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Eighty-six clients with serious mental illness were randomly assigned to an Accelerated Approach to supported employment (SE), which bypassed traditional prevocational preparation, or to a Gradual Approach, which consisted of a minimum of 4 months in prevocational preparation followed by SE services. At study admission, only 5% of participants expressed a preference for prevocational training prior to entry into the SE program. Results for 74 clients after 1 year suggested significantly better employment outcomes for Accelerated participants. Over 3 years later, follow-up at one site indicated that 59% of the Accelerated participants were competitively employed, compared to only 6% of Gradual participants. We conclude that for this population, early entry into competitive employment, with intensive support, is more effective than approaches incorporating prevocational training.