Download - Sponsored by The California Institute for Mental Health Facilitated by Gary Shaheen Laura Ware
“Work as a Priority”Strategies for Employing People with Psychiatric and Co-occurring Disabilities who are Homeless
Sponsored byThe California Institute for Mental Health
Facilitated byGary Shaheen
Laura WareAdvocates for Human Potential, Inc.
518-475-9146, ext. [email protected]
DAY #1 Learning Objectives
Learn about factors resulting from homelessness that affect people’s ability to obtain and retain employment
Understand how recovery and rehabilitation principles and practices can provide the foundation for employment success.
Understand how to address factors of motivation, self esteem, powerlessness that affect employment success
Apply information through scenario exercises
Larry MeredithIn Hooked by Lonny Shavelson 2001
“If we are going to make a difference, then we have to realize that drug abuse & mental health is related to housing is related to health care is related to joblessness is related to poverty. You can’t deal with any one of those without dealing with all of them.”
“RJ”
I have been homeless for five years
I have schizophrenia and have been drug addicted since the age of six
I smoked crack Did some time a few
years back on a burglary charge
I don’t know where I’m going to sleep tonight
Shelters are bad places where they rob you and beat you up. The staff looks the other way.
I am an artist. I could be a millionaire if I could get money to make and sell my paintings
If the Mayor can spend millions building a new city hall he should be able to give us money to help us get jobs and a decent place to live.
Disincentives to Employment……
Distrust Focus on immediate
needs Co-occurring
disabilities Learned helplessness
and emotional instability
Functional limitations Cognitive limitations Illiteracy Communication
deficits Physical/emotional
trauma Poor self-esteem Fragmented or
inadequate services/supports
Mobility Skills mismatch Fear Legal issues: custody
convictions, judgements, probation
Lack of personal documentation
Child care Transportation Earning disincentives Lack of permanent
address and phone # Lack of hope Lack of skills regarding
how to work towards a sustained goal, not just immediate gratification
Program-Level Challenges
Lack of knowledge, experience
“Paradigm paralysis” Different providers
speak different languages and often can’t share much information
Readiness prerequisites
Ethnic/cultural sensitivity
Different outcome expectations
Different roles and ‘turf issues’
Not enough $$ or in the wrong places
Lack of coordination, communication
Promising more than can be delivered
Different systems are not aware of each other, and are resistant to change
Fragmentation-funding sources, priorities, roles, criteria, etc
Political priorities and issues that may prevent effective communication
Stigma Lack of $$ Lack of cross-
systems training EBPs not
understood
Service System Challenges
“Breaking the Cycle”
Trust-building is fundamental Recognize/utilize personal strengths Provide factual information Teach by example Recognize and address complex needs Affirm personal dignity and self-worth Reinforce personal responsibility, choice and
empowerment Facilitate discussions to help individual see
how previous choices and decisions can be done differently
Adapt vocational approaches to meet needs Provide comprehensive, long-term supports
Common Themes
Jobs that people want and can manage well Linking Housing First/Work First Entrepreneurial approaches Clear & reasonable expectations for all parties Flexible outcomes Redefining failure Provide personal service supports No arbitrary time limits Hire consumers as staff Cultural competence/relevance Link to treatment, rehabilitation, recovery
services
Guiding Principles #1
Treat people on the basis of facts and inherent capabilities, not generalizations and stereotypes
Provide genuine, effective, and meaningful opportunity (provide reasonable accommodations and modifications) in integrated mainstream environments
Guiding Principles #2:Social Justice and Equity
XXX% of all people who are homeless are persons of color
Stigma, discrimination is a “triple whammy”- 1) homelessness + mental illness
+ substance abuse + criminal justice issues
2) poverty and disenfranchisement
3) racial stereotyping, prejudice and discrimination
You should consider the impacts of these factors on employment as well!
