Background

1. Supported Education and Supported Employment for College Students with Mental Health ChallengesAbraham Rudnick1*, Marnie Wedlake1,2, Wendy Lau3, Bob McEwan4, & Erica Lundberg1,4 1. University of Western Ontario, 2. Canadian Mental Health Association, 3. Leads Employment Services, 4. Fanshawe College. * Email: arudnic2@uwo.ca

2. Background • Many people with a serious mental illness (SMI) are commonly unemployed or underemployed (Mueser, Salyers & Mueser, 2001). • People with SMI experience barriers to employment, such as stigma and cognitive deficits (Mueser et al, 2001)

3. Background • Approximately 5-12% of the college student population report psychiatric symptoms (Megivern et al, 2003). • Persons with mental health challenges have lower educational levels & experience more disruptions in education (eg. Kessler, Foster, Saunders & Stang,1995). • Hence people with SMI have a low chance of gainful (trained/skilled) employment without special support.

4. Background • Supported employment is successful in securing gainful employment for people with mental illnesses (e.g. Cook, Leff, Blyer et al., 2005; Best, Still & Cameron, 2008; Gutman, 2008). • However, Supported Employment does not usually target skilled work. • There is a lack of connection between supported education and supported employment, although this combination may enhance gainful/skilled employment for people with SMI.

5. Background • Emerging evidence (e.g. Rudnick & Gover, 2009) indicates that combined supported education and supported employment services are beneficial to persons with SMI, by enhancing education and gainful/skilled employment success and personal wellbeing.

6. Fostering Recovery Project • Collaboration between Fanshawe College, Leads Employment Services, and the University of Western Ontario • Goal was to facilitate successful college education and employment of students with mental health issues via combining supported education and supported employment. • Funded by Ontario’s Ministry of Community & Social Services-Ontario Disability Support Program, Innovation Funds

7. Fostering Recovery Project • Fanshawe College • Over 14, 000 students; approximately 1,600 with disabilities • Offers over 100 programs leading to certificates, diplomas, and degrees. • Provides counselling and a variety of student supports

8. Fostering Recovery Project • Leads Employment Services • Employment assistance for persons with barriers to employment due to physical health, mental health, developmental or learning disabilities. • Provide job preparation, job and skills development, transitional employment, job coaching, and job retention supports

9. Fostering Recovery Project • 37 students were enrolled in the project in 2008-2009 school year. • Students saw both a college counselor and an employment specialist (at the college) on a regular or as needed basis. College counselors and employment specialists communicated with each other as needed. • The 37 students in the project: • went to 60 interviews • were placed in 29 positions (paid and non-paid) • those in paid positions earned $8.75-$18.17/hr (average $10.89/hr) • 19/29 placements were maintained 13+ weeks.

10. Research Objective & Question • To explore what is the lived experience of key involved stakeholders in relation to this project – of students, their significant others, and their college counselors and employment specialists.

11. Method • Funding for evaluation was received by CAREMH. HSREB and CRIC approvals, as well as written voluntary informed consent, were obtained. • Participants: • 6 students • 4 females, 2 males; 19-46 years • Bipolar disorder (2), Schizoaffective disorder (2), major depression (2), generalized anxiety disorder (3), panic disorder (4), Obsessive compulsive disorder (3) • enrolled in: culinary, interior decorating, tourism, computer programming, and social service worker • 5 significant others of these students • parents, spouses, children • 2 College Counselors, 2 Employment Specialists.

12. Method • A primarily phenomenological methodology with first person and shadowed data collection, by means of semi-structured interviews. • Student interviews: • at the outset of the project (diagnostic assessments and qualitative interviews) • mid-year • end-of-year • Shadowed data from students’ significant others and project counselors interviews: • mid-year • end-of year

13. Analysis • Thematic analysis was conducted on the transcribed and validated interview data. • Peer debriefing and triangulation across interviewee groups – for trustworthiness.

