IF EVERYONE’S ALREADY DOING IT, HOW COME IT NEVER GETS DONE ???. “ I feel so miserable without you, it's almost like having you here." Stephen Bishop. JOE MARRONE INSTITUTE FOR COMMUNITY INCLUSION MAIN OFFICE: BOSTON, MA NW OFFICE : 4517 NE 39 TH AVENUE
HOW COME IT NEVER GETS DONE ???
“I feel so miserable without you, it's almost like having you here."
------ JOE MARRONE
GREEK PROVERB OFF. “
“ BEFORE PRACTICING VIRTUE FIRST SECURE AN INDEPENDENT INCOME.“
TURKISH PROVERB OFF. “
“ HE WHO SPEAKS THE TRUTH SHOULD ALWAYS HAVE KEEP ONE FOOT IN THE STIRRUP. “
MARRONE OFF. “
"I'll be more enthusiastic about encouraging thinking outside the box when there's evidence of any thinking going on inside it. “
“ WE KNOW ALL THIS STUFF.
JUST BECAUSE WE DON’T DO IT,
DOESN’T MEAN WE DON’T KNOW IT !!! “
SOCIAL POLICY OUTCOMES HAVE TO INCLUDE MORE THAN CLIENT SELF DEFINED QUALITY OF LIFE INDICATORS
EXAMPLE: DROP OUT PREVENTION EFFORTS
IF EMPLOYMENT IS FIRST WHAT IS SECOND? “OPPORTUNITY”
SHOULDN’T WE BEGIN TO SEE EMPLOYMENT AS AN OUTCOME NOT A SERVICE STREAM?
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?
DO WE WORRY TOO MUCH ABOUT VALUES - STIGMA VS BEHAVIOR - DISCRIMINATION?
WHATEVER HAPPENED TO A JOB WITHOUT JARGON?
WHY ARE HIGHER OUTCOMES/ EXPECTATIONS NOT ENDORSED BY ADVOCATES RATHER THAN FEARED AS “CREAMING”?
DON’T THERE NEED TO BE WINNERS AND LOSERS OR ELSE HAS ANYTHING CHANGED?
HASN’T THERE BEEN MORE CHANGE IN WELFARE REFORM IN LESS THAN A DECADE THAN IN SUPPORTED EMPLOYMENT IN 20+ YEARS?
WHY WEREN’T GROUPS LIKE APSE FULLY BEHIND DOING AWAY WITH SUB MINIMUM WAGE (E.G., AZ)?
WHY CAN’T MH AND DD SYSTEM ADVOCATES WORK TOGETHER MORE ON EMPLOYMENT - BIAS ON BOTH SIDES (W.SAME POOR RESULTS = 20-25%)?
DO WE HAVE TOO MANY PLANS AND SUMMITS AND CENTERS OF EXCELLENCE AND NOT ENOUGH SIMPLE MEASURES OF SUCCESS TO GUIDE US?
WHAT TYPES OF EMPLOYMENT OPTIONS SHOULD WE ENCOURAGE? EMPLOYMENT - BIAS ON BOTH SIDES (W.SAME POOR RESULTS = 20-25%)?
ANY? SOME? ALL?
KEYS ARE REAL ECONOMIC ENGAGEMENT, RESOURCES, AND CITIZENSHIP NOT JUST SERVICE INTERVENTIONS
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)
REMAINING UNEMPLOYED IS WORSE FOR YOU THAN BEING EMPLOYED IS GOOD FOR YOU.AVOIDING LONG TERM UNEMPLOYMENT IS A BETTER OPTION THAN WAITING FOR AN IDEAL OR PERFECT JOB MATCH.
“ I CAN’T UNDERSTAND WHY PEOPLE ARE FRIGHTENED OF NEW IDEAS; I’M FRIGHTENED OF THE OLD ONES.”
JOHN CAGE, COMPOSER
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.
“Increasing employment for people with mental illness is one of the most urgent priorities in today’s mental health system” Mike Hogan
(excerpted from the Ohio Employment Leadership Alliance brochure).