Guiding Principles #3FULL PARTICIPATION
Involve people in decision-making at the individual, management and systems levels
Ensure informed choice and share information using various mediums
Provide support for self-determination, empowerment and self-advocacy
UPENN RESEARCH-MAJOR FINDINGS
Homelessness is a “Revolving Door” Phenomenon
Point in Time vs. Longer Time Frame
Identified 3 Subgroups * Transient * Episodic * Chronic
CULHANE’ S SUBPOPULATIONS
Transient: 80% of overall population, single, economically caused episode, low rates of illness
Episodic: 10 % of overall population, multiple episodes of homelessness over time
Chronic: 10% of overall population, multiple, complex problems, long term homelessness
Resources
“Changing for Good”-Prochaska, Norcross & DiClemente, 1994
“Motivational Interviewing: Preparing People to Change Addictive Behavior”-Miller & Rollnick, 2002
PATHPROGRAM.COM-Click on “Technical Assistance”
“Implementing Interventions for Homeless Individuals with Co-Occurring Mental Health and Substance Abuse Disorders”-Winarski, 1998
FOUR PHASES OF TREATMENT
• Engagement
• Persuasion
• Active Treatment
• Relapse Prevention
Source: Osher and Kofoed (1989)
STAGES OF TREATMENT
ACTIVE TREATMENT
RELAPSE PREVENTION
• Develop Relationship - Outreach Skills - Interpersonal Skills• Provide Basic Supports• Peer Intervention
Case Management - Planning - Linking - Advocating
• Hospitalization• Outpatient Treatment• Residential Treatment - Medication - Individual Therapy - Group Therapy - Peer Support• Psycho-education• Drug-education• Rehabilitation Skills for Supported - Housing Education Employment• Peer Interventions
• Community/Peer Support• Individual/Group Therapy• Psycho-education• Identify Signs/Triggers for Relapse• Rehabilitation Skills for: Supported - Housing Education Employment• Peer Interventions
ENGAGEMENT
PERSUASION
• Develop Relationship - Outreach Skills - Interpersonal Skills• Provide Basic Supports• Develop Readiness - Enhance Motivation• Peer Intervention
RECOVERY:
A
UNIFYING
CONCEPT
Consumer Self-Report of Items Important to Recovery (Ralph,R) Ability to have hope Trusting my own thoughts Enjoying my environment Feeling alert and alive Increased self-esteem, spirituality Knowing I have a tomorrow Having a job
How MH Professionals Help (Ralph,R)
Encourage my independent thinking Treat me like an equal in planning my
services Give me freedom to make my own
mistakes Listen to me and believes what I say Recognize my abilities Work with me to find the
resources/services that I need
UNDERSTANDING RECOVERY
• Recovery Occurs for All People
• Recovery Occurs at Multiple Levels and at Variable Rates: The Centrality of Loss
• Recovery Follows a Non-Linear Course
Source: Winarski and Dubus (1995)
FACILITATING RECOVERY
• Create Environments that are Conducive to Recovery.
• Attend to Motivational States.
• Respond to Mental Health & Substance Use Disorders Simultaneously.
• Create Community.
• Define Expectations.
Source: Winarski and Dubus (1995)
Role Recovery is….
Obtaining and sustaining a valued role as a: Worker Family-member Friend Homeowner/tenant Partner, etc
By overcoming personal losses, setbacks, obstacles, and limitations
Obtaining the skills and trust from others needed to perform that role
Educating others re: personal abilities
Using natural and professional supports as needed
Worker Role Recovery-Two Dimensions
INSIGHT DEVELOPMENT
Identify values preferences, choices
Prepare for change – personal and environmental
Honest self-assessment
Trust in self and others
Hope for the future
SKILL DEVELOPMENT
Setting work goals Testing work
preferences Evaluating skills,
personal strengths and supports against goals
Skills Teaching: tasks and work habits, as well as pursuing, obtaining and managing success
Support Service planning
ASSESSM
ENT
ASSESSMENT IS ON-GOING
• Longitudinal approach: collect and interpret information during each contact.
• Focus on signs and symptoms rather than making diagnosis.
• Comprehensive assessments may take many weeks and/or months.
THE ASSESSMENT PROCESS IS INTEGRATED WITH THE HELPING RELATIONSHIP
• Assessment takes place concurrently with activities that facilitate connection to the program.
• Information is most effectively gathered in the context of a trusting relationship.
• Gather information in an environment free from distractions.
ASSESSMENT PROCESS
Observe/
Listen
Collect and Interpret
Information
Ask Critical
Questions
Source: Bassuk (1994)
Tips for Effective Interviewing
Choose between open-ended and closed-ended questions.
Avoid leading questions.
Structure chronological answers.
Divide the experience into parts.
Share experiences by generalized feelings.
Be aware of ‘non-verbal communication
Conclude the interview.
Common Errors in Interviewing
Imposing values. Offering false reassurance. Asking double questions. Interrupting answers. Discouraging or forbidding the
expression of real feelings. Saying “I understand”
inappropriately.
Techniques for Identifying Dual Disorders
Screen-expectation not an exception. Increase the “Index of suspicion”.
Self-report Signs and Symptoms Chemical testing Collateral information Correlates or predictors of substance use
disorders Indirect measures (e.g. Family history -
Car accidents).
Source: Drake (1993) Assess 1
At Outreach/EngagementInformation about work
Conversations about work“Standing offer of Work”
Purpose:Develop Trust, Awareness & Motivation
Brief Intake/AssessmentInterviews
Situational AssessmentsPurpose:
Develop Initial Goal/Plan
Discovery OptionsPart-time/Transitional
WorkSocial EnterprisesPerson-centered
planningEducation
Volunteer WorkPurpose:
Further Define ChoicesDevelop
Confidence/Skills/Trust
Supported Employment EBP
OptionsRapid Job Placement in
Open Market JobsEmployer-sponsored
Training and Credentialing
Time-Unlimited SupportOngoing Assessment
Purpose:Get, Keep, Advance
Ongoing Contact with Employment
Specialist
Ongoing Support as Needed for Re-Placement, Job Acquisition, Advancement
Employment-Centered Outreach
Make work part of the conversation about engaging in services
Prompt and listen to people’s stories about jobs they had and jobs they may want
Encourage stories that help the individual to see unidentified yet transferable skills
Provide information Assess the value of an offer of
work as a ‘hook’ to influence positive change
Understand the ‘stages of change’
Principles/Practices #1:Linking Employment and
HousingChallenges
People may not be interested in services once they are in the housing unit
They are not sure what they want to do and avoid staff
They are engaged in behavior they are trying to hide from staff
Staff try to “over –engage” or overstep boundaries and push participants away
Staff may not maintain proper boundaries with participants, especially if he/she can relate to a particular challenge or situation
Lack of cultural sensitivity to the background, needs, challenges and goals of a specific participant
Suggested Responses
Offer incentives in order to develop their interest
Keep the conversation focused on what the participant is thinking or feeling, and what he/she wants to do about it
Be aware of how your body language or other non-verbal communication
Remember that the staff role is to guide and support, not direct, over-invest, “mother “ a participant, or become emotionally involved
Suggest meeting in an open space such as outdoors or in a private space such as a counseling room
Try to never force an interaction unless absolutely necessary, or unless someone’s safety is at risk
“Vocationalize” the housing environment by having a variety of available activities that offer opportunities for engagement around work
Vocationalizing
Creating a culture that expects work - verbally, mentally, environmentally and literally.
