POLICY AND ORGANIZATIONAL CULTURE AFFECTING EMPLOYMENT:

1. POLICY AND ORGANIZATIONAL CULTURE AFFECTING EMPLOYMENT: IF EVERYONE IS ALREADY DOING IT, HOW COME IT NEVER GETS DONE?

2. TERRY PRATCHETT "I'll be more enthusiastic about encouraging thinking outside the box when there's evidence of any thinking going on inside it. “ 

3. JOE MARRONE INSTITUTE FOR COMMUNITY INCLUSION School Of Global Inclusion And Social Development MAIN OFFICE: BOSTON, MA NW OFFICE: 4517 NE CESAR CHAVEZ BLVD PORTLAND, OR 97211-8124 TEL: 503-331-0687 CELL: 503-490-2072 FAX: 503-961-7714 EMAIL: joseph.marrone@gmail.com WEB: WWW.COMMUNITYINCLUSION.ORG

4. IF PEOPLE CANWORK PEOPLE SHOULDWORK

5. SYSTEMS MUST COMMUNICATE CONVICTION THAT: ALL PEOPLE SHOULDWORK SINCE PEOPLE W. DISABILITIES HAVE THE CAPACITY TO BECOME EMPLOYED HAVE THE CITIZENSHIP RIGHT TO EQUAL ACCESS TO EMPLOYMENT WILL BE ASSISTED TO DO SO BECAUSE EMPLOYMENT IS A WAY FOR PEOPLE TO BECOME ECONOMICALLY SELF-SUFFICIENT, HEALTHIER, AND FULFILLED. WORK IS NOT JUST AN OPPORTUNITY TO BE OFFERED PEOPLE TO "TAKE OR LEAVE" AS THEY PREFER; RATHER, IT IS A RESPONSIBILITY OF CITIZENSHIP.

6. OUTCOMES THAT SHOULD BE SOUGHT IF A HUMAN SERVICE SYSTEM IS MORE THAN A POSITIVE SLOGAN • Employment and educational outcomes • Housing outcomes • Course of illness/disabling condition • Community participation/ citizenship (voting, volunteering, criminal recidivism) • School completion • Income support • Client satisfaction with their own lives • Client satisfaction with services

7. OUTCOMES THAT SHOULD BE SOUGHT IN COMMUNITY SERVICES BECOMING A BETTER PERSON AND “SELF REALIZATION” IS THE CONSUMER’S RESPONSIBILITY. HELPING PEOPLE GET EMPLOYED, GET HOUSING, COMPLETE SCHOOL. STAY OUT OF HOSPITAL (& JAIL) AND REDUCE SYMPTOM IMPACT ARE STAFF’S RESPONSIBLITIES IN PARTNERSHIP WITH THE PERSON.

8. HIGH PERFORMING STATES – ICI SELN1] Leadership2] Strategic goals and operating policy3] Financing and contracting methods4] Training and technical assistance 5] Interagency collaboration/ partnership6] Services and service innovation7] Performance measurement and data management

9. SHOOK, J. (2010) HOW TO CHANGE A CULTURE. MIT SLOAN MGMT REVIEW, 51 (2), 62-68 WHAT PEOPLE DO VALUES- ATTITUDES CULTURE CULTURE

10. SHOOK, J. (2010) HOW TO CHANGE A CULTURE. MIT SLOAN MGMT REVIEW, 51 (2), 62-68 WHAT PEOPLE DO VALUES- ATTITUDES CULTURE CULTURE

11. ROLE/ LIMITS OF TRAINING? “You can teach a turkey to climb a tree, but it’s easier to hire a squirrel.” FROM Spencer M. Lyle Jr., McClelland C. David, Spencer M. Signe (1994) Competency Assessment Methods. History and state of the art. Paper first presented at the American Psychological Association Annual Conference, Boston, MA  P. 8

12. SYSTEMS ISSUES TO TACKLE • WHOSE PROBLEM IS IT?– MH, DD, VR OR ALL • DEFINING “WORK” AND “SUCCESS” • MAKING EMPLOYMENT AN ADMIN NOT JUST CLINICAL ISSUE • SHOULD ALL EMPLOYMENT MEET EBP OR BEST PRACTICE STANDARDS?

