NYS Shared Vision: Transform Employment for People with Psychiatric Disabilities

1. NYS Shared Vision: Transform Employment forPeople with Psychiatric Disabilities Prepared for: USPRA 36th Annual Conference Boston Massachusetts June 13, 2011

2. Presenters Douglas P. Ruderman, LCSW-R Director, Bureau of Program Coordination & Support, NYS OMH Aaron Vieira, LMSW Associate Director, Center for Rehabilitation & Recovery Paul Margolies, Ph.D. Associate Director, Center for Practice Innovations Chacku Mathai, CPRP Associate Executive Director, NYAPRS Oscar Jimenez, MPH Director of Community and Economic Development, NYAPRS Patricia Dowse Chief Operating Officer, NYSRA

3. Leadership Promotes the Vision • NYS OMH Commissioner Michael Hogan targeted improving employment outcomes for people with psychiatric disabilities. • The NYS Most Integrated Setting Coordinating Council (MISCC) formed an employment sub-committee to focus on integrated and competitive employment for people with disabilities. • The Medicaid Infrastructure Grant (MIG) NYS committee devoted resources to developing employment opportunities for people with disabilities.

4. Partnership • To create real change toward a recovery based and person centered employment support system you need partners from all sectors: • Recipients • Advocates • Trade Associations • Agency Leadership • Universities • Government

5. Targeted Change Supports the Vision • Transform non-integrated employment to integrated and competitive employment • Promote access to evidence-based practices for supported employment • Utilize work incentives like the Medicaid Buy-In and Ticket-to-Work • Use integrated treatment and rehabilitation services to support employment as a life role goal

6. Change Does Not Happen by Chance • Looking at the issue from 50,000 feet and then implementing a plan at ground level • Assessing the key impediments to success and creating a plan to overcome them • Believing in what you are doing and what can be accomplished Change is supported by:

7. Incentives Highlight the importance of work at all levels of a mental health service system: • Maintain financial support for integrated and competitive employment • Debunk urban myths about work participation and promote economic self-sufficiency • Promote the ticket-to-work program by encouraging agencies to become Employment Networks and benefit from ticket revenue

8. Organizational Level • Beliefs:The system and its members must believe that people with psychiatric disabilities can succeed at work. • Services: Services need to support integrated and competitive employment and incorporate evidence-based practices. • Behaviors: State and local government, agency executives and direct care staff, people with psychiatric disabilities and their natural support systems must act in a manner that secures and supports employment.

9. Systems Level • Redirect funding from sheltered workshops to support integrated employment programs • Target other non-integrated employment programs (enclaves and mobile work crews) • Partnership among many state agencies to create a shared smart system to link job banks to functional resumes • Emphasize quality work incentive supports vs. benefits advisement • Collect outcome data and make data available to the public

10. Funding Employment supports are funded in the following ways: • State dollars: includes converting state dollars used to support sheltered workshops into funds to support people in integrated and competitive employment • Federal dollars: includes supports through Ticket-to-Work, Medicaid Infrastructure Grant, & Rehabilitation Option Services that help people overcome mental health barriers to employment

11. Models • Support the evidence-based practice of Individual Placement and Support (IPS) and adapt it to integrated recovery and treatment programs • Support programs that get people jobs • Promote business models, including entrepreneurship, that employ people with psychiatric disabilities

12. Evidence-Based Practice • NYS OMH, partnering with the Center for Practice Innovations, provides technical assistance to implement the Individual Placement and Support (IPS) model and to adapt that model to recovery oriented services. • Intensive IPS training – per the traditional model • IPS training using a learning collaborative approach

13. Building Hope People with psychiatric disabilities have been told for so many years: “You can not and you should not work.” • The life role of employment has been turned into a distant dream. • We have partnered to change that distant dream into real options so people can choose to work. • Peers are speaking out through the “We Can Work” campaign to share their hopes and successes in employment.

