1. Substance Use and Employment Oregon Supported Employment Center for Excellence
CODA, Inc. Staff
Terry Myers, CADCI, QMHA
Supported Employment Manager
Freda, Terry, Jolene, Elissa
Central City Concern, Employment Access Center Staff
Freda Ceaser, MSW
Director of Employment Services
Elissa Black, BA
Supported Employment Supervisor
Jolene Kawecki, QMHA, BA

2. ROBERT’S STORY

3. So you help people get jobs when they are actively using?​
Everyone can work.
Supported Employment provides services regardless of symptoms.
Don’t be a barrier to employment.
Recognize a job might help foster recovery by providing meaning, structure, and natural support systems.
We do consider their substance use when we assess how to provide services.​
Freda’s slide

4. Client Stories
​A young man who was homeless around 28 years old. He lived on the street for four years on and off. He came to the CODA clinic and was invited to participate in the SE research project. After several months of exploring and discovering he was placed in a landscaping position making $18 an hour. Within 6 months became a supervisor and got medical benefits. He continues to work for this employer. Even though he was still using, employment allowed him to expand his goals and support network. He went from being homeless over a 4 year period, living in the neighborhood. He spent most of his day seeking food, shelter, clothing, and security for his personal belongings through the variety of community resources before coming to work with CODA. This gentleman is now living in permanent housing.
A customer who had addiction and gambling issues came into the program without identifying with recovery.  Jackie was pre-contemplative and felt like her marijuana/meth use and gambling were not very big deals despite her frequent hospitalizations. Jackie refused any disclosure and Job Developing was done for her only to find openings that she could apply for.  Since the jobs Jackie was most interested in applying for had drug tests she decided to quit her use in order to pass them.  Jackie was able to start working for Enterprise Rent a Car and used her job as a reason to stay clean.  She became and outstanding employee and was successfully exited.  That was two years ago and she is still working there to this day. ​​ ​
David has lost several jobs in the past due to relapse, a learning disability and mental health diagnosis that was not treated. Through the Supported Employment program, David was referred to Vocational Rehabilitation. David was provided help with supports from both the Supported Employment program and VR around his job search, learning disability and mental health. With that support David was able to begin an OJT through VR at a place he volunteered with for 2 years. He is now working on payroll as a Human Services Specialist and coordinates the volunteers.​
Terry, Jolene, and Elissa

5. Outreach and Engagement
Outreach when the customer is still using, meet in the community instead of in the office. How do you do this​?
Continue to be available to the client.
Set a new time to meet that would not coincide with their normal use (i.e. earlier in the day).
Freda and Terry

6. Reality Check
Be clear about the effects of substance use on the job search, and on the services that we can provide. ​
Inform client about employment drug screenings and who to formally disclose your prescription to.  ​
Help the client think through what might happen on the job due to their substance use.
Elissa

7. CODA participated in a 2 year IPS research project
CODA participated in a 2 year IPS research project. The population was methadone maintenance treatment.
Baseline demographic characteristics were similar between the two groups and representative of agency's patient population.
Both groups had high proportions of individuals with histories of homelessness, substance use, and incarceration, as well as self-reported negative consequences of drinking and drug use.
At baseline, stimulants and benzodiazepine were the most common additional substance use disorders.
Terry

8. Outside supports
Work with case managers to provide links to recovery services.
Engage recovery supports such as a 12-step sponsor.
Seek out friends, family, and their natural clean and sober supports in the community.
Encourage relationship building with new co-workers​.
Document all of these specific supports in the follow along plan.
Reach out to all the supports that your agency offers.
Terry

9. Alcohol and drug recovery goes hand in hand with employment success.
Educate customers as to the recovery process.
Respect recovery commitments and self-care needs.
Listen to client’s recovery experiences.
Recovery is a journey.
Follow along support plan is an opportunity to have these conversations.
Terry

10. Job development for clients with active substance use ​
Negotiate with the employer their needs and the clients skills.
To disclose or not to disclose?
Job Search Support vs. Job Development when your client is using.
Revisit disclosure with the customer often and discuss with your supervisor what your agency’s policy is around disclosing information about the client.
Elissa and Freda

11. Finding a good fit Be mindful of work environments and job duties.​
Know the environment and staff where the client will be working.
Freda

12. Repairing damage to employer relationships
Be proactive and prompt in connecting with the employer. ​
Listen to the employer, including letting the employer vent.
Explain the recovery process.
Ask for their feedback on what could have been different​.
Continue to check in with the employer to repair employer relationship.
Jolene

13. What happens when the job does not work out for the client?
Progress is not measured in a straight line; there will be ups and downs.  ​
What can be learned from the client’s experience?​
Complete a job end report and update the Vocational Assessment.
Elissa

14. IPS Results at EAC
Most participants are living in CCC’s alcohol and drug free housing programs and were previously homeless
Approximately 40% of participants experience co-occurring disorders
Approximately 60% experienced primary substance use disorders
Majority of clients have (70%) have histories of felony convictions
900 participants served in FY 2015
515 clients placed in employment, 57% job placement rate
Freda

15. The jobs obtained in the IPS group were sustained through month 12.
Employment Outcomes
Participants in the active IPS group were 11.0 times more likely to have a job within the first six months of participation and by twelve months were 2.6 times more likely to have gained employment as opposed to control group.
The jobs obtained in the IPS group were sustained through month 12.
When the waitlist group became eligible for IPS intervention at month 6, the number employed was from one at month 6 and five at month 12.
Terry

16. Table 5
Number of Days Worked and Salary for Employed Participants at 12 Months by Randomization Group
Characteristic
IPS
(n=11)
Waitlist
(n=5)
Days worked
Average
Range
177
156
Hourly salary
$12.84
$ $25.00
$13.25
$ $16.00
Received healthcare benefits
Yes 3 1
Terry

17. Table 6
Treatment Retention for Months 3 through 12 by Group Randomization
IPS
Waitlist
Month
In Treatment
Not In Treatment
Month 3 20 2 19 4
Month 6 17 5 16 7
Month 9 13 9 6
Month 12 11 18
Terry

18. Questions?