Arranging things, activities and resources to include and/or support employment.
Assign accountability for employment outcomes to all staff.
Develop and maintain organizational policies and practices that support client employment
Begin tracking employment outcomes.
“Mary”
Mary accepts housing but refuses to consider employment. Even though the Personal Services Coordinator reminds her that the program is offered only to those who want to work as well as get a place to live, she says she is “not ready” and won’t discuss it any further.
What are some ways you might help Mary address motivation
to work?
Principles and Practices #4Helping “Mary” Develop Motivation
for Work
Typical Challenges
Sense of hopelessness about vocational goals based on experience to date
Numerous setbacks in general or negative work or other vocational experiences
Many think of jobs or tasks that have historically been available without a great deal of creativity
Some may be struggling with depression or other clinical/medical issues that make it difficult to get motivated
Current stresses in life that make feeling motivated difficult
Negative consequences of work such as child support payments, credit debts, SSI/DI disincentives, etc
Suggested Responses
Motivation as a State not a Trait: it can change over time and be influenced
Ambivalence is Good: Tease out both sides, help tip balance towards change
“Resistance” is not a Force to be Overcome-Roll with it
Focus on Person as Ally, not Adversary
Recovery, Change and Growth are intrinsic to being Human
Remember that People who have suffered many losses may relinquish hope to survive
Paint a picture of immediate incentives that can trigger motivational thinking
STAGES OF BEHAVIOR CHANGE
Pre-contemplation: No awareness of problem or need to change
Contemplation: Emerging Awareness, ambivalence
Preparation: Identify, anticipate “hot spots”, planning, rehearsal, identify skills, supports
Action: Plan implementation with feedback loop
Maintenance: Reinforce what works Relapse Prevention: Anticipate and
plan for relapse, viewed as learning opportunity
FACTORS THAT INLUENCE CHANGE READINESS Perception of Need: Person’s
experience of discrepancy between the pain of the present and the potential for future improvement
Belief that Change is Possible: Positive outcome is achievable in reasonable time period
Sense of Self Efficacy: Believes they can succeed
Makes Stated Intention to Change
MOTIVATIONAL TASKS Pre-contemplation: educate, raise
doubt re: perception of risk, identify other areas of high motivation
Contemplation: Tip the Balance- evoke reasons to change and risk of not changing
Preparation: Choose best strategies, anticipate difficulties, plan, rehearse
Action: Frequent monitoring of progress and ongoing lessons
Relapse: Help reframe as learning opportunity, not failure, plan
Describe a time in your life you attempted change-how difficult?
Who helped? Outcome?
Principles and Practices #2Integrated Team Planning
Typical Challenges
Developing effective relationships with staff of other partners, especially when they are located elsewhere
Creating a “project culture” that encourages joint decision making
Effectively documenting services for overall reporting, informational and evaluation purposes
Seeing regular , consistent meetings as crucial, useful and a priority
Developing centralized systems and procedures for intake, assessment, r intervention, communication processes, follow-up, referral, contacts with outside community
Avoiding “turf” issues
Suggested Responses
Clarify for all staff and organizational partners, in writing, who is responsible for each role and component of the project
Sponsor a series of “shadowing” or “job switching” opportunities
Include discussion of partner and staff roles in regular staff meetings
Facilitate regular “case meetings”, at which all staff working with a specific participant are present and asked to share information as well as next steps
Create opportunities for staff to talk about successes and challenges, and for other staff to assist in problem-solving
Designate a team leader
“John”
John says that there is no use in trying to find a job, because all he will do is fail at it anyway. He used to be a good carpenter but that was many years ago. Years of living on the street has eroded those skills and reduced his stamina. He says he feels hopeless of ever finding anything better than dishwashing or carrying out garbage.
How would you help John develop an employment goal?
