Work as a Priority Strategies for Employing People with Psychiatric and Co-occurring Disabilities who are Homeless

1. �Work as a Priority�Strategies for Employing People with Psychiatric and Co-occurring Disabilities who are Homeless Sponsored by The California Institute for Mental Health Facilitated by Gary Shaheen Laura Ware Advocates for Human Potential, Inc. 518-475-9146, ext. 243 gshaheen@ahpnet.com

2. DAY #1 Learning Objectives Learn about factors resulting from homelessness that affect people�s ability to obtain and retain employment Understand how recovery and rehabilitation principles and practices can provide the foundation for employment success. Understand how to address factors of motivation, self esteem, powerlessness that affect employment success Apply information through scenario exercises

3. Larry MeredithIn Hooked by Lonny Shavelson 2001 �If we are going to make a difference, then we have to realize that drug abuse & mental health is related to housing is related to health care is related to joblessness is related to poverty. You can�t deal with any one of those without dealing with all of them.�

4. �RJ� I have been homeless for five years I have schizophrenia and have been drug addicted since the age of six I smoked crack Did some time a few years back on a burglary charge I don�t know where I�m going to sleep tonight Shelters are bad places where they rob you and beat you up. The staff looks the other way. I am an artist. I could be a millionaire if I could get money to make and sell my paintings If the Mayor can spend millions building a new city hall he should be able to give us money to help us get jobs and a decent place to live.

5. Disincentives to Employment�� Distrust Focus on immediate needs Co-occurring disabilities Learned helplessness and emotional instability Functional limitations Cognitive limitations Illiteracy Communication deficits Physical/emotional trauma Poor self-esteem Fragmented or inadequate services/supports Mobility Skills mismatch Fear Legal issues: custody convictions, judgements, probation Lack of personal documentation Child care Transportation Earning disincentives Lack of permanent address and phone # Lack of hope Lack of skills regarding how to work towards a sustained goal, not just immediate gratification

6. Program-Level Challenges Lack of knowledge, experience �Paradigm paralysis� Different providers speak different languages and often can�t share much information Readiness prerequisites Ethnic/cultural sensitivity Different outcome expectations Different roles and �turf issues� Not enough $$ or in the wrong places Lack of coordination, communication Promising more than can be delivered

7. Different systems are not aware of each other, and are resistant to change Fragmentation-funding sources, priorities, roles, criteria, etc Political priorities and issues that may prevent effective communication Stigma Lack of $$ Lack of cross-systems training EBPs not understood Service System Challenges

8. �Breaking the Cycle� Trust-building is fundamental Recognize/utilize personal strengths Provide factual information Teach by example Recognize and address complex needs Affirm personal dignity and self-worth Reinforce personal responsibility, choice and empowerment Facilitate discussions to help individual see how previous choices and decisions can be done differently Adapt vocational approaches to meet needs Provide comprehensive, long-term supports

9. Common Themes Jobs that people want and can manage well Linking Housing First/Work First Entrepreneurial approaches Clear & reasonable expectations for all parties Flexible outcomes Redefining failure Provide personal service supports No arbitrary time limits Hire consumers as staff Cultural competence/relevance Link to treatment, rehabilitation, recovery services

11. Guiding Principles #2:Social Justice and Equity XXX% of all people who are homeless are persons of color Stigma, discrimination is a �triple whammy�- 1) homelessness + mental illness + substance abuse + criminal justice issues 2) poverty and disenfranchisement 3) racial stereotyping, prejudice and discrimination You should consider the impacts of these factors on employment as well!

13. UPENN RESEARCH-MAJOR FINDINGS Homelessness is a �Revolving Door� Phenomenon Point in Time vs. Longer Time Frame Identified 3 Subgroups * Transient * Episodic * Chronic

14. CULHANE� S SUBPOPULATIONS Transient: 80% of overall population, single, economically caused episode, low rates of illness Episodic: 10 % of overall population, multiple episodes of homelessness over time Chronic: 10% of overall population, multiple, complex problems, long term homelessness

15. Resources �Changing for Good�-Prochaska, Norcross & DiClemente, 1994 �Motivational Interviewing: Preparing People to Change Addictive Behavior�-Miller & Rollnick, 2002 PATHPROGRAM.COM-Click on �Technical Assistance� �Implementing Interventions for Homeless Individuals with Co-Occurring Mental Health and Substance Abuse Disorders�-Winarski, 1998