“LIFE LIVED WITHIN THE CONFINES OF THE HUMAN SERVICE & REHABILITATION LANDSCAPE IS A LIFE IN WHICH THE FREEDOM TO BECOME & MAKE YOUR OWN FUTURE IS DIMINISHED”
20th World Congress Rehab International: Oslo, Norway – JUNE 2004
“ Transparent and measurable indicators of care should be used as a basis for quality improvement and for accountability.”
2008 Interim Report NY Statewide Comprehensive Plan for Mental Health Services
“ THE MOST IMPORTANT THING IN COMMUNICATION IS TO HEAR WHAT IS NOT BEING SAID”
BECOMING A BETTER PERSON AND “SELF REALIZATION” IS THE PERSON’S RESPONSIBILITY.
HELPING PEOPLE GET EMPLOYED, GET HOUSING, STAY OUT OF HOSPITAL (& JAIL) AND REDUCE SYMPTOM IMPACT ARE STAFF’S RESPONSIBLITIES IN PARTNERSHIP WITH THE PERSON.
"Any clod can have the facts, but having opinions is an art."
IF PEOPLE SLOGAN
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?
MOST CRPS PROVIDED WORK/ NONWORK SLOGAN MAJORITY OF EMPLOYMENT SERVICES - - INTEGRATED AND FACILITY-BASED INDIVIDUALS WITH DD/ID MOST LIKELY IN:1] FACILITY-BASED WORK (41%)2] NONWORK SERVICES (33%)3] INTEGRATED EMPLOYMENT (26%).Metzel, Boeltzig, Butterworth, Sulewski, and Gilmore (2007) Achieving Community Membership Through Community: Rehabilitation Provider Services: Are We There Yet?Intellectual And Developmental Disabilities, 45,149–160
Source: Houtenville, 2006
Source Houtenville 2006 Disability Status Report
Source Houtenville, 2006 Disability Status Report
(DOWN FROM 2004 !)
“IT IS NEARLY IMPOSSIBLE TO MAKE YOUR OWN FUTURE WHEN YOU ARE NOT PART OF THE ECONOMIC FABRIC OF THE CULTURE YOU LIVE IN”
20th World Congress Rehab International: Oslo, Norway – JUNE 2004
IS WORK GOOD FOR YOUR HEALTH & WELLBEING?WADDELL, G. & BURTON, K. (2006) Cited in:FINDING & KEEPING WORK: ISSUES, ACTIVITIES, & SUPPORT FOR THOSE WITH MENTAL HEALTH NEEDSBOOTH, D., FRANCIS, S., & JAMES, D. (2007) JOURNAL OF OCCUPATIONAL PSYCHOLOGY, EMPLOYMENT, & DISABILITYV 9, NO. 2, AUTUMN 2007
BEING IN RIGHT TYPE OF WORK GOOD FOR: YOUR HEALTH & WELLBEING?HEALTH, QOL, SELF ESTEEM – APPLIES TO ALL AGE GROUPSUNEMPLOYMENT:MORE SICKNESS, DISABILITY, OBESITY, USE OF MEDS, USE OF MED SERVICES, DECREASED LIFE EXPECTANCYRETURNING TO WORK AFTER UNEMPLOYMENT IMPROVES HEALTH BY AS MUCH AS UNEMPLOYMENT DAMAGES IT
Bruffaerts, R, Sabbe, M., Demyttenaere, K. YOUR HEALTH & WELLBEING?(2004) Effects of Patient & Health-System Characteristics on Community Tenure of Discharged Psych Inpatients
Psych Serv 55:685-690, June 2004-- increases in rehospitalizationDooley, D., Fielding, J., & Levi, L. (1996). Health and unemployment. Annual Review of Public Health
Kasl, S. V., Rodriguez, E., & Lasch, K. E. (1998). The impact of unemployment on health and well-being. In B. Dohrenwend, (Ed.). Adversity, Stress and Psychopathology
Lennon, M. C. (1999). Work and unemployment as stressors. In A. Horwitz, & T. Scheid, (Eds.). A Handbook for the Study of Mental Health: Social Contexts, Theories and Systems
Dooley, D., Catalano, R., & Hough, R. (1992). YOUR HEALTH & WELLBEING? Unemployment and alcohol disorders in 1910 and 1990: Drift versus social causation. Journal of Occupational & Organizational Psych----- increases alcohol useLinn, M. W., Sandifer, R., & Stein, S. S. (1985). Effects of unemployment on mental and physical health. American Journal of Public Health---- increases in anxietyDooley, D., Catalano, R., & Wilson, G. (1994). Depression and unemployment: Panel findings from the Epidemiologic Catchment Area study. American Journal of Community Psychology----- increases in depressionMathers, C. and Schofield, D. (1998)‘The Health Consequences of Unemployment: The Evidence’, Medical Journal of Australia, 168 (4), pp. 178–82 – general health deteriorates