Principles and Practices #3Helping “John” Create
Employment GoalsTypical Challenges
Many people have not thought about having vocational or employment goals, since their first goal on the streets has been survival
Many are focused on immediate gratification, such as earning a bit of money or paying off a debt
They may have had negative vocational or employment experiences because of the barriers they face
They have trouble thinking about small steps that will lead to achieving a vocational or employment goal
Some may not be currently motivated to pursue vocational or employment activities, and are content to maintain current status or activities
Some may need help to identify how current interests, activities or desired participation can be seen as vocationally-oriented
Suggested Responses
Create opportunities in which they can have a sense of immediate success or achievement
Focus on a person’s perceived or inherent strengths, gifts, skills and interests
Work with them to acknowledge all achievements (including survival on the streets) and make them visible to them as sources of strengths and knowledge that may have a job application,
Focus on immediate goals first, and how these can lead to a larger goal.
Give timeframes to specific goals as a way of motivating participant and yourself as a staff
Make sure all goals are developed or agreed-to by the participant
Make sure goals of any type are clearly defined and fleshed out by the participant and staff so that they are real and true
Principles and Practices #6Implementing a Standing Offer of
Work (In-House Jobs)
Typical Challenges
Changing attitudes and expectations of all parties
Acquiring jobs with built-in flexibility and opportunities for growth and transition
Finding effective partners and employers-internal/external
Resolving alcohol/substance abuse and mental health issues affecting work
Staff and new worker training
Providing supervision and support
Fulfilling employment services contract/performance requirements
Funding the effort “Fit” with SE Evidence
based practices
Suggested Responses
Assume employability All staff supports peoples’
desire to work Look internally as well as
externally for $$ Provide direct, tangible
workplace-based support to break down barriers
Avoid lengthy prerequisites –rapid access to a low-impact job
Allow multiple work options-one job does not fit all
Understand peoples’ needs, abilities and values
Communicate your work expectations
Celebrate all degrees of success
Weave in conversations and support for the next step
LAMP Village527 S. Crocker, Los Angeles, CA 90013 (213) 488-0031
Drop-in Center/Crisis Shelter Lamp Lodge-50 unit permanent housing
VILLAGE INDUSTRIES:
- Linen Services
- Public Laundromat
- Public Showers &Toilets 1/3 of staff are consumers
Employs 35 people per day
Principle # - Connecting to MH/SA Treatment Services
Typical Challenges
People may not be ready to accept treatment
People are fearful of treatment
Their friends are not good influences and may disapprove of a person’s decision to enter treatment
Stigma Side effects
Suggested Responses Establish referral
relationships so that the services are accessible to participants when needed
Help people understand the implications on goals they chose and commit to achieving
Enlist the support of peers to help people understand the positive effects of accepting treatment
Be clear about the rules regarding substance abuse on site at HUD housing
“Step-Back/Step-Out/Step-Up”
A Practical Strategy for Keeping the Door Open for Employment
WHAT IT IS: a) A strategy for helping
people address their treatment issues and impact on work
b) A way of keeping people involved in employment services while they deal with their substance use and/or MH treatment issues
c) A plan for putting together a support plan emphasizing growth
WHEN: At engagement, involvement, continuation
WHO: Implemented by staff, peers
WHERE: Shelters, employment programs, housing sites
“Step Back”
Offer alternatives to terminating program involvement for people when substance use interferes with their ability to get or keep employment
Focus on how substance use prevents someone from getting or keeping a job, not the behavior itself.
Provides alternative ‘step-down’ employment-related services that do not risk the safety of the person or others
Step downs still require people to be substance-free while they participate
Examples: employment counseling, presentations by peers or staff, resume writing, low-impact, P/T, time-limited in-house work experience, shadowing, P/T volunteer work
Expected Outcomes: Maintain connection, use stages of change strategy to change behaviors, show consequences (eg: person may lose job but staff “never go away”)
“Step Out”
Some people may not be ready to deal with their treatment issues that affect their jobs and they may need to “step out” of the
program.
Although you may have to get to the place of reinforcing rules of
enrollment-try to maintain contact (through outreach staff, shelter staff, peers, friends, etc) and let them know that the door is open
for them to try again.
“Step Up”
The job placement is only the first success Dealing with treatment issues affecting work is an
ongoing process ‘owned’ by the individual Advancement and stepping out of poverty is the
goal and is negatively affected by job and housing loss due to treatment issues
Ongoing, follow-along support by an IST to support both treatment and work goals
Support needs to accommodate for success as well as address challenges
Involve peers as counselors or mentors showing how people can overcome fears of change and advancement and maintain balance
Expect relapses and have a plan in place that deals with them
Expected Outcomes: Staff realize the job doesn’t end at placement; participants see the benefits of treatment and job retention and advancement; they have access to wrap around supports 24/7
Day #1 Summary:Breaking the “Readiness
Model”
Assume employability All staff supports peoples’ desire
to work Avoiding lengthy prerequisites
and rigid sequencing Allow multiple options-one ‘best
practice’ does not fit all Understand peoples’ needs,
abilities and values Understand what employers want Understand how to make a good
job fit Celebrate all degrees of success
Day #2Learning Objectives
Learn about employment services practices being used throughout the country
Understand tools and strategies for helping people choose, get, keep and advance in jobs
Understand how to use partnerships to improve program delivery
Learn about critical staff competencies for providing employment services
Address challenges and strategies using scenarios and exercises
“Customization” of Employment Best Practices-
A Challenge for the Field Why?
