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Employment, the Final Frontier

Employment, the Final Frontier. State of the States Conference The National Association of State Head Injury Administrators. Employment, the Final Frontier. “In the beginning, God created the world….”. Employment, the Final Frontier.

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Employment, the Final Frontier

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  1. Employment, the Final Frontier State of the States Conference The National Association of State Head Injury Administrators Karen Flippo, Brain Injury Association of America

  2. Employment, the Final Frontier • “In the beginning, God created the world….” Karen Flippo, Brain Injury Association of America

  3. Employment, the Final Frontier • Work is an individual’s strongest tie to reality. Sigmund Freud Karen Flippo, Brain Injury Association of America

  4. Employment, the Final Frontier • National Council on Disability recommends that in reauthorizing Rehabilitation Act, the Administration and Congress give consideration to broadening the scope of resources in the employment area. Society can no longer afford to consider so-called “disability issues” in isolation from the broader dimensions of policy and practice.” NCD A Progress Report, December 2000-December 2001. Karen Flippo, Brain Injury Association of America

  5. Employment, The Final Frontier • “A man’s work is his dilemma: his job is his bondage, but it also gives him a fair share of his identity and keeps him from being a bystander in somebody else’s world.” Melvin Maddocks Karen Flippo, Brain Injury Association of America

  6. Employment, the Final Frontier Data drives results! • Conduct an analysis to identify the features of successful outcomes and negative performance in one single agency. How else will you truly know? • AND, data drives policy. Karen Flippo, Brain Injury Association of America

  7. Research studies heavily oriented towards prediction of success/failure. Factors influencing employment: Substance abuse Gender Age Employment history Education Professional training Family support Self-awareness and ability to regulate affect. Negative correlation between personality change and successful employment outcome Employment, the Final Frontier Karen Flippo, Brain Injury Association of America

  8. Employment-The Final Frontier • Research Results • Unemployment rate of individuals with TBI ranges from 50-80%. • Supports are needed for individuals with TBI and other significant disabilities and traditional placement models do not work Wall, et al., 1998; Wehman, 2001 Karen Flippo, Brain Injury Association of America

  9. Employment, the Final Frontier • Approximately 75% of individuals with TBI who return to work lose their jobs within 90 days if work supports are not in place. • Literature shows an alarming lack of effective models with supported employment one of the more outcomes-based approach West, 1995; Oliver, et al. 16; Johnson, et. Al., 1998;Prigatano, et. Al. 1994; Sander, et al, 1996. Karen Flippo, Brain Injury Association of America

  10. Employment, the Final Frontier • 39% people with severe injury, 77% of those with moderate injury and 80% of those with mild injury return to work within 2 years. Dikmen, et al. 1994 • Important for those who sustain injury to understand that work is possible early after injury. Malec Karen Flippo, Brain Injury Association of America

  11. Employment, the Final Frontier • One year following TBI: • Employed persons fell from 69% to 31%. • Unemployed increased from 11% to 49%. • Average earned income per month declined from $1,491 to $726. Karen Flippo, Brain Injury Association of America

  12. Employment, the Final Frontier • Assuming study is representative of national statistics for TBI, first year post TBI associated with $642 million in lost wages, $96 million in lost income taxes, and $353 million in increased public assistance. • Johnstone et. al. MMBIS (2002) Karen Flippo, Brain Injury Association of America

  13. Employment, the Final Frontier • 35% - 50% did not have an employment history. (Corrigan) • Less than 1/3 of persons employed at time of injury are able to return to work afterwards. • Income highly correlated to life satisfaction but subjective well being not correlated to functional independence. Karen Flippo, Brain Injury Association of America

  14. Employment, the Final Frontier Results indicated that during 3 to 5-year period following discharge: • 47% of subjects were referred. • Average time from rehabilitation discharge to referral was 5.6 months, median was 2.4 months. • Of subjects referred, 53% were found eligible and of those, 29% eventually closed as successful rehabilitation; another 46% closed unsuccessfully; and remaining 25% still in process. Karen Flippo, Brain Injury Association of America

  15. Employment, the Final Frontier • The average total cost of services for those closed successfully was $9,380; the average for unsuccessful closures was $4,277. OVC TBIMIS Karen Flippo, Brain Injury Association of America

  16. Employment, the Final Frontier • Fraser and Baarslag-Benson (1994) identified key barriers for return to work: • Cognitive. • Emotional concerns. • Physical and motor impairments. • Pre-existing character or behavioral difficulties (might have been in place prior to injury). Karen Flippo, Brain Injury Association of America

