CMHSR Seminar Series John C. Bricout Ph.D.

1. Decanting the water cooler: Exploring the social dimensions of vocational learning for people with a severe mental illness CMHSR Seminar Series John C. Bricout Ph.D.

2. Decanting the water cooler • “‘The water cooler effect’ suggests that conversations that develop in and around a water cooler or in a cafeteria significantly enables knowledge transfer.” (Sarker, Sarker, Nicholson & Joshi, 2002, p. 10)

3. Why the Water Cooler Now? • Employment challenges for people with SMI • Evidence-based approach: supported employment as a ‘black box’ • Focus on client capacity • Programmatic compensatory strategies • Shifting the paradigm: transactional (Person-environment) social learning processes

4. What is Supported Employment? • Supported Employment (SE) Individual Placement and Support (IPS) • Integration with MH services • Assertive community treatment case management model • Individualized, rapid job search • Competitive-wage community jobs • Individually-held positions • Ongoing supports offered • More ‘meaningful’ work

6. What Makes Work Meaningful? • Meaningful Work • Work that is satisfying • Work that meets developmental needs • Work that furthers career growth • Work that enhances capability, sense of • Work that increases feeling of belonging • Work that meets material needs

8. Efforts to Get More Meaning • SE Delivery System Program and Agency Variations (Cook, et al., 2005) • IPS (MD, CT) • ACT (MA) Shared caseload, vocational assessment • Blended approach (SC) ACT plus IPS • IPS plus enhanced natural supports (TX) • IPS plus multifamily psychoed and MH Employer Consortium (ME)

9. SE Benefits and Limitations • SE/IPS Benefits • Higher wages • Higher rates of employment • Integrated employment • Consumer choice of job enhanced • (Meaningful work) • SE/IPS Limitations • Job tenure(short-term) • Low participation rate • Low-wage, part-time jobs

10. Job Tenure Factors • Factors related to structure of work or services • Inherent nature of jobs held (entry-level) • Entitlement/benefit contingencies • Follow-up costly long-term: may need more than a year of supported employment, or may be initially uninterested (Saylers, et al., 2004)

11. Job Tenure Factors • Factors related to the worker • Neurocognitive functioning (Lehman, et al., 2002) • Cognitive functioning (McGurk & Mueser, 2004; McGurk, et al., 2003) • Impaired social functioning (Lehman, et al., 2002) • Social Network Outcomes (Forrester-Jones, et al., 2004; Rollins, et al., 2003)

12. Program Factors on Functioning • Opening up the Programmatic Black Box “…a need to better understand how specific models of vocational rehabilitation work, including their interactions with cognitive functioning and symptoms.” (McGurk & Mueser, 2004, p. 160)

13. Program Factors on Functioning • Program Handling of Cognitive Limitations “Different vocational programs may have different approaches for dealing with the problem of cognitive impairment in program participants, resulting in different associations between cognitive functioning and work” (McGurk & Mueser, 2004, p. 151)

14. Program Factors on Functioning • Program Design of Social Environment “These mental health centers provided a culture in which work is valued and consumers are expected to work…” (Saylers, et al., 2004, p. 306)

15. Bridging Concept – Social Learning • Links labor-market potential and employability in a knowledge society • Links cognitive functioning, social networks and work functioning • Implies a transaction between the worker and the social environment in which the capacities of each individually, and both co-jointly are increased

16. Vocational Social Learning • ‘Vocational’ social learning is how I refer to the processes of social learning in vocational rehabilitation settings • Examples of social learning • Advice-giving • Instrumental aid • Feedback • Guidance

17. Vocational Social Learning • Learning is Situated and Active “Learning about only requires the accumulation of knowing that, which confers the ability to talk a good game but not necessarily to play one.” (Duguid, 2005, p. 113)

18. Vocational Social Learning • Tacit (how, apprenticed) knowledge critical to taking action • Knowing that can be codified and modeled, but that strains out the knowing how that makes knowledge actionable

20. Unpacking Social Learning • Exploring socialization to work – learning how to work (Pilot One) • Exploring socialization at work – learning how to work here (Pilot Two)

21. Pilot Projects • Pathways to employment pilot • Three focus groups at independence center • Evaluation data on members and staff by category • Participant observation data on preparatory ‘Edge workshop • Evaluation data on places of employment • Self-disclosure feasibility pilot • Independent employment (IE) worker and paired co-worker interviews on the social environment at work and self-disclosure

22. What is Independent Employment ? • Clubhouse Adaptation of SE • Roughly congruent with IPS but varies on: • Degree of ongoing supports • Clubhouse integrates mental health, psychosocial and vocational supports • Clubhouse members are exposed to ‘pre-vocational training’ and may not make rapid assessments and placement

