By Advocates for Human Potential Supported Employment: An Evidenced Based Practice to Increase Employment Outcomes Among Mental Health Consumers By Advocates for Human Potential

Modules Introduction to SE Setting the Job Goal and Assessment Employment Outcome Measures Developing Jobs Providing Employment Supports

Why Supported Employment? Find a Job Keep a Job Recover a valued role Help people with severe mental illnesses find and keep competitive jobs. Supported employment facilitates the recovery of work-interested consumers by supporting them in their efforts to get on with life beyond illness.

What is Supported Employment? A vocational rehabilitation strategy Real jobs in competitive settings Minimum wage or better 10 hours a week or more Low entry threshold Approach to vocational rehabilitation for individuals with disabilities that emphasizes helping people obtain competitive work in the community, and providing the supports necessary to ensure success at the workplace For the purpose of the Detroit project, the partners agreed that we would count jobs that are 10 hours a week or more. By low entry threshold, we mean that clients are not required to meet stringent eligibility requirements nor complete extensive pre-job placement (readiness) training. Every person with a disability is capable of working competitively if the right kind of job and work environment is found

What is Supported Employment? Competitive work in the community Provide the supports necessary to ensure success at the workplace Employment specialists might develop jobs with employers that match client interests or employment specialists might assist and support clients in representing themselves to employers. Jobs are in the community; jobs are not in sheltered workshops or other protected settings. A community job is work for an employer in which other non-disabled people also work. Supports are aimed at helping the client remain attached to the workforce, not always in the same job.

Shared Values/Congruent Strategies Supported Housing Integrated Choice-driven Skills for retention, growth Not contingent upon TX compliance No time limits Flexible, individualized supports Contingency planning Respect changing needs, preferences Supported Employment Integrated Choice-driven Skills for retention, growth Not contingent upon TX compliance No time limits Flexible, individualized supports Contingency planning Respect changing needs, preferences Why saturate the housing with employment supports and opportunities? Why connect housing and jobs? People in the housing are well known by the housing staff and a trusting relationship is important in taking the risks associated with going to work. There are shared values between supportive housing and supported employment.

Activities in Supported Employment Review capabilities Identify the job goal Counsel on benefits Job Search Negotiating with employers Coaching to start & keep the job The supported-employment specialist helps each customer with all steps of the employment process: Review capabilities – that is the client’s prior experiences, skills, and talents Identify the job goal that is based on the clients values and employment interests Assist with personalized benefits planning Search for a job Make a meaningful connection with an employer in the community

Steps of the Employment Process Conduct ongoing vocational assessment Representation in a job interview Acclimate to employer environment Problem solving job challenges Plan and prepare for new responsibilities Transition to new jobs Plan career paths Prepare for and attend an interview Acclimate to the work environment Assess performance and problem-solve (for employment tasks and social relationships) Plan and prepare for new responsibilities Transition to new jobs (with current and future employers) Career planning (i.e., plan long-term employment experiences

Summary SE is for anyone who expresses the desire to work Rapid job placement Continued follow along, on & off job site from the employment specialist Supported employment is a well-defined approach to helping people with mental illness find and keep competitive employment that is staffed by employment specialists who have frequent meetings with the treatment team Programs help anyone who expresses the desire to work Employment specialists help people look for jobs soon after entering the program Support from the employment specialist continues as long as consumers want the assistance. Support can take place at the clients place of work as well as off the job site, in social, living or other environments chosen by the SE client

Summary, continued Employment specialist is part of the TX team Jobs are seen as transitions SE is individualized People in SE will require assistance to move from job to another job, so that they remain attached to the labor market. Ideally jobs are progressive in that they offer more wages, benefits and tasks preferred by the worker All choices and decisions about work and support are individualized, based on the person's preferences, strengths, and experiences

Practice Principles of Supported Employment Zero exclusion: Eligibility is based on consumer choice Supported employment is integrated with treatment Competitive employment is the goal Personalized benefits counseling is provided Supported employment programs are based on a core set of practice principles. These principles form the foundation of the program, and they are critical to ensuring that services are available to all consumers, that program staff are respectful of consumer choices, and the program is effective in achieving and sustaining the goal of competitive work in the community