19. Consumer Self-Report of Items Important to Recovery (Ralph,R) Ability to have hope Trusting my own thoughts Enjoying my environment Feeling alert and alive Increased self-esteem, spirituality Knowing I have a tomorrow Having a job

20. How MH Professionals Help (Ralph,R) Encourage my independent thinking Treat me like an equal in planning my services Give me freedom to make my own mistakes Listen to me and believes what I say Recognize my abilities Work with me to find the resources/services that I need

23. Role Recovery is�. Obtaining and sustaining a valued role as a: Worker Family-member Friend Homeowner/tenant Partner, etc By overcoming personal losses, setbacks, obstacles, and limitations Obtaining the skills and trust from others needed to perform that role Educating others re: personal abilities Using natural and professional supports as needed

24. Worker Role Recovery-Two Dimensions INSIGHT DEVELOPMENT Identify values preferences, choices Prepare for change � personal and environmental Honest self-assessment Trust in self and others Hope for the future SKILL DEVELOPMENT Setting work goals Testing work preferences Evaluating skills, personal strengths and supports against goals Skills Teaching: tasks and work habits, as well as pursuing, obtaining and managing success Support Service planning

28. ASSESSMENT PROCESS

29. Tips for Effective Interviewing Choose between open-ended and closed-ended questions. Avoid leading questions. Structure chronological answers. Divide the experience into parts. Share experiences by generalized feelings. Be aware of �non-verbal communication Conclude the interview.

30. Common Errors in Interviewing Imposing values. Offering false reassurance. Asking double questions. Interrupting answers. Discouraging or forbidding the expression of real feelings. Saying �I understand� inappropriately.

31. Techniques for Identifying Dual Disorders Screen-expectation not an exception. Increase the �Index of suspicion�. Self-report Signs and Symptoms Chemical testing Collateral information Correlates or predictors of substance use disorders Indirect measures (e.g. Family history -Car accidents).

33. Employment-Centered Outreach Make work part of the conversation about engaging in services Prompt and listen to people�s stories about jobs they had and jobs they may want Encourage stories that help the individual to see unidentified yet transferable skills Provide information Assess the value of an offer of work as a �hook� to influence positive change Understand the �stages of change�

34. Principles/Practices #1:Linking Employment and Housing Challenges People may not be interested in services once they are in the housing unit They are not sure what they want to do and avoid staff They are engaged in behavior they are trying to hide from staff Staff try to �over �engage� or overstep boundaries and push participants away Staff may not maintain proper boundaries with participants, especially if he/she can relate to a particular challenge or situation Lack of cultural sensitivity to the background, needs, challenges and goals of a specific participant Suggested Responses Offer incentives in order to develop their interest Keep the conversation focused on what the participant is thinking or feeling, and what he/she wants to do about it Be aware of how your body language or other non-verbal communication Remember that the staff role is to guide and support, not direct, over-invest, �mother � a participant, or become emotionally involved Suggest meeting in an open space such as outdoors or in a private space such as a counseling room Try to never force an interaction unless absolutely necessary, or unless someone�s safety is at risk �Vocationalize� the housing environment by having a variety of available activities that offer opportunities for engagement around work

35. Vocationalizing Creating a culture that expects work - verbally, mentally, environmentally and literally. Arranging things, activities and resources to include and/or support employment. Assign accountability for employment outcomes to all staff. Develop and maintain organizational policies and practices that support client employment Begin tracking employment outcomes.

36. �Mary� Mary accepts housing but refuses to consider employment. Even though the Personal Services Coordinator reminds her that the program is offered only to those who want to work as well as get a place to live, she says she is �not ready� and won�t discuss it any further. What are some ways you might help Mary address motivation to work?

37. Principles and Practices #4Helping �Mary� Develop Motivation for Work Typical Challenges Sense of hopelessness about vocational goals based on experience to date Numerous setbacks in general or negative work or other vocational experiences Many think of jobs or tasks that have historically been available without a great deal of creativity Some may be struggling with depression or other clinical/medical issues that make it difficult to get motivated Current stresses in life that make feeling motivated difficult Negative consequences of work such as child support payments, credit debts, SSI/DI disincentives, etc Suggested Responses Motivation as a State not a Trait: it can change over time and be influenced Ambivalence is Good: Tease out both sides, help tip balance towards change �Resistance� is not a Force to be Overcome-Roll with it Focus on Person as Ally, not Adversary Recovery, Change and Growth are intrinsic to being Human Remember that People who have suffered many losses may relinquish hope to survive Paint a picture of immediate incentives that can trigger motivational thinking