Murphy, G.C. & Athanasou, J.A (1999) YOUR HEALTH & WELLBEING?. The Effect of unemployment on mental health. Journal of Occupational and Organizational Psychology--- large effect size for employment positive, smaller effect size for unemployment as bad. Darity, W.A. (2003). Employment Discrimination, Segregation, and Health. American Journal of Public Health 93, 226-231.--- bouts of unemployment lead to lower self esteem, lower motivation Darity, W.A. (1999). Who Loses from unemployment. Journal of Economic Issues--- cross national data: greater spousal abuse and suicideWinefield, A.H., Tiggemann, M., Winefield, H.R., & Goldney, R.D. (1993). Growing up with unemployment: A longitudinal study of its psychological impact.--- youth with similar characteristics in school after long term unemployment more depression and anxiety
Claussen YOUR HEALTH & WELLBEING?, B. (1999). Alcohol disorders and re-employment in a 5-year follow-up of long-term unemployed. Addiction, 94(1), 133.--- unemployment lead to drinking not vice versa Comino, E. J., Harris, E., Silove, D., Manicavasagar, V., & Harris, M. F. (2000). Prevalence, detection and management of anxiety and depressive symptoms in unemployed patients attending general practitioners. Australian & New Zealand Journal of Psychiatry, 34(1), 107.--- unemployed greater anxiety and depressionWeich, Scott, and Glyn Lewis. "Poverty, unemployment, and common mental disorders: population based cohort study."British Medical Journal 317.n7151 (July 11, 1998): 115(5) -- long term financial strain/ poverty increase amount/duration of MI . Jin RL, Shah CP, Svoboda TJ. The impact of unemployment on health: a review of the evidence. Canadian Medical Association Journal. 1995;153:529–540. -- strong positive association between unemployment and poor health
Benavides, F. G., Garcia, A. M., Saez-Lloret, I., & Librero, J. (1994). Unemployment and health in Spain: The influence of socio-economic environment.The European Journal of Public Health, 4(2), 103.--- Relationship between unemployment, ill health and more use of health services Crawford, A., Plant, M. A., Kreitman, N., & Latcham, R. W. (1987). Unemployment and drinking behaviour: Some data from a general population survey of alcohol use.Addiction, 82(9), 1007-1016.– Unemployed greater binge drinking & adverse results Montgomery, S. M., Cook, D. G., Bartley, M. J., & Wadsworth, M. E. J. (1999). Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men.International Journal of Epidemiology, 28, 95.--- Unemployment risk factor for psychological symptoms depression requiring medical attention even w/o prior issues
Goldberg, R. W., J. (1994). Lucksted, A., McNary, S., Gold, J. M., Dixon, L., & Lehman, A. (2001). Correlates of long-term unemployment among inner-city adults with serious and persistent mental illness.Psychiatric Services, 52(1), 101.Kessell, E. R., Catalano, R. A., Christy, A., & Monahan, J. (2006). Rates of unemployment and incidence of police-initiated examinations for involuntary hospitalization in Florida.Psychiatric Services, 57(10), 1435.--- Involuntary admissions increase with greater unemployment in labor market Lerner, D., Adler, D. A., Chang, H., Lapitsky, L., Hood, M. Y., Perissinotto, C., et al. (2004). Unemployment, job retention, and productivity loss among employees with depression.Psychiatric Services, 55(12), 1371 Lattimore, R. (2007),Men Not at Work: An Analysis of Men Outside the Labour Force, Australian Productivity Commission Paper -- over longer term, prolonged labor force inactivity associated with poorer overall health, independent of prior health status
Increased substance abuse J. (1994).
