6/14/2017. The Day the Voices Stopped. Do Your Clients Have to Work? If you think working is stressful and demanding, try unemployment.

Transcription

1 The Individual Placement and Support(IPS) Model of Supported Employment(SE) in Texas Texas Behavioral ln.5titute Presented by Harry Cunnfogham, The Mentill Health Center of Greater Manchester (MHCGMI, Manchester NH The Day the Voices Stopped "I feel so strongly about the need to be given meaningful work instead of the makebusy tasks or rote assignments that make up the bulk of what we are offered. If people are treated as capable, they often surprise everyone and live up to expectations." Ken Steele Do Your Clients Have to Work? If you think working is stressful and demanding, try unemployment. (A consumer in Kansasl 1

2 Why is Work Important? Recovery and the Desire to Work Income Status Connect to one's family and community Meaning How Important is Work? Is it as important as medication services? - Medication is critical to manage symptoms - Work is critical to have a life worth living Most people want to work Traditional Vocational Model: Train-Place Model Assumes that mentally ill clients need to be protected from the stress of work Often requires long testing and assessment to identify gaps in job "readiness" Stresses the learning of social and work behaviors to prepare to work Led to working apart from non-disabled 2

3 Main Objections to this Model Artificial preparation to work Reinforce the stigma of mental illness Identity of mental illness reinforced We lost a lot of clients along the way Supported Employment: Place-Tra in Model Rapidly place people with psychiatric disorders in real-world settings Allow them to experience the benefits, as well as the challenges of these situations Provide the necessary t raining and support to successfully maintain these placements. Evidence Based Practice Program models validated by rigorous research. Has guidelines describing the critical components. Has treatment manual. 3

4 Robert Wood Johnson Consensus Panel Cross representation in all areas of MH Five core services (EPBs) -Symptom Mgt. and Recovery(JMR) - Drug and Alcohol Abuse (IDDT) - Family involvement (FPE) - Assertive outreach for those most at ris I< (AC rj - Competitive employment (EBSE) Conclusions of 22 Randomized Controlled Trials of Supported Employment In 22 of 22 studies, SE had significantly better competitive employment outcomes than controls Mean across studies of consumers working competitively at some time: -56% for supported employment -24% for controls Competitive Employment Rates in R~~4.9.m_µ;e,4. ~.<>n,trnllec:j. I:ri~I~_<>f.Jf.S. I,. l..," J JI Ut11 4

5 Positive Outcomes from Competitive Work Better control of psychiatric symptoms Higher self-esteem More satisfaction with finances and with leisure (Bond et al., 2001) 8 Practice Principles of Supported Employment 1. Eligibility is Based on Consumer Choice Services are provided to consumers who identify themselves as being interested in competitive employment Consumers are not excluded from Supported Employment services because of severity of symptoms, substance use or recent hospitalizations 5

6 Open Referral to SE Two requirements to receiving SE services: Severely mentally ill Desire to work in competitive employment No exclusions because of Supported Employment Is Integrated with Mental Health Treatment Employment specialists coordinate services with the mental health treatment team, (for example, case manager, therapist, psychiatrist, etc.) 3. Competitive Employment Is the Goal The agency needs to devote sufficient resources to supported employment to permit full access to Supported Employment services for all consumers who seek competitive employment Consumers interested in employment are not steered into day treatment or sheltered work. 6

7 Mainstream job in the community Pays at least minimum wage Work setting includes people who are not disabled Intended for people with most severe disabilities Service agency provides ongoing support 4. Personalized Benefits Counseling is Provided Benefits planning and guidance help consumers make informed decisions about job starts and changes. Work Incentives/Benefits Counseling The most critical reason that people are reluctant to consider employment Good access to good information Necessary to make choices Needed early on and at critical periods Families might be affected by a job return Nothing worse than lousy, outdated info 7

8 5. Job Search Starts Soon After A Consumer Expresses Interest In Working Pre-employment assessment, training, and counseling are not required for consumers and are kept to a minimum 6. Follow-Along Supports Are Continuous Employment Specialists continue to stay in regular contact with the consumer and (when appropriate) the employer without arbitrary time limits. 7. Consumer Preferences Are Important Job finding is based on the consumer's individual preferences, strengths, and work experiences, not on a pool of jobs that are available. 8

