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A central issue is the ability of a person to hold a regular full-time job for a sustained period of time.
There have been several attempts to develop novel and radical models for program interventions designed to assist persons with SMI to sustain full-time employment while living in the community.
Most of the early attempts to evaluate such programs have naturally focused almost exclusively on employment outcomes.
However, theory suggests that sustained employment and living in the community may have important therapeutic benefits in addition to the obvious economic ones.
Controlled studies of sheltered workshop performance of persons with mental illness suggested only minimal success (Griffiths, 1974) and other research indicated that persons with mental illness earned lower wages, presented more behavior problems, and showed poorer workshop attendance than workers with other disabilities (Whitehead, 1977; Ciardiello, 1981).
In the 1980s, a new model of services called Supported Employment (SE) was proposed as less expensive and more normalizing for persons undergoing rehabilitation (Wehman, 1985).
Significant treatment effects were found on all four measures, but they were in the opposite direction from what was hypothesized.
Instead of functioning better and having more self esteem, persons in SE had lower functioning levels and lower self esteem.
The idea that this model could be generalized to persons with all types of severe disabilities, including severe mental illness, became commonly accepted (Chadsey-Rusch & Rusch, 1986).
One of the more notable SE programs was developed at Thresholds, the site for the present study, which created a new staff position called the mobile job support worker (MJSW) and removed the common six month time limit for many placements.