1. Mental Health and Employment in TVR Work Building on Our Strengths as Tribal Programs

2. Medical Model Medical Model v. Traditional Perspective  FOCUS ON INDIVIDUAL INCAPACITY  DIAGNOSIS RATHER THAN FUNCTIONING  LOOKS AT PEOPLE AT WORST TIMES IN THEIR LIVES  PERSON INDEPENDENT FROM ENVIRONMENT AND SUPPORTS  WESTERN MEDICINE VALUES CURE OVER MINIMZATION OR REMEDIATION OR ADAPTABILITY

3. Medical Model Traditional Perspective Medical Model v. Traditional Perspective

4. VR Considerations Mental Illness Defined  Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors.  Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function. Indigenous View  Lack of traditional acknowledgement of mental illness  Often not looked at as illness causing disconnect and inability to identify  Things viewed as broken in the medical model are at odds with traditional medicine beliefs (visions and channeling others emotions)  The more we accept the medical model the further we get away from the traditional teachings

5. RECOVERY VALUES IN WORKING WITH PEOPLE W. MI  CULTURE OF CLIENT BENEFIT – LIVING, WORKING, RELATIONSHIPS  PEOPLE HAVE RIGHT TO CONTROL THEIR LIVES, THEIR TX, & KINDS OF HELP THEY RECEIVE. STAFF SHOULD INFLUENCE.  ALL PEOPLE NEED HOPE & SUPPORT  PEOPLE W. MI DO GET BETTER --- > 60%  SYMPTOMS NOT PREDICTIVE IN OTHER AREAS  PEOPLE CAN WORK, SO THEY SHOULD WORK  PEOPLE W. MI BEST SERVED IN COMMUNITY  COMMUNITY/ PEER/ FAMILY SUPPORTS + PROS  CULTURE OF CLIENT BENEFIT – LIVING, WORKING, RELATIONSHIPS  PEOPLE HAVE RIGHT TO CONTROL THEIR LIVES, THEIR TX, & KINDS OF HELP THEY RECEIVE. STAFF SHOULD INFLUENCE.  ALL PEOPLE NEED HOPE & SUPPORT  PEOPLE W. MI DO GET BETTER --- > 60%  SYMPTOMS NOT PREDICTIVE IN OTHER AREAS  PEOPLE CAN WORK, SO THEY SHOULD WORK  PEOPLE W. MI BEST SERVED IN COMMUNITY  COMMUNITY/ PEER/ FAMILY SUPPORTS + PROS

6. Is there room for our IDENTITY?

7. Merging the Western and Traditional

8. Preparing for Employment…Assessment

9. PERSON ABILITIES - CAN DO? TOLERANCES - WHERE DO? VALUES - WANT/ NEED TO DO? PERSON ABILITIES - CAN DO? TOLERANCES - WHERE DO? VALUES - WANT/ NEED TO DO? EMPLOYER JOB NEEDS ABILITIES VALUES TOLERANCES JOB MATCH

10. IF YOU THINK WORK IS BAD FOR PEOPLE WITH MENTAL ILLNESS, THEN WHAT ABOUT POVERTY, UNEMPLOYMENT, AND SOCIAL ISOLATION? IF YOU THINK WORK IS BAD FOR PEOPLE WITH MENTAL ILLNESS, THEN WHAT ABOUT POVERTY, UNEMPLOYMENT, AND SOCIAL ISOLATION?

11. The Importance of Focusing on Wellness

12. How Has the Non-Native World Influenced Your Consumers?

13. LIZZIE BORDEN SYNDROME

14. LINE MANAGER -- S.F. “ I CAN’T IMAGINE HIRING SOMEONE WITH A PSYCHOLOGICAL PROBLEM. “

15. RECRUITER -- BALTIMORE “ I’D MUCH RATHER DEAL WITH THOSE WITH PHYSICAL CHALLENGES. SIMPLY BECAUSE THEIR WORK ETHIC IS BETTER & THEY’RE LESS LIKELY TO STAB YOU TO DEATH.”

16. STIGMA REDUCTION: ABILITY TO CHANGE BEHAVIOR THROUGH EDUCATION IN THIS AREA IS NEGLIGIBLE

17. IF YOU THINK WORK IS BAD FOR PEOPLE WITH MENTAL ILLNESS, THEN WHAT ABOUT POVERTY, UNEMPLOYMENT, AND SOCIAL ISOLATION? IF YOU THINK WORK IS BAD FOR PEOPLE WITH MENTAL ILLNESS, THEN WHAT ABOUT POVERTY, UNEMPLOYMENT, AND SOCIAL ISOLATION?

18. IF YOU THINK WORK IS BAD FOR PEOPLE WITH MENTAL ILLNESS, THEN WHAT ABOUT POVERTY, UNEMPLOYMENT, AND SOCIAL ISOLATION? IF YOU THINK WORK IS BAD FOR PEOPLE WITH MENTAL ILLNESS, THEN WHAT ABOUT POVERTY, UNEMPLOYMENT, AND SOCIAL ISOLATION?

19. What to Expect When Working With Consumers  Resistance  Deflection  Projection  Resistance  Deflection  Projection

20. Theory of Change Model

21. HELPING PEOPLE CHANGE: HOPE, HELP, AND HASSLING (What does “hassling” mean for different cultures?) HELPING PEOPLE CHANGE: HOPE, HELP, AND HASSLING (What does “hassling” mean for different cultures?)

22. HELPER’S RESPONSIBILITY TO ENGAGE & MOTIVATE HOPE VS. OPTIMISM? --- PAT ON BACK VS. COMMUNICATING THAT: YOU CARE YOU UNDERSTAND YOU WILL BE THERE YOU HAVE IDEAS & HELP TO OFFER HOPE VS. OPTIMISM? --- PAT ON BACK VS. COMMUNICATING THAT: YOU CARE YOU UNDERSTAND YOU WILL BE THERE YOU HAVE IDEAS & HELP TO OFFER

23. People don't resist change. They resist being changed. ~ Peter Senge

24. NO MOTIVATION (DO YOUR CLIENTS GET LABELED WITH THIS?) FEAR OF FAILURE NO SELF - CONFIDENCE POOR EXPERIENCES LOSS OF BENEFITS LACK OF INFORMATION LAZINESS ? OTHERS FEAR OF FAILURE NO SELF - CONFIDENCE POOR EXPERIENCES LOSS OF BENEFITS LACK OF INFORMATION LAZINESS ? OTHERS

25. MOTIVATIONAL INTERVIEWING Express empathy Develop discrepancy Avoid argumentation Roll with resistance Support self-efficacy Express empathy Develop discrepancy Avoid argumentation Roll with resistance Support self-efficacy Miller, W. & Rollnick, S. (1991).

26. Group Discussion  How do you incorporate tribal values, beliefs and teachings into the VR process?  What is working?  Where are the disconnects?  How do you incorporate tribal values, beliefs and teachings into the VR process?  What is working?  Where are the disconnects?

27. Thank You Lanor Curole, Director United Houma Nation Vocational Rehabilitation Services (985)223-3093 lanor.curole@unitedhoumanation.org Joe Marrone University of Massachusetts Institute for Community Inclusion