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Employment and Its Impact on Recovery Michael Boyle mboyle@fayettecompanies.org. Is Employment an Outcome of Recovery or Does Employment Facilitate Recovery? . Is Employment for Persons with SMI:. A stressor that should usually be avoided?

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employment and its impact on recovery michael boyle mboyle@fayettecompanies org
Employment and Its Impact on Recovery

Michael Boyle

mboyle@fayettecompanies.org

is employment for persons with smi
Is Employment for Persons with SMI:
  • A stressor that should usually be avoided?
  • A choice of persons with SMI to pursue regardless of the opinions of mental health professions who treat them?
  • A responsibility of citizenship that should be promoted?
what is individual placement and support model of supported employment

Goal of permanent competitive employment

  • Minimal screening for employability
  • Avoidance of pre-vocational training
  • Individualized placement instead of enclaves or mobile work crews
  • Time-unlimited support
  • Consideration of client preferences

What is Individual Placement and Support Model of Supported Employment?

A Working Life for People with Mental Illness.(2003) Deborah Becker and Robert Drake, Second Edition. Oxford University Press. Oxford, New York.

Bond, G. (1998). Principles of the individual placement and support model: Empirical support. Psychiatric Rehabilitation Journal, 22(1), 11-23.

slide5

What does IPS look like?

Requires full-time job coaches

Hard work

Complex but not complicated

Community context 80%

Team and office context 20%

1-1 with client f2f or phone 60%

Interdependent problem-solving

fidelity measures
Fidelity Measures
  • Caseload does not exceed 25
  • Employment specialists provide only vocational services.
  • Each vocational specialist carries out all phases of vocational services including engagement, assessment, job placement and follow-along supports.
fidelity measures7
Fidelity Measures
  • Integration of vocational services with mental health treatment
  • Employment specialists function as a unit/team
  • Zero exclusion criteria
  • Ongoing, work-based vocational assessment
  • Rapid search for competitive job
fidelity measures8
Fidelity Measures
  • Individualized job search based on job choices
  • Diversity of jobs developed that are in different settings
  • Jobs have permanent status rather than temporary or time-limited
  • Vocational specialists help persons find new jobs when one ends.
fidelity measures9
Fidelity Measures
  • Time-unlimited follow along supports
  • Community based services – 70% of time spent in community
  • Ongoing assertive engagement and outreach – ongoing encouragement
motivational interviewing
Motivational Interviewing
  • Based on Stage of Change theory
  • Weighs pros and cons of a change i.e. getting a job
  • Helps person identify discrepancies between life goals and behaviors
practices differentiating high performing from low performing supportive employment programs

Practices Differentiating High Performing from Low Performing Supportive Employment Programs

Gowdey, E.L., Carlson, L.S. and Rapp, C.A. Practices Differentiating High-Performing from Low Performing Supportive Employment Programs, Psychiatric Rehabilitation Journal, Vol. 26, No.3, 2003.Gowdey,E.L., Carlson, L.S. and Rapp, C.A. Organizational Factors Differentiating High Performing from Low Performing Supported Employment Programs, Unpublished Manuscript.

effective practices
Effective Practices
  • Exposure to supportive employment occurs during intake.
  • Case Managers initiate conversation about work.
  • Consumers are less fearful about working due to staff support of employment.
effective practices13
Effective Practices
  • De-emphasis on pre-vocational services.
  • Ensuring vocational assessment happens rapidly.
  • Rapid approval of vocational services and strong relationship with State vocational rehab services.
  • More comfort of staff in allowing disclosure of mental health problems.
effective practices14
Effective Practices
  • More direct contact with perspective employer on behalf of a specific client.
  • More frequent contact with employers on an ongoing basis.
  • Consumers perceive a high degree of ongoing support after starting a job.
  • Consumers view their work environment as helpful and flexible.
organizational factors
Organizational Factors
  • Program leaders emphasize the value of work in people’s lives and the belief that people can work.
  • Program leaders emphasize strength-based practices.
  • Program leaders use vocational data to guide programming and practice.
  • Staff do not view stigma as a barrier to employment
organizational factors16
Organizational Factors
  • Staff believe persons have a desire and motivation to work.
  • Stories are shared that reflect belief in the ability of individuals to succeed in the world of work.
  • SEP staff and case managers work as a team with a high degree of collaboration.
organizational factors17
Organizational Factors
  • Case managers support individual’s employment interests and vocational progress.
how to implement the ips principles

posters, graphs, cork boards, resource room with computers/fax/phone, networking, simple vocational plans, communicate with family and mental health team, team meetings, speed-dial mentality, job shadows, job clubs, simple questionnaires, generic job application, on the job evaluations, job satisfaction questionnaires, performance evaluations, natural supports, follow up plans

