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

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

3. 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.

4. 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

5. 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.

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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 , being Sections through 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, for a family of four in the contiguous 48 states and the District of Columbia, as published in the Federal Register: January 24, In order to provide the notice to employers required pursuant to Section (d) of the Ordinance, these rates shall become effective June 1, 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, 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)

16. 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

17. 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)

18. 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

19. 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

20. 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

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

22. 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

23. 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.

24. 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?

25. 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 ?

26. 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?

27. 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?

28. 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?

29. 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?

30. 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?

31. 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?

32. 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?

33. 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?

34. 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?

35. 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?)

36. 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?

37. 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.)

38. 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?

39. 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