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SUPPORTED EMPLOYMENT

Discover why focusing on employment is crucial for individuals with severe mental illness. Learn about the benefits, quotes from consumers and employers, and evidence-based principles of supported employment.

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SUPPORTED EMPLOYMENT

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  1. SUPPORTED EMPLOYMENT EVIDENCE-BASED PRACTICE

  2. Why Focus on Employment? • Viewed by many as an essential part of recovery • Most consumers want to work • A typical role for adults in our society • Cost-effective alternative to day treatment

  3. Positive Outcomes from Competitive Work • Higher self-esteem • Better control of psychiatric symptoms • More satisfaction with finances and with leisure (Bond et al., 2001)

  4. Is Work Too Stressful? • As compared to what? • Joe Marrone, an employment trainer: “If you think work is stressful, try unemployment.” • Stresses of work do not translate into higher rates of hospitalization

  5. Negative Effects of Unemployment in General Population • Increased substance abuse • Increased physical problems • Increased psychiatric disorders • Reduced self-esteem • Loss of social contacts • Alienation and apathy • (Warr, 1987)

  6. Competitive Employment for People with Severe Mental Illness • Say they want to work: 70% • Are currently working: <15%

  7. Quotes from Consumers • “I feel so much better about myself now that I have a job.” • “Holding down my job is not always easy but it has helped my self esteem.” • “When I go to work I don’t hear the voices.” • “Now that I am working again I can buy my daughter presents.”

  8. Quotes from Family Members • “I worried that if my son got a job he would get stressed. But just the opposite happened. He is doing so much better than before.” • “I feel better that she tries working when she has the support of mental health.” • “I was really glad that my son’s employment counselor asked me about work ideas. He landed a job that I suggested.”

  9. Quotes from Employers • “Andre is as good as any worker that I have.” Automotive parts store manager. • “I count on Juanita. If she is feeling stressed, she sits in the back room for awhile. That’s OK; she gets the job done.” Bakery supervisor. • “The employment counselor helped me understand why Tony paces. It’s okay in the security business.” Security business owner.

  10. Evidence for Effectiveness % Gaining Competitive Employment: • 58% -- Supported Employment • 21% -- Traditional Voc Services, such as: • Prevocational programs • Sheltered workshops • Transitional employment (Bond et al., 1997)

  11. Definition of Supported Employment • Mainstream job in community • Pays at least minimum wage • Work setting includes people who are not disabled • Service agency provides ongoing support • Intended for people with most severe disabilities

  12. Evidence-Based Principles • Eligibility is based on consumer choice • Supported employment is integrated with treatment • Competitive employment is the goal • Job search starts soon after a consumer expresses interest in working • Follow-along supports are continuous • Consumer preferences are important

  13. Eligibility Is Based on Consumer Choice • Consumers are not excluded because they are not “ready” or because of prior work history, hospitalization history, substance use, symptoms, or other characteristics. • No one is excluded who wants to participate.

  14. Supported Employment Is Integrated with Mental Health Treatment • Employment specialists coordinate plans with the treatment team, e.g., case manager, therapist, psychiatrist, etc.

  15. Competitive Employment Is the Goal • The agency needs to devote sufficient resources to supported employment to permit full access to all consumers who seek competitive employment • Consumers interested in employment are not steered into day treatment or sheltered work.

  16. Job Search Starts Soon After A Consumer Expresses Interest In Working • Pre-employment assessment, training, and counseling are kept to a minimum.

  17. Follow-Along Supports Are Continuous • Supported employment staff continue to stay in regular contact with consumer and (when appropriate) the employer without arbitrary time limits.

  18. Consumer Preferences Are Important • Job finding is based on consumers’ preferences, strengths, and work experiences, not on a pool of jobs that are available.

  19. Key Factors in Implementation • Build Consensus • Maximize Financing • Examine Agency Philosophy • Identify Leadership • Key on Organizational Structure • Provide Ongoing Training • Make Time Commitment • Track Process and Outcomes

  20. Build Consensus • Commitment of state mental health authority is not enough • Better to involve all stakeholders - consumers, family members, providers, and local and state administrators

  21. Maximize Financing • Determine how supported employment services can be funded • Explore funding through mental health, vocational rehabilitation, and Medicaid • Reallocate resources to supported employment when feasible

  22. What Does Supported Employment Cost? • Some programs, $2,000-$4,000 per client per year (Clark, 1998). • Figures vary according to severity of disability, local wages of employment specialists, and how much indirect costs and costs of clinical services are included

  23. Examine Agency Philosophy • Determine if service agency’s philosophy, mission statement, and service paradigm are consistent with recovery-oriented, evidence-based approach to supported employment.

  24. Identify Leadership • You need a champion! • Identify committed leader with sufficient authority to oversee and ensure implementation • Leaders at all levels visibly show support for supported employment • Center director buy-in is critical

  25. Leadership Roles • Provide necessary resources • Seek buy-in from consumers, families, and practitioners • Give recognition to staff and consumer for successes • Rapp’s finding – Critical role of supervisor in program success

  26. Organizational Structure • Employment specialists • Each join one or two treatment teams. • Share office space with treatment team. • Communicate frequently with treatment team members. • Team integrates supported employment, benefits counseling, case management, psychiatric services, and dual diagnosis treatment.

  27. Provide Ongoing Training • Initial training for all team members, including medical staff • Continuing access to expert consultation • Ongoing supervision that is outcomes-oriented

  28. Make Time Commitment • Typically, 6 - 12 months needed to develop skills, interest, and confidence for implementing evidence-based supported employment

  29. Track Implementation Process and Outcomes • Track employment outcomes monthly • Set goals: 40% rate of competitive employment is achievable • Service agencies should use 15-item Supported Employment Fidelity Scale to measure implementation of evidence-based practice (Bond et al., 1997)

  30. Summary • People with severe mental illness can work in competitive employment • Programs following evidence-based principles of supported employment have better outcomes • Programs must address financial and organizational barriers to be successful

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