How to implement the IPS principles

outcomes
Outcomes
  • 110 persons have obtained employment
  • 33 are currently working
  • 194 different jobs have been obtained
  • 5 have obtained health benefits through their employer
the beginning
The beginning
  • Five year grant from US Dept. of Labor’s Office of Disability Employment Policy
  • One of three Olmstead Action grants awarded in 2003
  • Training and Evaluation from the Center for Psychiatric Rehabilitation
intensive training
Intensive Training
  • Supervisor, job developer and 7 job coaches (two primary consumers)
  • All new staff except for supervisor
  • Ten days of IPS/MI training from CPR staff
  • Two days benefits training from Health and Disability Advocates and DRS Benefits Planning and Outreach
advisory committee
Advisory Committee
  • Primary consumers
  • Advocates – NAMI & GROW
  • One Stop Vocational Center
  • DMH staff
  • DRS state and local staff
  • Local Workshop
  • Center for Independent Living
partnering with one stop job center
Partnering with One Stop Job Center
  • SEP staff trained on resources available and their use
  • Job coaches assist consumers in utilizing the resources at One Stop employment center for resume development, interest inventories and job searches
  • Purchase of software for development of math and reading skills and software licenses for “international computer licenses”
  • Job clubs conducted at One Stop by SEP staff
early surprise
Early Surprise

Employers were very receptive to hiring persons with serious mental illness when visited by job developer.

Only two of over 100 “slammed door”.

problems encountered
Problems Encountered
  • Problem: Clients not having phone number for job applications
  • Solution: Phone line at staff office with answering machine having generic “leave a message”. Staff check for messages and contact client.
problems encountered29
Problems Encountered
  • Problem: Clients lack funds for needed expenses for beginning work when hired
  • Solutions: Establish revolving fund for minor expenses such as hair cut, bus passes. Rapid opening with DRS for expenses that are more costly i.e. fork truck license.
problems encountered30
Problems Encountered
  • Problem: Client and family fear of losing benefits.
  • Solution: Partnership with DRS Benefits Outreach and Planning project. HSC staff work with consumer to complete background information and obtain SSA information. BPAO specialist completes individual analysis detailing impact of perspective earnings on benefits and available options to retain benefits.
problems encountered31
Problems Encountered
  • Problem: early resignation from jobs due to fear of poor performance/firing.

Not contacting job coach before quitting

  • Solution: “Over-teaching availability of ongoing support. Contingency management for contacting job coach during first week of employment

Cell phone numbers given to clients

problems encountered32
Problems Encountered
  • Problem: culture change from protection to empowerment. Case management staff “sabotaging” employment:

-”It will be too stressful for you”

-”Only work part-time”

-”Start at a workshop first”

-” You tried this before and it did not work”

problems encountered33
Problems Encountered
  • Solutions:
  • Continued education of all staff on IPS model and research findings
  • Set organizational goal of 50% of clients employed in five years

- Management intervention for those not willing to change

problems encountered34
Problems Encountered
  • Problem: Clinical teams not integrating job coaches with their work.
  • Solutions:

-Mandate joint meetings between job coach, case manager and client during first two weeks of IPS involvement.

-Brochure to all staff outlining IPS services and expectations

-Job coaches attend full case management team meetings.

problems encountered35
Problems Encountered
  • Problem: More referrals needed
  • Solutions: Developed brochures for both staff and clients describing SEP services; monthly “marketing” meeting for consumers; encouraging referrals from peer mentors.
problems encountered36
Problems Encountered
  • Problem: DPA rule that persons in LTC facilities may only retained $55 of monthly earnings resulting in disincentive to work and inability to save for moving.
  • Solution: Legislative change, pilot study, and NOW A LAW SUIT!
next steps
Next Steps
  • Cognitive training for those who have lost jobs - Mueser and McGurk study
  • Compensatory training and adaptation on the job
  • Engage in supportive employment combined with Illness Management and Recovery at intake for new admissions.
  • Supportive Education
slide38

What are some resources?

www.samhsa.gov Evidence Based Practices Resource Kits

www.bhrm.org Clinical Guidelines/Mental Health

Bissonnette, D. (1994). Beyond Traditional Job Development

Work as a Priority. (2003). U.S. Department of Health and Human Services.

Psychiatric Rehabilitation Journal. (Spring 2004). Volume 27 Number 4.