Practice Principles of Supported Employment Rapid job search: Job search starts soon after a consumer expresses interest in working Follow-along supports are continuous Consumer preferences are important

Principle 1: Zero Exclusion: Eligibility is based on consumer choice All consumers who want to participate in Supported Employment are eligible All persons with a disability can work at competitive jobs in the community without prior training

Principle 2: Supported employment is integrated with treatment : Different providers of services integrate vocational rehabilitation and mental health treatment at the team level. Close coordination of supported employment services with other rehabilitation and treatment services ensures that everyone involved in providing services

Principle 3: Competitive employment is the goal Full or part-time jobs Jobs open to any applicant Minimum wage or living wage jobs "Competitive jobs" are part-time or full-time jobs that exist in the open labor market, pay at least a minimum wage, that anyone could have regardless of their disability status, not jobs that are set aside for persons with disabilities What is living wage for Detroit? NOTICE OF DETROIT LIVING WAGE RATES ADJUSTMENT EFFECTIVE JUNE 1, 2007 In accordance with Ordinance No. 45-98, being Sections 18-5-81 through 18-5-86 of the 1984 Detroit City Code, titled Detroit Living Wage Ordinance’ (Ordinance), the Purchasing Division of the City Finance Department has determined that the following adjustments to the living wage rates are necessary to reflect changes in the federal poverty level: 1) Where health benefits as defined in the Ordinance are provided to the employee, the living wage rate is $10.33 per hour (100% of the federal poverty level income guideline for a family of four); and 2)      Where health benefits as defined in the Ordinance are not provided to the employee, the living wage rate is $12.91 per hour (125% of the federal poverty level income guideline for a family of four). These rates are based upon the 2006 federal poverty level income guideline of $20,650.00 for a family of four in the contiguous 48 states and the District of Columbia, as published in the Federal Register: January 24, 2007. In order to provide the notice to employers required pursuant to Section 18-5-83 (d) of the Ordinance, these rates shall become effective June 1, 2007. These rates will be further adjusted periodically when the federal poverty level income guideline is adjusted by the U.S. Department of Health and Human Services. The Ordinance applies to employers who are contractors’ or grantees’ as defined in the Ordinance, where the contract or grant is entered into or renewed after the effective date of the Ordinance, which is December 16, 1998. A copy of the ordinance may be obtained from:   Ms. Janice M. Winfrey, City Clerk City Clerk’s Office 200 Coleman A. Young Municipal Center Detroit, MI 48226 (313) 224-2083

Principle 4: Benefits Counseling is Important Personalized Benefits Planning Address fears of losing benefits Provide accurate information to consumers Fear of losing benefits (e.g., Supplemental Security Income, Medicaid) is a major reason that consumers may not want to seek employment Employment specialists are responsible for ensuring that consumers access benefits counseling when they start supported employment services and when changes occur in their work status

Principle 5. Rapid job search: Job search starts soon after a consumer expresses interest in working Looking for work begins soon after a consumer begins meeting with an employment specialist, and is not postponed by requirements for completing extensive pre-employment assessment and training, or intermediate work experiences (like prevocational work units, transitional employment, or sheltered workshop experiences)

Principle 6: Time unlimited support Some consumers struggle with psychiatric disabilities that persist over time so their optimal treatment and rehabilitation requires a long-term commitment for many consumers the extent of support gradually decreases over time as employment specialists teach and facilitate the ability of consumers to meet their own needs for success at the workplace

Principle 7: Attention to consumer preferences Consumer preferences play a key role in: determining the type of job that is sought the nature of support provided by the employment specialist the decision about whether to disclose the person's psychiatric disability to the employer

7 Principles of Supported Employment Supported employment is guided by seven clear core practice principles. These principles, corroborated by research, describe supported employment and differentiate it from other practices

Employment Outcome Measures Monitoring outcomes is important for any evidence-based practice For supported employment, the main outcome is competitive employment

What is Competitive Employment? pays at least minimum wage the employment setting includes co-workers who are not disabled the position can be held by anyone, that is, one does not need to be a member of a population with a disability to hold the job

Supported Employment Fidelity Scale—Implementation The rater obtains objective information from a variety of sources including: agency records employment specialists other practitioners and supervisors, program managers consumers Fidelity Assessments are based on gathering data from observations, interviews with staff and review of documents including charts. The purpose of Fidelity Assessments is to measure the degree to which the practice of Supported Employment, as an evidenced based practice, is evident in a particular agency setting and its staff practices. The SE Assessment looks for the presence or absence of critical indicators for Supported Employment interventions and program organizational structures.