14. Results - Project Benefits Psycho/Social: • Increased skills: social, organization, stress management • Increased self-esteem • Students coping more effectively with their illnesses – expressed & demonstrated desire to better understand & manage their illnesses • Desire for independence – expressed importance of being independent

15. Results-Project Benefits Educational/Vocational: • Found it helpful to have someone to talk to; comfortable with counselors; liked hands-on Leads coaching & help with job search • Some students able to gain employment - felt good about finding & keeping work and earning income • Increased quality of schoolwork, socialization, confidence & sense of pride, self-advocacy • Overall a good experience for the counselors

16. Results - Project Challenges • Scheduling issues sometimes made it difficult to see project staff • Schoolwork + work were overwhelming • Some students needed to take time off for physical & mental health problems • Not all students were able to obtain employment • College and employment environments were, at times, more difficult for older students • Counselors noted that students with more serious mental illness were more difficult to serve • Communication was sometimes difficult between collaborators • Employment specialist not present in the college enough

17. Results – Student Related Barriers Psycho/Social: • Effects of students’ illness; Some had poor insight into illness • Students easily affected by stress • Low self-confidence • Student Immaturity • Difficulty with initiative • Personality conflicts with other students; Some engagement in socially inappropriate behaviours • Less than adequate social support network • Juggling education with family life was problematic at times

18. Results - Student Related Barriers • Educational/Vocational/Financial: • Some delay in seeking help; some did not wish to disclose their • illness to staff • History of personal & academic struggles • Attention problems and problems with organization & time • management often interfered with tasks • Programs chosen by students not always a good fit for • their needs, limitations, employment prospects • Limitations imposed by financial pressures (barriers related to • low income)

19. Results - Student Related Enablers • Motivated and determined to succeed • Hopeful, optimistic • Strong focus on college • Enjoyed the challenge, enjoyed going to college & work • Strong career and educational goals • College involvement may have put students further ahead than typical Leads clients (those with supported employment but without supported education)

20. Results - Others’ Related Barriers • Students needed more support • College set-up and schedule a poor fit for students with mental illness • Older students were rejected by younger peers who were perceived as immature • Professors’ lack of understanding/knowledge about mental health problems or learning disabilities • Employer stigma • Lack of job stability

21. Results - Others’ Related Enablers • Good liaisons between project staff & family and/or other services in the community • Helpful to have support during difficult times • Support by family, some peers, and some professors • College accommodations

22. Results - Suggestions for Improvement • Address need for increased social support • Improve coordination with other mental health care services • Make the college better fit student needs • Have Leads in the college more often, every week • Expand the project to other types of disabilities

23. Limitations of study (evaluation) • Exploratory design, e.g., small sample size, no control/active comparison • Short longitudinal evaluation (as compared to time needed to complete college and find and keep suitable work)

24. Conclusions • Various themes were found in relation to the lived experience of this project that combines supported post-secondary education with supported employment for people with mental illness. • Project content, process and context were relevant, some as barriers and some as enablers.

25. Future Directions • Further research is required and planned for more rigorous study of combining supported post-secondary education with supported employment for people with mental illness. • Adding cognitive remediation to this combination may further benefit this population, particularly people with SMI and with learning disabilities.

26. References Best, L. J., Still, M. & Cameron, G. (2008). Supported education: Enabling course completion people experiencing mental illness. Australian J of Occupational Therapy, 55, 65-68. Cook, J. A., Leff, S., Blyler, C. R., Gold, P. B., Goldberg, R. W., Mueser, K. T., Toprac, M. G., McFarlane, W. R., Shafer, M. S., Blankertz, L. E., Dudek, K., Razzano, L. A., Grey, D. D., Burke-Miller, J. (2005) Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness, Arch of Gen Psychiatry, 62, 505-512. Gutman, S. A. (2008) Supported education for adults with psychiatric disabilities. Psychiatric Services, 59, 326-327. Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995) Social consequences of psychiatric disorders, I: Educational attainment. Am J of Psychiatry, 152, 1026-1032. Megivern, D., Pellerito, S. & Mobray, C. (2003). Barriers to higher education for individuals with psychiatric disabilities. Psychiatric Rehabilitiation Journal, 26, 217-231. Mueser, K. T., Salyers, M. P., & Mueser, P. R. (2001). A prospective analysis of work in schizophrenia. Schizophrenia Bull, 27, 281–296. Rudnick, A. & Gover, M. (2009) Combining Supported Education and Supported Employment in Relation to Skilled (Vocational) Occupations.