9 8. Employment Specialists Build Relationships with Employers Learning about needs and preferences of each employer Not just a quick focus on job openings Employer as another customer who they will work with over time Putting the Principles into Practice Engaging Clients into SE Help clients to explore Work Incentives Counseling/Benefits Counseling Stages of Change as it applies to Work; particularly Motivational Interviewing skills 9

10 Assessment: The Voe Profile Meet at least several times with the client, family/supporters, team members: timely Hopes for future em pl oym ent - Dream job, Long-term career goa's - What job now? Preferences, skills, strength's, challenges, past work hx, context they could work, current life, networking potential Summarize all of this into a Voe Profile It is a never finished process A Strength-Based Approach t ~- People with severe and persistent mental illness" 1! can learn, grow and change. The focus of the helping process is upon the I consumer's strengths, interests and abilities, not upon their deficits or pathology. [ P!½'P,le--who-a,ye, ~ W\I ZbJIA'lfl"h.Gwe,~~ d,,-eam,.v. 1ney ~their ft"re+1ffdw I to-~ their ~ lra.t'lhr\,..! ~ Disclosure ADA "reasonable accommodations to the known... mental limitations of otherwise qualified individual It is often a gamble; will they know or not? Most clients pick non or selective disclosure Many decisions; when, to whom, how much information to disclose? The decision affects the SE services What are the pros and cons of disclosure? 10

11 The Employment Plan The overall employment goal in client's own words Behavioral objectives (outline of how to meet the employment goals) Specific people, services, and supports (to help achieve the objectives) Time frames for meeting the objectives A "living" plan The Job Search Generally starts within 30 days of referral Disclosure decision informs the worker's role - Active role or behind the scenes? Whole team needs to participate Decision whether to include VR Job Development Prepare to present yourself and your clients Cold calls, planned calls Approach the "right" person Learn about the employer - Ahead of ti me if possible - Develop obligations Get th em to talk; open ended questions - End with clear follow up with employer 11

12 Maintaining Jobs: Follow Along Supports {Cont.) Categories of support - Emotional support - Support in the workplace - Natural supports - Skills training and prob;em-solving\ - Supports to employer - How often to provide supports? Ma king the most out of a job ending Career development Job Support Group Peer support Education Spirituality Outside speakers Networking Problem solving Building motivation Format? - How often - Drop in or closed? - Employed oniy? SE Team Supervision minutes of admin issues including who got and lost jobs, client issues 30 minutes of a single client presentation on a rotating basis - Pose question to team: How can we help? - Basic client bacicground, progress to date - Problem solvir.g session usi~g problem-solving moaei 12

13 Gaps in Employment Many people at some point have gaps -School, child raising, illness, accident, laid off, - More than a year away may need explained Being up front & honest is best, but brief Cover letter to accompany resume/app7 Once in interview, another chance to explain NH Voe. Rehabilitation and M H Relationship You tell me what it is for your area It's their job too so we look for common ground - They have resources we dol"?'t have They require milestones a~d paperwork for payment Ideal is a collaboration - For example: VR person embedded in M H office - VR person attends some SE or treatment mtgs - Discuss shared clients Smart referrals from us - Ma ~e it easy for VR Criminal Record Disclosure Ethical dilemma for the employment specialist Criminal record check - Know what employer wi!i see - Sexual offender, abuse & neglect Annulment of criminal record 13

14 Criminal Record Upside Places that don't do checks Employers that are willing - Want to help - Like the support that comes along WOTC-Work Opportunity Tax Credit Federal Bonding Helping people with Co-Occurring Disorders to Work Traditionally excluded Work can motivate some people to manage SA Jobs and some worksites can support sobriety/harm reduction We need to be in for the long-term How to manage$ made? Cue for many Sometimes firm limit setting needed Textbook: SE Resources A Working Life for People with SMI, Becker, D.R., Drake, R. E., Oxford Press (2003 Manuals: Supported Employment: A Practical Guide far Practitioners and Supen,isors (Swanson, S.J., Becker, D.R. 2"" Edition 1013) - Sections on VR coll a bar ation, supervision, fidelity to the model, SA and SE, etc. (Purchase through Dartmouth College) Supported Employment: Training Frontline Staff Center for MH Services, Free at: Supported Employment: Applying the Individual Placement and Support (/PS} Madel to Help Clients Compete in the Workforce. Hazelden