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Employment, Evidence-Based Supported Employment and Recovery

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Title: Employment, Evidence-Based Supported Employment and Recovery


1
Employment,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

4
From 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.

5
From 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.

6
Is 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.

7
Is This You?
  • Competitively employed
  • or
  • Capable of being Competitively Employed?

8
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9
Where do Work and Recovery Intersect?
  • Where do Work and Recovery Travel Common
    Pathways?

10
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11
What is Recovery?What is not Recovery?
12
Recovery?
  • I need to be given advice and guidance about
    work so I wont make any mistakes or fail

13
Recovery?
  • I have a dream that someday I will be treatment
    adherent

14
Recovery?
  • Recovery means mental illness is not the center
    of my world.

15
Recovery?
  • My life has enough meaning now that I have a
    psychiatrist, medications and a case manager.

16
Recovery?
  • Someday, I hope to be compliant and a well
    managed case.

17
Recovery?
  • I want a warm and safe place for my family

18
Recovery?
  • Before I was really depressed but after I
    started working, it was a relief. I feel better
    working

19
Recovery?
  • I want to be the very best mental health client
    that I can be

20
Recovery?
  • I want a good place to live, a sweet car to
    drive, a good job and a date on Friday night

21
Young 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

23
National Consensus Statement on Mental Health
Recovery
  • www.SAMHSA.gov

24
Self-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.

25
Individualized 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.

26
Empowerment
  • 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.

27
Holistic
  • 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.

28
Non-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.

29
Strengths-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).

30
Peer 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.

31
Respect
  • 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.

32
Responsibility
  • 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.

33
Hope
  • 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.

34
Recovery Concepts in Supported Employment
  • Self-directed ?
  • Individualized ?
  • Empowering ?
  • Holistic ?
  • Non-Linear ?
  • Strengths-Based ?
  • Peer Supports ?
  • Respect ?
  • Responsibility ?
  • Hope ?

35
Personal Factors That Predict Better Employment
Outcomes
  • Diagnosis
  • Symptoms
  • Medication Compliance
  • Hospitalization History
  • Treatment Compliance
  • Gender

Better Employment Outcomes
MYTH
36
Supporting 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?

37
Supporting 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?

38
Employment 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
39
Employment 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
40
Low 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)

41
Does It Matter How We See People When It Comes to
Employment?
42
Can we see an employee with these on?
43
Recovery Lenses?
LABELS
DEFICITS
44
Can we see an employee with these on?
45
Recovery Lenses?
HOPE
STRENGTHS
46
  • I want to live my life not my disability
  • Pat Deegan

47
Which 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?

50
Simple 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

51
(No Transcript)
52
Employment Myth Busting
  • Employment is far too stressful for a person
    with a mental illness

MYTH
53
  • Extra, Extra
  • There is Scientific Evidence

54
Supported Employment An Evidence-Based Practice
55
Evidence Based Practice Definition
  1. The practice is clearly defined in a manual or
    other method to train practitioners
  2. The practice has a well-defined and
    operationalized fidelity scale
  3. The practice has demonstrated positive outcomes
    in a RCT
  4. The practice has demonstrated positive outcomes
    with different investigators in repeated research
    trials

56
16 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

57
RCTs Pre IPS
58
RCTs IPS Studies
59
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60
Summary 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

61
Is 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?

62
Dartmouth Supported Employment Web Site
  • http//www.dartmouth.edu/ips/

63
Helping 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?

64
Helping 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?

65
More 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
66
Employment Myth Busting
  • Employers dont hire people who have mental
    health symptoms, they only hire mentally healthy,
    well adjusted and non-disabled employees

MYTH
67
Employment Myth Busting
  • Employment is something that people should
    begin to think about only when they are stable
    and free of mental health symptoms

MYTH
68
Employment 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
69
Supporting 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

71
Recovery Hope
  • If people are treated as capable, they often
    surprise everyone and live up to expectations.
  • Ken Steele The Day the Voices Stopped.
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