long term system-level policies and funding mechanisms with implementation strategies to achieve sustainable scale-up of EBPs in mental health systems.",
  "abstract_shown": true,
  "affiliations": [
    "Center for Psychiatric Rehabilitation, Sargent College of Health and Rehabilitation Sciences, Boston University"
  ],
  "article_type": "brief report",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Marianne Farkas"
    },
    {
      "affs": [
        0
      ],
      "name": "Alexa Trolley-Hanson"
    },
    {
      "affs": [
        0
      ],
      "name": "Susan R. McGurk"
    },
    {
      "affs": [
        0
      ],
      "name": "Jane K. Burke-Miller"
    },
    {
      "affs": [
        0
      ],
      "name": "David Braverman"
    },
    {
      "affs": [
        0
      ],
      "name": "Chitra Khare"
    },
    {
      "affs": [
        0
      ],
      "name": "Kim T. Mueser"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/651ntf75pzpjd.bib",
  "cited_by": 0,
  "doi": "10.3389/fpsyt.2026.1867975",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13725467/?tool=EBI",
  "id": "651ntf75pzpjd",
  "issns": [
    "1664-0640"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1867975/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Brief Research Report"
    ],
    [
      "openalex",
      "3600|Health Policy Implementation Science"
    ]
  ],
  "openalex": "W7222914053",
  "pdf_url": "https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2026.1867975/pdf",
  "pmcid": "PMC13725467",
  "pmid": "42973898",
  "published": "2026-10-19",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/651ntf75pzpjd.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:18Z",
      "native_id": "10.3389/fpsyt.2026.1867975",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1867975/full"
    },
    {
      "first_seen": "2026-11-03T15:20:51Z",
      "native_id": "PMC:PMC13725467",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13725467"
    },
    {
      "first_seen": "2026-11-04T12:23:51Z",
      "native_id": "PMC13725467",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fpsyt.2026.1867975"
    },
    {
      "first_seen": "2026-11-04T15:20:48Z",
      "native_id": "MED:42973898",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42973898"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1664-0640",
      "subfield": "psychiatry"
    }
  ],
  "title": "Outcomes of the Integrated Scaling Approach: scaling an evidence-based employment intervention in public mental health systems",
  "title_text": "Outcomes of the Integrated Scaling Approach: scaling an evidence-based employment intervention in public mental health systems",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:21:43Z",
  "url": "https://research.draconitic.com/paper/651ntf75pzpjd",
  "venue": "Frontiers in Psychiatry",
  "versions": []
}