Supported Education and Supported Employment Summit May 3 rd, 2010

SUPPORTED EDUCATION Presented by: Tim Stringari Dan Chandler

BASICS Supported education may be defined as the provision of support and services to help persons with psychiatric disabilities gain access to and succeed in a postsecondary college or technical school.

What is Supported Education? Supported Education Programs are community partnerships made up of mental health consumers, family members, agency staff and college personnel. The purpose of these partnerships is to pool resources to maximize educational opportunities and employment outcomes for persons with psychiatric disabilities.

What is Supported Education (Cont.) Agency staff provide individualized and/or programmatic support to consumers returning to school. Supported Education Programs provide supports and services that are over and above existing educational services. Programs vary in structure and design according to the unique assets of each community, college, and participating agency.

Not One Model–Rather Principles Principles based on psychiatric rehabilitation and recovery: Normalization Self-determination Support, skills and resources Hope and recovery System change

A wide range of mental health service delivery models are in use MH agency, self-help or wellness groups or organizations, clubhouses, mobile staff, on-campus program can provide support Eligibility usually requires acceptance of illness, being in treatment and target group diagnosis

Why is Supported Education Needed?  Stigma and prejudice  Fluctuation of student needs  Service coordination  Psychosocial effects of mental Illness  Inadequate Disabled Student Services funding

Why is Supported Education Needed: Statistical Context (Cont.) 86% of persons with psychiatric disability withdraw from college prior to getting degree There are only 9,000 persons in California post secondary school with psychological disabilities but 650,000 public mental health consumers (34% with at least high school education) In 2007 only 6 social work of 833 undergraduates with psychological disability got a degree and 12 of 1,200 got a masters in social work

PROGRAM ELEMENTS Supported Education program elements focus on three domains of intervention: ACCESS RETENTION OUTCOMES

Supports to Facilitate ACCESS  Outreach and recruitment  Orientation and “walk-through” visits  Identified Contact Person  Assistance with registration  Assistance with financial aid

On-site support staff Transitional Classes Faculty training Peer Counseling Study labs Book funds Tutoring Crisis intervention Social activities Safe place to meet Supports to Facilitate RETENTION

Supports to Facilitate OUTCOMES Service and plan coordination Coordinated career planning Assistance with degree application Assistance with transfer application Liaison with transfer sites or employers

SUPPORTED EDUCATION OUTCOMES & FINDINGS “There are many positive outcomes for providing supported education services to people with psychiatric disabilities. A major one is that mental health consumers become college students. The role of college student in our society is highly valued. The role of mental health consumer is very devalued. With this change in role and identity, students realize they are not their illness, but a functioning, productive member of the community. Symptoms become something to be taken care of so goals can be accomplished.” Karen Unger, MSW, EdD

Evidence-base for supported education: Overview Virtually all studies report positive results, but… Methodology is generally weak 19 studies total 2 are unpublished 9 were pilot projects 1 randomized control comparison (but weak intervention) 1 three site comparison 1 quasi-experiment Outcomes are inconsistently measured from study to study and usually rely on self-report Is an “effective practice”

Program Participants in the Three Best Studies Average age: 34, 36 (17 to 75), 29 Hospitalizations: San Mateo: Average of 7 hospitalizations Unger: 86% hospitalized Diagnosis primarily schizophrenia spectrum disorder, major depression, bipolar disorder

Participants (Cont.) High proportion take psychiatric medications Tend to have more education and employment than other persons receiving mental health services: Mowbray: half had some college already Unger: 50 of 124 already had at least AA degree But (Unger) 29% had been homeless and 38% had been arrested

Success is Associated with: Mowbray: Productive activity at baseline, or having a partner Unger: Fewer hospitalizations, having a car In neither study were diagnosis, symptoms, or duration of illness associated with any measure of success

Evidence of success in 3 best studies Measures inconsistent across studies and vary widely in effectiveness Drop-outs reported by Mowbray: 44% Class enrollment rate 28% Mowbray; 83% Unger study (includes San Mateo); 42% Cook Course completion rate: 42% Mowbray; 90% Unger; average of 3.6 courses, Cook Reduced hospitalizations (Unger)

Evidence of success (cont.) Grade point average: 3.1 Unger Received degree or certificate: 14% Cook, 21% Unger Quality of life and self-esteem improve in one site (Mowbray), self-esteem alone (Cook), neither improved (Unger)

Our Experience in California Accommodations and services required by students with psychiatric disabilities are similar or identical to those provided to students with other disabilities. Students with psychiatric disabilities are neither prone to crisis or disruptive to the campus environment. As a result of participating in Supported Education program, students experience improvements in work readiness, social skills, and self-esteem. The development of personal supportive relationships with peers and other students is a key factor in the success of students with psychiatric disabilities. Most problems are related to the stigma of mental illness or due to role confusion on the part of the college staff.

SUPPORTED EDUCATION & EMPLOYMENT

Employment is Common among Supported Education Participants Many students also work Unger: 49% worked concurrently Cook: 78% employed within 3 year study period and half those employed at end Doughterty: 78% some employment in 18 month study period Employment after leaving school San Mateo: 51% work, 69% of these as part of MH system

School and Job Internships Boston University (2007): Combined college classroom computer training with community internship. Baseline work 18%, at one year 64% Kansas University (2005) Similar model but for peer counseling At 6 months 63% employed Housel (1993): On-campus Aide Training. 13 of 15 hired as MH aides after program San Mateo

Programs providing supported education and supported employment An early model (Egnew 1993) County MH contracted with one agency for both services Preliminary counseling covers short/long term and both employment and school Mobile approach used for both services School grads get special supported employment intervention

Programs providing supported education and supported employment (2) Nuechterlein(2005, 2008) Serve first break college drop outs Adapted IPS for work or school IPS Supported employment program also helped with return to education, performing all supported education functions 93% were successful returnees to: 36% School only 31% Jobs only 33% School and work

Getting to work!