SUPPORTED EMPLOYMENT

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SUPPORTED EMPLOYMENT

• EVIDENCE-BASED PRACTICE
• Training for Practitioners

2
Competitive Employment for People with Severe
Mental Illness

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

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What Is Evidence-Based Practice?

• A practice validated through rigorous research
• Has guidelines describing critical ingredients
• Ideally, has been successfully implemented in a
  wide range of settings

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Definition of Supported Employment

• Mainstream job in community
• Pays at least minimum wage
• Work setting includes people who are not disabled
• Service agency provides ongoing support
• Intended for people with most severe disabilities

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Evidence-Based Principles

• Eligibility is based on consumer choice
• 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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Eligibility Is Based on Consumer Choice

• No one is excluded who wants to participate.
• Consumers are not excluded because they are not
  ready or because of prior work history,
  hospitalization history, substance use, symptoms,
  or other characteristics.

7
Supported Employment Is Integrated with Mental
Health Treatment

• Employment specialists coordinate plans with the
  treatment team, which includes case managers,
  therapists, and psychiatrists.

8
Do Client Characteristics Predict Success in
Supported Employment?
Valued Gateway Client Inserted slide

• Co-occurring substance use does not lead to lower
  employment rates.
• Consumers generally do better in supported
  employment than in alternative programs
  regardless of background characteristics such as
  
• gender, education, ethnicity, diagnosis,
  hospitalization history, cognitive functioning

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Competitive Employment Is the Goal

• The agency needs to devote sufficient resources
  to supported employment to permit full access to
  all consumers who seek competitive employment.
• Consumers interested in employment are not
  steered into day treatment or sheltered work.

10
Job Search Starts Soon After A Consumer Expresses
an Interest in Working

• Pre-employment assessment, training, and
  counseling are kept to a minimum.

11
Follow-Along Supports Are Continuous

• Supported employment staff continue to stay in
  regular contact with consumer and (when
  appropriate) the employer without arbitrary time
  limits.

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Consumer Preferences Are Important

• Job finding is based on consumers preferences,
  strengths, and work experiences, not on a pool of
  jobs that are available.

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Supported Employment UnitRecommended Basic
Structure

• Minimum of 2 full-time staff
• Staff devoted exclusively to SE
• Full-time leader/supervisor who also provides
  employment services
• Offices physically located in mental health center

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Supported Employment Unit

• Individual caseloads, but help each other (with
  job leads, etc.)
• Caseloads of about 20 consumers or less
• Weekly team meetings individual supervision

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Roles of an Employment Specialist

• Problem-solver
• Team player
• Networker
• Employment specialist
• Customer-oriented
• Community-oriented
• Outcome-oriented

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Characteristics of Effective Employment
Specialists

• High energy
• Optimistic
• Likes to meet new people
• Good listener
• Knows the community
• Creative
• Projects confidence and professionalism

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Employment Coordinator Duties

• Manages referrals
• Hires and supervises employment staff
• Ensures employment specialists are learning and
  using effective skills in
• Engagement Assessment
• Job development Job support

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More Employment Coordinator Duties

• Role model good employment practices
• Provide supported employment information and
  training to all staff
• Ensure employment services are integrated with
  treatment teams

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Referral

• Make referral process simple!
• Have minimal eligibility criteria
• Unemployed (or working non-competitively) and
  wants competitive employment, or
• Employed, but not receiving employment supports,
  and wants such support
• Involve multiple stakeholders

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Collaboration With Vocational Rehabilitation
Valued Gateway Client What about the
collaboration? This slide is not very informative

• VR counselor meets consumers at mental health
  agency
• VR counselor is part of the treatment team
• VR counselor conveys same message as rest of team

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Engagement

• Build trusting, collaborative relationship
• Assume contacts are mostly outside mental health
  setting
• Maintain ongoing contact
• Involve family, treatment team, and other
  supporters

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Vocational Profile

• Gather comprehensive information from variety of
  sources over 1-2 weeks
• Consumer
• Family, friends
• Former employers
• Treatment team

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Disclosure of Psychiatric Status

• Disclosure is the consumers choice
• Nature of disclosure
• When to disclose?
• How much to disclose?
• Who to disclose to?