38. STAGES OF BEHAVIOR CHANGE Pre-contemplation: No awareness of problem or need to change Contemplation: Emerging Awareness, ambivalence Preparation: Identify, anticipate �hot spots�, planning, rehearsal, identify skills, supports Action: Plan implementation with feedback loop Maintenance: Reinforce what works Relapse Prevention: Anticipate and plan for relapse, viewed as learning opportunity

39. FACTORS THAT INLUENCE CHANGE READINESS Perception of Need: Person�s experience of discrepancy between the pain of the present and the potential for future improvement Belief that Change is Possible: Positive outcome is achievable in reasonable time period Sense of Self Efficacy: Believes they can succeed Makes Stated Intention to Change

40. MOTIVATIONAL TASKS Pre-contemplation: educate, raise doubt re: perception of risk, identify other areas of high motivation Contemplation: Tip the Balance- evoke reasons to change and risk of not changing Preparation: Choose best strategies, anticipate difficulties, plan, rehearse Action: Frequent monitoring of progress and ongoing lessons Relapse: Help reframe as learning opportunity, not failure, plan Describe a time in your life you attempted change-how difficult? Who helped? Outcome?

41. Principles and Practices #2Integrated Team Planning Typical Challenges Developing effective relationships with staff of other partners, especially when they are located elsewhere Creating a �project culture� that encourages joint decision making Effectively documenting services for overall reporting, informational and evaluation purposes Seeing regular , consistent meetings as crucial, useful and a priority Developing centralized systems and procedures for intake, assessment, r intervention, communication processes, follow-up, referral, contacts with outside community Avoiding �turf� issues Suggested Responses Clarify for all staff and organizational partners, in writing, who is responsible for each role and component of the project Sponsor a series of �shadowing� or �job switching� opportunities Include discussion of partner and staff roles in regular staff meetings Facilitate regular �case meetings�, at which all staff working with a specific participant are present and asked to share information as well as next steps Create opportunities for staff to talk about successes and challenges, and for other staff to assist in problem-solving Designate a team leader

42. �John� John says that there is no use in trying to find a job, because all he will do is fail at it anyway. He used to be a good carpenter but that was many years ago. Years of living on the street has eroded those skills and reduced his stamina. He says he feels hopeless of ever finding anything better than dishwashing or carrying out garbage. How would you help John develop an employment goal?

43. Principles and Practices #3Helping �John� Create Employment Goals Typical Challenges Many people have not thought about having vocational or employment goals, since their first goal on the streets has been survival Many are focused on immediate gratification, such as earning a bit of money or paying off a debt They may have had negative vocational or employment experiences because of the barriers they face They have trouble thinking about small steps that will lead to achieving a vocational or employment goal Some may not be currently motivated to pursue vocational or employment activities, and are content to maintain current status or activities Some may need help to identify how current interests, activities or desired participation can be seen as vocationally-oriented Suggested Responses Create opportunities in which they can have a sense of immediate success or achievement Focus on a person�s perceived or inherent strengths, gifts, skills and interests Work with them to acknowledge all achievements (including survival on the streets) and make them visible to them as sources of strengths and knowledge that may have a job application, Focus on immediate goals first, and how these can lead to a larger goal. Give timeframes to specific goals as a way of motivating participant and yourself as a staff Make sure all goals are developed or agreed-to by the participant Make sure goals of any type are clearly defined and fleshed out by the participant and staff so that they are real and true

44. Principles and Practices #6Implementing a Standing Offer of Work (In-House Jobs) Typical Challenges Changing attitudes and expectations of all parties Acquiring jobs with built-in flexibility and opportunities for growth and transition Finding effective partners and employers-internal/external Resolving alcohol/substance abuse and mental health issues affecting work Staff and new worker training Providing supervision and support Fulfilling employment services contract/performance requirements Funding the effort �Fit� with SE Evidence based practices Suggested Responses Assume employability All staff supports peoples� desire to work Look internally as well as externally for $$ Provide direct, tangible workplace-based support to break down barriers Avoid lengthy prerequisites �rapid access to a low-impact job Allow multiple work options-one job does not fit all Understand peoples� needs, abilities and values Communicate your work expectations Celebrate all degrees of success Weave in conversations and support for the next step

45. LAMP Village527 S. Crocker, Los Angeles, CA 90013 (213) 488-0031 Drop-in Center/Crisis Shelter Lamp Lodge-50 unit permanent housing VILLAGE INDUSTRIES: - Linen Services - Public Laundromat - Public Showers &Toilets 1/3 of staff are consumers Employs 35 people per day

