Employment and Its Impact on Recovery Michael Boyle mboyle@fayettecompanies.org

1. Employment and Its Impact on Recovery Michael Boyle mboyle@fayettecompanies.org

2. Is Employment an Outcome of Recovery orDoes Employment Facilitate Recovery?

3. Is Employment for Persons with SMI: • A stressor that should usually be avoided? • A choice of persons with SMI to pursue regardless of the opinions of mental health professions who treat them? • A responsibility of citizenship that should be promoted?

4. Goal of permanent competitive employment • Minimal screening for employability • Avoidance of pre-vocational training • Individualized placement instead of enclaves or mobile work crews • Time-unlimited support • Consideration of client preferences What is Individual Placement and Support Model of Supported Employment? A Working Life for People with Mental Illness.(2003) Deborah Becker and Robert Drake, Second Edition. Oxford University Press. Oxford, New York. Bond, G. (1998). Principles of the individual placement and support model: Empirical support. Psychiatric Rehabilitation Journal, 22(1), 11-23.

5. What does IPS look like? Requires full-time job coaches Hard work Complex but not complicated Community context 80% Team and office context 20% 1-1 with client f2f or phone 60% Interdependent problem-solving

6. Fidelity Measures • Caseload does not exceed 25 • Employment specialists provide only vocational services. • Each vocational specialist carries out all phases of vocational services including engagement, assessment, job placement and follow-along supports.

7. Fidelity Measures • Integration of vocational services with mental health treatment • Employment specialists function as a unit/team • Zero exclusion criteria • Ongoing, work-based vocational assessment • Rapid search for competitive job

8. Fidelity Measures • Individualized job search based on job choices • Diversity of jobs developed that are in different settings • Jobs have permanent status rather than temporary or time-limited • Vocational specialists help persons find new jobs when one ends.

9. Fidelity Measures • Time-unlimited follow along supports • Community based services – 70% of time spent in community • Ongoing assertive engagement and outreach – ongoing encouragement

10. Motivational Interviewing • Based on Stage of Change theory • Weighs pros and cons of a change i.e. getting a job • Helps person identify discrepancies between life goals and behaviors

11. Practices Differentiating High Performing from Low Performing Supportive Employment Programs Gowdey, E.L., Carlson, L.S. and Rapp, C.A. Practices Differentiating High-Performing from Low Performing Supportive Employment Programs, Psychiatric Rehabilitation Journal, Vol. 26, No.3, 2003.Gowdey,E.L., Carlson, L.S. and Rapp, C.A. Organizational Factors Differentiating High Performing from Low Performing Supported Employment Programs, Unpublished Manuscript.

12. Effective Practices • Exposure to supportive employment occurs during intake. • Case Managers initiate conversation about work. • Consumers are less fearful about working due to staff support of employment.

13. Effective Practices • De-emphasis on pre-vocational services. • Ensuring vocational assessment happens rapidly. • Rapid approval of vocational services and strong relationship with State vocational rehab services. • More comfort of staff in allowing disclosure of mental health problems.

14. Effective Practices • More direct contact with perspective employer on behalf of a specific client. • More frequent contact with employers on an ongoing basis. • Consumers perceive a high degree of ongoing support after starting a job. • Consumers view their work environment as helpful and flexible.

15. Organizational Factors • Program leaders emphasize the value of work in people’s lives and the belief that people can work. • Program leaders emphasize strength-based practices. • Program leaders use vocational data to guide programming and practice. • Staff do not view stigma as a barrier to employment

16. Organizational Factors • Staff believe persons have a desire and motivation to work. • Stories are shared that reflect belief in the ability of individuals to succeed in the world of work. • SEP staff and case managers work as a team with a high degree of collaboration.

