Making Work Work: Bridges to Successful Employment

1. Bette Stewart, Training Specialist University of Maryland School of Medicine, Training Center Stacy Seymore, Program Director Behavioral Health Administration, Maryland Employment Network Making Work Work: Bridges to Successful Employment Revised October 2015

2. Objectives • Attendees will learn about the Family Advocacy Team as well as Evidence-Based Supported Employment services in Maryland. • Attendees will gain a basic understanding of the impact of work on benefits and how work incentives combined with individualized support can lead to greater independence and self-sufficiency. • Session participants will leave with a greater understanding of how work IS possible for individuals living with mental illness.

3. Individualized Placement and Support (IPS) • IPS stands for individual placement and support. • The acronym “IPS” indicates the evidence-based approach rather than generic employment services.

4. IPS Supported Employment • Approach designed for persons with serious mental illness • Multiple research studies demonstrate superior outcomes • People who have access to IPS are two to three times more likely to obtain a job

5. Competitive Employment Rates in 20 Randomized Controlled Trials of Individual Placement and Support

6. Eight Principles of IPS 1: Zero exclusion criteria: Every interested person is eligible Every person is encouraged to consider how work might affect his or her life.

7. Eight Principles of IPS 2: Competitive jobs are the goal Regular jobs at regular wages. Jobs that anyone can apply for, regardless of disability status.

8. Eight Principles of IPS 3: Employment Services and Mental Health Services are Integrated Employment specialists and mental health providers meet weekly.

9. Eight Principles of IPS 4: Benefits Planning is Offered People are offered an opportunity to meet with a trained benefits planner before going to work and as they consider changes in their jobs.

10. Eight Principles of IPS 5: The job search occurs rapidly The employment specialist and/or job seeker makes face-to-face within a month of joining the IPS program.

11. Eight Principles of IPS 6. Employment specialists develop relationships with employers through multiple in-person visits to understand their business needs.

12. Eight Principles of IPS 7: Job supports are continuous Job supports are provided for as long as the person needs and wishes to receive IPS services. Typically about a year. Eventually, a mental health practitioner, such as a case manager, may be chosen to provide supports.

13. Eight Principles of IPS 8: Preferences are honored Preferences may be related to type of job, work hours, job location, …

14. The Intersection of Work and Recovery

15. So Work Sounds Good, but What About The Public Benefits?

16. Myth Busters • Work will be too stressful for my loved one and will set them back. • People can’t work while receiving Social Security benefits. • My loved one will lose his/her benefits if he/she decides to work. • People with serious mental illness are not able to achieve self-sufficiency.

17. Work and Social Security Disability Insurance (SSDI) • SSDI is based on work history. • Individual must be unable to perform Substantial Gainful Activity (SGA) • Gross monthly earnings of $1090 (SGA in 2015) or more may demonstrate SGA. • SSDI is all or nothing.

18. Work and SSDI-Part 2 • Trial Work Period • Extended Period of Eligibility • Expedited Reinstatement

19. Work and Supplemental Security Income (SSI) • Needs-based program for which the individual must have limited resources and income to qualify. • Automatically receive Medicaid/ Medical Assistance • The more you earn from work, the smaller the SSI check will be. • Continued Medicaid Coverage (1619B Rule)

20. Work Incentives • Impairment-Related Work Expenses (IRWEs) • Plan for Achieving Self-Support (PASS) • Subsidies • Employed Individuals with Disabilities (EID) • Special Individual Development Accounts to save for the future!

21. Ticket to Work • All beneficiaries have a Ticket • Social Security started the Ticket to Work program to help beneficiaries reduce dependency on cash benefits. • This is done by working with a Social Security approved Employment Network (EN).

22. Ticket to Work- Part 2 • How does this help a beneficiary? • Exemption from Continuing Disability Review (CDR) • No-cost employment support services • Ongoing personalized benefits counseling

23. Why is Benefits Counseling So Important? • Facilitates informed decision-making • Reduces anxiety of losing benefits • Educates individuals about how to make work work!

24. Maryland Employment Network (MD-EN) • Statewide Employment Network • Eligibility • Social Security beneficiary with assignable Ticket • Between ages of 18-64 • Desire to eliminate dependence on cash benefits MD-EN provides individualized job placement and retention supports as well as ongoing benefits counseling services to beneficiaries. This service can be provided in conjunction with IPS Supported Employment or in place of depending on the individual. It is important to find a program that best meets your needs!

26. Family Advocacyfor IPS Project • Individual Placement and Support (IPS) • The Johnson & Johnson – Dartmouth Community Mental Health Program • Family Advocacy Team (FAT) • 2008 • 2010 Maryland • Alameda County, CA, Connecticut, DC, Illinois, Kansas, Kentucky, Maryland, Minnesota, Missouri, Ohio, Oregon, S. Carolina, Vermont, Wisconsin, Colorado and N. Carolina, Tennessee, Alabama and Washington.

27. Purpose of the Family Advocacy Team • Advance family advocacy in three ways: • family advocates can educate IPS teams of the important role families play; • Families can help educate other families and community members about the value of employment in recovery; • Family advocates can help promote expansion of IPS services.

28. The Team • Leadership through NAMI MD • Behavioral Health Administration (BHA) • Evidence-Based Supported Employment State Trainer (EBP SE) • Evidence-Based Employment Programs • And, of course, NAMI consumer and family members.

29. The Plan • Build a working team of family advocates for each state. • Identify a team leader to serve as liaison between the team and Dartmouth Psychiatric Research Center. • Train team members on principles of practices of EBP SE. • Learn about employment as a key component of recovery. • Develop a work plan to direct advocacy initiatives.

30. Team Activity Examples • Presentations • Educating EBP SE staff • Including EBP SE in NAMI’s Family-to-Family Education curriculum (ch 10 & ch 11) • Educating NAMI Affiliate Board and staff

31. Take Aways • Work is very important in the recovery process! • IPS Supported Employment programs are available to assist people with even the most serious mental illness in returning to work • Understanding how work, work incentives and entitlements intersect is key to employment success. • People are typically better off financially and emotionally if they are working. • There are safety nets to have checks re-instated if lost due to work. • We need your help with the Family Advocacy Team to make a difference in Maryland! • Work IS possible!

32. Resources • Supported Employment Providers • Local Core Service Agencies • Maryland Employment Network • Division of Rehabilitation Services • NAMI MD • On Our Own of Maryland • Social Security Administration website

33. Contact Information Bette Stewart bstewart@psych.umaryland.edu 410-646-5181 Stacy Seymore stacy.seymore2@maryland.gov 443-201-6177 ticket2workmd.org

35. Questions