46. Principle # - Connecting to MH/SA Treatment Services Typical Challenges People may not be ready to accept treatment People are fearful of treatment Their friends are not good influences and may disapprove of a person�s decision to enter treatment Stigma Side effects Suggested Responses Establish referral relationships so that the services are accessible to participants when needed Help people understand the implications on goals they chose and commit to achieving Enlist the support of peers to help people understand the positive effects of accepting treatment Be clear about the rules regarding substance abuse on site at HUD housing

47. �Step-Back/Step-Out/Step-Up�A Practical Strategy for Keeping the Door Open for Employment WHAT IT IS: a) A strategy for helping people address their treatment issues and impact on work b) A way of keeping people involved in employment services while they deal with their substance use and/or MH treatment issues c) A plan for putting together a support plan emphasizing growth WHEN: At engagement, involvement, continuation WHO: Implemented by staff, peers WHERE: Shelters, employment programs, housing sites

48. �Step Back� Offer alternatives to terminating program involvement for people when substance use interferes with their ability to get or keep employment Focus on how substance use prevents someone from getting or keeping a job, not the behavior itself. Provides alternative �step-down� employment-related services that do not risk the safety of the person or others Step downs still require people to be substance-free while they participate Examples: employment counseling, presentations by peers or staff, resume writing, low-impact, P/T, time-limited in-house work experience, shadowing, P/T volunteer work Expected Outcomes: Maintain connection, use stages of change strategy to change behaviors, show consequences (eg: person may lose job but staff �never go away�)

49. �Step Out� Some people may not be ready to deal with their treatment issues that affect their jobs and they may need to �step out� of the program. Although you may have to get to the place of reinforcing rules of enrollment-try to maintain contact (through outreach staff, shelter staff, peers, friends, etc) and let them know that the door is open for them to try again.

50. �Step Up� The job placement is only the first success Dealing with treatment issues affecting work is an ongoing process �owned� by the individual Advancement and stepping out of poverty is the goal and is negatively affected by job and housing loss due to treatment issues Ongoing, follow-along support by an IST to support both treatment and work goals Support needs to accommodate for success as well as address challenges Involve peers as counselors or mentors showing how people can overcome fears of change and advancement and maintain balance Expect relapses and have a plan in place that deals with them Expected Outcomes: Staff realize the job doesn�t end at placement; participants see the benefits of treatment and job retention and advancement; they have access to wrap around supports 24/7

51. Day #1 Summary:Breaking the �Readiness Model� Assume employability All staff supports peoples� desire to work Avoiding lengthy prerequisites and rigid sequencing Allow multiple options-one �best practice� does not fit all Understand peoples� needs, abilities and values Understand what employers want Understand how to make a good job fit Celebrate all degrees of success

52. Day #2Learning Objectives Learn about employment services practices being used throughout the country Understand tools and strategies for helping people choose, get, keep and advance in jobs Understand how to use partnerships to improve program delivery Learn about critical staff competencies for providing employment services Address challenges and strategies using scenarios and exercises

53. �Customization� of Employment Best Practices- A Challenge for the Field Why? Replace staff-driven employment services with more person-centered approaches How? Modify existing practices like: TEP: Each time-limited job is individually negotiated/the person AND the job can change What Outcomes? Improve outcomes-satisfaction, tenure, growth

54. Transitional Employment (TEP) (Est. 1964 Fountain House, NYC)  Primary vocational services of Clubhouses Time-Limited Part-Time Competitive Negotiate job slots set aside for rotating workers Usually entry level jobs Agency guarantees the job will be done On and Off-Site Job Coaches, peer supports Disadvantages: Time limitations Agency is responsible for performing the job Dependency issues

55. ACT/PACT Continuous 24 hour treatment planning approach Employment specialist is member of multi-disciplinary Team Rapid placement, continuous follow-along and reassessment Recognizes that work is integral to the community treatment process Focus on �work first� � on-the job learning, adaptation and accommodation Clash between short-term funding and long-term support needs

56. Customized Employment (NCWD) Individualizing the employment relationship between job seekers and employers to meet the needs of both. Determine the strengths, requirements, and interests of a person with a complex life. It is not a program, but rather a set of principles and strategies that result in employment. Builds on supported employment and results in individually designed services, supports, and jobs negotiated to fit the needs of a specific job seeker or employee. 

