The Aspiring Workforce: Research to Date and Plans for the Future Bonnie Kirsh , PhD.

1. The Aspiring Workforce: Research to Date and Plans for the Future Bonnie Kirsh, PhD. University of Toronto

2. Employment • A social determinant of health • A fundamental right of citizenship • United Nations Declaration of Human Rights, Article XXIII • Charter of Rights and Freedoms • Employment Equity Act • Human Rights Act • Organizes human social activities • Improves socio-economic status • Enables voice, power, identity

3. We have come a long way • Work is recognized as feasible, attainable and desirable for persons with SMI • Services –a wide range • Research –a growing literature on work • Advocacy and policy-emphasis on inclusion, rights • Funding-better than ever before (with some twists)

4. The Mental Health Commission of Canada: Workforce Advisory Committee • The Workforce Advisory committee aims to help all workforce leaders change the way mental health is dealt with so that workforce environments are more capable of dealing with mental health matters in a manner that leads to the betterment of the workforce and the workplace. • The committee is also focusing on the barriers that must be recognized, then dismantled as they pertain to: job re-entry, finding employment, sustainable income, skill development, and even housing. • Leadership Video: • http://www.mhccleadership.ca/

5. Nevertheless… • Work outcomes are still low • Stigma exists re: work • SMI associated with downward economic mobility • Much more work to be done to determine what constitutes evidence based practice • Many disparate approaches, beliefs, programs focusing on work

6. Supported Employment: An evidence based practice • Two meta-analyses compared SE to day treatment SE participants earned more and worked more hours per month than those registered in prevocational programs. • Crowther RE, Marshall M, Bond GR, et al: Helping people with severe mental illness to obtain work: systematic review. British Medical Journal322:204–208,2001 • Twamley EW, Jeste DV, Lehman AF: Vocational rehabilitation in schizophrenia and other psychotic disorders: a literature review and meta-analysis of randomized controlled trials. Journal of Nervous and Mental Disease191:515–523,2003

7. Supported Employment Programs across the Globe • Interest in implementing SE programs has spread from the US to several countries: • United Kingdom • Finland • Germany • Netherlands • Japan • Hong Kong • Canada • Implementation of SE programs in different social and cultural contexts has led to adaptations of the SE components, impacting the fidelity and potentially the quality of these SE programs.

8. Individualized Placement and Support (IPS) • The most studied SE program for people with SMI • IPS differs from other SE programs with its zero exclusion criteria • all clients who express interest in competitive employment can be registered in IPS programs

9. Supported employment components recognized as evidence-based • IPS rests on 7 main principles(Drake, Becker, Clark, & Mueser, 1999; Corrigan et al., 2008): • Evidence Based: • Eligibility is based on consumer choice; • Supported employment is integrated with mental health treatment; • Attention is focused on consumer preferences; • Competitive employment is the goal; • The job search is rapid from the start; • Follow-along supports are continuous and time- unlimited. • Benefits counselling is provided.

10. Additional Components Affecting Outcomes (Program Level) • de-emphasizing prevocational programming • quick approval for vocational rehabilitation • high degree of support from vocational staff if problem occurs on job site • a problem-solving approach to work and daily living • training of vocational staff. • wide variations of vocational success within SE programs specifically between employment specialists • solid working alliance between SP and client

11. Additional Components Affecting Outcomes (Workplace Level) • disclosure of mental illness to employers • work accommodation • attention to work environment • support and education for employers • pay • on-the-job training • buddy system on the job-site • job development

12. Promises… * Based on 7 studies in Bond et al.’s (2008) review ** Based on 6 studies in Bond et al.’s (2008) review

13. In Canada …. • “As in previous studies, a significant • proportion (here, 53%) of the supported • employment clients were unable to • achieve any competitive employment over • their first year in the programme. Only a • small minority (13%) were able to average • even 5 h work per week over the 1-year follow- • up period.” • (Latimer et al, 2006)

14. Questions: At the Individual Level • Are people who are the most marginalized being granted the opportunity to explore work? • What are the characteristics of people who benefit most from SE? • What is the lived experience of participation in SE?

15. Questions: At the Program Level • Is it taking a long time to get to “the work question” ? • What levels and types of employment are targeted by SE? • Support: what type, length, nature? • Training in SE: competencies?

16. Questions: At the Workplace Level • Disclosure: to whom, how, when, how much? • How do workplace cultures intersect with disclosure? • Accommodation: to what extent? • Employers: what do they need, want?

17. Questions: At the Policy Level • How can policy reduce disincentives and enable people with SMI to more effectively leave the benefits system? • How can SE programs be most effectively funded?