Replace staff-driven employment services with more person-centered approaches
How? Modify existing practices like:
TEP: Each time-limited job is individually negotiated/the person AND the job can change
What Outcomes? Improve outcomes-satisfaction,
tenure, growth
Transitional Employment (TEP) (Est. 1964 Fountain House, NYC)
Primary vocational services of Clubhouses
Time-Limited Part-Time Competitive
Negotiate job slots set aside for rotating workers
Usually entry level jobs
Agency guarantees the job will be done
On and Off-Site Job Coaches, peer supports
Disadvantages: Time limitations Agency is
responsible for performing the job
Dependency issues
ACT/PACT
Continuous 24 hour treatment planning approach
Employment specialist is member of multi-disciplinary Team
Rapid placement, continuous follow-along and reassessment
Recognizes that work is integral to the community treatment process
Focus on “work first” – on-the job learning, adaptation and accommodation
Clash between short-term funding and long-term support needs
Customized Employment (NCWD)
Individualizing the employment relationship between job seekers and employers to meet the needs of both.
Determine the strengths, requirements, and interests of a person with a complex life.
It is not a program, but rather a set of principles and strategies that result in employment.
Builds on supported employment and results in individually designed services, supports, and jobs negotiated to fit the needs of a specific job seeker or employee.
Customized Employment (NCWD)
Customized Planning Profiles, portfolios, etc to capture,
organize, and represent the information that was collected during exploration
Negotiating Negotiating job duties and
employee expectations. Can include job carving, negotiating a job description, job creation, job sharing, etc.
Self-Employment A recognized CE option
Career Mapping-A New Approach to Assessments and Job Planning
(Based on materials developed by Sowers, McLean and Shelton Empowerment for Life Project-Portland, OR)
Recognizes the complex impacts of homelessness and disability on employment
Seeks to bridge issues of trust Uses interactive group or individual
techniques Results in pictographs (“maps”) that
are the basis for referral to career services
Assumes the result is mainstream employment with support services planning
Key Elements of Mapping
LIFE HISTORY -draw correlations to past experiences. Identify patterns over their life span and recognize reoccurring themes, interests, and passions
STRENGTHS, GIFTS and CAPACITIES - Identify what they are able to do, what they enjoy doing, and what they have done in the past to develop a job goal
WHAT WORKS - Create a list of job characteristics that work well for them and those that do not work well for them
POSSIBLE RESOURCES - Community-based resources available to them, as well as resources within the One Stop system
POSSIBLE JOBS - List of possible jobs for themselves using strengths, gifts and capacities and what works as the only criteria
REFFERAL – Work with staff to develop a plan to get the job they want
A ‘Map in Progress’
Strengths, Gifts, CapacitiesJoker, dreamer, water ski, fix cars, traveler, bikes, large machines-forklift, guitar player, quick, curious, learner, bowler, great balance, basketball, coordinated, snappy dresser
Possible Jobs
Truck driver, Dancing instructor, Physical Ed teacher, Tour guide, Researcher, Writer, Mechanic, Furniture maker, Welder, Pilot, Travel agent, Personal
trainer
WorksDoesn’t WorkSpiritualityFear of dyingEarly morningsPushy peopleHands on learningNight workExercise dailyNoisy settingsRight medicationsWrong medications
SAMHSA’S MODEL FOR EBPs
SAMHSA National Registry of Effective Programs and Practices (NREPP) http://modelprograms.samhsa.gov
Evidence-Based Programs•Conceptually sound and internally consistent
•Program activities related to conceptualization•Reasonably well implemented and evaluated
Promising•Some positive outcomes
Effective•Consistently positive outcomes
•Strongly implemented and evaluated
Model•Availability for dissemination
•Technical assistance available from program developers
Why Use Evidence Based Approaches?
Evidence based practices yield better outcomes
Evidence based programs have fidelity measures
SAMHSA acknowledges that the evidence base is limited in some areas
SAMHSA supports promising practices where evidence of effectiveness is based on: Formal consensus among
recognized experts Evaluation studies not yet
published
IPS/SE Fidelity (Bond 2003)
Fidelity is important because programs that faithfully implement evidence based practices have better outcomes.