57. Customized Employment (NCWD) Customized Planning Profiles, portfolios, etc to capture, organize, and represent the information that was collected during exploration Negotiating Negotiating job duties and employee expectations. Can include job carving, negotiating a job description, job creation, job sharing, etc. Self-Employment A recognized CE option

58. Career Mapping-A New Approach to Assessments and Job Planning (Based on materials developed by Sowers, McLean and Shelton Empowerment for Life Project-Portland, OR) Recognizes the complex impacts of homelessness and disability on employment Seeks to bridge issues of trust Uses interactive group or individual techniques Results in pictographs (�maps�) that are the basis for referral to career services Assumes the result is mainstream employment with support services planning

59. Key Elements of Mapping LIFE HISTORY -draw correlations to past experiences. Identify patterns over their life span and recognize reoccurring themes, interests, and passions STRENGTHS, GIFTS and CAPACITIES - Identify what they are able to do, what they enjoy doing, and what they have done in the past to develop a job goal WHAT WORKS - Create a list of job characteristics that work well for them and those that do not work well for them POSSIBLE RESOURCES - Community-based resources available to them, as well as resources within the One Stop system POSSIBLE JOBS - List of possible jobs for themselves using strengths, gifts and capacities and what works as the only criteria REFFERAL � Work with staff to develop a plan to get the job they want

60. A �Map in Progress�

61. SAMHSA�S MODEL FOR EBPsSAMHSA National Registry of Effective Programs and Practices (NREPP) http://modelprograms.samhsa.gov

62. Why Use Evidence Based Approaches? Evidence based practices yield better outcomes Evidence based programs have fidelity measures SAMHSA acknowledges that the evidence base is limited in some areas SAMHSA supports promising practices where evidence of effectiveness is based on: Formal consensus among recognized experts Evaluation studies not yet published

63. IPS/SE Fidelity (Bond 2003) Fidelity is important because programs that faithfully implement evidence based practices have better outcomes. Fidelity Scales assess the adequacy of implementing an evidence based practice

64. Supported Employment EBP (Drake, et al) Basis for SAMHSA Toolkit on Supported Employment Blending of assertive case management and supported employment Has been used to replace continuing/day treatment Work is considered both treatment and outcome Employment specialist is member of tx. Team Vocational assessment is continuous and obtained from multiple sources Focus on �work first� - learning through doing Services in the community on flexible schedule Has established a fidelity scale with staff/customer ratios

65. Social Enterprises �Meeting the Market with a Mission� Businesses which affirmatively employ persons with disabilities and who have been homeless and/or other disadvantages Achieve social change: More people get jobs Achieve Economic Change: Build healthy business communities

66.  Social Enterprises Characteristics Agency-sponsored businesses employing people with disabilities, people who have been homeless and/or other disadvantages Objectives Exposure and experience, skills development Add to the available jobs in the marketplace Advantages Agency �owns the jobs� �Business to business� potential Disadvantages High risk-requires sound business planning Can create numerous issues of roles and boundaries for staff and clients

67. COMMUNITY VOCATIONAL ENTERPRISES 1425 Folson St., San Francisco, CA 94103 (415) 544-0424 Training and employment for persons with mental illness & other people with disadvantages Service Master Partnership Transitional employment in 4 agency-run businesses Professional development seminars Support services/Case management Enrolls +200 persons/year. 50-70 persons employed at any one time

68.  Supported Self Employment Characteristics Consumer owned and operated businesses Objectives Self-sufficiency through owning one�s means of livelihood Advantages Consumer �owns the job� Self-reliance, independence, �role shift� from consumer to entrepreneur Disadvantages High risk-requires sound business planning Complications re: benefits are different from other employment scenarios �The buck stops here�

69. Homelessness and Choosing a Job Need to address considerable �concrete� barriers, i.e., access to laundry, showers, clothing Lack of fixed address for mail or telephone to receive and return messages Personal humiliation about current homelessness and past record, such as criminal histories Poor employment histories and track record regarding employment Access to transportation Focus on immediate needs vs. longer term goals Impact of change Managing housing stability/recovery and work Unclear expectations/inadequate information Physical limitations

70. Getting a Job:  What Level of support is needed? Work while choosing or job goal first? Identify values Identify strengths and gifts Identify preferences: type of work, location, hours of work, wage scale Identify resources: postings, ads, friends, family, staff Why this job? Why now? Sustained assistance regarding set-backs Support services-on and off job

