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1 Introduction

The onset of the 2008 financial crisis dramatically increased unemployment rates in many countries and they are still high or at or near historic levels in Europe and the United States (EuroStat publication of the European Commission 2014). In 2012, unemployment rate in the 28 EU countries was 10.5 % with rates as high as 24.3 and 25.0 % in Greece and Spain. Furthermore, the long-term unemployment rate of those no longer employed for 12 months or longer was 4.7 %, slightly less than half of the total rate of unemployment. While somewhat lower than in Europe, but still higher than usual, the unemployment in the US during that time was 8.1 % with a long-term unemployment rate of 2.4 %.

Thus, the economic crisis or 2008 will, like many economic crises before it, turned into a prolonged period of economic downturn that will affect millions of workers. Job loss and unemployment represent the loss of vital resources to individuals and also produces an additional cascade of health threatening resource losses. We first review the harmful impact of the loss of these resources and then discuss the various approaches to prevent or mitigate these effects.

1.1 Impact of Unemployment on Physical and Mental Health

When people become unemployed they suffer a cycle of losses of resources which often results in a deterioration of their mental health and social functioning (Feather 1990; Hobfoll 1989). The most obvious of these resource losses is the loss of income from paid work which frequently creates serious financial hardship. Most people around the world are dependent on the income from their employment to provide their basic necessities for food and health and to sustain their standard of living. Job loss means they experience financial strain and setbacks in providing for the necessities of life for themselves and their family. Numerous studies have demonstrated that financial events leading to financial strain are the strongest contributor to the elevated depression and anxiety experienced by the unemployed (Broman et al. 1990; Kessler et al. 1987a; Vinokur and Schul 2002).

The pioneering early writing on unemployment by Marie Jahoda in the 1930s and then later in the 1970s and 1980s vividly described the deprivations experienced by the unemployed (Jahoda et al. 1933; Jahoda 1982). These deprivations include the loss of structured daily activities, the loss of an occupation that is an important source of personal fulfillment, professional esteem, and pride as bread winners for their family, as well as loss of self-esteem, identity and meaning in life. These resource losses, which usually begin with financial losses, create cascades of negative events such as loss of control and diminished functioning (Price et al. 2002), social undermining in family relationships and diminished marital satisfaction (Vinokur et al. 1996) that elevate feelings of depression in the job loser (Dooley et al. 1994) and their spouse/partner (Howe et al. 2004; Vinokur et al. 1996). This cascade of events may contribute to adverse outcomes among the unemployed such as marital separation and divorce (Atkinson et al. 1986; Liem and Liem 1988), drug abuse (Catalano et al. 1993), child abuse (Steinberg et al. 1981) and suicidal ideation (Kessler et al. 1987b).

The detrimental impact of unemployment on mental and physical health has recently been reviewed extensively by Wanberg (2012). In her review she cites meta-analyses studies of the adverse effect of unemployment on well-being by Paul and Moser (2009), and McKee-Ryan et al. (2005), and on suicide by Platt and Hawton (2000). Wanberg (2012) also reviewed studies that suggest unemployment may also have an impact on physical health and mortality, though the evidence is not as strong as evidence on the adverse effects of unemployment on mental health. Thus, the findings of both earlier studies and recent reviews consistently show that job loss and the multiple negative life events and deprivations associated with these events produce a cascade of stressors that lead to adverse effects on both physical and mental health.

1.2 How the Harmful Effects of Unemployment Can Be Mitigated?

Several approaches to mitigate the harmful effects of unemployment were inspired by the work of Jahoda (1982). These approaches attempt to replenish the psychological and material benefits of work that are lost with the loss of the job by various programs that involve placing the unemployed in work settings to promote return to work. These programs may include subsidized vocational training and work place participation with various levels of unemployment insurance benefits, often described as income replacement. In a study conducted in Sweden by Strandh (2001) it was found that the workplace participation program with income replacement benefits mitigated the harmful effects on mental health; and that the income replacement benefits mediated the positive effects particularly when unemployment was prolonged.

Another distinct approach to address the harmful effects of job loss is to activate and invigorate the efforts of the unemployed to search and find a job with the goal of regaining paid employment. There are numerous outplacement counseling programs that are offered on individual basis to unemployed workers but we could not find a scientifically sound evaluation of these programs in the literature (e.g., Borgen and Butterfield 2014).

