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Employment Supports for Individuals with Psychiatric Disabilities and Substance Abuse Disorders Brianne Lott, MRC, CRC Jackie Tijerina, M.Ed. Center on Community Living and Careers Indiana Institute on Disability and Community Indiana University #NationalAPSE2015

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Lott & Tijerina APSE 2015 #NationalAPSE2015

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Lott & Tijerina APSE 2015 #NationalAPSE2015

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Lott & Tijerina APSE 2015 #NationalAPSE2015

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Lott & Tijerina APSE 2015 #NationalAPSE2015

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Lott & Tijerina APSE 2015

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Why Does it Matter? Average of 80% of individuals with mental illness are unemployed Estimated 9.6 million adults in the U.S. (4.1% of the population) have a serious mental illness Twice as likely to have a co-occurring substance abuse disorder Lott & Tijerina APSE 2015 #NationalAPSE2015

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Bipolar Disorders Lott & Tijerina APSE 2015 Depression Elevated or irritable mood Impulsive Easily distracted Pressured speech Flight of ideas #NationalAPSE2015

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Schizophrenia & Related Disorders Unable to think clearly Difficulty relating to others Impaired reality testing Odd sensory experiences Severe mood disturbances False beliefs Positive symptoms Hallucinations, delusions, and disorganized speech Negative symptoms Flat affect, lack of motivation, ambivalence Lott & Tijerina APSE 2015 #NationalAPSE2015

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Anxiety Disorders Panic Disorder Sudden sense of doom Increased heart rate, difficulty breathing, dizziness, and terror Generalized Anxiety Disorder Constant worry Obsessive-compulsive Disorder Intrusive thought and impulses with ritualistic and illogical behavior Post-traumatic Stress Disorder Extreme emotional reaction including nightmares and flashbacks Estrangement from others and poor concentration Lott & Tijerina APSE 2015 #NationalAPSE2015

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Personality Disorders Antisocial Personality Disorder Violates the rights of others without remorse Borderline Personality Disorder Instability of interpersonal relationships Narcissistic Personality Disorder Exaggerated sense of self-importance Histrionic Personality Disorder Very emotional and attention seeking Avoidant Personality Disorder Extreme social discomfort Lott & Tijerina APSE 2015 #NationalAPSE2015

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One Womans Story http://www.independentmail.com/news/anders on-woman-with-bipolar-disorder-struggled-to- find-a-job_73473290http://www.independentmail.com/news/anders on-woman-with-bipolar-disorder-struggled-to- find-a-job_73473290 Lott & Tijerina APSE 2015 #NationalAPSE2015

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Methamphetamine After quitting psychotic symptoms can last months, even years (typically precipitated by stress) Changes activity in the dopamine system of the brain which can lead to impairments in verbal learning & reduced motor speed Emotional & cognitive problems/deficits Lott & Tijerina APSE 2015 #NationalAPSE2015

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Prescription Opioids Depressed respiration (hypoxia) can cause brain damage Deterioration of white brain matter may lead to difficulty making decision, regulating behavior & responding to stressful situations Link to using heroin (cheaper & easier to obtain) Lott & Tijerina APSE 2015 #NationalAPSE2015

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Heroin Deterioration of white brain matter may lead to difficulty making decision, regulating behavior & responding to stressful situations Heart lining & valves can become infected, abscesses, gastrointestinal cramping, and liver or kidney disease Pulmonary complications including pneumonia Lott & Tijerina APSE 2015 #NationalAPSE2015

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Injection Drug Use and HIV & HCV Infection Injecting drugs = high risk of HIV and HCV infections HIV treatment side effects Dizziness, pain & nerve problems, fatigue, decrease in bone density (increase risk of injury) Hepatitis considerations Fatigue, confusion, drowsiness, and slurred speech Lott & Tijerina APSE 2015 #NationalAPSE2015

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Austin, IN: A case study https://www.youtube.com/watch?v=lmsvOO0ZX Uc Population ~ 4,000 171 HIV positive as of 6/10/2015 15 times national estimates IV drug use, sharing needles Lott & Tijerina APSE 2015 #NationalAPSE2015