71. Principles and Practices #7Employer Marketing Typical Challenges Devalued group of people with stigma Multiplicity of physical, psychological problems that could affect work Lack of recent solid work history Appearance and mannerisms Few resources (e.g. transportation, child care, etc) Poor self-image and lack of confidence, fear May not be a clear �job match�-negotiation may be necessary Employers� understanding of the features/benefits Employers� fears of accident liability Suggested Responses Assess employer needs and concerns Represent the job seeker Develop and use marketing tools �brochures, testimonies, videos, etc. Develop sustained relationships with employers that allow for more non-traditional �job matches� Consider sectoral approaches Becoming familiar with the current labor market to make an informed match Guide job seekers on disclosure of disability and options for requesting reasonable accommodations. Provide information about work site accommodations to employers Guide job seekers on ways to address a record of conviction/incarceration Support successful job seeker interviews

72. Principles and Practices #8Job Development and Placement Typical Challenges Force-fitting to meet program outcomes �Passive job development� Not following up on a regular basis with active and potential employers Focusing on the disability rather than the ability Starting with tax incentives Promising �two for one� Guaranteeing 100% productivity or attendance Offering to do all the training and supervision Failing to plan for the next step (advancement, transition) Suggested Responses Be creative- you want the same thing Offer examples to employers of ways part time, negotiated or carved jobs has helped an employer in the past Review the assessment information on an ongoing basis and update as needed Help the job seeker break down the job development process into attainable steps Select, train and support mentors Offer to provide disability sensitivity training to employers� staff Include benefits planning as an ongoing part of the process

73. Highlights: Who Does What? Here is the context. You need to decide how you will exert leverage. As the saying goes, to eat your dinner, you have to be at the table. After today�s presentation, I think the most useful thing is for people to go back to your program leadership and figure out how you can be included in the state and local planning process so your folks are consideredHere is the context. You need to decide how you will exert leverage. As the saying goes, to eat your dinner, you have to be at the table. After today�s presentation, I think the most useful thing is for people to go back to your program leadership and figure out how you can be included in the state and local planning process so your folks are considered

74. One Stop Services Core services: - Available to any job seeker - Self-service job search, resume development - Use of One Stop facilities, job fairs, employer presentations, etc Intensive services: For those not successful in Core services Vocational counseling, remedial education and skills and support development, guided job search, enrollment into WIA funded training programs, etc Training services: Enrollment in classes, specialized trades training, etc Point here is that everyone gets core-the other services are available on assessment, need and funding availabilityPoint here is that everyone gets core-the other services are available on assessment, need and funding availability

75. Principles and Practices #5Connecting to Mainstream Employment Typical Challenges Mismatch between customer�s readiness and the self-guided core services at a one stop Participants feel uncomfortable in One-Stop environments One Stop staff feel uncomfortable working with people who are chronically homeless Different goals regarding employment placement Different languages and expectations No history of coordination Suggested Responses Have information of relevance to people who are homeless at the One Stop Develop partnerships for targeted outreach Cross-train staff Use the resources of the DPN Review services forms and documents to determine how they are consistent with each other, and where they contradict each other Introduce people to One Stop services as a normal part of the employment process

76. Example #1: CTWorks-Bridgeport, CT Operated by Career Resources, Inc., Partnerships with LWIB, Bridgeport Continuum of Care, the CT Division of Rehabilitation Services, the CT Department of Mental Health and Addiction Services and the Veterans Employment Service. 50+ corporate donors, the United Way, US Department of Education grant ,DOL Work Incentive Grant and Disability Program Navigator funding

77. CT Works!- Why? Meets people who are homeless with services �where they are at� Developed a �Career Coach� mobile One Stop with the technology on board to connect people who are homeless to core services Important partner is HVRP to connect Vets to core, intensive, training services Visionary Leadership! Public/private funding mix

78. Example #2: SEARCH-Houston, TX Active member of the local Continuum of Care Permanent and transitional housing, daily lunch for 250, a food pantry, mobile outreach, day care, medical assistance and psychological evaluations, and a one-stop career center for the homeless Received JTPA and WIA Adult funding for employment services for homeless

79. SEARCH Works! Why? Realized it could not �go it alone� Offers on-site occupational skills training (computers, etc) for growth jobs Understands it needs to braid/blend funding to provide support services and intensive counseling

80. Ending Chronic Homelessness Partnerships HUD, ODEP, ETA, VETS funded x 5 years 5 Cities: LA, Boston, SF, Indianapolis, Portland, OR 297 people housing + jobs Lead applicant is workforce development

