Assessment in SE for People Experiencing Homelessness

1. Assessment in SE for People Experiencing Homelessness John Rio, MA, CRC

2. Principles of EBP Supported Employment • Zero Exclusion • Job finding is individualized based on consumer preferences • Rapid job search • Competitive employment is the goal • Employment is integrated with clinical MH treatment • Long-term supports are proactive and ongoing • Benefits counseling & management

3. Measures of Fidelity to SE EBP • 25 items in three areas: • Staffing • Organizational • Services

4. SE Fidelity Items - Staffing • Caseload Size • Employment Services Staff • Vocational Generalists

5. SE Fidelity Items - Organization • Integration – thru team assignment • Integration – thru frequent contact • Collaboration – employment specialists & VR • Vocational Unit • Role of Employment Supervisor • Zero Exclusion • Agency focus on Competitive Employment • Executive Team Support for SE

6. SE Fidelity Items - Services • Work Incentive Planning • Disclosure • Work-based Assessment • Rapid Job Search • Individualized Job Search • Job Development –frequency and quality • Diversity of Jobs • Diversity of Employers • Competitive Jobs • Individualized Follow Along Supports

7. Supported Employment Is… Consumer-centered Consistent with societal goals Supported by strong evidence

8. But, Does SE Work for Homeless Jobseekers? • People experiencing homeless try to work (30+%) • Employment rates for MH consumers is low (15-22%) • Research on target population is limited, but evidence for MH consumers is strong • What happens if we don’t use it?

9. Why do consumers want to work? To have money Encouraged by others Being productive = Basic human need It’s a typical role for adults in our society Consumers may see work as an essential part of recovery Work may be a way out of poverty

10. Have money Be productive Do something meaningful Be healthy Afford things I need or like Meet new friends at work Loose my SSI and Medicaid Give up my freedom Relapse Loose my housing Be poor Dilemma I WANT TO: I DON’T WANT TO:

11. Availability of SE is limited… • Low priority of employment in ending homelessness • Need for population specific evidence • Not enough trained practitioners • Limited resources • Who is accountable?

12. Assessment in SE • EBP says zero exclusion, those who express desire to work are included • Down plays consumer readiness • Some research suggests preparation for employment may be important to outcomes • Are clients making informed decisions about choosing work?

13. Choosing Employment… • An individualized decision • Consider the consequences of leaving unemployment • Examining how ready I am to work & meet employer demands • Determining whether employer accommodations can assist me to work • Sometimes a forced choice because of the need for income

14. Debunking the Myth of Work Readiness Voc training/rehab programs typically exclude people with active symptoms, difficult behaviors, substance abuse Have “readiness” criteria that can dampen motivation to work Offering job options can provide motivation to address recovery Strike balance between no symptoms and tolerating some symptoms of MI or CD

15. The “Readiness to Work Challenge” • Redefine what we mean by “job ready” • Redefine what we mean by “work” • Meet people “where they are” • Recognize skills and strengths derived through survival • Allow flexible measures of success on a “slow entry ramp” • Recognize the difference between intent to work and capacity for employment

16. Going to work means change… Am I prepared to make needed changes?

17. Need for Change • Internally or externally driven ANCHORS • No consequences for inaction; others very satisfied • Action required, immediate interruption of situation, individual & others dissatisfied

18. Commitment to Change ANCHORS • None are present - Hopefulness about change; potential for change; desire to follow thru; change is part of recovery; others will support my change • All are present

19. Self-awareness ANCHORS • Does not describe self in terms of interests, assets, challenges, values and aptitudes • Does express self in terms of interests, assets, challenges, values and aptitudes

20. Awareness of the Work World ANCHORS • Restricted understanding of work demands, employer needs, role expectations. • Describes specific future alternative work options and their expectations; references past learning about managing work environments

21. Wellness ANCHORS • Does not describe understanding and activities to manage health issues • Does describe understanding and activities to manage health issues

22. Connecting ANCHORS • Expresses reluctance to work with others toward their employment goal • Relates positively to the idea of working with others to achieve an employment goal.

23. Supporting Individual Capacity for Employment • Identifying specific job interests • Developing skills and resources as well as the need for customizing job options • Managing entitlements • Interviewing and getting employment • Job retention skills and supports

24. Homelessness and Choosing a Job • Need to address considerable “concrete” barriers, i.e., access to laundry, showers, clothing • Lack of fixed address for mail or telephone to receive and return messages • Personal humiliation about current homelessness and past record, such as criminal histories • Poor employment histories and track record regarding employment • Access to transportation • Focus on immediate needs vs. longer term goals • Impact of change • Managing housing stability/recovery and work • Unclear expectations/inadequate information • Physical limitations

25. Consumer Preferences may include: Number of hours Type of job Workplace environment Work shift Disclosure (or no disclosure) Location Types and Frequency of support Research has shown that people with severe mental illness generally have realistic ideas about what work they can do, how many hours a week they can work and what work environments are good or bad for them.

26. Staff Knowledge & Skills Needed to Conduct Assessment in SE • Interviewing skills • Developing and maintaining an alliance with homeless job seekers • Reflecting an understanding of homelessness and its relationship to work • Developing connections with employers • Representing clients to employers • Integrating treatment and employment goals • Advocacy for individual job seekers

27. Resources • Roberts, Melissa M. and Pratt, Carlos W. (2007). Putative Evidence of Employment Readiness. Psychiatric Rehabilitation Journal, 30:3. • Roberts, Melissa M. and Pratt, Carlos W. (2010). A Construct Validity Study of Employment Readiness in Persons with Severe Mental Illness. AmJ Psych Rehab,13:1. • Casper, E. and Carloni C. (2006). Increasing the Utilization of SE Services with the Need for Change Scale. Psychiatric Services, 57:10. • Smith, TE, Rio, et al. (1997). Differential Effects of Symptoms on Rehabilitation and Adjustment in People with Schizophorenia. Psych Rehab J, 21:2. • Smith, TE, Rio, et al. (1998). The Rehabilitation Readiness Determination Profile: A needs assessment for adults with severe mental illness. Psych Rehab J, 21:4.

28. John Rio, MA, CRCAdvocates for Human Potential10233 Aspen Willow DriveFairfax, VA 22032914-433-5192jrio@ahpnet.com