14. NYS Advocacy on Employment • History of advocacy related to improved outcomes and relationships with State VR since 1993 • Supported advocacy for Ticket to Work legislation in late 90’s; NYS Implementation since 1998 • Direct involvement with NY Works Demonstration • Call for increased resources for supported employment in 1998 • Medicaid Buy-In for WPD in 2003

15. NYS Campaign for Employment • State Leadership on Employment • Interagency Task Force on Employment • Pursue Medicaid Infrastructure Grant (CES) • We Can Work Campaign • Redirect Resources to integrated employment • Develop integrated funding and data system • Connect employers with people seeking work

16. NYS OMH WORKCENTER TRANSFORMATION PROJECT A commitment to more employment that is integrated and leads to self sufficiency

17. Historical Notes 2009 NYS OMH Ambulatory Restructuring Report • NYS Ambulatory System serves almost 458,000 people annually • All mental health services that are provided in the community are included outside of clinics • Support – Vocational Supports: Sheltered Workshops, Assisted Competitive Employment, Ongoing Integrated Supported Employment Services, Transitional Employment, and Affirmative Business/Industry and Work Programs

18. NYS Makes Work Pay • NYS receives the Medicaid Infrastructure Grant • Mission: • Through research, policy analysis, training, and technical assistance, the New York Makes Work Pay Initiative provides policy and practice solutions to address New York State's estimated 70% of working-age people with disabilities who are not employed • NYSRA is a strategic partner and is asked to meet the following goals: • Identify and define best practice models for transitioning program priorities and resources to support competitive, integrated employment. • Influence state systems’ transformation by introducing and modeling customized and entrepreneurial approaches to employment.

19. Our GOALS • Facilitate a “Stakeholder” workgroup as recommended in final paper of the “21st century SE Workgroup” that advocate for increased opportunities for integrated employment. • Develop with EDI of Cornell University and Burton Blatt Institute of Syracuse University an organizational assessment tool (CRP Assessment Tool and WORKqual) inclusive of a set of principles and practices that agencies can adopt to support organizational transformation to more integrated employment options. • Options need to include not only individualized job placement but also self-employment, self-employment incubators, cooperatively owned businesses or social enterprises consistent with established practices. • Ongoing consultation with community provider agencies (CRP’s) receiving state deficit financing from NYS OMH supporting their workcenter. Assist the agency to develop Business plans to transform programs and resources toward full competitive, integrated employment • Develop recommendations for policy changes, waivers, modifications to regulations etc.

20. INCLUSIVE WORKFORCE INITIATIVE LDA Learning Disabilities Association of New York State, Inc. CMEP/Coalition of Mainstream Employment Programs Correctional Educational Consortium

21. Inclusive Workforce • The Inclusive Workforce Workgroup began convening in April of 2010 and has worked since that time to identify recommendations to be shared to all partners in New York State to assist in the development of a workforce development system that would be characterized by funding and services that demonstrate flexibility, responsiveness and collaboration. • For such a workforce to exist in our state, individuals with disabilities who are expressing an interest to work must be supported by their families, peers, the provider community, NY’s Businesses, as well as State and Local government. • It must be responsive to both Business and Job seekers’ needs. • The Inclusive Workforce Workgroup identified key factors necessary to establish an effective employment system in New York.

22. Key Factors to Development Success • The system must provide seamless access to services, timely response to individuals’ needs, and be inclusive to enable any and all individuals the opportunity to seek and gain employment. • New York State must have in place effective partnerships with businesses to meet their hiring needs and the needs of job seekers for the jobs they offer. • It is imperative that the needs of the business owners be met large and small.

23. True Accountability • BOTH Job seekers and businesses are satisfied – we need both business and ALL residents to feel New York wants and needs them in their workforce!   • Businesses are educated, engaged, and supported in their quest to hire, train and retain employees that help them meet their bottom line; • Individuals are assisted to find, choose, and maintain employment which matches the person’s career goals, interests, and skills; and • Critical data on the attainment of outcomes in the system is collected so true progress in our State can be objectively measured.

24. CRP Assessment Tool & WorkQual • Offer an inclusive of a set of principles and practices that agencies can adopt to support organizational transformation to more integrated employment options. • Works to assist the agency to evaluate their Community Partners and resources for transformation.

25. The Tool • Series of questions to assess an organizational, resource and market environment. These categories develop a profile of your organizational environment, available resources, and market situation. • Key to the use of the tool understanding your organization’s current status and not projecting where you would like to be. • An important baseline is provided that then allows you to conduct an organizational assessment.

