Fidelity of supported employment: Lessons learned from the National Evidence-Based Practice Project.

PURPOSE: To describe the implementation of supported employment in the National Evidence-Based Practices Project, examining and interpreting fidelity changes over two years of program implementation. METHOD: Nine new supported employment programs were evaluated by examining supported employment fidelity ratings at baseline and every 6 months thereafter. Site reports based on the nine case studies were used to interpret the fidelity findings. RESULTS: At two years, eight of nine sites achieved high fidelity. Most changes occurred within the first year. Twelve of the 15 supported employment fidelity items showed rapid improvement. DISCUSSION: A review of the site reports suggested four factors that facilitated movement toward high fidelity: (1) Discontinuing non-evidence-based vocational services, (2) Making rapid structural changes through administrative action, (3) Measuring key process indicators to move toward desired changes, and (4) Gradually improving integration of the employment specialists with clinical services, primarily through supervisor leadership.