1.2.1 Job-Search Programs for Enhancing Reemployment and Mental Health

In contrast to individual counseling programs, beginning in the early 1970s we find empirical tests of various intervention programs delivered to groups of job seekers to enhance their search behavior with the goal of getting a job (e.g., job club: Azrin et al. 1975). These interventions were focused primarily at those short-term unemployed, generally those unemployed less than a year, as distinguished from the long-term unemployed. More elaborate and theory based developments of the early efforts continued in the 1980s and 1990s at the University of Michigan using the JOBS intervention to enhance job-search skills and job-search self- efficacy (Caplan et al. 1989; Vinokur et al. 1995) and the Työhön Job Search Program in Finland (Vuori et al. 2002). The interventions spurred in these efforts turned out to be successful for the short-term unemployed, and at least in one case, also for the sub-population of long-term unemployed who received generous unemployment benefits (Vuori et al. 2002). More recently, a similar group-based intervention that targeted performance goal orientation as a mechanism to increase job search and reemployment has been reported by van Hooft and Noordzij (2009) to produce promising results. A recent meta-analysis study of all these job search interventions concluded that the odds of finding employment were 2.85 times higher for job seekers participating in them compared to those in the control group (Liu et al. 2013). This analysis also demonstrated that the direct effect of the interventions on employment was also mediated by job search skills, job search self-efficacy and job search behaviors.

Below we offer an exchange theory perspective to understand the phenomenon of unemployment and its implications more comprehensively and to examine ways in which program practice and social policy might be directed.

1.2.2 An Exchange Theory Perspective on Unemployment and Programs to Aid the Unemployed

We take an exchange theory perspective to help explicate the challenges faced by job seekers and what is required to implement and disseminate effective programs such as the JOBS program. The exchange perspective was pioneered by Blau (1964) and Emerson (1976) and later similar ideas were used to develop resource dependence theory (Pfeffer Salancik 2007) to describe strategic organizational behavior and conservation of resources theory (Hobfoll 1989) to describe individual coping behavior aimed at seeking and preserving individual resources.

The exchange perspective is based on several assumptions. The first is that all individuals and organizations are dependent on resources from their environment. Employed individuals are dependent on the income derived from paid work as well as the psychological resources associated with having an identity as a productive worker for example. Loss of these resources often results in stress and a cascade of health threatening events. Organizations are dependent on resources from their environment to support their programs, to maintain their legitimacy as organizations. Second, to maintain these valued resources individuals or organizations must engage in exchange relationships offering appropriate behaviors such as effective performance in a work role or maintaining on certain levels of performance in the case of organizations. Third, since both individuals and organizations are dependent on these valued resources in their environments they will attempt to conserve or seek alternative sources of the valued resources if they are threatened or lost.

In the case of job seekers, this means that to successfully seek new jobs they must understand what valued resources of their own they possess such as job skills and work experience they have that they can offer to employers in exchange for paid employment. In the case of organizations this means that organizations must be able to maintain the quality of their services or performance at an acceptable level if they are to continue to receive support from their supporting institutions. In both individual and organizational cases they will cope by attempting to conserve their resources, find alternative resources or exchange them for resources that are more secure.

Employers in the market environment may require job seekers to meet certain work requirements and at the agency level, governments or institutions may require agencies to meet certain standards in an anticipated exchange relationship. This may occur without outside intervention, but in some cases a third-party intervention may be required to guide the transaction to successful completion. Programs such as JOBS (see Price and Vinokur 2014) provide job seekers with an understanding of the nature of the exchange relationship involved in offering one’s personal resources in the process of seeking a new job. Similarly in the process of implementation of new programs in an organized service system, all parties need to understand the nature of the resources both material and symbolic resources being exchanged such as program funding training certification and commit to the agreed upon exchange of resources over longer periods of time.

Implementing an effective program such as the JOBS program using trained facilitators serves this purpose for the individual job seeker. In the case of broad dissemination of a program such as JOBS, a systematic organizational collaboration is required between the government or institutional sponsor and the service agency actually implementing the program to establish the terms of exchange, often in contractual form.

In what follows we will see these processes of resource exchange play out repeatedly (1) in the stress of job loss and its effects on health and wellbeing, (2) in the role of effective job search program models such as JOBS in aiding job seekers obtain new jobs with all their essential resources and (3) in the dissemination of the JOBS program in new national and international systems, and finally (4) in suggesting extensions of the underlying principles of the JOBS program to new program applications that promise to provide resources for populations in need of additional support.

