Implementing Supported Employment and Helping Consumers Get and Keep Jobs: Research Findings

1. Implementing Supported Employment and Helping Consumers Get and Keep Jobs: Research Findings Gary R. Bond Dartmouth Psychiatric Research Center Oregon SE Statewide Training Breakout Session July 26, 2011

2. When starting up a new supported employment program, the first step should be to provide intensive training for new staff. FALSE

3. Limitations of Training • Intensive training in early stages often premature (waste of time) • Problems of staff turnover • Limitations of lectures and PowerPoints • Practitioners learn more from field mentoring

4. Most Important Factors in Implementing a New Program (Torrey et al., 2011) • Exerting leadership -- by both center administrators and SE team leader • Selecting appropriate staff • Developing infrastructure (see fidelity standards)

5. Consumers who use alcohol or drugs are less likely to be successful in employment. FALSE • This is a belief that dies hard, despite numerous studies that show no difference between mental health consumers with and without substance use

6. Will Employers Hire People with Criminal Justice Histories? • Conventional wisdom: • Most types of businesses will not • Research evidence: • Very little research!

7. Many mental health consumers have criminal justice histories (Frounfelker, 2011)

8. Employment Outcomes for IPS Clients with and without CJI (Frounfelker, 2010)

9. Employer Survey: Hiring People with Felonies • 128 employers in 9 states • Many kinds of businesses • 63% had knowingly hired someone with a felony • Few had written policies • No strong pattern in which businesses more likely to hire (Swanson, Reese, & Bond, submitted)

10. Employers reasons for hiring a person with a felony

11. Employers won't hire someone with a criminal justice history. MOSTLY FALSE • Finding jobs are more challenging • Many employers do screen out known felons, especially drug offenses • But many employees are flexible

12. Training in interviewing and social skills is the best way to prepare consumers for jobs. FALSE • Extended skills training before looking for a job has been shown to reduce employment rates. • After starting a job, skills training has little or no effect.

13. Should Consumers Disclose Their Mental Illness? • Very little research, and the research is unclear • Consumer preferences are critical consideration • What, when, and to whom matter greatly

14. Disclosure of Mental Illness at Workplace (Jones, 2011) • Disclosure to supervisor associated with increased emotional support • Disclosure to co-workers associated with increased criticism

15. Consumers are better off not disclosing their mental illness. NEITHER TRUE NOR FALSE IT DEPENDS!

16. Is it harder to find jobs for consumers in rural areas? • Common assumption: Employment is more difficult in rural areas • The research says: • Rural programs have as much success achieving high-fidelity SE and getting people jobs • But methods differ somewhat from urban programs

17. Urban vs. Rural SE Programs (Becker, 2006) • 26 sites in 7 states • 12 urban • 14 rural (population < 50,000) • Examined predictors of competitive employment outcomes • Predictors included SE fidelity

18. Comparing Rural to Urban Sites in Becker Study • SE fidelity was almost identical (rural = 63.6 vs. urban = 63.8) • Access to supported employment was very similar • Competitive employment rate was slight better in rural sites

19. Outcomes in 87 Urban & Rural IPS Programs (Haslett, 2011)

20. Crucial Implementation Issuesfor Supported Employment in Rural Areas • Transportation • Small population base • SE unit supervision • Job development • Stigma (Thanks to: Sarah Swanson, Linda Carlson, Debbie Becker, David Lynde, Laura Flint)

21. Transportation: Strategies • Ask: “How does everyone else get to work?” • Ask at church or civic groups • Informal taxi service/coworkers • Rural mass transit less rigid (senior ride program) • Kansas solution: Donate cars • Job develop/interview using client’s expected transportation system

22. Job Development: Issues • Fewer options for job matching • Economy may be tied to a single employer • What happens if only factory shuts down? • Confidentiality issues associated with rural familiarity

23. Job Development Strategies • Skillful persistent job development still crucial • Different interpersonal approach to employers in rural areas compared to cities • Personal networks • Self-employment??

24. Stigma: Issues • Everyone knows everyone – Cannot hide behind anonymity • Reputation may be hard to overcome • May be a barrier to hiring

25. Strategies for Overcoming Stigma • Familiarity can be used to advantage • Rural communities “take care of their own” • “Word of mouth” produces quick information on job leads • Consulting frequently with local VR counselor

26. It’s harder to find jobs for consumers in rural areas. FALSE

27. The type of medications a consumer takes can greatly influence success in employment. PROBABLY TRUE, BUT EVIDENCE LACKING • Skilled medication management is an important adjunct to SE • One finding: Type of antipsychotic does not affect employment (Resnick, 2008; Percudani, 2004)

28. Suggesting coping skills on the job can make a big difference in helping consumers keep jobs. TRUE • McGurk and Mueser (2006): Employment specialists who suggested more coping strategies had greater success helping consumers keep jobs.

29. For transitional-aged youth, the best way to help them gain work experience is to place them in unpaid internships. UNKNOWN • Very little research to date on employment for this important population.

30. Is long-term support important after consumers get a job? • For how long? • How often should the employment specialist meet? • Can it be by telephone? • What type of support should employment specialist provide?

31. How Often Should Employment Specialists Meet After Consumer Begin Working? • Few studies to answer this • (Lots of studies showing importance of job development) • Bond and Kukla (2011) examined 2-year follow-up of 100 IPS consumers who started a job

32. Monthly Employment Specialist Contact with Consumers (Bond & Kukla, 2011)

33. Importance of Ongoing Support After Consumers Start Work • Frequency of contact correlated with months employed over 2 years (r=.27) • Brief contacts (<30 min.) were as effective as long contacts (>30 min.) • Face-to-face contact was effective • Telephone contact was not

34. Conclusions: How Often Should Employment Specialists Meet After Consumer Begin Working? • Close contact in the first few days and weeks are critical • Long-term contact appears to make a difference (for 2 or more years) • Brief monthly contact probably adequate most of the time • Contacts should be face-to-face

35. Once a consumer gets a job, the contact can be by phone. FALSE

36. What Makes for a Successful Employment Specialist? • Belief that clients can work • Time management skills • Passion for job • Thick-skinned • Team orientation • % of time spent in the community (Glover, in press; Gowdy, 2003; Taylor, submitted; Whitley, 2010)