13. SYSTEMS ISSUES TO TACKLE • SHOULD ALL EMPLOYMENT HAVE VR INVOLVEMENT? • DISPARITY IN DD, MH & VR FUNDING • TTW POSSIBILITIES- REAL OR NOT? • MEDICAID ISSUES • USE OF HCBS UNDER REHAB OPTION (1915[i])

14. SPECIFIC EMPLOYMENT PRACTICE ISSUES YOUTH (16-25) • BETTER LINKAGE WITH TRANSITION TYPE SERVICES • BETTER INTEGRATION OF YOUTH AND ADULT MH/DD SERVICES IN TERMS OF PHILSOPHY OF “EMPLOYMENT FIRST”, RECOVERY AND TRANSITION TO WORK • PARENTS/ SIGNIFICANT OTHERS SHOULD HOLD MORE SWAY THAT STAFF EVEN IF THEY ARE “WRONG” • YOUTH NEED MORE DIRECTION • PLANNING LESS IMPORTANT THAN ACTION - IMMEDIACY • JOBS THAT WE SHY AWAY FROM FOR ADULTS MORE AND MORE (FOOD, FILTH, FLOWERS ETC ETC) ARE MORE ATTRACTIVE & APPROPRIATE FOR YOUTH • DON’T TRY TO GET YOUTH TO ACT LIKE ADULTS IN TERMS OF JOB/ EMPLOYMENT STABILITY

15. VR ISSUES ESPECIALLY FOR YOUTH • Improving developmentally appropriate strategies for VR counseling and service delivery • Modifying traditional approach to IPE development to incorporate a “work and career development” phase • Vocational supports unique to youth built on but not replicating heavily researched adult evidence based practice of SE/ IPS • VR service interventions for youth that use greater variety of employment models, especially those based on experiential, work- based learning • Models of youth vocational peer support Marrone, J & Taylor, S. (2013) Serving Youth with Psychiatric Disabilities in the Vocational Rehabilitation System. Focal Point, 27 (1), p.37-39.

16. VR ISSUES ESPECIALLY FOR YOUTH • Developing system interactive pathways focusing on speed and rapid engagement that swiftly include youth in concrete experiential services rather than long periods of assessment or verbal discussions about planning • Enhancing transition services that support attachment to adult services where needed or possibly divert youth from them provided appropriate transition age interventions enhance adult life success • Fostering increased use of social media to engage youth in a variety of work options and in vocational rehabilitation services. Marrone, J & Taylor, S. (2013) Serving Youth with Psychiatric Disabilities in the Vocational Rehabilitation System. Focal Point, 27 (1), p.37-39.

17. VISION OF LIFE SUCCESSJOE MARRONE IS WORK THE MOST IMPORTANT PART OF LIFE FOR EVERYONE? NO. BUT IT IS THE MOST IMPORTANT PART OF LIFE THAT WE IN HUMAN SERVICES ARE LEAST SUCCESSFUL AT HELPING OUR CONSTITUENCY ACHIEVE.

18. REMAINING UNEMPLOYED IS WORSE FOR YOU THAN BEING EMPLOYED IS GOOD FOR YOU(MORE DATA LATER).AVOIDING LONG TERM UNEMPLOYMENT IS A BETTER OPTION THAN WAITING FOR AN IDEAL OR PERFECT JOB MATCH.

19. “IT IS NEARLY IMPOSSIBLE TO MAKE YOUR OWN FUTURE WHEN YOU ARE NOT PART OF THE ECONOMIC FABRIC OF THE CULTURE YOU LIVE IN” PATRICIA DEEGAN 20th World Congress Rehab International: Oslo, Norway – JUNE 2004

20. WORK IS A CITIZENSHIP RESPONSIBILITY NOT JUST AN “OPPORTUNITY” SOCIAL POLICY OUTCOMES HAVE TO INCLUDE MORE THAN CLIENT SELF DEFINED QUALITY OF LIFE INDICATORS INCLUDING CQL OUTCOMES EXAMPLE: DROP OUT PREVENTION EFFORTS

21. MARRONE IN FULL CRANK MODE: QUESTIONS I PONDER, SOME, NOT ALL, I KNOW THE ANSWERS TO

22. LILY TOMLIN “No matter how cynical you become, it's never enough to keep up.”

23. MARRONE EASY QUESTION IS IT BETTER TO WORK 2-3 HOURS A WEEK AT SOMETHING A PERSON LIKES THAN 15-20 HOURS WEEK (OR MORE) JUST TO MAKE A LIVING? SIMPLE ANSWER: NO HOW DO YOU ANSWER THIS QUESTION FOR YOURSELF OR YOUR LOVED ONES?

24. DO WE WORRY TOO MUCH ABOUT VALUES - STIGMA VS BEHAVIOR - DISCRIMINATION? ISN’T A JOB THE OUTCOME WE WANT RATHER THAN OFFERING CUSTOMIZED OR SUPPORTED EMPLOYMENT (PROCESS) ?

25. IF EMPLOYMENT IS FIRST WHAT IS SECOND? SHOULDN’T WE BEGIN TO SEE EMPLOYMENT AS AN OUTCOME NOT A SERVICE STREAM?

26. IF YOU THINK WORK IS BAD FOR PEOPLE WITH MENTAL ILLNESS, THEN WHAT ABOUT POVERTY, UNEMPLOYMENT, AND SOCIAL ISOLATION?

