Integrating%20Employment%20Services%20with%20Community-Based%20Clinical%20Programs:%20Lessons%20Learned%20from%20the%20Ways%20to%20Work%20Demonstration%20Project - PowerPoint PPT Presentation

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Integrating%20Employment%20Services%20with%20Community-Based%20Clinical%20Programs:%20Lessons%20Learned%20from%20the%20Ways%20to%20Work%20Demonstration%20Project

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New York Work Exchange. 1 ... the implementation of the Ways to Work Demonstration. Why implement the Ways to Work Project? Immediate and more long-term goals ... – PowerPoint PPT presentation

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Title: Integrating%20Employment%20Services%20with%20Community-Based%20Clinical%20Programs:%20Lessons%20Learned%20from%20the%20Ways%20to%20Work%20Demonstration%20Project


1
Integrating Employment Services with
Community-Based Clinical Programs Lessons
Learned from the Ways to Work Demonstration
Project
  • Alysia Pascaris
  • New York Work Exchange, CVMHA
  • Rita Liegner and Richard Meador
  • Riverdale Mental Health Association
  • Karin Abrahamian and Anthony Cox
  • Brooklyn Bureau of Community Services
  • Colleen Gillespie
  • Center for Health and Public Service, NYU Wagner

NYAPRS Conference September 30, 2004
2
Why Were Here Today and Who We Are
  • Why? To share multiple and practical
    perspectives on the process of integrating
    employment services
  • Who we are (and what well talk about)?
  • Person who conceived of and oversees the
    implementation of the Ways to Work Demonstration
  • Why implement the Ways to Work Project?
  • Immediate and more long-term goals
  • Evaluator of the Ways to Work Demonstration
  • What are the outcomes of these programs?
  • How did these programs implement this new
    approach?
  • Organizational change, staff change, consumer
    change
  • Staff from two of the Ways to Work Projects
    (including both clinical and vocational staff)
  • What lessons did they learn from setting up and
    running these programs?

3
What is the Ways to Work Project?
  • Demonstration Project Integrating Supported
    Employment and Clinical Services
  • Research Project Process and Outcome Evaluation
  • Learn from Staff
  • Administrators, Clinicians and Vocational Staff
  • Learn from Consumers
  • A Bridge Between Research and Practice
  • Application of Lessons Learned
  • Increase Employment Goals
  • Support Organizational Change Process

4
What is the Ways to Work Project(continued)
  • Training and Technical Assistance
  • NH-Dartmouth Psychiatric Research Center
  • Principles of Evidence-Based Supported Employment
  • The Role of Work in Recovery
  • Off-site and On-site
  • New York Work Exchange
  • Program of Study
  • Workshops
  • Seminars

5
Why Do Ways to Work?
  • Trends in Mental Health Policy
  • Accountability and Outcomes
  • Funding
  • Evidence-Based Practice
  • Consumer Needs and Preferences
  • Doing More than the Status Quo

6
Beginning Ways to Work
  • Requests for Proposals
  • Guidelines Core Evidence-Based Principles of SE
  • Competitive, Integrated, Minimum Wage
  • Integrated Rehabilitation and Mental Health
  • Choice and Preferences
  • Rapid Job Search
  • Ongoing Support
  • Staffing
  • Funds
  • Employment Staff
  • Eligibility
  • Expressed Desire
  • Minimum Exclusionary Criteria
  • Outcomes
  • Work-related Outcomes

7
The Ways to Work Programs
  • 5 agencies
  • Brooklyn Bureau of Community Services CDTP
    Project Moving On
  • Jewish Board of Family Childrens Services CDTP
    Coney Island CSS Program
  • Riverdale Mental Health Association CDTP
  • Transitional Services, Inc CDTP
  • Jamaica Consultation Center
  • Postgraduate Center for Mental Health CDTP
    Clinic
  • Westside CDTP and Outpatient MH Clinic

8
Diversity of Agencies Hosting Ways to Work
Programs
  • Location
  • 4 NYC Boroughs (Bronx, Brooklyn, Manhattan,
    Queens)
  • Community location ranges from vibrant,
    resource-rich to isolated, barren neighborhoods
  • Size
  • From about 1,500 clients served/yr to 55,000
  • Emphasis/Expertise
  • Some with little employment/vocational experience
  • Others with extensive employment/vocational
    experience

9
Ways to Work Clinical Settings
  • Clinical Settings
  • 4 programs associated with CDTPs
  • 1 program associated with both CDTP and clinic
  • Size of Clinical Settings
  • CDTPs 50 100 participants
  • Clinic approximately 250 participants