81. Progress so far��.. Through 9/30/05 Number served 357 # full or part time competitive jobs: 113 Employment rate (# placed in housing: # entering employment) = 43% Innovations (one stop satellite; career mapping strategy, mobile �one-stop�)

82. Accessing Mainstream Resources for Employment Medicaid (www.cms.hhs.gov) 1619(b) Buy-In Rehab Option HUD (www.hud.gov) Section 8 CDBG ESG ROSS/Hope VI Tenant-Based Rental Assistance USDOL (www.dol.gov) WIA SSA (www.ssa.gov) Ticket to Work SSA Work Incentives Dept. of Agriculture (www.usda.gov) FSET RSA/VR (http://www.ed.gov/offices/OSERS) State VR HHS (http://www.acf.hhs.gov/programs/ocs/dcdp/joli/welcome.htm) JOLI

83. Job Search Planning Assessment-skills/resources/supports Person-centered planning-preferences/goals, job expectations Researching employer(s) Complete/modify resume, cover letters, applications; Obtain transcripts, credentials, references Resolve disclosure issue Address criminal justice involvement Identify �hot buttons and plan response Practice interviews and how to deal with surprises Develop a schedule and plan

84. Disclosure: A Personal Choice Disclosure of disability can occur: At the time of the job application (by the applicant or by their representative) During the interview After the job is accepted After adjusting to the job, demonstrating competency and prior to the need for reasonable accommodation When asking for an accommodation Never Sometimes it is optimal to discuss the disability in terms of behavior and resulting behaviors

85. Menu of �Keep� Services Job Coaching & Follow-Along Educational, Professional, Peer, Natural Job Supports Professional, Peer, Natural Housing, Recovery Supports Benefits Management & Advocacy Growth and Career Planning

86. Principles and Practices #9Job Retention and Advancement Typical Challenges Having $$ New friendships/disengaging from problematic old relationships Managing new structure, scheduling and time demands Pressures to share new funds or luxuries with less fortunate neighbors New routines New lifestyle Co-worker, supervisor relationships �Threat of success� Suggested Responses

87. Tools and Activities: Utilizing Natural Workplace Supports Job coach as training consultant, not trainer Utilize typical employee orientation and training process and resources Assist to understand workplace culture, cues, politics Don�t �switchboard� questions & feedback Help people develop skills to establish their own natural workplace supports Explore possibility of �training the employer� to facilitate the best results for everyone

88. Understanding and Addressing Work-Related Triggers Having $$ New friendships/disengaging from problematic old relationships Managing new structure, scheduling and time demands Pressures to share new funds or luxuries with less fortunate neighbors New routines New lifestyle Co-worker, supervisor relationships �Threat of success�

89. Scenario Questions �Choosing, Getting and Keeping a Job� What are this person�s strengths and assets? What employment goal(s) do you think they might choose? What employment program option might they prefer and why? What concrete barriers may arise or exist that need to be addressed? How would an integrated services team proceed with the participant? Will this person choose to disclose their disability or not? Describe how the plan for job search might look What natural supports does this person have available? What triggers will affect job retention? What are some of the elements of the employment support plan?

90. For Systems/Programs For People

91. Building a Culture Supporting Employment � Some Examples Employment is part of our Mission Statement Targeted increases in rate of employment is an agency priority Consumers are included in program decision-making Skill building of participants is an integral part of all service delivery � teaching the participants how to meet their own needs We hire consumers as staff We have ongoing staff training on employment Consumers are clear on why they are participating in employment programs Staff support consumer involvement, dignity, choice and community integration Consumers, their families and staff express hope that employment is possible All staff throughout the organization are interested in and committed to employment opportunities for participants Formal vendors and outside partners are viewed as potential employers for participants

92. Developing Capacity-Examples We have employment program written policies and procedures We have clear employment outcome measures We have the goal of assisting participants in relevant ways with employment goals in the job descriptions of all staff We have a dedicated budget for employment We have a process for resource development and business planning We have employment specialists on staff We are risk-takers We have a strong management team We are culturally competent We have experience with developing partnerships We think of all partners and vendors as potential employers of our participants

93. Opportunities-Examples We are aware of local hiring and economic development trends We look for non-mental health funding sources as part of our employment funding mix We have staff assigned to resource development and program growth We build coalitions among families, mainstream resources and institutions, peers and professionals to address stigma We are members of Chambers of Commerce We initiate and participate in the development of access to new employment sectors for our participants, i.e. hotel industry, specific unions, etc. We build upon the principles of the Americans with Disability Act, New Freedom Initiative, Olmstead Decision, TTW/WIA and local hiring goals/requirements for new program development We help to make sure employment is on the agenda for State Policy Academies