27. THOMAS EDISON “ RESULTS! WHY, I’VE GOTTEN A LOT OF RESULTS. I KNOW SEVERAL THOUSAND THINGS THAT WON’T WORK. “

28. US AND MO MH SYSTEMS /EMPLOYMENT FIGURES 2012 ADULTS WITH ANY EMPLOYMENT IN FY 2012 = US:16.9%; MO:10.9% ADULTS IN LABOR FORCE (I.E., EMPLOYED OR LOOKING FOR WORK) = US:33.7%; MO:11.7% ACCESS TO EBP SE = US: 1.7%; MO: 0.9%

29. US AND MO DD SYSTEMS /EMPLOYMENT FIGURES 2012 ADULTS IN INTEGRATED EMPLOYMENT IN FY 2012 = US:18%; MO:11% INTEGRATED EMPLOYMENT RATE PER 100K GEN POP: US:35; MO: 9

30. YOU CAN HAVE A JOB WITHOUT A CAREER BUT YOU CAN’T HAVE A CAREER WITHOUT A JOB! (YOU CAN’T DISCOVER WHAT ISN’T THERE)

31. WHY DON’T WE SEEK TO HELP AND ENCOURAGE PEOPLE TO GET OFF SSA AND WELFARE? IF INDIVIDUAL FUNDING AND FISCAL CONTROL OCCURS SHOULDN’T QUALITY ASSURANCE LOSE RELEVANCE?

32. WHAT TYPES OF EMPLOYMENT OPTIONS SHOULD WE ENCOURAGE? ANY? SOME? ALL? KEYS ARE REAL ECONOMIC ENGAGEMENT, RESOURCES, AND CITIZENSHIP NOT JUST SERVICE INTERVENTIONS

33. JERRY GARCIA “ SOMEONE HAS TO DO SOMETHING AND IT’S PRETTY PATHETIC IT’S GOT TO BE ONE OF US “

34. HELPING PEOPLE (AND SYSTEMS) CHANGE: HOPE, HELP, AND HASSLING

35. DAVID KAHNEMANNPsychologist – Economist “I am not very optimistic about people’s ability to change the way they think, BUT I am fairly optimistic about their ability to detect the mistakes of others.”

36. PRIMARILY EPIDEMIOLOGICAL SUPPORTING DATA ON SEPARATE PPT

37. “ WHAT DRIVES ME UP THE WALL IS THE INTENTIONAL TEACHING OF FEAR OF HAVING ANY KIND OF MEANINGFUL LIFE BECAUSE ‘YOU WILL DECOMPENSATE’ OR ‘ YOU ARE STRESS SENSITIVE’. THE MOST STRESSFUL THING IN THE WORLD IS BEING A COUCH POTATO WITH NOTHING TO DO, NO WHERE TO GO, AND NO ONE TO TALK TO. “ ED KNIGHT, PH.D.

38. W. EDWARDS DEMING “ BEWARE THE CONTINUOUS IMPROVEMENT OF THINGS NOT WORTH IMPROVING “

39. HELPING PEOPLE (AND SYSTEMS) CHANGE: HOPE, HELP, AND HASSLING

40. KEN MILLER “The length of a minute is relative, depending on which side of the bathroom door you are on.” From WE DON’T MAKE WIDGETS

41. SO WHAT USUALLY GETS IN THE WAY OF IMPROVING EMPLOYMENT OR CHANGE AT ANY LEVEL?

42. ANY DEAD HORSES IN YOUR ORGANIZATION?(TAKEN FROM MATERIAL FROM ARTHUR EVANS, PH.D., FORMER DEPUTY COMMR, CT DMHAS), NOW MH DIRECTOR, PHILA MH

43. Dakota tribal wisdom says that when you discover you are riding a dead horse, the best strategy is to dismount. However, in human services, we often try other strategies with dead horses, including the following:

44. * Saying things like “This is the way we have always ridden this horse.”or from a Native American Tribal Saying:"If we don't turn around now, we just may get where we're going."

45. * Appointing a committee to study the horse.* Harnessing several dead horses together for greater performance* Providing additional funding to increase the horse’s performance* Arranging to visit other sites to see how they ride dead horses

46. * Increasing the standards to ride dead horses* Creating a training session to increase our riding ability* Changing the requirements; declaring “this horse is not dead.” * Declaring the horse is “better, faster and cheaper” dead* Promoting the dead horse to a supervisory position

47. Finding a consultant knowledgeable about dead horses.

48. " There is nothing you can say in answer to a compliment. I have been complimented myself a great many times, and they always embarrass me -- I always feel they have not said enough. "Mark Twain