Vocationalizing Supported Vocationalizing Supported Housing Housing

DESC’s Mission StatementDESC’s Mission StatementThe Downtown Emergency Service Center works to end the homelessness of vulnerable people, particularly those with serious mental and addictive illnesses.  Through partnerships and an integrated array of comprehensive services, treatment and housing, we give people the opportunity to reach their highest potential.  At DESC, uncommon efforts produce uncommon results that eliminate homelessness, one person at a time.

Why Focus on Employment? For adults in our society - Viewed as an essential part of recovery Most residents want to work but are fearful A typical role in our society Cost-effective alternative to treatment Instills Hope & encourages involvement in community and treatment

Positive Outcomes from Competitive Work

Better control of Behavioral Health symptoms More satisfaction with finances and with leisure Higher self-esteem

(Bond et al., 2001)

The time is right for helping our clients and residents get and keep

jobs Locally – King County Employment Initiative

in Mental Health; Ten Year Plan Statewide – Health Care for Workers with

Disabilities; Willing Partnership Initiative Nationally – Changes in Social Security Law;

Changes in Medications; Recovery Movement; National Preoccupation

Why have Employment ServicesWhy have Employment Services

Normalization

Civil Rights Issue

End Homelessness

Recovery Model of Service

Is Work Too Stressful?As compared to what?

“If you think work is stressful, try unemployment.”

Joe Morrone

Stresses of work do not translate into higher rates of hospitalization or loss

of housing.

Negative Effects of Unemployment in General

Population Increased substance abuse

Increased physical problems Increased psychiatric disorders

Reduced self-esteem Loss of social contacts Alienation and apathy

(Warr, 1987)

When people are making When people are making transitions they need supporttransitions they need support

DESC has taken initiative in developing Employment

Services for the people we serve -

• Hiring Practices

• The Connections Program

• Supported Employment Program

• The Graduation Housing Program

2008 DESC Survey of Residents of the Morrison Regarding Employment •All respondents indicated that they had worked at some point in their lives. •5% had worked in the past month

•86% had not worked in the preceding year or longer.

•56% indicated that they had worked a year or longer at their longest job.

•66% indicated that they would like help from DESC to get and keep a job.

•Consistent with the literature: the majority of homeless persons with disabilities want to work and accept support to do so

People in recovery from mental illness and/or homelessness need to

identify routes to successful employment

The Connections ProgramEstablished in May 2006 Serves persons who are homeless, seeking employment & housing, who have no other case manager Since its inception through 2009 Connections Case Managers have assisted 1,111 persons to find work and more than 582 to find housing

The Connections Program

On site services at include: case management, meals, showers, laundry, computer lab, outreach, classes, education

DVR serves many Connections clients through our partnership with them. DVR orientations are offered on site and DVR refers clients for employment services. A DVR counselor comes regularly to provide coordinated services.

Education Services

• Connections is the the site of DESC's College Prep Class.

• Seattle Central Community College has offered full-time classes at Connections since Fall of 2009.

• Classes assist students earn GEDs, enhance skills, and earn credits that can transfer to other accredited programs.

Supported Employment

Mainstream job in the community Pays at least minimum wage Work setting includes people who are not disabled Service agency provides ongoing support People with most severe disabilities

History of Supported Employment

Developmental Disabilities - first to use this type of Vocational Service Intended for the most seriously disabled Defined in the Rehabilitation Act Amendment of 1986 Introduced in Washington Mental Health System in 1988 when 9 pilot programs were selected by DVR and the Mental Health Division

Traditional Vocational Services: Typical

Features Stepwise: Training or sheltered work first Work readiness criterion: Clients screened for placement Brokered: different agencies provide vocational and mental health services Short-term: Support services reduced when job is found

An all-too-familiar fear for people in recovery

Evidence Based Supported Employment

SAMHSA ResearchOne of Six practices qualified as Evidence Based PracticeSupported by more that 15 major studiesIdentified characteristics that best serve persons with behavioral health problems Fidelity Scale

Components of EBP Supported Employment

Limited case load size Dedicated staff who are generalists Integrated into treatment Collaboration with Division of Vocational Rehabilitation Vocational unit with distinct supervision

EBP Supported Employment Zero exclusion Rapid, individualized search for competitive jobs Agency-wide focus on Employment Executive team support Work incentive planning Disclosure is participant's choice Long Term Individualized Follow Along Support

“Vocationalization” of Housing

The Corporation for Supportive Housing (CSH) Culture and practices of an organization and its tenant community are transformed to fully support the goal of work.

More than workshops or assistance in the creation of resumes for selected tenants.

The creation of a culture in which employment is encouraged and expected.

"Every policy, practice, activity of my organization supports my ability to help tenants get employed".

“Vocationalization”

Vocationalizing Supported Housing

Vocational Histories and Goals are discussed at all intakes and reviews

Bulletin boards that highlight job opportunities

Employment brochures are readily available to all

Increased discussions of work incentives associated with benefit programs including Housing subsidies

Care conferences with Housing, Clinical, and Employment staff when a person is transitioning to a increased level of activity

Developing ways to recognize those who are making strides towards work and community involvement

Increased opportunities for clients to volunteer in structured activities

Other?