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A Vignette Gloria

• Gloria, I dont want my boss to know that I have
  a mental illness. I will be treated
  differently.
• What would you, the employment specialist, say?

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Benefits Counseling

• Fear of losing benefits is major barrier to
  employment
• Concerns of consumers and families often
  underestimated by clinicians
• Rules and regulations are complicated
• Benefits counseling provides consumer-specific
  information

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A Vignette Paul

• Paul, I dont know what I want to do.
  Maintenance work would be okay. I will do
  anything. I want to make money.
• What would you, the employment specialist, say?

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Employment Plan

• Explore jobs by visiting work sites
• Develop employment plan
• Revise assessment and employment plan based on
  consumers experiences

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Job Search

• Begin soon after referral
• Employer contacts within 1 month
• Preparatory work
• Resumé
• Job application
• Two forms of identification
• Practice interviewing
• Release of information

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Individualized Job Search

• Base on consumers preferences, strengths,
  abilities, experiences, and deficits (e.g.,
  substance use)
• Seek
• Permanent competitive jobs
• Diverse jobs suiting individual consumers
• Different settings

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Ways to Find Jobs

• Identify leads primarily through networking
• Include family and treatment team
• Attend job fairs
• Use Chamber of Commerce and community
  organizations (e.g., Rotary Club)

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More Ways to Find Jobs

• Newspaper (However, lots of others seeking same
  job)
• Internet
• Previous employers
• Tell everyone you meet
• Track contacts
• Stay persistent

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Engaging Employers

• Present confidently and professionally
• Help solve employer problem
• Recommend qualified applicant
• Respect employers time
• Identify next step Meet job candidate?
• Be dependable Do what you say you will do

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Job Support

• Individualized and time-unlimited support
• Mostly away from work site
• Include consumers support network (treatment
  team, family, friends, employer, coworkers)
• Negotiate accommodations with employer

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Common Job Accommodations (MacDonald-Wilson, 2002)

• 37
• 26
• 21
• 16

• Cognitive (e.g., learning job, concentrating)
• Social (e.g., interacting, reading social cues)
• Emotional (e.g., managing symptoms, tolerating
  stress)
• Physical (e.g., stamina)

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Job Endings

• Each job viewed as learning experience
• Job transitions are considered normal
• With a job loss, consumer and entire (SE and
  treatment) team strategize for next step

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A Vignette Marguerite

• Marguerite worked for three weeks at a dry
  cleaners. She was let go because of slow work
  speed.
• What would you, the employment specialist, say?

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Community-Based Services

• Employment specialists in community gt 50 time
• Best way to contact consumers, families,
  employers
• Services do not generalize well to different
  settings
• People reveal more about who they are outside of
  the agency

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Time Management

• Focus on spending time with a few consumers
  nearing employment vs. meeting everyone each week
• Take phone book, cell phone, maps, newspapers,
  address book if possible when job developing
• Review daily/weekly schedule with supervisor

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The Dreaded Paperwork

• Comes with territory
• As much as feasible, supervisor protects staff
  from busy work
• Important paperwork
• Vocational profiles
• Employment plans
• Fidelity checks on
• program implementation
• Monitoring outcome

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Track Outcomes

• Track employment outcomes monthly
• Set goals 40 rate of competitive employment is
  achievable
• Things that you pay attention to are more likely
  to be improved

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Track Implementation

• Use 15-item SE Fidelity Scale to measure
  implementation of evidence-based practice
• Staff in supported employment program can see if
  they are on track
• Basis for giving objective feedback

43
Hartford Study Stable and high fidelity over
time after short start-up
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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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What About Dual Diagnosis and Work?

• Work to support sobriety
• Money as a cue
• Same SE process

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Motivation and Work

• State vs. trait
• Hopelessness as part of illness
• What has been offered?
• Program norms
• What ES and practitioners say
• What does consumer want?
• Change over time

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Problem Solving

• What does consumer want?
• Are SE principles being followed?
• Is leader ensuring staff has skills to implement
  supported employment?
• Have training and resource materials been
  utilized?

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Summary

• Programs following evidence-based principles of
  supported employment have better outcomes
• Effective employment coordinators are key to good
  implementation
• Resource materials complement training and
  supervision