Post on 20-Jan-2016
description
New York Work Exchange1
Integrating Employment Services with Community-Based Clinical
Programs: Lessons Learned from the Ways to Work Demonstration Project
Alysia PascarisNew York Work Exchange, CVMHA
Rita Liegner and Richard MeadorRiverdale Mental Health Association
Karin Abrahamian and Anthony CoxBrooklyn Bureau of Community Services
Colleen GillespieCenter for Health and Public Service, NYU Wagner
NYAPRS Conference
September 30, 2004
New York Work Exchange2
Why We’re 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 we’ll 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?
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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
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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
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Why Do Ways to Work?
Trends in Mental Health Policy Accountability and Outcomes Funding Evidence-Based Practice
Consumer Needs and PreferencesDoing More than the Status Quo
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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
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The Ways to Work Programs
5 agencies Brooklyn Bureau of Community Services CDTP
Project Moving On Jewish Board of Family & Children’s 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
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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 neighborhoodsSize
From about 1,500 clients served/yr to 55,000Emphasis/Expertise
Some with little employment/vocational experience Others with extensive employment/vocational experience
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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
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Ways to Work CDTP Populations
Age (mostly adults, 18 – 55) One program serves mostly older adults, 75% > 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%)
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The Ways to Work Approach
CDTP/Clinic
Participants
Determine Who Wants To Work
Consumer Choice(e.g., sign-up list)
Ways to Work Program
AssessmentJob Profile
Career Interests/Goals
Rapid Job SearchIndividualized Job Development
Individualized Job Placement
Job Support (Follow Along Supports)
Job CoachingPeer Support
Family Support
Integration with CDTP and Mental Health Treatment Services
Work Incorporated
Into All TX Goals/Plans
Integration of Work & Clinical Goals• Team Meetings/Case Conferences• Regular Communication
On-the-Job Assessment• Regular Communication• Management of
MedicationsSymptoms
Other SupportsPsychosocial ClubsFamily Education
HousingBenefits
Counseling
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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
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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
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One Man’s 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 he’d 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!
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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?
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Number of W2W Participants (n=190)
19
47
28
35
13
23
118
0
10
20
30
40
50
Q1(2002)
Q2(2002)
Q3(2002)
Q4(2002)
Q5(2003)
Q6(2003)
Q7(2003)
Q8(2003)
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Characteristics of W2W Participants
43%
57%
Gender
Male
46%
39%
11%3%
Race/Ethnicity
African American
AsianLatino/a
White
36%
31%
29%
5%
EducationHS
Less than HS
Some College
College
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Characteristics of W2W Participants
35%
6%
33%
26%
Housing Situation
27%
4%
69%
Primary Diagnosis
Schizophrenia
Other
DepressionAssisted Ind/Family
Shelter Adult Home
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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
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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
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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
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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
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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 realisticChanged How Failures Were Viewed
Encouraged consumers and staff to view jobs as transitions
• Failures are instructive• Failures are expected and unavoidable
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How’d 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
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Integrating Employment Services
Communication between Clinical and Employment Staff
Sharing Information
Expertise/Training Background
Culture Clashes
Role of Employment Specialist
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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
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Job Coaching and Support
Interpersonal Skills vs. Job SkillsDifficulties 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 WorkConsumers’ Expectations About Working
Fear of Failure Culture of Dependency Access to Role Models/Success Stories Benefits
Family Members and Other Providers (Housing)
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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
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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
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Sustaining Ways to Work
Organizational Change
Attitude Change
Billing, Billing, Billing
PROS