Staffing: Caseload size Does each vocational staff person have a discreet caseload? How many clients does each vocational staff person (full-time equivalent) have on his/her caseload? How often does the vocational staff person meet with each person on the caseload? Approximately how long do clients stay on the caseload? When is a client removed from the caseload?

Staffing: Vocational Services Staff Do Any of the Vocational Staff Provide Other Services Besides Vocational, Such As casemanagement, Day Programming, or Residential Services? How Much of Their Time Do They Provide nonvocational Services ?

Staffing: Vocational generalists Do different vocational staff persons provide different aspects of the vocational service? For example, one person only does job development or one person only does job support. What different aspects of the vocational process does each provide?

Organization: Integration of rehabilitation treatment with mental health treatment Do vocational workers interact with case managers about their mutual clients? In what situations do they interact and how regularly (meetings, telephone, etc.)? Are vocational workers assigned to work with specific case managers or case management teams? Do they participate in shared decision making about client services? Who (staff) makes the final decision? Where are the offices located for case managers and for vocational workers?

Organization: Vocational unit Do the vocational workers have the same supervisor? Do the vocational workers meet as a group for supervision? How often? Do the vocational workers provide services for each others’ clients?

Organization: Zero exclusion criteria What are the criteria to be eligible to receive vocational services? Who makes referrals? Who conducts the screening? Are there provisions made for being sure no one is excluded? What is the rate of referral?

Services: Ongoing, work-based vocational assessment Does the program include vocational evaluation procedures? What type of assessment procedures do you use and in which settings? Are their certain assessment procedures that must be completed prior to obtaining a competitive job, e.g. testing, prevocational work adjustment? How much pre-placement assessment do you do? How much time is spent on vocational assessment?

Services: Rapid search for competitive job What is the average length of time between when a person begins the program and the first contact with a competitive employer? What is the range of time? What is the philosophy of the program about when to start the job search? Are there steps in the program that people take before starting to look for a job?

Services: Individualized job search How is it decided which jobs are identified in the job search? Who makes these decisions? What information is it based on? How has the nature of the job market affected the type of jobs clients obtained?

Services: Diversity of jobs developed Does the vocational worker ever suggest to clients that they work at the same job setting as other clients? What percentage of clients work in the same job settings? Does the vocational worker ever suggest to clients that they obtain the same type of job as other clients? What percentages of clients have the same type of work?

Services: Permanence of jobs developed What percentage of the jobs that the vocational worker suggests to clients are permanent, competitive jobs? Does the vocational worker ever suggest jobs that are temporary, time-limited, or volunteer? How often?

Services: Jobs as transitions Do vocational workers help clients to find another job when one ends? What percentage of the vocational worker’s clients who have ended jobs have been provided assistance in finding another job? What are reasons a vocational worker would not help a client find another job when one has ended? (e.g., client was fired due to poor attendance, problems with substance abuse?)

Services: Follow-along supports Does the vocational worker provide follow-along supports to the client and the employer? What kind of supports? What percentage of working clients has follow-along supports provided? Is there a time limit for providing supports?

Services: Community-based services Where do the vocational workers spend most of their time? What percentage of their time is spent outside the mental health facility? (Ask the vocational worker to review how she spends her time over the last couple of days to determine location of services.)

Services: Assertive engagement and outreach Does the vocational worker provide any outreach if a client does not engage or drops out of services? What kinds of outreach are provided? How often are outreach attempts made? Is there a time limit to providing outreach if a client stops attending? What is the time limit?

Stages of Change Stages of Change Preparation Contemplation Termination recovery relapse Action Maintenance Preparation Contemplation Precontemplation Stages of Change Prochaska et al, 1991 Stages of Change