Fidelity Scales assess the adequacy of implementing an evidence based practice
Supported Employment EBP (Drake, et al)
Basis for SAMHSA Toolkit on Supported Employment
Blending of assertive case management and supported employment
Has been used to replace continuing/day treatment
Work is considered both treatment and outcome
Employment specialist is member of tx. Team Vocational assessment is continuous and
obtained from multiple sources Focus on “work first” - learning through doing Services in the community on flexible
schedule Has established a fidelity scale with
staff/customer ratios
Social Enterprises“Meeting the Market with a
Mission”
Businesses which affirmatively employ persons with disabilities and who have been homeless and/or other disadvantages
Achieve social change:
More people get jobs Achieve Economic Change:
Build healthy business
communities
Social Enterprises
Characteristics Agency-sponsored businesses
employing people with disabilities, people who have been homeless and/or other disadvantages
Objectives Exposure and experience, skills
development Add to the available jobs in the
marketplace Advantages
Agency “owns the jobs” “Business to business” potential
Disadvantages High risk-requires sound business
planning Can create numerous issues of roles and
boundaries for staff and clients
COMMUNITY VOCATIONAL ENTERPRISES 1425 Folson St., San Francisco, CA 94103 (415) 544-0424
Training and employment for persons with mental illness& other people withdisadvantages
Service Master Partnership Transitional employment in
4 agency-run businessesProfessional development seminars
Support services/Case management Enrolls +200 persons/year. 50-70 persons
employed at any one time
Supported Self Employment
Characteristics Consumer owned and operated
businesses Objectives
Self-sufficiency through owning one’s means of livelihood
Advantages Consumer “owns the job” Self-reliance, independence, “role shift”
from consumer to entrepreneur Disadvantages
High risk-requires sound business planning
Complications re: benefits are different from other employment scenarios
“The buck stops here”
Homelessness and Choosing a Job
Need to address considerable “concrete” barriers, i.e., access to laundry, showers, clothing
Lack of fixed address for mail or telephone to receive and return messages
Personal humiliation about current homelessness and past record, such as criminal histories
Poor employment histories and track record regarding employment
Access to transportation Focus on immediate needs vs. longer term
goals Impact of change Managing housing stability/recovery and work Unclear expectations/inadequate information Physical limitations
Getting a Job: What Level of support is
needed?
? Work while
choosing or job goal first?
Identify values Identify strengths
and gifts Identify preferences:
type of work, location, hours of work, wage scale
Identify resources: postings, ads, friends, family, staff
Why this job? Why now?
Sustained assistance regarding set-backs
Support services-on and off job
Principles and Practices #7Employer Marketing
Typical Challenges
Devalued group of people with stigma
Multiplicity of physical, psychological problems that could affect work
Lack of recent solid work history
Appearance and mannerisms
Few resources (e.g. transportation, child care, etc)
Poor self-image and lack of confidence, fear
May not be a clear ‘job match’-negotiation may be necessary
Employers’ understanding of the features/benefits
Employers’ fears of accident liability
Suggested Responses
Assess employer needs and concerns
Represent the job seeker Develop and use marketing
tools –brochures, testimonies, videos, etc.
Develop sustained relationships with employers that allow for more non-traditional “job matches”
Consider sectoral approaches
Becoming familiar with the current labor market to make an informed match
Guide job seekers on disclosure of disability and options for requesting reasonable accommodations.
Provide information about work site accommodations to employers
Guide job seekers on ways to address a record of conviction/incarceration
Support successful job seeker interviews
Principles and Practices #8Job Development and
PlacementTypical Challenges
Force-fitting to meet program outcomes
‘Passive job development’
Not following up on a regular basis with active and potential employers
Focusing on the disability rather than the ability
Starting with tax incentives
Promising “two for one” Guaranteeing 100%
productivity or attendance Offering to do all the
training and supervision Failing to plan for the
next step (advancement, transition)
Suggested Responses
Be creative- you want the same thing
Offer examples to employers of ways part time, negotiated or carved jobs has helped an employer in the past
Review the assessment information on an ongoing basis and update as needed
Help the job seeker break down the job development process into attainable steps
Select, train and support mentors
Offer to provide disability sensitivity training to employers’ staff
Include benefits planning as an ongoing part of the process
Highlights: Who Does What?
USDOL
Governor
LOCAL WIBs
ONE-STOPS/SATELLITES
Legislative, regulatory framework for WIA
5Yr plan, policies, LWIB jurisdictions, responsible for state performance
State WIB
Appoint, convene SWIB, discretionary $$, priority pops
Local plans, priority pops, administer 1 Stops, contracts for priority pops
Core, intensive, training services, house VR services, DPNs,
One Stop Services
Core services: - Available to any job seeker- Self-service job search, resume
development- Use of One Stop facilities, job fairs,
employer presentations, etc Intensive services:
For those not successful in Core services Vocational counseling, remedial
education and skills and support development, guided job search, enrollment into WIA funded training programs, etc
Training services: Enrollment in classes, specialized trades
training, etc
Principles and Practices #5Connecting to Mainstream
EmploymentTypical Challenges
Mismatch between customer’s readiness and the self-guided core services at a one stop
Participants feel uncomfortable in One-Stop environments
One Stop staff feel uncomfortable working with people who are chronically homeless
Different goals regarding employment placement
Different languages and expectations
No history of coordination
Suggested Responses
Have information of relevance to people who are homeless at the One Stop
Develop partnerships for targeted outreach
Cross-train staff Use the resources of the
DPN Review services forms
and documents to determine how they are consistent with each other, and where they contradict each other
Introduce people to One Stop services as a normal part of the employment process
Example #1: CTWorks-Bridgeport, CT
Operated by Career Resources, Inc., Partnerships with LWIB, Bridgeport
Continuum of Care, the CT Division of Rehabilitation Services, the CT Department of Mental Health and Addiction Services and the Veterans Employment Service.
50+ corporate donors, the United Way, US Department of Education grant ,DOL Work Incentive Grant and Disability Program Navigator funding
CT Works!- Why?