94. Working with your VR Agency: Challenges Time-limited nature of VR services Incentives for VR case closures Demonstrate how VR, One Stop, agency staff and participant can build a partnership for success Mutual suspicion & misunderstanding Staff training issues Incentives for collaboration Funding limitations

95. Working with your VR Agency: Best Practices for Partnerships Make people with mental illness and co-occurring disorders a priority Staff training Define milestones for payment relevant to the population Role definition and clarity Hire consumers as VR staff Co-location of counselors Non-traditional providers Involve employers in these partnerships

96. Business Improvement Districts Convergence of need Resources for outreach, engagement Job development Anti-stigma Opportunity for developing better understanding of community needs � employers and participants

97. Staff competencies Knowledge Skills Attitudes Cultural sensitivity

98. Staff Competencies: Knowledge Job Market (current and projected) Job features, credentials and skills (hard and soft) requirements Entitlement systems and related work incentives Strong understanding of vocational rehabilitation practices throughout all delivery of services Mainstream community organizations, natural supports, self-help & peer supports, non-traditional (eg. Faith-based) resources Employer associations, Chambers, One-Stops, WIBs, VR Other potential employers � small businesses and community-based organizations Agency purchasing procedures/services they are contracting-out Homeless services and coalitions Asset development strategies-IDAs, ITAs, etc

99. Staff Competencies: Skills Active Listener Good Communicator (verbal, written, and telephone) Able to integrate vocational growth into all service delivery Consistent follow-through Networker and strong relationship-builder (Giant Rolodex) Teacher Negotiator

100. Staff Competencies: Attitudes Shared values Flexible Self-confident Outgoing Patient Respectful and Tolerant Well-trained and conscious about cultural differences �Hands-on� Tenacious Inventive

101. Some More Important Questions������.. How are you involving consumer leaders in employment program development? What funding sources are you using to address employment? What partnerships are necessary to increase employment? What advocacy tools do you use to promote employment? What skills must staff know to provide/support employment? How do you approach employers to achieve greatest number of opportunities? What do you need to do differently to increase employment?

102. Resources on the Web www.dol.gov/odep www.mentalhealthpractices.org www.redf.org http://www.psych.uic.edu/eidp/eidptoolkit.htm www.ahpnet.com www.csh.org www.hud.gov/offices/fheo/section3/section3brochure.cfm

103. Baker�s Dozen �To-Do�s�/�Who Does?� Leadership for employment within the disability services systems Unified vision re: employment as a priority across service systems Share best practices Visible consumer leadership Develop a toolkit for employment implementation Work with employers and develop knowledge of employers throughout process Statewide training initiative to improve staff competencies Develop individual outcome measures Develop program accountability measures Develop local partnerships-business, FCBOs, One-Stops, VR, employer and labor sectors, etc. Help other systems understand employment and recovery Train housing staff on employment and recovery Use State purchasing power to support employment

104. Picturing a Champion Recognized leader �Big and small� picture knowledge Technical skills Community organizer Collaborator Familiar with and committed to issue and population Responsive Resources/resourceful Risk taker Passionate commitment Representative

105. Providing Services What are your challenges in providing effective, quality outcomes for job-seekers with psychiatric disabilities who are homeless? What strategies are you using to achieve those outcomes? What resources do you have and use to achieve those outcomes? What resources do you need to achieve those outcomes? What training opportunities would be especially important and useful?

106. Building Systems Who are your local partners? Describe the plan/steps for developing stakeholders for employment of people with psychiatric disabilities who are homeless What does each stakeholder, including employers and employment sectors, bring to the table that helps meet those outcomes? What challenges do you anticipate in developing partnerships and collaborations? What training, technical assistance and support do you need to develop and sustain these partnerships/collaborations?

107. �Culture-Capacity-Opportunity� What are the tools and activities you need to utilize to develop and/or improve the organizational Culture that supports employment in your agency, government unit, community and employment sectors? What resources and/or knowledge must you as a practitioner and your agency as a provider acquire to build your Capacity to implement employment? What Opportunities do you see to support and expand employment services, and how do you propose to address challenges that could impede your ability to take advantage of these opportunities? (e.g.: funding, public policy, local hiring plans, employer tax incentives, Medicaid, DMH initiatives, initiatives by other sectors (faith-based, DOL, etc.)