1.3 Reemployment as a Gateway to Renewed Financial and Psychological Resources

We begin with the assumption that the negative health impacts of unemployment is caused primarily by cycles of resource loss (Hobfoll 1989). The losses are financial, personal and social including relationships with a spouse or partner, and children and friends. The impact of job loss can be ameliorated by replenishing the losses with new gains. Loss of income from paid employment in some countries is commonly buffered by unemployment benefits (Strandh 2001). These benefits differ widely depending on the social policies of the country in question. However, research has consistently shown a substantial restoration of mental health and well-being when reemployment is achieved with renewed financial resources from paid work (Kessler et al. 1989; Ginexi et al. 2000), and a substantial improvement in one’s financial position (Vinokur and Schul 1997). Therefore, the most promising sustainable way to promote the mental health of the unemployed is to promote reemployment in good quality work as quickly as possible. The importance of good quality work needs to be highlighted in view of studies that have shown that the mental health of employees with poorest quality of work deteriorates over time, even more than that of the deterioration seen in unemployed workers (Butterworth et al. 2011; Siegrist et al. 2012).

Reemployment not only restores the financial loss in most cases, but also replenishes other functions served by having a job. Promoting reemployment can be achieved through national macroeconomic policy or program. However, smaller scale community based programs focused on job search can help the unemployed return to the market place through their own job search activities. Below we describe research on the JOBS program that can serve as a prototype for establishing local programs and a set of underlying research based principles for both local program delivery and for wider dissemination in service systems.

1.4 JOBS Promotes Reemployment and Restores Financial and Psychological Resources

Interventions aimed at the promotion of reemployment must empower the unemployed persons themselves to enact intensive, persistent, and skillful job-search behaviors. These interventions must therefore include features to motivate the unemployed individuals to engage in job search behavior. The JOBS reemployment intervention and the Finnish version called “Työhön” are based on a model that weaves together motivational elements with elements of job search skill building to create a psychological state of job search self-efficacy, which enhances the motivation to engage in intense and persistent job search (Vinokur and Schul 1997, 2002). A similar intervention that emphasizes performance goal orientation has recently been tested by van Hooft and Noordzij (2009). As the JOBS intervention, it also demonstrated enhanced intention to seek jobs, greater job search intensity and a higher rate of reemployment.

A detailed account of the development and design of the JOBS intervention and its evaluation and dissemination has recently been provided in by Price and Vinokur (2014). We briefly describe the JOBS intervention, focusing on its design then review the results of major randomized controlled trials (1) demonstrating the effectiveness of JOBS (2) describing the populations who benefit most from the intervention and (3) the underlying processes that account for its effectiveness and offer (4) research based principles for high quality implementation of job search programs. Following this we offer a brief description of dissemination efforts of the JOBS program in the United States and in other countries and offer principles for effective dissemination of job search programs based on this experience.

1.4.1 Design of JOBS

The JOBS intervention is designed as a workshop consisting of 5 half-day sessions (totaling about 20 h) led by two trainers who facilitate the learning of job search skills and the motivation to use them effectively. The intervention uses active learning group process and typically involves a group of 8–18 participants. The workshop is typically held in community facilities (e.g., community centers, schools, churches, union halls) or in rented meeting facilities.

The core of the JOBS intervention is shown in Table 10.1 and includes the activation of active learning and supportive processes to gain the key skills of job-search. The activation of the processes leads to the acquisition of the job-search skills, which in turn, results in enhanced job-search efficacy and inoculation against setbacks; the two major ingredients that were shown in our research to mediate the effects of the intervention on job-search, reemployment and mental health.

Table 10.1 The JOBS program: program features, short term effects on skills and motivation and long term outcomes
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Workshop participants are engaged in a standard cycle of activities throughout the sessions. For each major topic of job search, participants are engaged in (1) activities that involve diagnosing desired goals, problems and tasks that are needed to meet the goals; then, moving to (2) diagnosing solutions and skills needed to implement the solutions; and finally, (3) engage in practicing these skills. These three-step cycle is repeated again focusing on diagnosing barriers and handling setbacks. While the overall goal of the first three-step cycle is to build job-search self-efficacy, the overall goal of the second three-step cycle is to build inoculation against setbacks.

