Title: Integrating%20Employment%20Services%20with%20Community-Based%20Clinical%20Programs:%20Lessons%20Learned%20from%20the%20Ways%20to%20Work%20Demonstration%20Project
1Integrating 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
2Why 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?
3What 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
4What 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
5Why 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
6Beginning 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
7The 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
8Diversity 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
9Ways 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
10Ways 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)
11The 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
12Principles 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
13Consumer 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
14One 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!
15Evaluation 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?
16Number of W2W Participants (n190)
17Characteristics of W2W Participants
Gender
Race/Ethnicity
Asian
Latino/a
White
African American
Male
College
Less than HS
Some College
HS
Education
18Characteristics of W2W Participants
Housing Situation
Primary Diagnosis
Depression
Assisted
Ind/Family
Adult Home
Other
Shelter
Schizophrenia
19Job 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
20Characteristics 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
21What 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
22What 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
23What 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
24Howd 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
25Integrating Employment Services
- Communication between Clinical and Employment
Staff - Sharing Information
- Expertise/Training Background
- Culture Clashes
- Role of Employment Specialist
26Changing 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
27Job 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)
28Job 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
29Maintaining 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
30Sustaining Ways to Work
- Organizational Change
- Attitude Change
- Billing, Billing, Billing
- PROS