Outcomes of the Integrated Scaling Approach: scaling an evidence-based employment intervention in public mental health systems
- 1Center for Psychiatric Rehabilitation, Sargent College of Health and Rehabilitation Sciences, Boston University
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.
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BibTeX
@article{farkas2026outcomes,
title = {{Outcomes of the Integrated Scaling Approach: scaling an evidence-based employment intervention in public mental health systems}},
author = {Marianne Farkas and Alexa Trolley-Hanson and Susan R. McGurk and Jane K. Burke-Miller and David Braverman and Chitra Khare and Kim T. Mueser},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1867975},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1867975/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Outcomes of the Integrated Scaling Approach: scaling an evidence-based employment intervention in public mental health systems
AU - Marianne Farkas
AU - Alexa Trolley-Hanson
AU - Susan R. McGurk
AU - Jane K. Burke-Miller
AU - David Braverman
AU - Chitra Khare
AU - Kim T. Mueser
PY - 2026
DA - 2026/10/19
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1867975
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1867975/full
AB - 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.
SN - 1664-0640
ER -