Title: Employment, Evidence-Based Supported Employment and Recovery
1Employment,Evidence-Based Supported
Employmentand Recovery
- David Lynde, MSW
- Supported Employment Consultant
2- Which came first
- employment
- or
- mental health?
3- Dorothea Lynde Dix
- Born, Hampden, Maine, 1802
- Relentless advocate and crusader for people with
mental illness
4From the Biography of Dorothea Lynde Dix
- The indigent insane and feebleminded usually
lived under the most shocking conditions of all.
Some communities actually placed their "paupers"
on the auction block. Leasing, in effect, "their
weak minds and strong bodies" to work for the
bidder who made the most attractive offer to the
town or county.
5From the Biography of Dorothea Lynde Dix
- Dorothea Dix traveled thousands of miles from
state to state - by train, coach, carriage and
river boat - always systematically gathering
facts which she could use to try to convince
those in authority of the need of improvement in
the care of the mentally ill.
6Is This You?
- Superior functioning in a wide range of
activities, life's problems never seem to get out
of hand, is sought out by others because of his
or her many qualities. No symptoms.
7Is This You?
- Competitively employed
- or
- Capable of being Competitively Employed?
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9Where do Work and Recovery Intersect?
- Where do Work and Recovery Travel Common
Pathways?
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11What is Recovery?What is not Recovery?
12Recovery?
- I need to be given advice and guidance about
work so I wont make any mistakes or fail
13Recovery?
- I have a dream that someday I will be treatment
adherent
14Recovery?
- Recovery means mental illness is not the center
of my world.
15Recovery?
- My life has enough meaning now that I have a
psychiatrist, medications and a case manager.
16Recovery?
- Someday, I hope to be compliant and a well
managed case.
17Recovery?
- I want a warm and safe place for my family
18Recovery?
- Before I was really depressed but after I
started working, it was a relief. I feel better
working
19Recovery?
- I want to be the very best mental health client
that I can be
20Recovery?
- I want a good place to live, a sweet car to
drive, a good job and a date on Friday night
21Young Adults Recovery
- The aspirations of young people following a first
episode of psychosis appear to be similar to
those of any other young person wanting to be
rich and powerful (Brady 2008) to drive a sports
car, live in a nice house, to have a job and a
career, and be totally self-sufficient (BGW,
2002) wanting to lead a life free of symptoms of
illness with a partner, a family and a career
(Parker 2001) - Rinaldi, Miles, Killackey, Eoin et al. First
episode psychosis and employment A review.
International Review of Psychiatry (Submitted
2010)
22- Now that I have served my country I want to
collect disability income to support my family
23National Consensus Statement on Mental Health
Recovery
24Self-Direction
- Consumers lead, control, exercise choice over,
and determine their own path of recovery by
optimizing autonomy, independence, and control of
resources to achieve a self-determined life. By
definition, the recovery process must be
self-directed by the individual, who defines his
or her own life goals and designs a unique path
towards those goals.
25Individualized and Person-Centered
- There are multiple pathways to recovery based on
an individuals unique strengths and resiliencies
as well as his or her needs, preferences,
experiences (including past trauma), and cultural
background in all of its diverse representations.
26Empowerment
- Consumers have the authority to choose from a
range of options and to participate in all
decisionsincluding the allocation of
resourcesthat will affect their lives, and are
educated and supported in so doing.
27Holistic
- Recovery encompasses an individuals whole life,
including mind, body, spirit, and community.
Recovery embraces all aspects of life, including
housing, employment, education, mental health and
healthcare treatment and services, complementary
and naturalistic services, addictions treatment,
spirituality, creativity, social networks,
community participation, and family supports as
determined by the person.
28Non-Linear
- Recovery is not a step-by-step process but one
based on continual growth, occasional setbacks,
and learning from experience. Recovery begins
with an initial stage of awareness in which a
person recognizes that positive change is
possible.
29Strengths-Based
- Recovery focuses on valuing and building on the
multiple capacities, resiliencies, talents,
coping abilities, and inherent worth of
individuals. By building on these strengths,
consumers leave stymied life roles behind and
engage in new life roles (e.g., partner,
caregiver, friend, student, employee).
30Peer Support
- Mutual supportincluding the sharing of
experiential knowledge and skills and social
learningplays an invaluable role in recovery.
Consumers encourage and engage other consumers in
recovery and provide each other with a sense of
belonging, supportive relationships, valued
roles, and community.
31Respect
- Community, systems, and societal acceptance and
appreciation of consumers including protecting
their rights and eliminating discrimination and
stigmaare crucial in achieving recovery.
Self-acceptance and regaining belief in ones
self are particularly vital. Respect ensures the
inclusion and full participation of consumers in
all aspects of their lives.
32Responsibility
- Consumers have a personal responsibility for
their own self-care and journeys of recovery.
Taking steps towards their goals may require
great courage. Consumers must strive to
understand and give meaning to their experiences
and identify coping strategies and healing
processes to promote their own wellness.
33Hope
- Recovery provides the essential and motivating
message of a better future that people can and
do overcome the barriers and obstacles that
confront them. Hope is internalized but can be
fostered by peers, families, friends, providers,
and others. Hope is the catalyst of the recovery
process.
