Time to rethink “one-size-fits-all”

1. Alternative Approaches to Employment Supports: Advancing the field of PSRPSR/RPS Canada Conference 2010Pam LaheyPolicy AnalystCMHA OntarioSeptember 21, 2010

2. Time to rethink “one-size-fits-all” How to increase employment rates for persons with severe mental illness (SMI)? Evidence shows that supported employment approaches are most effective Individual Placement and Support is dominant model

3. Why explore other approaches? Current supported employment (SE) models do not measure: • long-term job tenure • job quality • skill level or • rate of pay Studies indicate: • 40% of SE participants do not find jobs and for those that do job tenure is brief – US studies • Job tenure is typically less than 5 months

4. Exploring alternatives is a policy priority • Increased commitment to develop new knowledge needed to ensure that the most effective and appropriate treatments, services, and supports become available - Mental Health Commission of Canada (Toward Recovery and Well-being: a framework for a mental health strategy 2009) • Explore other models that support employment for people with mental illness in New Brunswick • BUILT Network and Let’s Work (CMHA Fredericton) • Potential for expansion of these models. - Judge McKee (A transformed mental health system for New Brunswick, 2009)

5. Exploring alternatives is a policy priority Develop a range of evidence-based, person-directed approaches – Strategic Directions, Ministry of Community and Social Services Service delivery models are needed that can identify and provide more intensive help to the smaller number who require it. - Guelph-Wellington Employment Training Committee 2009 Need for more Canadian research into service delivery models, including employment -OMHAKEN Creating Together Agenda – Toronto Consultations

6. Need for moreCanadian research into employment Value-based supported employment programs with range of employment options Increase opportunities for goal planning and success Offer choice and promote self-determination Dorio, 2004 as cited in CAMH and CMHA Ontario discussion paper

7. Need for more Canadian research Which types or combinations of services work best for which individuals with severe mental illness? - Corbiere, 2010 Mental Health Commission of Canada’s (MHCC) Aspiring Workforce project: • preliminary results by end of year.

8. Need for more Canadian research Support for education and employment programs to innovate, adapt, evaluate and improve - Emerging and promising practices at the community level - Identify and evaluate new and adapted employment support models – CAMH and CMHA Ontario discussion paper, 2010

9. Emerging and Promising Practices • Emerging practices: innovations in practice that : • address critical needs of a particular program, population or system, • but do not yet have scientific or broad expert consensus support - CMHA National • Promising Practices: Are often used to indicate practices or approaches that have not been evaluated as rigorously as "best practices", but which address a widely held client need or gap in our service system • E.g. CAMH – augmented education

10. Why evaluate practices at the community level? Enables us to: Identify programs strengths and weaknesses Create action plans for improving program Help job seekers achieve their goals for recovery Deliver effective and efficient vocational services Outcome measures capture the results or achievements in your program.

11. What is needed to encourage research of emerging and promising practices Community and government champions Pilot demonstration projects (to illustrate social and financial benefits) Replicate successful learnings in other regions Build critical mass A policy framework based on recovery principles

12. Adapting existing models • Less-studied models can have positive vocational outcomes when adapted to social, cultural, and economic context • Capturing a broader range of outcomes: type of employment position, number of hours worked, number of weeks, wages, place of employment, reason for job termination • Merge existing evidence-based practices • e.g. augmented education

13. Adapting existing models Choose-Get-Keep: Three sets of program activities, Choosing, Getting and Keeping, form the program structure and parallel the supported employment components described by others as pre-employment, placement, and training/follow-along more uptake in Canadian context (often level-entry jobs) extensive prevocational career exploration with access to skills training

14. Supported education and employment interventions • Cognitive Remediation (e.g. thinking skills for work program) – limited studies have shown improved competitive employment outcomes (working more hours, earning higher wages. Etc. – need for Canadian studies • Motivational interviewing (Motivation key factor in preventing successful work entry) • Building in employer Incentives/penalties

15. Funding is needed for system reform It is necessary to invest more, [and] it will also be important to review and expand the scope of research so that it covers the full range of approaches – MHCC (Toward Recovery and Well-being: a framework for a mental health strategy) Change in funding structure- PROCEEDINGS FROM CMHA ONTARIO’S EMPLOYMENT FORUM 2010

16. Sharing results Develop understanding and support for practice (e.g. Facilitated and shared with knowledge exchange networks (regional employment networks, OMAKEN) Create enthusiasm for program Provide new way of delivering service Generate interest for funding

17. For More Information: Contact: Pam Lahey 416-977-5580 x4129 plahey@ontario.cmha.ca Cited Research Canadian Mental Health Association, Ontario, “Proceedings of Employment Forum 2010” unpublished [2010]. Centre for Addiction and Mental Health, Community Support and Research Unit, “Augmented Education: Effectiveness of a New Employment Training and Support Model for People with Mental Illness,” unpublished [2009]. M. Corbière & T. Lecomte, “Vocational Services Offered to People with Severe Mental Illness,” Journal of Mental Health (2009; 18[1]: 38-50). M. Corbiere, “Work Accomodation and job tenure of people with mental disorders,” Presentation to the Centre for Addiction and Mental Health, Toronto, Ontario, March 17 2010. J. Dorio, “Tying It All Together – The PASS to Success: A Comprehensive Look at Promoting Job Retention for Workers with Psychiatric Disabilities in a Supported Employment Program,” Psychiatric Rehabilitation Journal (2004; 28[1]: 32-39). Guelph-Wellington Employment and Training Committee, “Dialogue with Job Seekers and Employers in Guelph-Wellington: What They Need, What Helps the Most, What Changes are Needed,” unpublished [2009]

18. Cited Research The Honourable Judge Michael McKee. “Together into the Future: A transformed mental health system for New Brunswick,” April 2009. S. McGurk et al., “Cognitive Training for Supported Employment: 2-3 Year Outcomes of a Randomized Controlled Trial,” American Journal of Psychiatry (2007; 164: 437-441); W.R. Miller & S. Rollnick, Motivational Interviewing: Preparing People to Change (NY: Guilford Press, 2002). E.S. Rogers, W.A. Anthony & M. Farkas, “The Choose-Get-Keep Model of Psychiatric Rehabilitation: A Synopsis of Recent Studies,” Rehabilitation Psychology (2006; 51[3]: 247-256). Ontario Mental Health and Addiction Knowledge Exchange Network , “Developing a Mental Health and Addictions Research Agenda for Ontario” Provincial Consultations; Summary Notes from the Toronto In-Person Consultation [unpublished July6, 2010]. Mental Health Commission of Canada, “Toward Recovery & Well-Being: A Framework for a Mental Health Strategy for Canada, November 2009. Ministry of Community and Social Services, “Mental Health & Addictions Strategy: Stakeholder Engagement, MCSS Stakeholders Regional Roundtable With a Focus on Employment Supports” North/North East Region Video Conference November 24, 2009.