  17. Employment, the Final Frontier • “After 12 years of university education, I labor to read a short story, must ask my high school trained assistant for instructions on how to do my job, and use an alarm every three minutes while driving to get to the correct destination.” Claudia Osborn, Over My Head, 1998 Karen Flippo, Brain Injury Association of America

  18. Employment, the Final Frontier • New York University Medical Center Head Trauma Program • 59 participant characteristics (moderate to severe head injuries); mean age: 27.14 years; mean education 14.17 years; mean days in coma 36.2; acceptance variable and successful vocational outcome was 0.78. Karen Flippo, Brain Injury Association of America

  19. Employment, the Final Frontier • Acceptance. • Active participation in therapeutic community. • Willingness to own up to problems. • Willingness to endorse staff recommendations. • Compliance with program routines and objectives. Ezrachi et. Al., 1991 Karen Flippo, Brain Injury Association of America

  20. Employment, the Final Frontier • Lack of awareness of injury, inability to read others’ emotions, disinhibition and emotional lability all were associated negatively with success at the workplace (Making it difficult to discuss accommodation with an employer). Dikmen, et al. 1994. Karen Flippo, Brain Injury Association of America

  21. Employment, the Final Frontier • Attempt to focus on medical complications can hinder rehabilitative efforts to improve cognition and only prolongs adjustment to injury. Holzberg, 2000 Karen Flippo, Brain Injury Association of America

  22. Employment, the Final Frontier • Successful return to work related to youthfulness, higher education and professional training, and access to a voc rehab counselor throughout the hospital phase of rehabilitation . Crisp, 1992 Karen Flippo, Brain Injury Association of America

  23. Extensive literature review found: Weak representation of programs that focus on career planning and job readiness or programs with a focus on getting a job! Holzberg, 2000 Employment, the Final Frontier Karen Flippo, Brain Injury Association of America

  24. Employment, the Final Frontier • Dichotomy between research studies and employment practice values. • Disability versus ability. • Labels versus actual behavior. Karen Flippo, Brain Injury Association of America

  25. Employment, the Final Frontier • “Best Employment Practice” • Believe that a person with a disability can work, if that is their choice. Choose Work! • Through career planning process, identify job goals, roles and responsibilities and timelines. • Situational assessments follow goal identification. Karen Flippo, Brain Injury Association of America

  26. Employment, the Final Frontier Work Defines WHO we are, WHAT we can become, HOW we will lead a self-determined life. • For individuals with TBI, work is a means toward rehabilitation. Karen Flippo, Brain Injury Association of America

  27. Employment, the Final Frontier • And money makes the world go round. Karen Flippo, Brain Injury Association of America

  28. Employment, the Final Frontier • TBI and the VR System (RSA/RTI Longitudinal Study, 2002). Only 1.8% of those served in VR have a TBI. • Similarities in work history for those with and without TBI although more individuals with TBI receive SSDI. Karen Flippo, Brain Injury Association of America

  29. Employment, the Final Frontier • Motivation to Apply for VR services TBI All VR clients • Medical treatment 8.4 16.5 • AT devices/services 8.5 17.4 • Counseling/psychotherapy 22.8 24.9 • SSA requirement 3.8 4.7 • Referral from other agency 44.9 46.7 • Friend/family member 5.3 29.4 • Help in getting/keeping job 69.8 76.0 • Help for voc training/college 96.7 74.6 Karen Flippo, Brain Injury Association of America

  30. Employment, the Final Frontier • Overview of VR services TBI All VR clients • Time in service 21.5 mos. 20.7 • Cost of purchased service $3.279 $3,489 Karen Flippo, Brain Injury Association of America

  31. Employment, the Final Frontier • Types of Services Received • Assessment Services % of TBI Consumers • Medical Eval. 66 • Voc assessment 44.1 • Psych/assessment 38 • Neuropsych eval. 31.9 • Ed. status assessment 12.6 Karen Flippo, Brain Injury Association of America

  32. Employment, the Final Frontier • Types of Services Received • Medical/psych services % of TBI Consumers • Medical Treatment 18.2 • Psychological/psychiatric 12.3 • Counseling 30.5 Karen Flippo, Brain Injury Association of America

  33. Employment, the Final Frontier • Types of Services Received • Ed emp/dev. services % of TBI Consumers • Business/voc. Trng. 15.2 • Job placement 13.4 • Supported employment 12.8 • Job development 10.6 Karen Flippo, Brain Injury Association of America

  34. Employment, the Final Frontier • Types of Services Received • Mobility/other support % of TBI Consumers • Transportation 24.6 • AT services 17.4 • Physical therapy 12.6 Karen Flippo, Brain Injury Association of America