18. The Big Question: Does SE Improve Life? • Does it offer: • Meaningful work • Some degree of choice and control • Social support, beyond professional support • Freedom from stigma and discrimination • Good working conditions • Opportunities to advance

19. CMHA Niagara Branch R E A L Presents: work Renewed Employment Access Link

20. CMHA Niagara R E A L work Renewed Employment Access Link Introductions Employment Counsellors: Mary Lou Linton R.E.A.L. Work, St. Catharines O Bruno Lizzotti R.E.A.L. Work, Niagara Falls O Melissa Mitchell R.E.A.L. Work, St. Catharines O Sheila Prevost R.E.A.L. Work, Welland, Fort Erie CMHA Niagara O Pam Tervo R.E.A.L. Work, St. Catharines O Dana Tirone R.E.A.L. Work, Welland, Port Colborne O

21. CMHA Niagara R E A L work Renewed Employment Access Link Overview of Presentation 1. What is R.E.A.L. Work (History)? 2. How can R.E.A.L. Work assist? How will I know if I’m R.E.A.L READY? 3. 4. Successful Employment Teamwork. CMHA Niagara 5. Where have R.E.A.L. Go Getters Gone? Partnerships 6.

22. Is an employment service offered through the Canadian Mental Health Association • We serve individuals who are 16 years and over • Who are unemployed, not in school and who would like to explore their options of returning to work, and/or upgrade their school or skills and/or volunteer options CMHA Niagara • And who struggle with their mental health and other stressors that interrupt their life and are in need of personal supports • And who see the need to develop or enhance their Life Skills abilities and community connection sources R E A L work Renewed Employment Access Link What is R.E.A.L. Work?

23. CMHA Niagara R E A L work Renewed Employment Access Link History of R.E.A.L. Work Started in 1993 with one staff member. By 2006 we have expanded to 4 locations covering Niagara Region. O O Originally funded through a Trillium Foundation grant. O Since 2nd Year: 1994, funded by Service Canada now , Employment Ontario.

24. CMHA Niagara R E A L work Renewed Employment Access Link R.E.A.L. Work’s Mission To provide opportunities for people, who have experienced mental issues, to find and maintain employment and to live more independent and integrated lives.

25. Fear of having ODSP or CPP Disability denied or interrupted when returning to work. - - No work experience / no recent work experience. - Don’t have training / education for the job CMHA Niagara - The side effects of medication. - No work experience / no recent work experience. - Low self esteem. R E A L work Renewed Employment Access Link How can R.E.A.L. Work Assist? Employment counselors meet one on one with individuals in a private setting to give support tailored to client needs… • We discuss what the barriers to employment have been, such as:

26. CMHA Niagara R E A L work Renewed Employment Access Link R.E.A.L. Work Assist con’t How can R.E.A.L. Work Assist? • In addition counselors also….. • Discuss and identify individual strengths • Develop an action plan (IPS model) Include other supports such as: • Building self awareness • Strengthening mental health management & wellness • Increase confidence & self-esteem • Identify skills, interests & life values in relation to vocational goals and create an action plan • Provide support and encouragement • Certified Level 1 Life skill workers provide group & individual Life Skills support and training O

27. Competitive, integrated employment • Job Direct Support • Integrated Employment and Mental Health Supports • All support based upon consumer preferences and goals • Continued Assessment based upon competitive work experiences • Individualized “follow-along” supports CMHA Niagara R E A L work Renewed Employment Access Link IPS Principles CMHA Niagara

28. CMHA Niagara R E A L work Renewed Employment Access Link How will I know if I am R.E.A.L. READY? • You are ready for change but your feeling stuck, not sure what to do or how to get started. • Recognize that there are barriers to reaching your goals and you are ready to explore ways to overcome them. • You are at a point in your recovery where you feel ready for new challenges.

29. As you begin your job search the need for some of the following supports will be identified: • Career Counseling • Resume/Cover Letter Creation • Job Searches • Interviewing Skills • Advocacy and Referral • Vocational Connections • Educational Support • Job Maintenance Support • Group and Individual Life Skills training & Support CMHA Niagara R E A L work Renewed Employment Access Link Successful Employment Teamwork. You and the Employment Counselor will define what steps are needed to reach YOUR goals.

30. CMHA Niagara R E A L work Renewed Employment Access Link Why REAL Work works Uninterrupted funding for 12 years, resulting in growth and improvement in service. O Individuals who participate in the program have the freedom to choose their own direction. O O Specifics Targets (outcomes) must be reached each year in order for funding to be renewed: jobs, academic courses and training, promotion.

31. CMHA Niagara R E A L work Renewed Employment Access Link January – December, 2009 • clients 195 RTWAP participants • 120 competitive employment placements • 21 incidental placements • 44 pre-employment placements • 514 prospective participants

32. CMHA Niagara R E A L work Renewed Employment Access Link Lifeskills • Stress Management • Mental Health 101 • Communication • Community Connection • Assertiveness • Self Esteem • Group Dynamics/Listening Skills • Time Management • Emotional regulation/Anger • Goal setting • Problem solving/Decision making

33. CMHA Niagara R E A L work Renewed Employment Access Link Partnering Agencies Employment Help Centre Welland and St. Catharines O O Niagara Employment Help Centre Niagara Falls O Club 2000 – French Language Services Welland O South Ridge Shelter (EES Program CMHA Niagara Salvation Army (EES Program) O O Start Me Up Niagara (EES Program O Port Cares Port Colborne

34. CMHA Niagara R E A L work Renewed Employment Access Link Sites District School Board of Niagara Niagara Detention Centre Shelter Programs Employment Agencies CMHA Niagara Multicultural Centres