EMPLOYMENT For People with Psychiatric Disabilities

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EMPLOYMENTFor People with Psychiatric
Disabilities

• Deborah R. Becker
• Dartmouth Psychiatric Research Center
• Region III - CRP-RCEP
• April 5, 2006

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Traditional Vocational ServicesTypical Features

• Stepwise Training or sheltered work first
• Work readiness criterion Clients screened for
  placement
• Brokered Different agencies provide vocational
  and mental health services
• Short-term Services reduced when job is found

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Competitive Employment for People with Serious
Mental Illness

• Say they want to work 70
• Are currently working lt15
• Current access to supported employment lt5

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Definition of Supported Employment

• Mainstream job in community
• Pays at least minimum wage
• Work setting includes people who dont have a
  disability
• Service agency provides ongoing support
• Intended for people with most severe disabilities

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Definition of Competitive Employment

• Pays at least minimum wage
• Integrated community setting
• Owned by the worker
• Not set aside for people with disabilities

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Evidence-Based Practice

• Program model validated by rigorous research
  (different investigators)
• Has guidelines describing critical components
• Has a treatment manual

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Primary Evidence for Supported Employment

• 5 day treatment conversion studies
• 13 completed randomized controlled trials
• 3 correlational studies of work and program
  implementation

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Competitive Employment Rates in 12 RCTs of
Supported Employment
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Conclusions Randomized Controlled Trials of
Supported Employment

• In 13 of 13 studies, SE had significantly better
  competitive employment outcomes than controls
• Mean across studies of consumers working
  competitively at some time
• 60 for supported employment
• 22 for controls

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Long-Term Follow Up

• 3 supported employment research studies - 8-12
  years
• Similar findings
• Most worked for pay
• Current jobs were mostly competitive
• People held multiple jobs over time

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Positive Outcomes from Competitive Work

• Higher self-esteem
• Better control of psychiatric symptoms
• More satisfaction with finances and with leisure
• (Bond et al., 2001)

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What Does Supported Employment Cost?

• Some programs, 2,000-4,000 per client per year
  (Clark, 1998).
• Latimer (2004) 2,449 per full-year equivalent
  client.
• Figures vary according to severity of disability,
  local wages of employment specialists, caseload
  sizes, and how much indirect costs and costs of
  clinical services are included.

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Evidence-Based Principles

• Eligibility is based on consumer choice
• Personalized benefits planning is provided
• Supported employment is integrated with treatment
  
• Competitive employment is the goal
• Job search starts soon after a consumer expresses
  interest in working
• Follow-along supports are continuous
• Consumer preferences are important

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Job Preferences Are Important
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Competitive Jobs

• Landscaper
• Machine Operator
• Photographer
• Receptionist
• Reporter
• Sales Clerk
• Security officer
• Welder

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More Competitive Jobs

• Bakers assistant
• Childcare Worker
• Data Entry
• Deli Meat Cutter
• Grocery Bagger/Carriage Attendant
• Housekeeper
• Dishwasher

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Role of Practitioners

• Provide encouragement and support - foundation
  for realizing potential
• Point out strengths and gifts - translate into
  job opportunities
• Coordinate clinical and vocational services

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More Roles

• Problem solve employment needs
• Be positive
• Develop transportation plan
• Help obtain supplies/equipment for job
• Assist with 2 forms of ID, applications,
  researching jobs and businesses

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More Roles

• Help plan good job matches
• Help people manage their illnesses
• Help people manage substance use
• Help people manage interpersonal issues on job
• Provide follow-along support

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Role of Employment Specialists

• Engage people
• Listen
• Be respectful
• Promote self efficacy
• Develop vocational profile
• Assist consumer with employment plan

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More Roles

• Ensure access to benefits counseling
• Discuss disclosure (ongoing)
• Job search
• Employer education
• Job support
• Team player

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Role of Supervisor

• Monitor job matches
• Partner in job search
• Teach skills
• Use outcomes -oriented supervision

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Role of Consumers

• Develop your work plan
• Access comprehensive benefits counseling
• Identify job choices
• Participate in job search
• Connect with working peers
• Update support plan

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Collaboration with Vocational Rehabilitation

• Overcome system differences
• Learn each others system
• Define roles
• Serve together

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VR Services

• VR counselors
• purchase services
• arrange services from other agencies
• provide guidance and counseling

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VR Services

• Training
• Situational assessment
• Job shadowing
• Job-related equipment, supplies
• Tuition
• Placement
• Planning
• Support

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Role of Employers

• Hire qualified employees
• Learn ways to support employees
• Communicate with employment specialist
• Tell other employers about untapped workforce

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Mental Health Agencys Role

• Employment is an agency goal
• Employment is viewed as part of quality of life
• Agency demonstrates importance of employment
• Culture of recovery

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Key Factors in Implementation

• Build Consensus
• Maximize Financing
• Examine Agency Philosophy
• Identify Leadership
• Key on Organizational Structure
• Provide Ongoing Training
• Make Time Commitment
• Track Process and Outcomes

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SE Fidelity

• Staffing
• Caseload Size
• Vocational Services Staff
• Vocational Generalists
• Organization
• Integration of Rehab. MH Treatment
• Vocational Unit
• Zero Exclusion Criteria

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SE Fidelity cont.

• Services
• On-going Work-based Assess.
• Rapid Job Search
• Individualized Job Search
• Diversity of Jobs
• Permanence of Jobs

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SE Fidelity cont.

• Services
• Jobs as Transitions
• Follow-along Supports
• Community-based Services
• Assertive Engagement and Outreach

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What About Supported Education?

• Consumer choice always a primary consideration
• Education and training expand options
• SE program should help consumers enroll in
  community programs (GED classes, colleges,
  technical schools)

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Resources

• Dartmouth Vocational Publication List
• karendunn_at_dartmouth.edu
• 603-448-0263

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More Resources

• A Working Life for People With Severe Mental
  Illness-Becker and Drake, Oxford University
  Press, 2003
• Supported employment resource kit
  Mentalhealth.samhsa.gov

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Summary

• People with severe mental illness can work in
  competitive employment
• Programs following evidence-based principles of
  supported employment have better outcomes
• Programs must address implementation factors to
  be successful