10
Ways to Work CDTP Populations
  • Age (mostly adults, 18 55)
  • One program serves mostly older adults, 75 gt 40
  • One program serves more younger adults
  • Varied Housing
  • adult home residents
  • homeless individuals
  • 40 agency-associated housing
  • Gender
  • 3 programs have a majority of men, 2 a majority
    of women
  • Race/Ethnicity
  • 3 programs majority white (50 - 55)
  • 2 programs majority African American (52 - 76)
  • Representation of Latinos/as same across all 5
    (15 - 24)

11
The Ways to Work Approach
Determine Who Wants To Work Consumer
Choice (e.g., sign-up list)
CDTP/Clinic Participants
Other Supports Psychosocial Clubs Family
Education Housing Benefits Counseling
Ways to Work Program
Assessment Job Profile Career Interests/Goals
Rapid Job Search Individualized Job
Development Individualized Job Placement
Job Support (Follow Along Supports) Job
Coaching Peer Support Family Support
  • On-the-Job Assessment
  • Regular Communication
  • Management of
  • Medications
  • Symptoms

Work Incorporated Into All TX Goals/Plans
  • Integration of Work Clinical Goals
  • Team Meetings/Case Conferences
  • Regular Communication

Integration with CDTP and Mental Health
Treatment Services
12
Principles of Supported Employment
  • The goal is to assist consumers in obtaining
    competitive and satisfying jobs in community
  • The work pays at least minimum wage
  • People are employed in a work setting that
    includes non-disabled co-workers
  • Service agency provides ongoing support
  • Intended for consumers with a desire to work
  • Includes people with the most severe
    disabilities
  • Eligibility for Supported Employment services is
    based on consumer choice
  • Consumer preferences are important
  • Supported employment is integrated with mental
    health treatment
  • Competitive employment is the goal
  • Job search process starts soon after a consumer
    expresses interest in working
  • Follow-along supports are continuous for employed
    consumers

13
Consumer Experience of the Ways to Work Program
One Example
  • 40 yr old man
  • Realized several years ago that he wants to work
  • Cares about what people in the real world feel
    about people like him
  • Wants to prove to doctors, therapists, family
    members that he can take care of himself, get a
    job (tired of people telling him what to do and
    what he can do)
  • Pays his own bills, does own laundry and
    shopping, self medicates
  • Has been enrolled in CDTP for about 2 ½ years
  • Hears voices but knows he can work through the
    voices because they have been with him all his
    life
  • Scant work and education background
  • Worked 3 summer jobs in the 1960s
  • 6 mos of high school

14
One Mans Story .continued
  • Agreed to work with Employment Specialist as a
    team
  • Worked on resume together
  • Talked about his skills and interests
  • What things made him feel like he was
    accomplishing something?
  • What did he like and dislike doing?
  • What were his interests and hobbies?
  • Immediately began canvassing the neighborhood
  • Went to stores, filled out applications, went on
    interviews
  • Wore his tie and interview clothes but refused to
    wear his upper dentures as he felt that must hire
    him with the real person showing
  • Said hed like to work as a messenger
  • Studied the NYC subway maps
  • Got an interview went to interview on his own,
    completed the application, and even included a
    cover letter with his resume
  • HE GOT THE JOB!

15
Evaluation of the Ways to Work Programs
  • Two major goals
  • To document the outcomes of integrating
    employment services with clinical services
  • Do the Ways to Work programs work?
  • To describe the process of implementing and
    sustaining the Ways to Work projects in order to
    be able to share that information with other
    providers seeking ways to most effectively
    promote competitive employment within clinical
    settings
  • How do the Ways to Work programs work?
  • What had to change? How was that change achieved?

16
Number of W2W Participants (n190)
17
Characteristics of W2W Participants
Gender
Race/Ethnicity
Asian
Latino/a
White
African American
Male
College
Less than HS
Some College
HS
Education
18
Characteristics of W2W Participants
Housing Situation
Primary Diagnosis
Depression
Assisted
Ind/Family
Adult Home
Other
Shelter
Schizophrenia
19
Job Outcomes
  • 58 jobs obtained over two years
  • 51 unique jobs (190 participants)
  • 27 employment rate
  • Time in Ways to Work programs until employed
  • Year 1 4.8 months and Year 2 8.4 months
  • Job tenure (5.5 months)
  • Year 1 7.7 months and Year 2 2.6 months