26. WorkQual Online • Find it here http://www.ilr.cornell.edu/edi/allqual/workqual-login.cfm

27. NYS OMH WorkcenterTransformation • Consultation with 28 agencies began in October of 2009 • Host for videoconference on “Business Planning” utilizing the State Small Business Development Centers in April 2010 • June 2010 unveiled the CRP Assessment Tool and WorkQual • Affirmative Business White paper - July 2010 http://www.ilr.cornell.edu/edi/nymakesworkpay/docs/Transforming_NYS_business_072010.html • September 2010 – Held Employment Institute showcasing ideas for change and business strategies • Ongoing consultation offered by NYSRA, NYS OMH, Cornell University and Burton Blatt Institute of Syracuse University • December 31, 2010 – Deadline for Business Concepts to NYS OMH

28. Business Ideas and Initiatives • Three Year Plan – pending NYS Budget • Shifting funds to Personalized Recovery Oriented Services (PROS) • Incubator Businesses • Realignment of Prevailing wage employment opportunities • Corporate Partnerships • Wage Subsidies

29. Future Steps • Revisit and redo regulations • Identify Alternative uses for “workcenter” space • Building an Inclusive Workforce • Student transition Planning • Policies that “include” all

30. Center for Practice Innovations bringsIPS Supported Employment to PROS Programs in NYSPaul Margolies, Ph.D.Center for Practice Innovations at Columbia PsychiatryUSPRA ConferenceJune 13, 2011

31. Public-Academic Partnership

33. Individual Placement and Support

34. What is Supported Employment? Supported Employment helps people diagnosed with mental illnesses find and keep meaningful jobs in the community. These jobs exist in the open labor market, pay at least minimum wage, and are in work settings that include people who are not disabled. SAMHSA Supported Employment Tool Kit

35. Individual Placement and SupportPrinciples Competitive employment is the goal Eligibility is based on consumer choice – zero exclusion Consumer preferences are important Supported employment is integrated with treatment Personalized benefits counseling is provided Rapid job search -- starts soon after a consumer expresses interest in working Follow-along supports

36. Individual Placement and SupportPractitioner Skills Engagement Assessment: Career / Vocational profile Employment planning Benefits counseling Job development Working with ACCES-VR Follow-along supports

37. CPI’s efforts to bring IPS to consumers in NYS

38. Two approaches to implementation • Begin with focus on PROS programs • Significant on-site technical assistance • Regional learning collaboratives and training sessions

39. Significant on-site consultation, coaching and training • Methods Hands-on work with program and agency leadership, supervisor(s), and team members with special emphasis on employment specialists(s)

40. Significant on-site consultation, coaching and training • PROS Programs Now Involved • HALI • Clubhouse of Suffolk • FEGS • Federation of Organizations • Putnam Family and Community Services • Occupations, Inc.

41. Joining a Learning Collaborative A learning collaborative establishes a resource panel who work with providers to improve outcomes through the use of basic quality improvement strategies.

42. Learning Collaborative 69 PROS programs and soon-to-be PROS programs now participating Implementation support for program leaders Training for employment staff

43. Learning Collaborative Methods Regional meetings Regional conference calls Program-specific consultation calls Webinars

44. Learning Collaborative Examples of activities: January regional conference calls with PROS program leadership focused on: Engagement of staff, consumers and others Adaptation of IPS fidelity to PROS Updates on implementation efforts

45. Learning Collaborative Examples of activities: February and April regional two-day training workshops for employment staff focused on 7 core clinical components of IPS, with lots for exercises, role plays and video

46. Learning Collaborative • Examples of activities: • March statewide webinar for program leadership focusing on the use of an implementation guide – 18 questions that leadership may consider in developing program-specific implementation plans

47. Sample Training Exercise • This training exercise is used to teach employment staff about recovery values, engagement, and the “zero exclusion” principle of IPS. It raises issues that are then covered in a debriefing session.

48. Exercise Person #1 is the consumer. You want to work full time. You have had some difficulty with drinking and smoking marijuana. You haven’t worked in 15 years, except for 4 months in a transitional employment position in a copy center two years ago. Person #2 is the practitioner. You are convinced that this consumer should not be working at this point in time, for many reasons. Your task is to explain this to the consumer.

49. Additional Implementation Supports Under Development Guidebook for consumers and staff (NASMHPD/SAMHSA grant) Will focus on key activities for choosing, getting and keeping competitive employment Will be used by consumers working directly with employment staff Each topic will have Important information Questions to answer/decisions to make/personalized worksheet Next steps Should reduce the need for staff training

50. Additional Implementation Supports Under Development Online training module Introduction to IPS Will include video clips. Examples may include: consumer discussing how IPS helped him/her find and keep a meaningful job consumer discussing how fear about losing benefits hurt motivation to work and once he/she learned the facts, his/her motivation increased tremendously consumer who had been actively using substances found the motivation to cut back on this use because he/she was working practitioner discussing how his/her attitude about zero exclusion has changed once working with consumers in IPS program