1. A Strengths-Based Approach to IPS Supported Employment:
Learning from Strengths Model Case Management Implementation and Impact on Employment Outcomes
Rick Goscha, PhD
California Institute for Behavioral Health Solutions
October 3, 2018

2. What I want to convey
Employment is an essential component to helping people build and re-build their lives
Employment exploration begins day 1 of service not at the point of IPS referral
Being strengths-based doesn’t always come natural in our systems of care
IPS staff play an essential role in keeping strengths on the organizational agenda

3. Goal of the Strengths Model
Help people build or re-build lives, beyond our systems of care, that bring meaning, purpose, and valued identity
Help increase people’s ability to exercise power related to:
* How they view themselves
* How they interact with their environment

4. Intrapersonal Narratives
Empowering
Intrapersonal Narratives
Goal of SMCM
Entrapping
Empowering
Environmental Niches
Entrapping

5. Examples of Entrapping Narratives
I am just……
“I’m not worth anything”
I don’t deserve better
“I am incapable of…..”
I can’t do it because of ……

6. The Strengths Assessment is about creating space
For narratives of hope, recovery, and wellness to co-exist

7. What is the Strengths Model?
An evidence-based practice that….
…combines concepts and principles of recovery, empowerment, and person/environment niches…
…with practical tools, methods, and practice interventions…
…to help people build or re-build lives worth living, beyond formal systems of care, that bring meaning, purpose, and positive identity.

8. Primary providers of Strengths
Best fit: Community-based, direct service workers (i.e care managers, case managers, community support workers)
Promising fit: Peer support, supported employment, supported education, supported housing
Practical application: outpatient clinicians, crisis services, residential services

9. The Context of Strengths Model Work
11/29/2018
The Context of Strengths Model Work
Recovery
Meaning
Purpose
Identity

10. What People Want Safe place to call home Economic stability
Role with meaning, purpose, and valued identities
Connection to others
Connection with the community
To love and be loved
Feel safe
Support to stay well

11. The Context of Strengths Model Work
11/29/2018
The Context of Strengths Model Work
Engagement
Understanding
Hope
Alliance
Tools/Methods
Strengths Assessment
Personal Plan
Group Supervision
Recovery
Meaning
Purpose
Identity

12. Principles of the Strengths Model
People have the capability to recover, reclaim, and transform their lives
Focus is on strengths versus deficits
The community is viewed as an oasis of potential resources
The person is the director of the helping process
The relationship with the person is primary and essential
The primary setting for our work is in the community

13. Integrative Role of Strengths
Strengths Model
Outpatient Therapy
Supported Employment/ Education
Crisis Services
Residential Services
Medical Services

14. Compatibility of Strengths with other strengths-based, recovery-oriented approaches
Strengths Model
Cognitive Behavioral Therapy
Motivational Interviewing
Dialectical Behavioral Therapy
Solution focused approaches
Shared-decision making

15. 10 Strengths Model Studies
Competitive Employment
Psychiatric hospitalization
Housing
Post-secondary education
Symptoms
Community involvement
Social Support
Social Isolation
Quality of Life

16. Fidelity and Outcomes Competitive Employment

17. Types Of Strengths Qualities/Personal Characteristics
Environmental Strengths
Interests/ Aspirations
Talents and Skills

18. Introducing Dean

19. Organization of the Strengths Assessment
Seven Life Domains
Three Temporal Orderings
Encompasses both simplicity and complexity

20. Introducing Elizabeth

21. Overview of Elizabeth at the beginning of her road to recovery
33 year old, white, heterosexual woman
Living with mother and step-father.
Mostly isolated from community.
Frequent hospitalization (7 times in one year)

22. Overview of Elizabeth at the beginning of her road to recovery
Frequent calls to crisis services (suicidal ideation)
History of childhood physical, sexual, and emotional abuse.

