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Supported employment for people with severe mental illness is an evidence- based practice, based on converging findings from eight randomized controlled trials and three quasi-experimental studies. The critical ingredients of supported employment have been well described, and a fidelity scale differentiates supported employment programs from other types of vocational services. The effectiveness of supported employment appears to be generalizable across a broad range of client characteristics and community settings. More research is needed on long-term outcomes and on cost-effectiveness. Access to supported employment programs remains a problem, despite their increasing use throughout the United States. The authors discuss barriers to implementation and strategies for overcoming them based on successful experiences in several states. [ABSTRACT FROM AUTHOR]

Objective: The authors reviewed the literature related to telepsychiatry-- applications of videoconferencing technology for mental health care-- which offers hope for an affordable means of solving long-standing workforce problems, particularly in geographical areas where specialist providers are not readily available. Methods: To conduct a comprehensive review of the telepsychiatry literature, the authors searched the MEDLINE database (1970 to February 2000), using the keywords telepsychiatry, telemedicine, and videoconferencing. Studies were selected that included the use of videoconferencing technology for the provision of any form of mental health care services. Results and conclusions: Psychiatric interviews conducted by telepsychiatry appear to be generally reliable, and patients and clinicians generally report high levels of satisfaction with telepsychiatry. A significant limitation of the literature is the lack of empirical research on telepsychiatry, especially cost analyses and clinical outcome studies. The authors outline a research agenda addressing the procedural and methodological issues that should shape future research: study design, outcome measurement, consideration of patient characteristics, and program design [ABSTRACT FROM AUTHOR]

The article comments on the PRiSM Psychosis Study published in the November 1998 issue. The study suggests that it is the first to examine how far specific community care interventions proven efficacious in experimental studies are effective in ordinary clinical circumstances. The authors cite reasons why PRiSM is not a study of effectiveness of specific community care interventions. The intervention in the PRiSM study is not a single model of care, but a mixture of two models.