Cathy O'Toole

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Integrated Employment Project Specialist
Disability Employment Network Mental Health
Cathy O'Toole
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Presentation Overview

• About Advance Employment Inc.
• Integrated Employment Project Evidence Based
  Practice
• Service Delivery Model

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About Advance Employment Inc.

• A Disability Employment Network (DEN) member 4
  STAR Rating
• Specialising in Mental Health in the Townsville
  region (Qld, Australia).
• Funded by the Department of Education, Employment
  and Workplace Relations (DEEWR).

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Where is Advance Employment?
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Townsville
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Townsville
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Townsville
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Staff
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Mental Health Employment What are your thoughts?
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Mission Statement

• Advance Employment will promote encourage,
  assist and support job seekers to improve their
  mental health in order to achieve meaningful,
  open employment through employment related
  opportunities.

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Mental Health vs Mental Illness

• Mental health focuses on emotional well-being,
  the capacity to live a full and creative life,
  and the flexibility to deal with life's
  inevitable challenges.
• Mental Illness focuses on negative symptoms and
  personal deficits.

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What is Mental Health?

• Dr William Glasser, 2003 defines mental health or
  happiness as
• enjoying the life you are choosing to live,
  getting along well with the people near and dear
  to you, doing something with your life you
  believe is worthwhile, and not doing anything to
  deprive anyone else of the same chance of
  happiness you have.

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Organisational Culture

• Little distinction between management, staff and
  job seekers, other than to respect individuality
  and remember who is the job seeker and who is the
  service provider.
• See past disability/label/diagnosis and focus on
  the value strengths of the human being.
• Treat job seekers with dignity respect at all
  times
• Resist making value judgements
• Nurture job seekers to foster self value and
  belief
• Educate regarding rights and responsibilities
• Provide appropriate empowering opportunities to
  encourage facilitate educated informed choices

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Communication Strategy

• Communicating to convey information i.e.
  listening with curiosity an open mind when it
  is not your turn to talk henceconversing-to-conv
  ey. 
• Resist communicating with the emphasis on
  convincing the other that you are right hence..
  the goal is to convince - to be right. 
• Thom Rutledge 2002

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Direction Statement 1

• Create partnerships across industry sectors
  within the local labour market to maximise open
  and meaningful employment opportunities for Job
  Seekers.

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Direction Statement 2

• Create a quality organisation, by maintaining
  improving core business, professional development
  and empowerment opportunities within the
  organisation.

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Direction Statement 3

• Create collaboration across mental health
  services to provide maximum opportunities to
  assist job seekers to achieve their employment
  and life goals.

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Direction Statement 4

• Ensure that the management structure meets the
  growth requirements of the organisation using a
  lead management approach.

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Employment Assistance Outcomes
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Employment Maintenance Outcomes
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Integrated Employment Project

• How competitive/open employment facilitates
  recovery
• Reduces stigma and marginalisation
• Reduces disabilities secondary to the illness
• Helps people reclaim a valued place in society
• Few other things can be done for 8 or more hours
  a day
• Strengthens self-efficacy and self esteem
• Validates recovery progress through real
  measurable accomplishments
• Increases opportunities for positive regard from
  others
• Greater opportunities for social inclusion and
  acceptance by the wider community
• Geoff Waghorn Meredith Harris (QCMHR University
  of Queensland)

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Integrated Employment Project
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Integrated Employment Project

• Psychiatric Disabilities are the most challenging
  for Disability Employment Services (DEN)
• Australian DEEWR unpublished data 2006
• Of the 12 disability categories assisted by DEN,
  psychological/psychiatric had the poorest job
  retention
• 25 of workers with psychological/psychiatric
  disabilities accumulated 26 weeks of employment
• 35 of all DEN workers attained this milestone
• Geoff Waghorn Meredith Harris QCMHR

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Integrated Employment Project

• What works best for people with mental health
  conditions...
• Most effective approach targeting individual
  career development is the Drake-Becker Individual
  Placement and Support approach (SE-IPS)
• SE most similar to DEN services in Australia and
  New Zealand
• Evidence includes 6 day treatment conversions and
  16 Random Control Trials (RCTs)
• RCTs are the strongest scientific design for
  evaluating whether an intervention works
• 16 qualifying RCTs to date
• 12 in USA
• 1 in Hong Kong
• 1 in Canada
• 1 in Europe (6 European Countries)
• 1 in Australia (in press with BJP)
• Geoff Waghorn Meredith Harris QCMHR

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Integrated Employment Project

• 7 Evidence-Based Principles
• Eligibility is based on consumer choice
• Supported/Open Employment is integrated with
  treatment
• Competitive employment is the goal
• Rapid job search (within 4 weeks)
• Job finding is individualised
• Follow-along supports are continuous
• Financial planning is provided
• Geoff Waghorn Meredith Harris QCMHR

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Integrated Employment Project
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Integrated Employment Project

• Implications for Australian service development
• Australian DEN services characterised by...
• Segregation from mental health treatment and care
• Difficulty with zero exclusion
• Difficulty with rapid job search
• Difficulty with financial counselling
• Demand often exceeds places available
• Otherwise a highly suitable type of service for
  people with severe mental health conditions
• Geoff Waghorn Meredith Harris QCMHR

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Advance Employment Kirwan
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Service Delivery Model

• Choice Theory
• Reality Therapy
• Lead Management
• Service delivery that is focussed on encouraging
  and teaching job seekers the skills required to
  interact effectively meaningfully within
  relationships.