34Recovery Concepts in Supported Employment
- Self-directed ?
- Individualized ?
- Empowering ?
- Holistic ?
- Non-Linear ?
- Strengths-Based ?
- Peer Supports ?
- Respect ?
- Responsibility ?
- Hope ?
35Personal Factors That Predict Better Employment
Outcomes
- Diagnosis
- Symptoms
- Medication Compliance
- Hospitalization History
- Treatment Compliance
- Gender
Better Employment Outcomes
MYTH
36Supporting People Thinking About Work
- Have conversations about
- What are your goals?
- Have you thought about how work may help with
your goals? - Do you have goals related to employment or a
career? - What types of work have you done in the past?
37Supporting People Thinking About Work
- Have conversations about
- What types of jobs do your family members or
friends have? - What types of hobbies do you enjoy?
- Which people do you respect or admire? What do
they do for work?
38Employment Myth Busting
- People should only apply for jobs when they
know that they will definitely like the job and
when they are absolutely sure that they will be
successful at the job
MYTH
39Employment Myth Busting
- There is evidence that, when it comes to mental
health, we can predict who will and who will not
be a successful employee
MYTH
40Low Expectations
- Research about the low expectations of mental
health professionals in relation to people with
mental health conditions gaining employment is
now very well documented. These expectations are
often underpinned by concern about issues of
risk, stress and relapse. Such low expectations
can result in them and their families receiving
very cautious messages from mental health
professionals about gaining employment. - Rinaldi, Miles, Killackey, Eoin et al. First
episode psychosis and employment A review.
International Review of Psychiatry (Submitted
2010)
41Does It Matter How We See People When It Comes to
Employment?
42Can we see an employee with these on?
43Recovery Lenses?
LABELS
DEFICITS
44Can we see an employee with these on?
45Recovery Lenses?
HOPE
STRENGTHS
46- I want to live my life not my disability
- Pat Deegan
47Which is most stressful?
- Employment
- Or
- Unemployment
48- How many of us have managed the stress of
- Poverty?
- Discrimination?
- Homelessness?
- Hallucinations?
- Involuntary treatment commitment?
49- How many people with mental illness have managed
the stress of - Poverty?
- Discrimination?
- Homelessness?
- Hallucinations?
- Involuntary treatment commitment?
50Simple Stress Test
- The following is a picture of two identical
dolphins - If you are struggling with managing stress you
will see differences in these two dolphins
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52Employment Myth Busting
- Employment is far too stressful for a person
with a mental illness
MYTH
53- Extra, Extra
- There is Scientific Evidence
54Supported Employment An Evidence-Based Practice
55Evidence Based Practice Definition
- The practice is clearly defined in a manual or
other method to train practitioners - The practice has a well-defined and
operationalized fidelity scale - The practice has demonstrated positive outcomes
in a RCT - The practice has demonstrated positive outcomes
with different investigators in repeated research
trials
5616 Randomized Controlled Trials of Supported
Employment
- 4 conducted before Individual Placement and
Support (IPS) model was developed - 11 used full implementation of IPS
- 1 studied supported employment on an ACT team
57RCTs Pre IPS
58RCTs IPS Studies
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60Summary Randomized Controlled Trials of
Supported Employment (SE)
- In 15 of 16 studies, SE had significantly better
competitive employment outcomes than controls - Mean across studies of consumers working
competitively at some time - 60 for supported employment
- 24 for controls
- Effect size (d) .77
61Is this the right time for Supported Employment?
- When food is scarce, we dont think malnutrition
is okay - When housing is hard to find, we dont think
homelessness is okay - When healthcare is difficult to obtain, we dont
think sickness is okay - Then why, when jobs are scarce, do we begin to
think that unemployment is okay?
62Dartmouth Supported Employment Web Site
- http//www.dartmouth.edu/ips/
63Helping People Thinking About Work
- Have conversations about
- What are the potential benefits or drawbacks to
employment for you? - Did you know that people who have symptoms are
able to work? - Did you know that work actually helps reduce
substance use?
64Helping People Thinking About Work
- Have conversations about
- What concerns do you have about employment?
- Is there anyone in your family or group of
friends that may be supportive of your work
goals?
65More income
Keep my disability income
Feel better about myself
Worried about benefits
Bored
Dont know what to say to co-workers
Dont like relying so much on others
66Employment Myth Busting
- Employers dont hire people who have mental
health symptoms, they only hire mentally healthy,
well adjusted and non-disabled employees
MYTH
67Employment Myth Busting
- Employment is something that people should
begin to think about only when they are stable
and free of mental health symptoms
MYTH
68Employment Myth Busting
- The Americans with Disabilities Act will
provide you with complete protection against
stigma and discrimination in the work place if
you decide to discuss your mental health with any
of your supervisors or colleagues
MYTH
69Supporting People Who Are Searching for Work
- Have conversations about
- Areas at work where coping strategies and skills
may be useful for the person - Plans for the first day of work, help the person
identify and use structured problem-solving to
work out seemingly little things
70- I thought Oh No, what will my son do now.
- Mother, Detroit Michigan
71Recovery Hope
- If people are treated as capable, they often
surprise everyone and live up to expectations. - Ken Steele The Day the Voices Stopped.