One of the most enduring innovations of the Clubhouse Model is something called transitional employment, usually shortened to TE. It is a clever, somewhat counterintuitive solution to the central problem of returning to work after serious mental illness: the employer wants a proven worker, the worker wants a real job, and neither is willing to absorb all of the risk.
A transitional employment placement is a time-limited (typically 6 to 9 months) part-time job in a real business at the prevailing wage, in which the program guarantees coverage — if the worker cannot make it on a given day, the program sends a substitute.
The basic structure
A TE placement involves three parties:
- The employer — a real business in the community (a hospital cafeteria, a hotel housekeeping service, a law firm's mailroom, a city library) that contracts with the program.
- The program — typically a Clubhouse or community mental-health agency that holds the contract with the employer and trains the workers.
- The member — a person living with serious mental illness who works the job for an agreed period (often 15 to 20 hours per week for 6 to 9 months) at the prevailing wage.
The pivotal element is the program's promise to the employer: If the member cannot work a shift, we will send someone — a staff member or another trained member — to cover it. This single guarantee removes the employer's biggest fear about hiring someone with an unpredictable medical history.
Why it works for the employer
Employers that take TE placements typically describe three benefits. They get reliable coverage of the position. They build a pipeline of workers who, if the placement goes well, are excellent candidates for permanent hire. And they get genuine impact in the community without taking on risk that they would not normally accept for an entry-level role.
Why it works for the member
For the member, TE provides several things at once:
- A real job. Real wages, real W-2 (or country equivalent), real reference for the next job.
- A safety net. If symptoms flare or hospitalisation is needed, the placement is covered and the member's employment record stays intact.
- A bounded commitment. The 6-to-9-month structure means the member is not signing up for a forever job — many people find a shorter horizon less intimidating after years out of the workforce.
- A track record. Successfully completing a TE placement is often the foundation for confidence to pursue a permanent job afterwards.
How the placement is filled and supported
Members are typically prepared with on-site training by program staff. The trainer learns the job thoroughly first — sometimes working it directly for several days — and then trains the member, fading support over time. Once the member is working, regular check-ins continue. If the member misses a shift, the program covers it and works to understand what happened.
Importantly, TE is structured so that several members may rotate through the same placement over time. The placement is "owned" by the program, not by the individual. When one member completes their term, another starts.
The evidence
Research on TE comes mostly from the Clubhouse literature. Findings include:
- Members who complete TE placements have substantially higher rates of subsequent competitive employment than members who do not.
- Average earnings rise meaningfully during and after TE.
- Hospitalisation rates do not increase during TE — and in some studies decrease.
- Employer satisfaction with TE workers is generally high.
Compared with full IPS-style supported employment, TE produces lower long-term earnings on average but is more accessible to people who cannot yet imagine holding a permanent job. Many programs offer both, and members can move from TE to supported or independent employment as their confidence and stability grow.
Where TE sits relative to other models
It can help to think of vocational pathways as a menu rather than a ladder:
- IPS supported employment — direct help finding and keeping a permanent job in the open market, with time-unlimited support.
- Transitional employment — time-limited, part-time, real-wage placement in an outside business with program-guaranteed coverage.
- Social firm employment — employment in a business specifically designed to employ people with disabilities at competitive wages.
- Self-employment — running one's own small business, often part-time, on flexible hours.
Many people use several of these over a working life.
Practical considerations
Benefits
TE earnings affect SSI, SSDI, and Medicaid the same as any other earnings. Programs typically include benefits counselling. SAMHSA's Ticket to Work programme and the Social Security Red Book are useful references.
Disclosure
In TE, the employer typically knows the placement comes through a mental-health programme but does not necessarily know the individual member's diagnosis. Programs and members can negotiate this in advance.
Schedule
Most TE placements are part-time, often 15 to 20 hours per week, which makes the work compatible with continued treatment, medication routines, and daytime appointments.
Returning to work, even at a part-time TE placement, is a real adjustment. Sleep, medication adherence, and contact with a clinician matter more, not less, in the first weeks. Talk with your treatment team before starting and build the new routine around your existing supports.
How to find TE
The most reliable source of TE placements is an accredited Clubhouse — see Clubhouse International's directory. Many community mental-health agencies and state vocational rehabilitation agencies fund TE placements outside the Clubhouse model. NAMI affiliates often know what is available locally.
What TE is not
TE is not a substitute for IPS or for permanent employment if those are achievable. It is not a "stepping stone" everyone must take before competitive work. For many people, going directly into IPS-supported competitive employment is the right path. TE is a powerful option for people who want or need a more structured re-entry — and the evidence suggests it works well for the people who choose it.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.