1. Comparative Employment Strategies for Serving Individuals with Significant or Most Significant Disabilities: Customized Employment and Evidence-based Supported Employment David W Lynde Supported Employment Consultant Michael Callahan Marc Gold & Associates (MG&A) November 7, 2012

2. Evidence – Based Supported Employment David W Lynde, MSW Supported Employment Consultant

3. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 3 Overview Principles of Evidence Based Supported Employment Supported Employment/Individual Placement and Support as an Evidence Based Practice Supported Employment Fidelity Scale Items

4. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 4 Principles of Supported Employment Helping people obtain competitive employment is the goal Participating in SE is based on each person’s own choice SE is integrated with other mental health services

5. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 5 Principles of Supported Employment Each person has access to good work incentive planning information SE helps people find real jobs soon after they start the program, not requiring lengthy assessments or job trials

6. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 6 Principles of Supported Employment Each person’s goals and preferences regarding work are honored SE helps people to be successful at work through follow along supports Employment specialists use systematic job development strategies

7. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 7 Definition of Competitive Employment A job in the competitive labor market that is performed on a full-time or part-time basis in an integrated setting; and For which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals who are not disabled

8. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 8 Competitive Employment Is the Goal Each person is helped to find their own competitive job, one that they own, where they receive the paycheck directly from the employer

9. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 9 Competitive Employment Is the Goal People are not steered into accepting jobs in pre-arranged job slots People are not directed into sheltered workshops, lengthy vocational assessments or working in job enclaves Jobs are identified or developed to fit each person’s individual job goals and job preferences

10. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 10 Participating in SE: A Person’s Own Choice SE services are provided to all people who identify themselves as having competitive employment as a recovery goal

11. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 11 Low Expectations Research about the low expectations of mental health professionals in relation to people with mental health conditions gaining employment is now very well documented. These expectations are often underpinned by concern about issues of risk, stress and relapse. Such low expectations … can result in them and their families receiving very cautious messages from mental health professionals about gaining employment. Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and employment: A review. International Review of Psychiatry

12. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 12 Participating in SE: A Person’s Own Choice People are not excluded from SE because of diagnosis, symptoms or other agency imposed rules People are not excluded because of the mental health providers own biases about who is and who is not ready for employment

13. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 13 “Work Ready” “I was going to a day treatment program forever. I was waiting to be anointed by someone that I was ‘work ready’.” Maureen Marrin

14. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 14 Supported Employment Is Integrated with Mental Health Treatment Each person in SE receives integrated mental health services. Employment specialists work in an integrated way with the other members of the person’s mental health treatment team (for example, case manager, peer supports, therapist, psychiatrist, etc…).

15. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 15 “I want to live my life not my disability” Pat Deegan

16. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 16 People Access Individualized Work Incentive Planning Each person in SE has access to good, accurate work incentive planning that is based on their individual situation Work incentive planning helps people to determine what role benefits will play in their recovery

17. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 17 People Access Individualized Work Incentive Planning People are empowered to make their own choices about benefits and are not directed to “earn less than SGA” What works best for the person is their own personal choice

18. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 18 People Receive Timely Job Search Services When people start SE, their goals to obtain competitive jobs are respected People are not required to participate in pre- employment assessments, job-hardening activities, or trial work periods

19. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 19 Each Person’s Goals and Preferences are Honored People are helped to find work that matches with their individual work goals, preferences, strengths, and work experiences People are not directed into other pre-vocational tasks to prove they want to work

20. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 20 Employed People Receive Follow- Along Supports The employment specialist and the mental health center help employed people to be successful at work by providing follow along supports for employment Follow along supports are based on each individual’s unique situation and needs

21. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 21 Systematic Job Development Employment specialists develop direct relationships with employers, based upon clients’ work goals, by meeting face-to-face over multiple visits in the community Employment specialists learn about the work environment and the employers’ work needs in order to match clients with employers 21

22. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 22 Supported Employment An Evidence-Based Practice for Adults with Mental Illness

23. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 23 Evidence Based Practice Definition (Mental Health Practices) Practice is manualized Practice has a fidelity scale Practice has demonstrated success helping consumers with their goals in published research trials Research trials have been done by more than one researcher with good outcomes 23

24. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 24 16 Trials of Supported Employment 4 conducted before Individual Placement and Support (IPS) model was developed 11 used full implementation of IPS 1 studied supported employment on an ACT team 24

25. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 25 Competitive Employment Rates in 16 Randomized Controlled Trials of Supported Employment

26. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 26 www.samhsa.gov Search Supported Employment Toolkit SAMSHA’S National Health Information Center

27. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 27 Dartmouth Supported Employment Web Site http://www.dartmouth.edu/~ips/ 27

28. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 28 Evidence Based Supported Employment Fidelity Scale Overview

29. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 29 Fidelity Scale Structure 3 Components 1. Staffing 2. Organization 3. Services

30. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 30 Fidelity Scale Structure - Staffing 1. Caseload Size Maximum is 20 clients 2. Vocational Services Primarily provide SE services only 3. Vocational Generalists Provide all phases of employment process

31. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 31 Fidelity Scale Structure - Organization 1. Integration of rehabilitation with mental health thru team assignment 2. Integration of rehabilitation with mental health thru frequent team member contact

32. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 32 Fidelity Scale Structure - Organization 3. Collaboration between employment specialists and Vocational Rehabilitation counselors 4. Vocational unit  Meets at least once a week 5. Role of employment supervisor  Supervisors team members, sets goals

33. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 33 Fidelity Scale Structure - Organization 6. Zero exclusion criteria 7. Agency focuses on competitive employment 8. Agency leadership team provides support for SE

34. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 34 Fidelity Scale Structure - Services 1. Work incentives planning 2. Disclosure decisions about job search and supports 3. Ongoing, work-based vocational assessment  Develop Vocational Profiles with clients

35. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 35 Fidelity Scale Structure - Services 4. Rapid search for competitive job  Within about one month 5. Individualized job search 6. Job development—Frequent employer contact  Minimum 6 contacts per week 7. Job development—Quality of employer contact

36. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 36 Fidelity Scale Structure - Services 8. Diversity of job types 9. Diversity of employers 10. Competitive jobs 11. Individualized follow-along supports  Based on person’s needs and challenges

37. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 37 Fidelity Scale Structure - Services 12.Time-unlimited follow-along supports  Until client not longer needs supports 13.Community-based services  65% of employment specialist time in the community 14.Assertive engagement and outreach by integrated treatment team

38. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 38 Assuring that “All” means All: Customized, Supported Employment A concept and process for insuring access to successful employment for all Michael Callahan Marc Gold & Associates (MG&A )

39. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 39 Customized Employment Customized Employment provides a business- friendly strategy to assist job seekers with significant disabilities, who find competitive demand a barrier to paid work in the community, a process that avoids job openings in favor of a negotiated relationship based on mutual benefit.

40. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 40 Customized Employment According to US/DOL: Customized employment means individualizing the employment relationship between employees and employers in ways that meet the needs of both. It is based on an individualized determination of the strengths, needs, and interests of the person with a disability, and is also designed to meet the specific needs of the employer.

41. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 41 Unbundling demand Employers have typically met needs by bundling demands into job descriptions. Job seekers with complex lives often don’t have the “whole package” to offer. Customized Employment allows employers to “unbundle” demand and to take advantage of discrete competencies.

42. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 42 Customized Employment History Started in late 1980’s through projects by United Cerebral Palsy and others who recognized demand employment as a barrier. Based on Job Carving and Restructuring During the 1990’s CE was referred to as Negotiated Supported Employment The term Customized Employment was coined by ODEP/USDOL in 2001

43. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 43 Customized Employment History ODEP funded 36 national projects from 2001 - 2007 that featured CE as the central theme WestStat completed research on the ODEP CE projects 2007 ODEP funded ICF to research the KSAO’s (knowledge, skills, abilities and other characteristics)of CE in 2009 Wisconsin DVR included CE process in its technical specifications for supported employment in 2010

44. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 44 The Job Seeker’s side of the Equation Conditions for Success Interests toward an aspect of the Labor Market Potential Contributions to Employers

45. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 45 The Employer Side: Needs/Benefits Analysis Unmet Workplace Needs: This area focuses on tasks that need to get done but are not getting done in the way the employer would like. It also can include tasks that have not been performed but need to be. Tasks better performed by others: This area focuses on aspects of jobs that might better be performed by others at a lower pay grade. This option can directly save money for employers. Specific Benefit/ Productivity: This area focuses on workplace needs for additional productivity in specific tasks. It must be matched with job seeker’s specific competencies.

46. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 46 Balancing the Customized Equation Customized employment seeks to balance the equation between Job Seekers and Employers Job Seeker Conditions Interests Contributions Employer Unmet needs Tasks better performed by others Specific benefit =

47. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 47 The Employment Matrix There are job seekers who will not need either SE or CE to become employed and to stay employed There are job seekers who will need CE to become employed but will not need SE to stay employed There are job seekers who will not need CE to become employed but who will need SE to stay employed There are job seekers who will need both CE to become employed and SE to stay employed Natural Supports and Reasonable Accommodation only Supported Employment and Natural Supports Competitive Employment Customized Employment

48. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 48 Features of Customized Employment Based on discovery of the applicant more than on evaluative/comparative processes Driven by a customized plan developed by the applicant’s strengths, needs and interests Focuses on tasks rather than job titles to negotiate essential responsibilities

49. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 49 Features of Customized Employment Specific job duties are negotiated with employers, voluntarily, to customize the job Occurs in regular community workplaces or in self-owned businesses Involves pay of at least the minimum wage up to prevailing wage

50. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 50 Features of Customized Employment Applicable to all users of workforce system Includes on-going supports and reasonable accommodations, as appropriate Starts with the individual as the source of information and direction to labor force

51. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 51 Customized Process Discovery Capturing discovery through profiles Customized, person-centered planning Portfolio/visual resume development Job development and negotiation Here, CE dovetails with Supported Employment Job site analysis, accommodations, support

52. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 52 CE: An outcome based process Each aspect of the CE process is designed to be compatible with evidence-based research and outcome-based payment systems. Outcome products, how-to materials, step-by-step procedures, narrative manuals and support materials and data collection processes have been developed, implemented and studied.

53. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 53 Outcome products of CE Discovery: Discovery logs, discovery notes Profiles: Profile forms, samples and guides Customized Planning Meeting: Plan worksheets, proposed blueprint for job development, proposed task list, specific employer list Representational materials: Visual Resume, Agency Portfolio Job Development and Negotiation: Employer needs analysis form and sample, employer contact sheets, blueprint indicating features of actual job developed

54. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 54 Sample Outcome Payments of CE Discovery: $600 - $1,000 Profile: $200 - $300 Customized Plan for Employment: $250 Visual Resume Development: $250 Employer Needs Analysis: $250 Job Development Calls based on Plan: $75/each Job Development Outcome payment at Day One: $1,000 - $1,500

55. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 55 Final Analysis Although to this point Customized Employment has not been studied with the rigor to indicate its status as an evidence-based process, the years of successful utilization coupled with the outcome- based structure presented here merits its use as an effective approach to employment for those who fail assessments and are excluded from demand job openings.

56. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 56 TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 56 Comments & Questions

57. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 57 TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 57 Thank You

58. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 58 TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 58 Contact Information David W Lynde Supported Employment Consultant Email: David.Lynde@Dartmouth.edu Michael Callahan Marc Gold & Associates (MG&A) Email: MICALLAHAN@aol.com

59. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 59 TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 59 Education Credits CRCC Credit - (2.0) Approved by Commission on Rehabilitation Counselor Certification (CRCC) By November 17, 2012, participants must score 80% or better on a online Post Test and submit an online CRCC Request Form via the MyTACE Portal. My TACE Portal: TACEsoutheast.org/myportal

60. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 60 TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 60 Southeast TACE Region IV Toll-free: (866) 518-7750 [voice/tty] Fax: (404) 541-9002 Web: TACEsoutheast.org My TACE Portal: TACEsoutheast.org/myportal Email: tacesoutheast@law.syr.edu

61. TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 61 TACE Center: Region IV, a project of the Burton Blatt Institute. Funded by RSA Grant # H264A080021. © 2012 61 Disclaimer This presentation was developed by the Southeast TACE Center: Region IV ©2012 with funds from the U.S. Department of Education, Rehabilitation Services Administration (RSA) under the priority of Technical Assistance and Continuing Education Projects (TACE) – Grant #H264A080021. However, the contents of this presentation do not necessarily represent the policy of the RSA and you should not assume endorsement by the Federal Government [34 CFR 75.620 (b)].