1.4.2 Impact of JOBS on Reemployment and Health

The randomized trials of the JOBS Program and later the Finnish version of the program called Työhön have been shown to prevent poor mental health (Vinokur et al. 1995; Vuori et al. 2002) and promote reemployment (Vinokur et al. 1991a, 1995; Vuori et al. 2002). The impact of the JOBS II, a replication and extension of the initial JOBS intervention, also demonstrated improved role and emotional functioning and also increased rates of reemployment in better quality jobs. In turn, the higher employment rate in better jobs had a significant effect on lowering financial strain (Vinokur and Schul 1997; Vinokur et al. 1995). Furthermore, in both the JOBS and the later Finnish Työhön study it was found that the preventive effects of the intervention extended to 2 years (Vinokur et al. 2000; Vuori and Silvonen 2005). Finally, using a benefit-cost analysis, Vinokur et al. (1991b) demonstrated large economic net benefits of the JOBS intervention for the participants, as well as for state, and the federal government that funded the intervention.

1.4.3 Who Benefits Most from JOBS?

Interestingly, the benefits of these job-search interventions are not distributed equally to all the participants. In the initial JOBS trial, Price et al. (2002) found that a subgroup of participants which at the outset were characterized primarily as experiencing higher levels of depression symptoms, but short of clinical level, benefitted from the JOBS intervention most in terms of future reduction in depressive symptoms. The same result was tested prospectively and replicated in the JOBS II trial (Vinokur et al. 1995). The Finnish Työhön study demonstrated similar results (Vuori et al. 2002).

1.4.4 What Makes JOBS Effective?

Further research was aimed at uncovering the active ingredients of JOBS by examining the mediating mechanisms of the intervention. Following the first JOBS randomized trial, van Ryn and Vinokur (1992) demonstrated that the increase in the sense of job-search efficacy was as a critical mediator that increased the intention and the intensity of job-search behavior. In the investigation of the second JOBS trial, Vinokur and Schul (1997) reported again that sense of mastery that includes job-search efficacy mediated the effects of the intervention on both reemployment and mental health. In addition they found that the intervention increased inoculation against setbacks and resilience by protecting job seekers from depression when the event of a second job loss occurred following reemployment. In a similar vein, based on the Finnish Työhön randomized trial, Vuori and Vinokur (2005) identified job search preparedness, the combination of job-search self-efficacy and inoculation against setbacks, as a key mechanism that accounted for the benefit derived by the participants from the Finnish Työhön intervention. Finally, Choi et al. (2003) showed that group processes that enhance job-search efficacy were key ingredients in group-based aspects of the JOBS intervention.

2 Key Outcomes of Dissemination: Demonstration, Sustainability and Innovation

Identifying populations who will most benefit from a program and ensuring that the program itself offers the appropriate opportunity for skill development and motivation are important, but they are of little value if effective methods are not available for disseminating the program. In what follows we describe five cases of program dissemination of the JOBS program both in the United States and internationally. While the initial implementation of JOBS was successful in all cases, the outcomes beyond initial implementation were quite different. In some cases, the dissemination did not continue beyond a large initial demonstration, in others, the JOBS program or its local version showed sustainability beyond the initial implementation period and program innovations were initiated to respond to the needs of local populations in need. These cases suggest testable hypotheses for promoting successful program dissemination (Rogers 1995; Price et al. 1998). Table 10.2 summarizes the key features of implementation that led to varying degrees of sustained success in dissemination across the five cases.

Table 10.2 Six cases of JOBS implementation with varying levels of support for long term adoption and continuing innovation
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2.1 California and China: Demonstration Without Sustainability

With funding from the California Wellness Foundation, the Michigan Prevention Research Center (MPRC), in collaboration with the Claremont Graduate School and the Manpower Demonstration Research Corporation, the JOBS program was disseminated in three diverse community sites in California as a large scale demonstration project (Price et al. 1998). As part of the demonstration project 30 group workshop facilitators were trained in Michigan for 2 weeks with later on site follow-up training and supervision in California. Subsequently, 6,500 unemployed persons in California participated in the demonstration program. The 5-year large scale demonstration project established the viability of the JOBS workshop for adoption by community based organizations. Choi et al. (2003) showed that the group learning environment designed as a key feature of the workshop produced enhancement in job-search efficacy that was critical for later successful job-search efforts. However, despite the successful demonstration the California program, no local champion for the program emerged and it was not continued or expanded to other service sites in California.

In the People’s Republic of China a rapidly changing economy from state socialism to a market based system has meant that State Owned Enterprises that supported many Chinese workers were subject to market pressures and downsizing of the work force (Price and Fang 2002). The Michigan Prevention Research Center entered into collaboration with the Institute of Psychology of the Chinese National Academy of Science to deliver the JOBS program in seven cities in China (Price and Fang 2002). After initial planning the training was delivered by MPRC training staff in collaboration with Chinese colleagues to agency staff from seven cities and the Chinese version of the program was delivered and evaluated in all seven sites. While the program had a champion for the initial successful demonstrations, the Ministry of Labor did not support continuation of the program. However, data from the project on the effect of job loss and unemployment on family dynamics yielded interesting and important results (Price et al. 2006).

