Implementing Supported Implementing Supported Employment and Helping Employment and Helping

Consumers Get and Keep Jobs: Consumers Get and Keep Jobs: Research FindingsResearch Findings

Gary R. BondGary R. BondDartmouth Psychiatric Research CenterDartmouth Psychiatric Research Center

Oregon SE Statewide TrainingBreakout Session

July 26, 2011

When starting up a new supported employment program, the first step should be to provide intensive training for new staff.

FALSE

Limitations of Training

Intensive training in early stages often premature (waste of time)–Problems of staff turnover–Limitations of lectures and

PowerPoints–Practitioners learn more from field

mentoring

Most Important Factors in Implementing a New Program

(Torrey et al., 2011)

Exerting leadership -- by both center administrators and SE team leader

Selecting appropriate staff Developing infrastructure (see

fidelity standards)

Consumers who use alcohol or drugs are less likely to be successful in employment.

FALSE This is a belief that dies hard, This is a belief that dies hard,

despite numerous studies that show despite numerous studies that show no difference between mental no difference between mental health consumers with and without health consumers with and without substance usesubstance use

Will Employers Hire People with Will Employers Hire People with Criminal Justice Histories?Criminal Justice Histories?

Conventional wisdom: –Most types of businesses will not

Research evidence: –Very little research!

Many mental health consumers have criminal justice histories (Frounfelker, 2011)

Past events disclosed at admission

Arrests 345 38% 546 50%Charges 255 28% 389 36%Convictions 203 22% 338 31%Incarcerations 156 17% 273 25%

Total 913 1,085

Receiving IPS Services

Admitted During 2009

X2=.10 p=.12

t =1.79 p=.08

t =1.14 p=.26

t =-1.96 p=.06

Test of Significance

No CJI N = 81

CJIN = 73

Competitively employed during follow-up

30 (37%) 18 (25%)

28.8 (8.6)

Days employed

N =30 N =18

Hourly wages

Hours worked per week

Mean (SD) Mean (SD)

29.4 (68.2)54.0 (97.3)

Worker Sample

$9.55 (3.8)

23.8 (8.2)

$8.46 (1.2)

Employment Outcomes for IPS Clients with and without CJI

(Frounfelker, 2010)

Employer Survey:Employer Survey: Hiring People with Felonies Hiring People with Felonies

128 employers in 9 states– Many kinds of businesses

63% had knowingly hired someone with a felony– Few had written policies– No strong pattern in which businesses

more likely to hire

(Swanson, Reese, & Bond, submitted)

Employers reasons for Employers reasons for hiring a person with a felonyhiring a person with a felony

31 (42%) Qualifications to do the job

16 (22%) Good interviewing skills

13 (18%) Referral from a person the employer knew

11 (15%) Belief that the person had changed

10 (14%) Length of time since last conviction

6 (8%) Sincerity and honest when talking about record

5 (7%) Belief that the person would be dependable

3 (4%) Conviction not related to the job

Employers won't hire someone with a criminal justice history.

MOSTLY FALSE Finding jobs are more challenging Many employers do screen out known

felons, especially drug offenses But many employees are flexible

Training in interviewing and social skills is the best way to prepare consumers for jobs.

FALSE Extended skills training before Extended skills training before

looking for a job has been shown looking for a job has been shown to to reducereduce employment rates. employment rates.

After starting a job, skills training After starting a job, skills training has little or no effect.has little or no effect.

Should Consumers Disclose Their Should Consumers Disclose Their Mental Illness? Mental Illness?

Very little research, and the research is unclear

Consumer preferences are critical consideration

What, when, and to whom matter greatly

Disclosure of Mental Illness at Disclosure of Mental Illness at Workplace (Jones, 2011) Workplace (Jones, 2011)

Disclosure to supervisor associated with increased emotional support

Disclosure to co-workers associated with increased criticism

Consumers are better off not disclosing their mental illness.

NEITHER TRUE NOR FALSE

IT DEPENDS!