23. What is Transitional Employment? • Clubhouse-run Employment Program • Jobs held by Clubhouse (Clubhouse responsible) • Time limited • Jobs contracted by Clubhouse • Enclave setting • Worker MH status widely known

24. Member Placement Characteristics • Transitional placements = 44 • Transitional employers = 11 • TE jobs: mailroom clerk, assembler --------------------------------------------------- • Shared TE/IE placements = 6 --------------------------------------------------- • Independent placements = 92 • Independent employers =68 • Self-employment = 1 • IE Jobs: clerical, food preparation

25. Pathways Pilot Rationale • Explore the workplace socialization process for clubhouse members taking two paths to IE: a direct path and one preceded by TE • Explore the nature and role of Clubhouse philosophy and practices in fostering competitive employment-relevant habits of mind, expectations and competencies • Explore how the Clubhouse initially and over time shapes the worker role and ‘being’ for members

26. Sampling Frame Member Employment Statistics 2000-2005 • Independent plus transitional = 43 • Independent employment only = 35 Clubhouse Vocational Staff Statistics 2005 • Unit Staff/Placement Managers = 18 • Employment Staff = 6

27. Focus Group Characteristics • Pathways to Employment Focus Groups • Members in I.E. only (N=6) • Range of time in workforce: 3-20 years • Time in current job: 0-4years • Members in I.E. with T.E. experience (N=8) • Range of time in workforce: 3-20 years • Time in current job: 0-1 year • Vocational staff members • (N=11)

28. IE Focus Group Themes • The clubhouse fosters trust in self and in staff • Clubhouse teaches you getting along • Clubhouse is more flexible than employers • Knowing your strengths and weaknesses is important • Knowing what supports you need at work is important

29. TE to IE Focus Group Themes • Clubhouse support indispensable • Clubhouse members are an important part of that support, as well as staff • Clubhouse provides a sense of belonging and place • Clubhouse a training ground for skills important to stressful work situations • Family members and co-workers also have important support roles

30. Staff Focus Group Themes • Relationships—both with members and staff—are key confidence-builders and supports in illness times • Clubhouse has unique, intentional, non-judgmental approach to work • Clubhouse teaches how to learn to work • Clubhouse generates work peer pressure • Critical workplace supports hinge on degree of clubhouse participation/connect

31. Focus Group Conclusions • Clubhouse structure and philosophy aim to enhance member vocational self-efficacy, collective efficacy (as a person with a psychiatric disability) and learning how to be a worker • Societal prejudices and demands vitiate Clubhouse learning, perspectives and habits • The unique ‘bubble’ of Clubhouse learning may be more beneficial readying members for the world of work than maintaining them there • The real-world-Clubhouse expectations disconnect suggests transitioning

32. Self-Disclosure Pilot Rationale • Examines the role of self-disclosure in context of social networks, workgroup member interdependence, mutuality and respect • Tests feasibility of recruiting and questioning paired third-parties in the workgroup • Examines correspondence of IE worker and workgroup member perspectives on workgroup

33. Exploratory Questions • Topics for exploration • What is the nature of their social networks? • Is self-disclosure more prevalent in work environments characterized by more interdependence? • Are better relationships with co-workers related to the prevalence of self-disclosure • For follow-up • Is self-disclosure part of at least one pattern of fostering social learning at work?

34. Interview Structure • Two structured interviews aimed at assessing the feasibility of collecting data from an IE worker and co-worker on how workgroup members treat one another, the nature of IE worker self-disclosure, and the degree of workgroup member interdependence. • The IE worker interview is substantially longer because it includes an idiosyncratic section on workplace social networks; apart from those items the two questionnaires roughly parallel one another.

35. Interview Items • Member (IE Worker) Interview: 88 items. Twenty-eight items developed for this project. Ten items are part of a standardized social network measure that is repeated 6 times for different people. • Co-Worker interview: 18 items developed for this project

36. Ethical Issues • Ethical Challenges • Risks to IE worker • Confidentiality breach • Peace of mind • Employment status • Co-worker relationships • Ethical Imperatives • Cost of exclusion • Justice issue – participation • Respect for persons – capacity to consent/participate

37. Ethical Design • Changes to Design • Sampling frame ‘protections’ – agency vetting of sites and sample • Nomination process replaced by direct IE worker contact of co-worker • Consent and interview process isolated from workplace • Consents warn of confidentiality risks • Co-worker knowledge pre-assessed

38. Sampling Frame • Current Status • Agency vocational staff have identified seven work-stable IE workers in ‘safe environments’ who have agreed to be contacted by researcher for the IE Worker (Member) interview, three more in process

39. Conclusion • Need measurement development (observational, self-report, archival) for vocational social learning • The relationship of vocational social learning needs to be investigated with job fit, satisfaction, job performance and vocational development • Vocational social learning conceptually integrates individual-focused, transpersonal and organizational efforts at improving the employability of persons with a psychiatric disability