17. Organizational Factors • Case managers support individual’s employment interests and vocational progress.

18. posters, graphs, cork boards, resource room with computers/fax/phone, networking, simple vocational plans, communicate with family and mental health team, team meetings, speed-dial mentality, job shadows, job clubs, simple questionnaires, generic job application, on the job evaluations, job satisfaction questionnaires, performance evaluations, natural supports, follow up plans How to implement the IPS principles

19. What impact would this model have on recovery?

20. What problems may be encountered in implementing the supportive employment model?

21. Two years of implementation experience at Human Service Center

22. Outcomes • 110 persons have obtained employment • 33 are currently working • 194 different jobs have been obtained • 5 have obtained health benefits through their employer

23. The beginning • Five year grant from US Dept. of Labor’s Office of Disability Employment Policy • One of three Olmstead Action grants awarded in 2003 • Training and Evaluation from the Center for Psychiatric Rehabilitation

24. Intensive Training • Supervisor, job developer and 7 job coaches (two primary consumers) • All new staff except for supervisor • Ten days of IPS/MI training from CPR staff • Two days benefits training from Health and Disability Advocates and DRS Benefits Planning and Outreach

25. Advisory Committee • Primary consumers • Advocates – NAMI & GROW • One Stop Vocational Center • DMH staff • DRS state and local staff • Local Workshop • Center for Independent Living

26. Partnering with One Stop Job Center • SEP staff trained on resources available and their use • Job coaches assist consumers in utilizing the resources at One Stop employment center for resume development, interest inventories and job searches • Purchase of software for development of math and reading skills and software licenses for “international computer licenses” • Job clubs conducted at One Stop by SEP staff

27. Early Surprise Employers were very receptive to hiring persons with serious mental illness when visited by job developer. Only two of over 100 “slammed door”.

28. Problems Encountered • Problem: Clients not having phone number for job applications • Solution: Phone line at staff office with answering machine having generic “leave a message”. Staff check for messages and contact client.

29. Problems Encountered • Problem: Clients lack funds for needed expenses for beginning work when hired • Solutions: Establish revolving fund for minor expenses such as hair cut, bus passes. Rapid opening with DRS for expenses that are more costly i.e. fork truck license.

30. Problems Encountered • Problem: Client and family fear of losing benefits. • Solution: Partnership with DRS Benefits Outreach and Planning project. HSC staff work with consumer to complete background information and obtain SSA information. BPAO specialist completes individual analysis detailing impact of perspective earnings on benefits and available options to retain benefits.

31. Problems Encountered • Problem: early resignation from jobs due to fear of poor performance/firing. Not contacting job coach before quitting • Solution: “Over-teaching availability of ongoing support. Contingency management for contacting job coach during first week of employment Cell phone numbers given to clients

32. Problems Encountered • Problem: culture change from protection to empowerment. Case management staff “sabotaging” employment: -”It will be too stressful for you” -”Only work part-time” -”Start at a workshop first” -” You tried this before and it did not work”

33. Problems Encountered • Solutions: • Continued education of all staff on IPS model and research findings • Set organizational goal of 50% of clients employed in five years - Management intervention for those not willing to change

34. Problems Encountered • Problem: Clinical teams not integrating job coaches with their work. • Solutions: -Mandate joint meetings between job coach, case manager and client during first two weeks of IPS involvement. -Brochure to all staff outlining IPS services and expectations -Job coaches attend full case management team meetings.

35. Problems Encountered • Problem: More referrals needed • Solutions: Developed brochures for both staff and clients describing SEP services; monthly “marketing” meeting for consumers; encouraging referrals from peer mentors.

36. Problems Encountered • Problem: DPA rule that persons in LTC facilities may only retained $55 of monthly earnings resulting in disincentive to work and inability to save for moving. • Solution: Legislative change, pilot study, and NOW A LAW SUIT!

37. Next Steps • Cognitive training for those who have lost jobs - Mueser and McGurk study • Compensatory training and adaptation on the job • Engage in supportive employment combined with Illness Management and Recovery at intake for new admissions. • Supportive Education

38. What are some resources? www.samhsa.gov Evidence Based Practices Resource Kits www.bhrm.org Clinical Guidelines/Mental Health Bissonnette, D. (1994). Beyond Traditional Job Development Work as a Priority. (2003). U.S. Department of Health and Human Services. Psychiatric Rehabilitation Journal. (Spring 2004). Volume 27 Number 4.