20
Characteristics of Jobs
  • Types of Jobs
  • Security Guard
  • Newspaper Salesperson
  • Retail
  • Messenger
  • Maintenance
  • Tutor
  • Administrative Assistant
  • Telemarketer
  • Construction Worker
  • Child Care Worker
  • Wages
  • 6.75/hr
  • 5.75 - 15.00
  • Hours
  • 23 hrs/week
  • 6 40 hrs/wk

21
What Did the Ways to Work Programs DO to Help 27
of Participants Get Jobs? (1)
  • Changed agency structure
  • Integrated employment and clinical services
  • Employment Specialist attends all team meetings
  • Re-allocated resources
  • 1-on-1 individualized sessions, small caseload
  • Changed the intake process
  • Asked all consumers about career goals
  • Eliminated entry criteria
  • Created new way of delivering services
  • Not group-based
  • Job search begins immediately, no readiness work

22
What Did the Ways to Work Programs DO to Help 27
of Participants Get Jobs? (2)
  • Changed attitudes
  • Changed clinicians beliefs about consumers
    ability to work
  • Provided staff with latest evidence on what works
  • David Lynde, Evidence-Based Practice Project
  • Advertised unexpected successes
  • Shared information about consumers abilities
    outside of CDTP
  • Changed consumers expectations about what was
    possible
  • Provided role models
  • Encouraged peer support
  • Responded immediately to consumers job interests
  • Helped families support employment goals
  • Provided education about benefits and working

23
What Did the Ways to Work Programs DO to Help 27
of Participants Get Jobs? (3)
  • Changed How Jobs Were Developed
  • Developed specific jobs for specific people
  • Individualized
  • Explored full range of consumers
    employment-related goals to identify job matches
  • Used local resources
  • Went out into community with consumers
  • Encouraged staff to allow consumers to get
    feedback from the real world on what was
    realistic
  • Changed How Failures Were Viewed
  • Encouraged consumers and staff to view jobs as
    transitions
  • Failures are instructive
  • Failures are expected and unavoidable

24
Howd They Do All That?
  • Lessons Learned
  • Radiating impact of initial changes
  • Small changes paved the way for bigger changes
  • Strategies for overcoming barriers to change
  • Realistic assessments of how much effort and time
    is required to achieve changes
  • Tensions between ideal and real
  • Values and philosophical approaches
  • Situational and contextual constraints
  • Maintaining and sustaining changes

25
Integrating Employment Services
  • Communication between Clinical and Employment
    Staff
  • Sharing Information
  • Expertise/Training Background
  • Culture Clashes
  • Role of Employment Specialist

26
Changing Attitudes
  • Beliefs about CDTP Consumers and Employment
  • Clinicians Attitudes About Consumers and Jobs
  • Consumers Expectations About Working
  • Fear of Failure
  • Culture of Dependency
  • Access to Role Models/Success Stories
  • Benefits
  • Family Members
  • Other Providers
  • Housing

27
Job Coaching and Support
  • Interpersonal Skills vs. Job Skills
  • Difficulties of Disclosure
  • Supporting Consumer Choice
  • Disclosure vs. Job Coaching/Support
  • Disclosure vs. Reasonable Accommodations
  • Disclosure vs. Keeping Employer as Future
    Prospect
  • Groups vs. Individual Meetings and 1-on-1 Work
  • Consumers Expectations About Working
  • Fear of Failure
  • Culture of Dependency
  • Access to Role Models/Success Stories
  • Benefits
  • Family Members and Other Providers (Housing)

28
Job Development
  • Individualized Job Development vs. Slots
  • Balancing Needs of Consumers with Wanting to
    Maintain Employer as Future Prospect for Others
  • Volunteer Positions vs. Competitive Jobs
  • Transitional?
  • Varied Approaches to Match Diversity of Consumer
    Needs/Preferences

29
Maintaining Ways to Work Approaches
  • Initial Success May Wane Over Time
  • Most motivated, most capable consumers may get
    jobs fast
  • Remaining may need more encouragement, support,
    time
  • Jobs and job experiences that help them
  • Get closer to identifying their career goals
  • Get closer to achieving their career goals
  • More work in changing expectations, addressing
    fears
  • Role of the Employment Specialist
  • Rare set of skills (generalist w/ specialist
    employment skills)
  • Alone (no one else like them, no home
    department)
  • Burn-out/Turnover
  • Providing proper balance of challenge and support

30
Sustaining Ways to Work
  • Organizational Change
  • Attitude Change
  • Billing, Billing, Billing
  • PROS
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