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Rehabilitation & Employment Ideas Lott & Tijerina APSE 2015 #NationalAPSE2015

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General Considerations Employment goal Culture Ideas Beliefs Values Benefits currently receiving SSDI/SSI Medicare, Medicaid, other health insurance Housing subsidies Food stamps/TANF Natural supports Lott & Tijerina APSE 2015 #NationalAPSE2015

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Medications and side effects Traditional antipsychotics can cause tardive dyskinesia (involuntary movements of the mouth and face), listlessness, and blurred vision Atypical antipsychotics can cause weight gain leading to associated risk factors (diabetes, hypertension, etc) Mood stabilizers have side effects including sedation and irregularity of the cardiovascular system Lott & Tijerina APSE 2015 #NationalAPSE2015

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Strategies for Support Lott & Tijerina APSE 2015 On-site Accommodations Job coaching/extra training to reach full productivity Electronic organizers To do lists Weekly meetings Clear goals and consequences in writing Assistance modifying schedule to improve attendance #NationalAPSE2015

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Strategies for Support On-site Accommodations Assistance concentrating on work tasks Reduce distractions Private work area Frequent Breaks Addressing work safety issues (common employer concern) Lott & Tijerina APSE 2015 #NationalAPSE2015

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Strategies for Support Off-site Accommodations Assistance with transportation (increase attendance rates) Interpersonal skills & stress tolerance counseling Praise and positive reinforcement Employee assistance programs Educating on rights Contact Job Accommodation Network (JAN) Know provisions and limitations of ADA When and how to contact the EEOC Lott & Tijerina APSE 2015 #NationalAPSE2015

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References http://www.drugabuse.gov/publications/drugfacts/hero inhttp://www.drugabuse.gov/publications/drugfacts/hero in http://www.drugabuse.gov/publications/research- reports/methamphetamine/what-are-long-term-effects- methamphetamine-abusehttp://www.drugabuse.gov/publications/research- reports/methamphetamine/what-are-long-term-effects- methamphetamine-abuse http://www.drugabuse.gov/publications/drugfacts/pres cription-over-counter-medicationshttp://www.drugabuse.gov/publications/drugfacts/pres cription-over-counter-medications https://www.aids.gov/hiv-aids-basics/just-diagnosed- with-hiv-aids/treatment-options/side-effects/https://www.aids.gov/hiv-aids-basics/just-diagnosed- with-hiv-aids/treatment-options/side-effects/ http://www.mayoclinic.org/diseases- conditions/hepatitis-c/basics/symptoms/con-20030618http://www.mayoclinic.org/diseases- conditions/hepatitis-c/basics/symptoms/con-20030618 Lott & Tijerina APSE 2015 #NationalAPSE2015

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References http://www.nih.gov/news/health/jan2014/nida -03.htmhttp://www.nih.gov/news/health/jan2014/nida -03.htm http://www2.nami.org/Template.cfm?Section= press_room&template=/ContentManagement/C ontentDisplay.cfm&ContentID=169616http://www2.nami.org/Template.cfm?Section= press_room&template=/ContentManagement/C ontentDisplay.cfm&ContentID=169616 http://www.nimh.nih.gov/health/statistics/prev alence/index.shtmlhttp://www.nimh.nih.gov/health/statistics/prev alence/index.shtml Lott & Tijerina APSE 2015 #NationalAPSE2015

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References Walls, R.T., Batiste, L.C., Moore, L.C., Loy, B. (2009). Vocational Rehabilitation and Job Accommodations for Individuals with Substance Abuse Disorders. Journal of Rehabilitation, (75)4, 35-44. Beimers, D., Beigel, D.E., Guo, S., Stevenson, L.D. (2010). Employment Entry through Supported Employment: Influential Factors for Consumers with Co-Occurring Mental and Substance Abuse Disorders. Best Practices in Mental Health, (6)2, 85-102. Lott & Tijerina APSE 2015 #NationalAPSE2015