Meets people who are homeless with services ‘where they are at’
Developed a “Career Coach” mobile One Stop with the technology on board to connect people who are homeless to core services
Important partner is HVRP to connect Vets to core, intensive, training services
Visionary Leadership! Public/private funding
mix
Example #2: SEARCH-Houston, TX
Active member of the local Continuum of Care
Permanent and transitional housing, daily lunch for 250, a food pantry, mobile outreach, day care, medical assistance and psychological evaluations, and a one-stop career center for the homeless
Received JTPA and WIA Adult funding for employment services for homeless
SEARCH Works! Why?
Realized it could not ‘go it alone’
Offers on-site occupational skills training (computers, etc) for growth jobs
Understands it needs to braid/blend funding to provide support services and intensive counseling
Ending Chronic Homelessness Partnerships
HUD, ODEP, ETA, VETS funded x 5 years
5 Cities: LA, Boston, SF, Indianapolis, Portland, OR
297 people housing + jobs
Lead applicant is workforce development
Progress so far…….. Through 9/30/05
Number served 357
# full or part time competitive jobs: 113
Employment rate (# placed in housing: # entering employment) = 43%
Innovations (one stop satellite; career mapping strategy, mobile “one-stop”)
Accessing Mainstream Resources for Employment
Medicaid (www.cms.hhs.gov) 1619(b) Buy-In Rehab Option
HUD (www.hud.gov) Section 8 CDBG ESG ROSS/Hope VI Tenant-Based
Rental Assistance
USDOL (www.dol.gov) WIA
SSA (www.ssa.gov) Ticket to Work SSA Work
Incentives Dept. of Agriculture (
www.usda.gov) FSET
RSA/VR (http://www.ed.gov/offices/OSERS) State VR
HHS (http://www.acf.hhs.gov/programs/ocs/dcdp/joli/welcome.htm) JOLI
Job Search Planning
Assessment-skills/resources/supports Person-centered planning-
preferences/goals, job expectations Researching employer(s) Complete/modify resume, cover letters,
applications; Obtain transcripts, credentials,
references Resolve disclosure issue Address criminal justice involvement Identify “hot buttons and plan response Practice interviews and how to deal
with surprises Develop a schedule and plan
Disclosure: A Personal Choice
Disclosure of disability can occur:- At the time of the job application (by
the applicant or by their representative)- During the interview- After the job is accepted- After adjusting to the job,
demonstrating competency and prior to the need for reasonable accommodation
- When asking for an accommodation- Never- Sometimes it is optimal to discuss the
disability in terms of behavior and resulting behaviors
Menu of “Keep” Services
Job Coaching & Follow-Along
Educational, Professional, Peer, Natural Job Supports
Professional, Peer, Natural Housing, Recovery Supports
Benefits Management & Advocacy
Growth and Career Planning
Principles and Practices #9Job Retention and
AdvancementTypical Challenges
Having $$ New
friendships/disengaging from problematic old relationships
Managing new structure, scheduling and time demands
Pressures to share new funds or luxuries with less fortunate neighbors
New routines New lifestyle Co-worker, supervisor
relationships “Threat of success”
Suggested Responses
Tools and Activities: Utilizing Natural Workplace Supports
Job coach as training consultant, not trainer
Utilize typical employee orientation and training process and resources
Assist to understand workplace culture, cues, politics
Don’t “switchboard” questions & feedback
Help people develop skills to establish their own natural workplace supports
Explore possibility of “training the employer” to facilitate the best results for everyone
Understanding and Addressing Work-Related Triggers Having $$ New friendships/disengaging from
problematic old relationships Managing new structure, scheduling
and time demands Pressures to share new funds or
luxuries with less fortunate neighbors New routines New lifestyle Co-worker, supervisor relationships “Threat of success”
Scenario Questions “Choosing, Getting and
Keeping a Job” What are this person’s strengths and assets? What employment goal(s) do you think they
might choose? What employment program option might they
prefer and why? What concrete barriers may arise or exist that
need to be addressed? How would an integrated services team proceed with the participant?
Will this person choose to disclose their disability or not?
Describe how the plan for job search might look
What natural supports does this person have available?
What triggers will affect job retention? What are some of the elements of the
employment support plan?
For Systems/Programs For People
CULTURE
CAPACITY
HOPE FOR THE
FUTURE
SKILLS/SUPPORTS
OPPORTUNITY
Building a Culture Supporting Employment – Some Examples
Employment is part of our Mission Statement Targeted increases in rate of employment is an
agency priority Consumers are included in program decision-
making Skill building of participants is an integral part of
all service delivery – teaching the participants how to meet their own needs
We hire consumers as staff We have ongoing staff training on employment Consumers are clear on why they are
participating in employment programs Staff support consumer involvement, dignity,
choice and community integration Consumers, their families and staff express
hope that employment is possible All staff throughout the organization are
interested in and committed to employment opportunities for participants
Formal vendors and outside partners are viewed as potential employers for participants
Developing Capacity-Examples
We have employment program written policies and procedures
We have clear employment outcome measures
We have the goal of assisting participants in relevant ways with employment goals in the job descriptions of all staff
We have a dedicated budget for employment We have a process for resource development
and business planning We have employment specialists on staff We are risk-takers We have a strong management team We are culturally competent We have experience with developing
partnerships We think of all partners and vendors as
potential employers of our participants
Opportunities-Examples
We are aware of local hiring and economic development trends
We look for non-mental health funding sources as part of our employment funding mix
We have staff assigned to resource development and program growth
We build coalitions among families, mainstream resources and institutions, peers and professionals to address stigma
We are members of Chambers of Commerce We initiate and participate in the development
of access to new employment sectors for our participants, i.e. hotel industry, specific unions, etc.