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Reality Therapy Application Interview

• Current World
• How do you see your life at this point in time?
• What is your current situation?

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Reality Therapy Application Interview

• Quality World
• Who are the people that are important in your
  life?
• What are things, activities or events that are
  important in your life?
• What is a belief that you hold?

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Reality Therapy Application Interview

• What do you want?
• How would you like your life to be? (work or
  personal)
• What would this mean to you?
• What difference would this make for you?
• How do you see me/Advance Employment helping you
  to move forward?

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Reality Therapy Application Interview

• What are you Doing?
• What does a day look like for you?
• Who is someone that you can get to support you?
• Where do you go for fun enjoyment?

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Reality Therapy Application Interview

• Is what you are doing getting you what you want,
  or taking you in the direction that you want to
  go?
• ? Yes ? No
• If Yes how?
• If No What would you need to do things
  differently?

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Reality Therapy Application Interview

• Are you willing to do something else?
• Yes ? No
• What would that be?
• What is your first step?
• Where will this take you?
• What is your Plan?

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Choice Theory

• Choice theory states that
•  All we do is behave,
• That almost all behaviour is chosen, and
• That we are driven by our genes to satisfy 5
  basic needs
• Survival
• Love and Belonging
• Power
• Freedom
• Fun
• The most important need is love and belonging, as
  this is a requisite for satisfying all of the
  needs.
• Dr William Glasser The William Glasser
  Institute
• The greatest power that a person possesses is the
  power to choose!
• J. Martin

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5 Basic Needs Employment

• Survival Somewhere to live, something to eat,
  money personal safety
• Love Belonging Connectedness with work
  colleagues, friends family and being a part of
  something meaningful
• Power Recognition, appreciation purpose
• Fun Continued growth, learning enjoying life
• Freedom Choice of job/home, decision making
  skills independence
• Dr William Glasser The William Glasser
  Institute

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Choice Theory

• 7 Caring/Connecting Habits
• Supporting
• Encouraging
• Listening
• Accepting
• Trusting
• Respecting
• Negotiating differences
• Dr William Glasser The William Glasser
  Institute

• 7 Deadly/Disconnecting Habits
• Criticizing
• Blaming
• Complaining
• Nagging
• Threatening
• Punishing
• Bribing, rewarding to control

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10 Axioms of Choice Theory

• The only person whose behavior we can control is
  our own.
• All we can give another person is information.
• All long-lasting psychological problems are
  relationship problems.
• The problem relationship is always part of our
  present life.
• What happened in the past has everything to do
  with what we are today, but we can only satisfy
  our basic needs right now and plan to continue
  satisfying them in the future.
•  Dr William Glasser The William Glasser
  Institute

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10 Axioms of Choice Theory

• We can only satisfy our needs by satisfying the
  pictures in our Quality World.
• All we do is behave.
• All behaviour is Total Behavior i.e. Acting,
  Thinking, Feeling and Physiology.
• All Total Behavior is chosen we have direct
  control over acting and thinking. Feeling and
  physiology is controlled indirectly through
  chosen actions and thoughts.
• All Total Behavior is designated by verbs e.g.
  not he made me unhappy but I am choosing
  unhappiness
• Dr William Glasser The William Glasser
  Institute

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Reality Therapy

• Reality Therapy is
• A method of counselling/interviewing based on
  Choice Theory and is aimed at helping individuals
  gain more effective control over their lives.
• The process of developing effective counselling
  and management skills.
• Based on the belief that we all choose what we do
  with our lives and that we are responsible for
  these choices.
• Responsibility is defined as learning to choose
  behaviours that satisfy ones needs and, at the
  same time do not deprive others of a chance to do
  the same.

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Reality Therapy

• Reality Therapy is used to work with Job Seekers
  to...
• Focus on the present - avoid discussing symptoms
  and complaints
• Focus on what the job seeker can do directly -
  act and think.
• Avoid criticizing, blaming and/or complaining
• Remain non-judgmental and non-coercive
• Teach the job seeker that legitimate or not,
  excuses stand directly in the way of their making
  needed connections
• Focus on specifics
• Help the job seeker to make specific, workable
  plans to reconnect with the people they need, and
  then help self evaluation of progress
• Be patient and supportive but keep focusing on
  the source of the problem - the disconnectedness

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Lead Management

• Encourages honest discussion regarding both
  quality and the cost needed for the organisation
  to be successful.
• Models expected outcomes from the top down and
  the bottom up.
• Understands that the individual knows best what
  high quality work is and how to produce it at the
  lowest possible cost.
• Teaches that the essence of quality is continual
  improvement.

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Questions
?