Increased physical problems
Increased psychiatric disorders
Loss of social contacts
Alienation and apathy
Warr, P.B. (1987), Work, Unemployment and Mental Health, Clarendon Press, OxfordSIDE EFFECTS OF UNEMPLOYMENT IN THE GENERAL POPULATION
“Given a choice between changing and proving that it is not necessary,
most people get busy with the proof.”
WHAT’S KEY IN ORGANIZATIONAL CHANGE? J. (1994).
ORGANIZATIONAL CHANGE J. (1994).
VISION and VALUES
IF YOU’RE NOT PART OF THE SOLUTION, THERE IS STILL GOOD MONEY TO BE MADE FROM PROLONGING THE PROBLEM
Grieff, D., Proscio, T., & Wilkins, C. (2003). Laying a new foundation: Changing the systems that create and sustain supportive housing. Oakland, CA: Corporation for Supportive Housing
Growing cadre of skilled practitioners at most levels in the delivery chain, practicing methods not previously common or considered desirable. Practitioners are now expert in skills that new system demands & have set a standard for effective delivery of results.
New definition of performance or success, & often a new understanding of the people to be served & the problem to be solved [i.e., new goals]. The new definition & understanding are commonly held among most actors in the system, & are no longer in great dispute
GREEK PROVERB J. (1994).
“ BEFORE PRACTICING VIRTUE, FIRST SECURE AN INDEPENDENT INCOME. “
Clear Policy statement from funding authority and program administration that:
Assisting people to enter employment is integral to the overall mission of agency/ providers and thus inherent in the responsibilities of all its staff & providers,
even those not explicitly charged with employment service responsibility
NOT JUST EMPLOYMENT FIRST IN PLAN BUT EMPLOYMENT OUTCOMES
HOPE, J. (1994).
HOPEVS. OPTIMISM? ---
PAT ON BACK VS.
COMMUNICATING THAT: YOU CARE
YOU WILL BE THERE
YOU HAVE IDEAS & HELP TO OFFER
“ YOU NEED A LITTLE LOVE IN YOUR LIFE & FOOD IN YOUR STOMACH BEFORE YOU CAN HOLD STILL FOR SOME DAMN FOOL’S LECTURE ABOUT HOW TO BEHAVE.”
SPECIFIC ISSUES FOR YOUTH (16-25) STOMACH BEFORE YOU CAN HOLD STILL FOR SOME DAMN FOOL’S LECTURE ABOUT HOW TO BEHAVE.”
W. EDWARDS DEMING STOMACH BEFORE YOU CAN HOLD STILL FOR SOME DAMN FOOL’S LECTURE ABOUT HOW TO BEHAVE.”“ BEWARE THE CONTINUOUS IMPROVEMENT OF THINGS NOT WORTH IMPROVING “
NEVER GET MAD AT SOMEONE
FOR NOT DOING SOMETHING
YOU HAVEN'T ASKED THEM
SOMETIMES YOU CAN
THE BEST YOU CAN DO,
NOT THE BEST THAT CAN BE DONE.
KNOW AND STATE THE DIFFERENCE.
GREEK PROVERB STOMACH BEFORE YOU CAN HOLD STILL FOR SOME DAMN FOOL’S LECTURE ABOUT HOW TO BEHAVE.”
“ BEFORE PRACTICING VIRTUE, FIRST SECURE AN INDEPENDENT INCOME. “
“I am not inattentive,
you are just boring.“
So why have Employment Outcomes not improved enough given the level of attention of groups like APSE?
ANY DEAD HORSES IN YOUR ORGANIZATION? enough given the level of attention of groups like APSE?(TAKEN FROM MATERIAL FROM ARTHUR EVANS, PH.D., FORMER DEPUTY COMMR, CT DMHAS), NOW MH DIRECTOR, PHILA MH
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:
* 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: 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."
* 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: 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
* 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: 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
“ ANY TIME YOU THINK YOU HAVE INFLUENCE, TRY ORDERING AROUND SOMEONE ELSE’S DOG”
If 1 person calls you a jackass, ignore him;
If a second person calls you a jackass, think about it;
If a third person calls you a jackass- get a saddle.
" 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
“ have been Some cause happiness wherever they go; others, whenever they go.”
“ DON’T LET IT END LIKE THIS. have been
TELL THEM I SAID SOMETHING.”
LAST WORDS OF PANCHO VILLA