Is it harder to find jobs Is it harder to find jobs for consumers in rural areas?for consumers in rural areas? Common assumption: Employment is

more difficult in rural areas The research says:

– Rural programs have as much success achieving high-fidelity SE and getting people jobs

– But methods differ somewhat from urban programs

Urban vs. Rural SE Programs (Becker, 2006)

26 sites in 7 states–12 urban–14 rural (population < 50,000)

Examined predictors of competitive employment outcomes–Predictors included SE fidelity

Comparing Rural to Urban Sites Comparing Rural to Urban Sites in Becker Studyin Becker Study

SE fidelity was almost identical (rural = 63.6 vs. urban = 63.8)

Access to supported employment was very similar

Competitive employment rate was slight better in rural sites

Outcomes in 87 Urban & Rural IPS Programs (Haslett, 2011)

Crucial Implementation IssuesCrucial Implementation Issuesfor Supported Employment for Supported Employment

in Rural Areasin Rural Areas Transportation Small population base SE unit supervision Job development Stigma

(Thanks to: Sarah Swanson, Linda Carlson, Debbie Becker, David Lynde, Laura Flint)

Transportation: StrategiesTransportation: Strategies Ask: “How does everyone else

get to work?” Ask at church or civic groups Informal taxi service/coworkers Rural mass transit less rigid

(senior ride program) Kansas solution: Donate cars Job develop/interview using client’s

expected transportation system

Job Development: Issues

Fewer options for job matchingFewer options for job matching Economy may be tied to a single Economy may be tied to a single

employeremployer What happens if only factory shuts What happens if only factory shuts

down?down? Confidentiality issues associated

with rural familiarity

Job Development Strategies Skillful persistent job

development still crucial Different interpersonal approach

to employers in rural areas compared to cities

Personal networks Self-employment??

Stigma: Issues

Everyone knows everyone – Cannot hide behind anonymity

Reputation may be hard to overcome

May be a barrier to hiring

Strategies for Overcoming Stigma

Familiarity can be used to advantage Rural communities “take care of

their own” “Word of mouth” produces quick

information on job leads Consulting frequently with local

VR counselor

It’s harder to find jobs It’s harder to find jobs for consumers in rural areas.for consumers in rural areas.

FALSE

The type of medications a consumer takes can greatly

influence success in employment.PROBABLY TRUE,

BUT EVIDENCE LACKING Skilled medication management is

an important adjunct to SE One finding: Type of antipsychotic

does not affect employment(Resnick, 2008; Percudani, 2004)

Suggesting coping skills on the job can make a big difference in

helping consumers keep jobs.TRUE

McGurk and Mueser (2006): Employment specialists who suggested more coping strategies had greater success helping consumers keep jobs.

For transitional-aged youth, the best way to help them gain work experience is to place them in unpaid internships.

UNKNOWN Very little research to date on

employment for this important population.

Is long-term support important after consumers get a job?

For how long? –How often should the

employment specialist meet? –Can it be by telephone?

What type of support should employment specialist provide?

How Often Should Employment Specialists Meet After

Consumer Begin Working? Few studies to answer this (Lots of studies showing

importance of job development) Bond and Kukla (2011) examined

2-year follow-up of 100 IPS consumers who started a job

Monthly Employment Specialist Contact with Consumers (Bond & Kukla, 2011)

QuickTime™ and aGraphics decompressor

are needed to see this picture.

Importance of Ongoing Support After Consumers Start Work

Frequency of contact correlated with months employed over 2 years (r=.27)

Brief contacts (<30 min.) were as effective as long contacts (>30 min.)

Face-to-face contact was effective Telephone contact was not

Conclusions: How Often Should Employment Specialists Meet

After Consumer Begin Working? Close contact in the first few days and

weeks are critical Long-term contact appears to make a

difference (for 2 or more years) Brief monthly contact probably adequate

most of the time Contacts should be face-to-face

Once a consumer gets a job, the contact can be by phone.

FALSE

What Makes for a Successful What Makes for a Successful Employment Specialist? Employment Specialist?

Belief that clients can work Time management skills Passion for job Thick-skinned Team orientation % of time spent in the community

(Glover, in press; Gowdy, 2003; Taylor, submitted; Whitley, 2010)