23. Overview of Elizabeth at the beginning of her road to recovery
Only lived once on her own (lasted 5 months)
Evicted from apartment and was homeless for two months
Re-entered the hospital
Returned to living with mom and stepfather

24. Where Elizabeth is now (five years later)
Own apartment for five years
Sings in a church choir
Helps out occasionally at nursery during Sunday school classes
Has a close friend at her apartment complex
Has a dog

25. Where Elizabeth is now (five years later)
Has been hospitalized twice in the past five years
Calls the crisis line periodically (3-4 times a year)
Still struggles at times with depression, disassociation, voices, and suicidal thoughts, although less frequent
Is considering employment

28. What shifts created the environment to help Elizabeth recover?
“I am not worth anything. Therefore, this is best life will ever be.”
“A better life is possible.”
Worker:
“I am not sure she can live on her own.”
“I’m nervous about it, but maybe she can do it.”“
“I’m nervous about it, but maybe she can do it.”
Agency culture:
“We have to be careful getting people excited about hopes and dreams that are unrealistic.” –and– “Taking risk is a liability for the organization.”
“If people do not dream and take risks, there’s no way we can help them recover.”
Hope

29. What shifts created the environment to help Elizabeth recover?
“I’m just trying to cope. Others are making life difficult for me.”
“I want my own place. I want to prove to myself and others I can do this.”
“I want my own place. I want to prove to myself and others I can do this.”
Worker:
“Once you’re stable, we can try to work on a goal like getting your own place.”
““I’m not sure what it is going to take to achieve this goal, but if it is important to you, I will help you explore it and take steps to achieve it.”
“I’m not sure what it’s going to take to achieve this goal, but if it’s important to you, I’ll help you explore it and take steps to achieve it.”
Agency Culture:
“Make sure every goal on the treatment plan meets the criteria for medical necessity.”
“Make sure every goal on the treatment plan is clearly something the person is passionate about and then make sure your role in that goal meets the criteria for medical necessity”
“Make sure every goal on the treatment plan is clearly something the person is passionate about and then make sure your role in that goal meets the criteria for medical necessity.”
Meaningful and Important Goal

30. What shifts created the environment to help Elizabeth recover?
“I am mentally ill.”
“I’m a singer, a friend, a daughter, a member of a faith community, who also struggles at times with distressing thoughts.”
“I’m a singer, a friend, a daughter, a member of a faith community, who also struggles at times with distressing thoughts.”
Worker:
“She is mentally ill.”
“I’m a singer, a friend, a daughter, a member of a faith community, who also struggles at times with distressing thoughts.”
“She’s a singer, a friend, a daughter, a member of a faith community, who also struggles at times with distressing thoughts.”
Agency Culture:
“We serve people with severe and persistent mental illnesses.”
“Make sure every goal on the treatment plan is clearly something the person is passionate about and then make sure your role in that goal meets the criteria for medical necessity”
“We help people with the lived experience of mental illness build and/or rebuild lives that have meaning
and purpose.”
Identity and Focus

31. Critical Components of the Strengths Assessment (Content)
Written in a context that is meaningful and important to the person
“I want my own place. I want to prove to myself and others I can do this.”
“I want my own place”
“I would like more friends to do things with”
Hope-inducing for the person
““I’m not sure what it is going to take to achieve this goal, but if it is important to you, I will help you explore it and take steps to achieve it.”
The process of exploring possibilities and visualizing tangible strengths created an aura of hope
Thorough, detailed and specific
* Brother (Roy) can take me places if I need anything
* Lamictal helps with the depression – “I don’t feel suicidal as much”
Written from the person’s perspective
and using his/her own words
“I want…”
“I have…..”

32. Critical Components of the Strengths Assessment (Process)
Evolves at the person’s pace
As opposed to a rush to fill out paperwork
Most important is that person is engaged `
Conducted in a conversational manner
““I’m
As opposed to an interview
Uses the boxes to record, not guide
Occurs in the person’s natural environment whenever possible
As opposed to a majority of meeting occurring in the office
The nature of the goal will often dictate setting
Part of an ongoing process in which information is updated on a regular basis
As opposed to a one-time assessment
You are creating a portrait or building a narrative, not completing a form

33. Thank You!