It is notable that both of these implementation projects successfully met their initial demonstration objectives and also yielded valuable scientific results. But despite a substantial initial investment of resources for demonstration, neither project continued beyond the initial demonstration stage. In neither case was a commitment of resources for continuation beyond the initial demonstration phase offered by government sponsors even if the project proved successful. It seems clear from these examples and from previous research (Rogers 1995) that locally based scientifically verifiable demonstration of the positive impact of new programs is not enough for successful and sustainable large scale dissemination.

Ireland, Maryland and Finland: Success depends on the spectrum of support for adoption and innovation. Ireland has had both times of economic expansion and periods of dramatic downturn over the last several decades. Irish workers, particularly in rural and northern areas, have experienced long and severe periods of job loss and unemployment. The JOBS program has been implemented through collaboration with colleagues at the National University of Ireland and Irish Health Service to implement the program with experimental trials both in Northern Ireland and in the Republic of Ireland. The JOBS program was shown to be effective not only with chronically unemployed Irish workers, but also with service recipients in the mental health system (Barry 2005). Leadership by our colleagues both in the University of Ireland and in the Irish Health Service to advocate for the program created interest in local agencies and some funding support. As the high and nearly intractable unemployment rate in Ireland continued the new interest has developed in providing innovative workshops to encourage participation in volunteer roles in the community.

The JOBS program was also implemented and evaluated in the State of Maryland as the central component of a mandated program “From the Ground Up” for welfare-to-work clients and was administered by the Department of Social Services of Baltimore County. During that period, 1,543 welfare applicants participated in the workshops. The intervention workshop increased participants’ sense of mastery and control as well as job-search efficacy, which, in turn increased job search intention and reemployment (Lee and Vinokur 2007). Participation in the workshop also resulted in improved mental health and well-being and facilitated the entry of the participants into the work force. The program with its positive impact on clients has continued to operate in its original form for the past 12 years with a stream of support from the community college system in which it is embedded. In addition the Maryland program created a successful innovation in providing the program to welfare clients, a population with greater needs than most of the unemployed population. Both the sustained funding stream and supportive service system in which the JOBS program was embedded are clear assets to successful sustained program delivery.

The earliest and ultimately the most successful dissemination effort has taken in Finland. The Finnish Institute of Occupational Health with later support from the Ministry of Labor in Finland funded the dissemination of the JOBS program, (locally named “Työhön”), in the city of Turku and later in a large-scale nationwide program. The positive initial research evidence from the first Työhön trial in Turku led to an expansion to a nationwide program. Results were very similar to those demonstrated by the JOBS program in the US, showing that the program promoted the mental health of the unemployed and facilitated in their re-entry to the work force (Vuori et al. 2002).

As in the US version of the JOBS program, the results also demonstrated that self-efficacy and inoculation against set-backs were the key mediating mechanisms of the intervention (Vuori and Vinokur 2005). Finally, the wealth of data from the national program was subjected to a cross-level analysis that identified trainer skill level and preparation of participants for setbacks as the critical group level factors responsible for the positive effects of the intervention (Vuori et al. 2005). Beyond these developments, innovative new programs have been developed using the JOBS group based intervention principles and successfully implemented to serve youths making career choices in elementary schools (Vuori et al. 2008) and most recently to help workers in the Finnish work force make better decisions about sustainable careers and retirement (Vuori et al. 2012).

These cases show that demonstration of scientifically proven programs is not by itself enough for large scale adoption of innovative programs like JOBS. Our experience suggests that, as Table 10.2 implies, that sustained successful dissemination and additional program innovation to meet local needs requires a combination of skillful advocacy by a program champion, receptive delivery sites with adequate resources to actually implement the program, and long term financial and political support from sponsoring institutions.

3 When Job Search Programs Are Not Enough

There are circumstances where programs to promote paid reemployment may not be feasible either because of the absence of jobs due to economic conditions that may make reemployment difficult or due to lack of skills in specific disadvantaged populations such as older or disabled workers. Interventions that focus on the needs of these populations can be developed using the proven behavioral principles first developed in the JOBS program. For example programs designed to help with financial management skills and stresses as within families are needed for people experience in prolonged periods of unemployment. In what follows we draw broadly on social exchange theory (Emerson 1976) and the conservation of resources framework (Hobfoll 1989) to conceptualizing new pathways to new relationships skills and enhanced mental health.