Staff & Residents May See a Return to Work as a Big Risk

Getting on Benefit programs may have taken years Pervasive myths about negative effect of work on benefits Negative experiences in past when attempting to work without supports For some there have been few role models of successful employment Unrealistic views of what work means Others?

What Can WeDo to Make the Risks More Manageable?

Shared Decision-MakingShared Decision-Making

A decision making process jointly shared by A decision making process jointly shared by clients and their providers; clients play an active clients and their providers; clients play an active role; based on the best evidence of the risks and role; based on the best evidence of the risks and benefits of all the available optionsbenefits of all the available options

What Makes SDM So Hard?What Makes SDM So Hard?

Research shows that people want to share Research shows that people want to share decisions; but often don’t.decisions; but often don’t.

Risk Aversion vs. Loss AversionRisk Aversion vs. Loss Aversion Concepts from the psychology of decision-making Concepts from the psychology of decision-making

under risk & uncertaintyunder risk & uncertainty

RISK AVERSIONRISK AVERSION Risk aversion is the Risk aversion is the

reluctance of a person to reluctance of a person to accept a bargain with an accept a bargain with an uncertain payoff rather uncertain payoff rather than another bargain than another bargain with a certain, but with a certain, but lower, expected payoff.lower, expected payoff.

LOSS AVERSIONLOSS AVERSION Loss aversion refers to Loss aversion refers to

people's tendency to people's tendency to strongly prefer avoiding strongly prefer avoiding losses to acquiring gains. losses to acquiring gains. Studies suggest that losses Studies suggest that losses are twice as powerful, are twice as powerful, psychologically, as gains.psychologically, as gains.

Barriers to SDM

Open communication between clients & providers Open communication between clients & providers can be complicated by what each brings to the table can be complicated by what each brings to the table

Providers educated to view themselves as Providers educated to view themselves as experts who impart informationexperts who impart information

Concerns (often due to stigma) about Concerns (often due to stigma) about competence of consumers to make decisions in competence of consumers to make decisions in their best interests their best interests

Lack of experience among clients and providers Lack of experience among clients and providers to deal with decisional conflictto deal with decisional conflict

Key Elements of SDMKey Elements of SDM

Create a context in which Create a context in which clients'clients' viewviews s about service options are about service options are valuedvalued & & deemed deemed necessarynecessary

Share technical Share technical informationinformation, making sure , making sure clients clients understandunderstand the information, & the information, & helping them base their preference on the helping them base their preference on the best evidencebest evidence

Elicit Elicit clients' preferencesclients' preferences, share provider’ , share provider’ recommendationsrecommendations, & explicitly , & explicitly acknowledge acknowledge uncertaintyuncertainty in the decision- in the decision-making process.making process.

Ottawa Personal Decision Guide

Helps people assess their decision-making needs, plan Helps people assess their decision-making needs, plan for next steps, and track progress for next steps, and track progress

Identify Options

List benefits & risks for each optionList benefits & risks for each option

– Rate the importance of each benefit & riskRate the importance of each benefit & risk

– Choose the option with the most Choose the option with the most important benefits & the fewest risksimportant benefits & the fewest risks

– Pending stage of change, plan for next Pending stage of change, plan for next steps:steps:

• What is supporting/impeding the What is supporting/impeding the decision?decision?

• What is the person willing to try? What is the person willing to try? • Specifically, how can providers help?Specifically, how can providers help?

Helpful Internet Resources How to-- Overviews:

Corporation for Supported Housing's Toolkit for Connecting Supported Housing Tenants with Employment

http://www.csh.org/index.cfm (look for the Employment tool kit)

Dartmouth Supported Employment

http://www.dartmouth.edu/~ips/index.html

SAMSHA toolkit for Supported Employment (Mental Health and Substance Abuse services)

http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/employment/default.aspx

Benefit Planning

Redbook for SSI & SSDI Work Incentives

http://www.ssa.gov/redbook/2010/introduction.htm

Health Care for Workers with Disabilities-- Medicaid

http://maa.dshs.wa.gov/Eligibility/HWD.htm

Background and Training Material on HUD's Earned Income Disregard Program

http://www.hudhre.info/index.cfm?do=viewEID --

General Employment Resources for People with Challenges

Washington Division of Vocational Rehabilitation http://www.dshs.wa.gov/dvr/Default.aspx

Ottawa Supported Decision Making Guide

http://decisionaid.ohri.ca/decguide.html

Directory of Occupational Titles (detailed job descriptions and general requirements)

http://www.wave.net/upg/immigration/dot_index.html

Life-skills for Vocational Success

http://www.workshopsinc.com/manual/index.html --

Resources for Persons with Legal Background Challenges

Federal Department of Corrections Employment Resource http://pretrial.wawd.uscourts.gov/workforce/index.html

State Offenders Employment Services http://www.wa.gov/esd/oes/

"Security is mostly a superstition. It does not exist in nature, nor do [people] as a whole experience it. Avoiding danger is no safer in the long run than outright exposure."

-Helen Keller

Thank you!Thank you!