  35. Employment, the Final Frontier • Factors that Predict Employment Outcomes (RSA) • Consumers perceptions regarding quality of the consumer/counselor relationship. • Receipt of job placement services. Karen Flippo, Brain Injury Association of America

  36. Employment, the Final Frontier • Individuals with TBI had a higher hourly earnings at exit, one year later, and two years later than all consumers. • Example: $8.03/hr vs. $7.33 (at exit) Karen Flippo, Brain Injury Association of America

  37. Employment, the Final FrontierExamples of Best Practices • Team orientation—one person doesn’t have all of the answers! • Situational assessments—paper and pen tests don’t give the true picture. DOL allows 215 hours of non-paid situational assessment. • Use MAPS, PATH, or any personal centered planning process to obtain a comprehensive, complex, historic and future context of the individual and their choices. Karen Flippo, Brain Injury Association of America

  38. Employment, the Final Frontier • Keep current on changes in regulation and policy—state and federal. (SSA, Ticket to Work-2003, PASS Plans, IWRE, SGA), Medicaid Waivers, TANF, Voc Rehab, CMS Real Choice Systems Change Grants). • Understand how resource facilitation works, and undertake blended funding for people you serve. • Purchase services from vendors who get results and believe in employment. Karen Flippo, Brain Injury Association of America

  39. Employment, the Final Frontier • On the job training conducted by business gives supervisors a greater sense of control and responsibility Curl and Chisholm, 1993 Karen Flippo, Brain Injury Association of America

  40. Employment, the Final Frontier • Supported employment is one of the more successful approaches to placement and retention of individuals with TBI • Self-employment--Persons with disabilities have higher rates of self-employment than persons without disabilities. 7.8% vs. 12.2% Presidential Task Force on Employment of Adults with Disabilities 1999 Karen Flippo, Brain Injury Association of America

  41. Employment, the Final Frontier • Brain Injury Association of America and University of Montana, Rural Institute on Disabilities. • Self-Employment Research and Development Project for Individuals with TBI. • 3 years, 3 sites (Utah, Virginia and Minnesota). • 20 individuals receive extensive training and support to operate their own businesses. Karen Flippo, Brain Injury Association of America

  42. Employment, the Final Frontier • Business speaks… • “The nation needs a new clarity in defining both what is expected of workers and what they have a right to expect in return: Hard work and personal responsibility must remain the foundation of our economy, and people who work should not be poor. Karen Flippo, Brain Injury Association of America

  43. Employment, the Final Frontier • “Workers should be flexible and expect to shift jobs and careers. Workers should be responsive to the needs of employers, co-workers and customers, and work should improve, not detract from, the lives of families. Karen Flippo, Brain Injury Association of America

  44. Employment, the Final Frontier • “Business and government must make an unprecedented commitment to develop new training and skills-building strategies….Industry is better equipped than government to anticipate needed skills and train workers accordingly. Karen Flippo, Brain Injury Association of America

  45. Employment, the Final Frontier • “Employers need more tax support for training. • Federal and state governments should allow some welfare recipients to participate in training directly related to employers and specific jobs rather than go immediately to work, in some cases. David T. Ellwood, Exec. Dir, Aspen Institute’s Domestic Strategy Group, September 2002 Karen Flippo, Brain Injury Association of America

  46. Employment, the Final Frontier • Bring employers into the employment process; brainstorm with them what will work for them and for the applicant. • Collaboration with P&As, AT projects. Karen Flippo, Brain Injury Association of America

  47. Employment, the Final Frontier • Use a variety of staffing approaches-depends on preference of employee and employer, such as natural supports (paid or unpaid coworker) or employment consultant. • Explore a variety of employment approaches, volunteer, AmeriCorps, job sharing. Karen Flippo, Brain Injury Association of America

  48. Employment, the Final Frontier • Program Without Walls-NY (TBI caseload) • State VR counselor is fully accountable and does not transfer responsibility to anyone else! • Build a team of experienced contractors and vendors to provide services. • Two key components: situational assessment and service coordination. Karen Flippo, Brain Injury Association of America

  49. Employment, the Final Frontier • Outcomes-higher rates of placement and rehabilitation versus other counselors. • Higher rates of rehabilitation are achieved without negative impact on hours worked, earnings, placement type. • Cost of PWW is not significantly higher than standard services Karen Flippo, Brain Injury Association of America

  50. Employment, the Final Frontier • Do research results create a challenge that is too difficult? • Find the Rainbow. • Creativity, coordinated systems, long-term service, replication, and evaluation. • Qualified, competent, and values-based providers who are true advocates and partners with focus person in employment process. Karen Flippo, Brain Injury Association of America

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