A well-organized community program to help long term unemployed individuals might begin with a need assessment phase that includes assessment of occupational goals, financial needs, family relationships status and problems, and psychological well-being. Based on the assessment the unemployed person or indeed the entire family could be invited to participate in relevant community interventions – for example, a job-search workshop intervention, financial planning workshop, family relationship workshop, and/or a general improving well-being workshop. Our research experience suggests workshop interventions could be delivered to groups of 8–18 participants because the group method of delivery is both more effective and more economical. Group learning provides an effective way to de-stigmatize of bad experiences, facilitates role modeling and creates an opportunity for role playing exercises in giving and receiving help from similar others, and allows participation in richer informative discussion for problem solving. Ideally the delivery of such interventions would be guided by two training facilitators rather than one because two trainers can more readily expand the effectiveness of training by demonstrating role modeling, monitoring the reactions of group members more carefully and respond accordingly.

A financial management and planning workshop could address how to deal with all household and family financial issues including costs of housing, health care, education and daily living. Participants could learn how to set priorities, prepare and monitor basic budget and perhaps most importantly, how to collaborate on these matters in a cooperative manner with significant others and children. In addition, participants could learn about various federal, state and community programs that provide financial aid, their eligibility to these programs and would be provided with help in applying to such programs. A family relationship workshop might aid navigating the social relationships with spouse, partner, children and other significant others during a stressful period of unemployment. For those seeking a job, this type of intervention could also facilitate their job-search efforts as conflict is avoided and energies could be deployed to a more effective job-search. A family relationship workshop could be based on what is known about best practices in couple education (Halford et al. 2003; Laurenceau et al. 2004) and apply these practices to the issues that emerge and persist during unemployment.

Finally some unemployed people may not seek to return to the workforce because they lack marketable job skills or because of advanced age or poor health status. To protect the health and well-being of this population of the unemployed a workshop intervention could be designed to get them involved in activities that replace some of the psychological functions of paid work. Individuals become volunteers in service provider organizations providing a new social role embedded in a social network to allow the rebuilding of lost social connections, and a way to structure time and daily activities. Volunteers in a service organization are likely to re-experience new pride and self -esteem as contributing members to the community (Musick et al. 1999; Thoits and Hewitt 2001; Wilson 2000).

All these elements of positive activities could be combined in a special workshop formed as a guided self-help group with trained group facilitators. Yet, since the majority of unemployed individuals are those who need or prefer to reenter the labor market we argue that the most important way for improving their mental health and well-being is to facilitate their reentry to paid work through their job search activities. Thus, we devote our next section primarily to describe examples and features of community based successful job-search workshop interventions.

4 Recommendations for the Future

It is now clear from a vast array of research evidence that involuntary job loss and unemployment produce a cascade of losses that in turn produce stressful and health threatening impacts on both the unemployed and their families. It is now equally clear that carefully designed and implemented job search programs such as JOBS and similar programs such as Työhön in Finland can facilitate the return to reemployment and with it reduce the health and mental health risks associated with unemployment, economic hardship and family distress. The key mechanisms underlying effective programs including (1) social support, (2) inoculation against setbacks and (3) promoting skills in the search process all can be embedded in high quality programs only with careful training of facilitators and quality monitoring and continued of the program itself.

However, our experience with large scale dissemination in both US and international settings suggests that real large scale impact can only be achieved if a number additional conditions are met including the presence of (1) an active and effective champion of the program to advocate for its support at the policy level, (2) service delivery agencies that are open to innovation, and finally (3) a continuing flow of resources and funding to sustain the program over time.

Finally while a great deal of attention is given to the plight of the unemployed attempting to re-enter the labor market, there is also a need to devote more attention to subpopulations of the unemployed that are not able to return to the job market due to lack of employable skills, advanced age, or poor health status. Different interventions could be developed to accommodate the mental health and well-being needs of these subpopulations. Thus, those who lack marketable skills may do well in retraining programs designed for their skill level. Other unemployed individuals may fare better in more general health and well-being promotion programs. In short, there is a need to plan and design intervention programs to accommodate the special need populations of drop-out youth, single parents, older workers, retirees, the disabled, and immigrant groups. In all of these groups unemployment is at higher rates than the general population and the challenge to join the paid labor force is difficult to overcome but alternative programs can bring them other life affirming experiences and purposes.