We build upon the principles of the Americans with Disability Act, New Freedom Initiative, Olmstead Decision, TTW/WIA and local hiring goals/requirements for new program development
We help to make sure employment is on the agenda for State Policy Academies
Working with your VR Agency: Challenges Time-limited nature
of VR services Incentives for VR
case closures Demonstrate how
VR, One Stop, agency staff and participant can build a partnership for success
Mutual suspicion & misunderstanding
Staff training issues Incentives for
collaboration Funding limitations
Working with your VR Agency: Best Practices for Partnerships
Make people with mental illness and co-occurring disorders a priority
Staff training Define milestones
for payment relevant to the population
Role definition and clarity
Hire consumers as VR staff
Co-location of counselors
Non-traditional providers
Involve employers in these partnerships
Business Improvement Districts
Convergence of need Resources for outreach, engagement Job development Anti-stigma Opportunity for developing better
understanding of community needs – employers and participants
Staff competencies
KnowledgeSkillsAttitudesCultural sensitivity
Staff Competencies:
Knowledge
Job Market (current and projected) Job features, credentials and skills (hard and
soft) requirements Entitlement systems and related work
incentives Strong understanding of vocational
rehabilitation practices throughout all delivery of services
Mainstream community organizations, natural supports, self-help & peer supports, non-traditional (eg. Faith-based) resources
Employer associations, Chambers, One-Stops, WIBs, VR
Other potential employers – small businesses and community-based organizations
Agency purchasing procedures/services they are contracting-out
Homeless services and coalitions Asset development strategies-IDAs, ITAs, etc
Staff Competencies:
Skills
Active Listener Good Communicator (verbal,
written, and telephone) Able to integrate vocational
growth into all service delivery Consistent follow-through Networker and strong
relationship-builder (Giant Rolodex)
Teacher Negotiator
Staff Competencies:
Attitudes
Shared values Flexible Self-confident Outgoing Patient Respectful and
Tolerant Well-trained and
conscious about cultural differences
“Hands-on” Tenacious Inventive
Some More Important Questions………………..
How are you involving consumer leaders in employment program development?
What funding sources are you using to address employment?
What partnerships are necessary to increase employment?
What advocacy tools do you use to promote employment?
What skills must staff know to provide/support employment?
How do you approach employers to achieve greatest number of opportunities?
What do you need to do differently to increase employment?
Resources on the Web
www.dol.gov/odep www.mentalhealthpractices.org www.redf.org http://www.psych.uic.edu/eidp/eidptoolkit.h
tm www.ahpnet.com www.csh.org www.hud.gov/offices/fheo/section3/section
3brochure.cfm
Baker’s Dozen “To-Do’s”/”Who Does?”
Leadership for employment within the disability services systems
Unified vision re: employment as a priority across service systems
Share best practices Visible consumer
leadership Develop a toolkit for
employment implementation
Work with employers and develop knowledge of employers throughout process
Statewide training initiative to improve staff competencies
Develop individual outcome measures
Develop program accountability measures
Develop local partnerships-business, FCBOs, One-Stops, VR, employer and labor sectors, etc.
Help other systems understand employment and recovery
Train housing staff on employment and recovery
Use State purchasing power to support employment
Picturing a Champion
Recognized leader “Big and small”
picture knowledge Technical skills Community
organizer Collaborator Familiar with and
committed to issue and population
Responsive Resources/
resourceful Risk taker Passionate
commitment Representative
Providing Services
What are your challenges in providing effective, quality outcomes for job-seekers with psychiatric disabilities who are homeless?
What strategies are you using to achieve those outcomes?
What resources do you have and use to achieve those outcomes?
What resources do you need to achieve those outcomes?
What training opportunities would be especially important and useful?
Building Systems
Who are your local partners? Describe the plan/steps for developing
stakeholders for employment of people with psychiatric disabilities who are homeless
What does each stakeholder, including employers and employment sectors, bring to the table that helps meet those outcomes?
What challenges do you anticipate in developing partnerships and collaborations?
What training, technical assistance and support do you need to develop and sustain these partnerships/collaborations?
“Culture-Capacity-Opportunity” What are the tools and activities you
need to utilize to develop and/or improve the organizational Culture that supports employment in your agency, government unit, community and employment sectors?
What resources and/or knowledge must you as a practitioner and your agency as a provider acquire to build your Capacity to implement employment?
What Opportunities do you see to support and expand employment services, and how do you propose to address challenges that could impede your ability to take advantage of these opportunities? (e.g.: funding, public policy, local hiring plans, employer tax incentives, Medicaid, DMH initiatives, initiatives by other sectors (faith-based, DOL, etc.)