Job Development, Placement & Support Strategies for Consumers w/SMI- Part 2 Improving Employment Outcomes for Individuals with Mental Health Disabilities

Job Development, Placement & Support Strategies for

Consumers w/SMI- Part 2Improving Employment Outcomes for

Individuals with Mental Health Disabilities Learning Community Series

Charles Bernacchio, Ed.D., CRCEileen J. Burker, Ph.D., CRC

University of North Carolina at Chapel Hill

Consultants: Bonnie Schell, Consumer Affairs Project Manager

Obie Johnson, BA/QMHPLaurie Coker, Director of NC CANSO

April 17, 2012

TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012

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Webinar Overview

• Employment rights under ADA• Identifying employment opportunities, and job

creation• Customer service, ongoing relationships, job

leads and job supports (including job coaching and long-term supports- important issue) Natural supports (e.g., co-worker) Peer specialists Peer support

• Suggestions/recommendations for rehabilitation counselors

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Background on Job Accommodations

• Mandated by the Americans with Disabilities Act, 1990 and Rehabilitation Act of 1973

• Employers are required to provide ‘reasonable accommodations’ to qualified individuals with disabilities unless doing so would create an undue hardship unreasonably high costs

significant disruption to the nature of the business. *Fast Facts sheet on Reasonable Accommodations & the

ADA


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Identifying Employment Opportunities & Job CreationJob Creation is:• Modifying an existing job or• Figuring out a combination of job tasks that meet

the work needs of an employer and match the skills and strengths of a client with a disability

You have to thoroughly know the hopes, skills, attributes of the person with a disability and really know the employer’s needs not just current job descriptions.

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5 Key Tasks in Job Creation

1. The Job Seeker Profile2. The Brainstorming Group3. Gathering Info from Employers4. The List of Jobs and Tasks5. Employer Negotiations

(Condon, Enein-Donovan, Gilmore, & Jordan, 2004)

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Task 1: The Job Seeker Profile

What does your client want to do?a) Observe your client in a variety of situationsb) Talk with folks who know your client wellc) Sit with client and ask questions: dreams, activities, likes & dislikes

at home, work, school, daily activities and fun.d) Also ask:

What environment do you fit best in? Most enjoy? Are there certain types of people you fit with the best? Most

comfortable with? Accommodations? Support needs? Where have you been the happiest? The most success? Where have you had the most difficulty?


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Task 2: The Brainstorming Group

a) Get other people involved: family members, friends, other professionals, community contacts--people from different perspectives

b) The group helps by: Increasing resources Creating access to personal

networks/connections/referrals Coming up with ideas Giving emotional support Sharing technical expertise Sharing personal stories

Condon, Enein-Donovan, Gilmore, & Jordan, 2004)

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Task 3: Gathering Info from EmployersWhat are the tasks needed in the business?a) When is the company busiest? (Day, week, year)b) Are there ways to increase efficiency?c) Are things not being done b/c there is no time?d) Do some tasks take people away from their key roles?e) Are folks working overtime?f) What is the biggest challenge in day-to-day operations?g) Areas of growth?h) Are there tasks being done by students or temp workers?i) Are there things the company could offer if they had the right

person?j) What is the atmosphere/culture of the company?


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Task 4: The List of Jobs and Tasks

a) Create a list of tasks or jobs where the client can meet a need

b) Don’t create a job that devalues someone by separating them from other employees or having them do tasks that are dangerous or unpleasant

c) Figure out what accommodations can increase your client’s chance of success

Most accommodations cost less than $500!(Condon, Enein-Donovan, Gilmore, & Jordan, 2004)

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Task 5: Employer Negotiations

a) Use situational assessment, short-term job try-outs or temp employment

b) Extol the benefits of job creation for the company: Increases workplace effectiveness/efficiency Fills gaps in workplace Reduces costs of temp help & overtime Improves customer satisfaction


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Customized Employment (CE)(Griffin et al. 2008)

• Discovery: meetings w/ family and acquaintances, paid work experiences, observation of skills, talents, and interests in desired community environment.

• Informational interview: reviewing voc. profile to identify areas of interest and competence revealed thru discovery, making list (15 or 20) work settings w/ where interests/talents are common and contact w/ employers to do a tour or shadow experience

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Customized Employment cont’d.(Griffin et al. 2008)

• Resource ownership: a mutually beneficial process of acquiring materials, equipment, or skills that, when matched to job seeker’s interests and customer needs, generates profits for employer and wages for employee.

• Entry-level work & deep job development: matching first jobs to person’s skills and interests often fosters more rapid vocational maturation w/ an opportunity to develop a career path.

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Customizing Employment Service

The methodologies of customizing a job include:

• Job carving; creating a job from one or more but not all of the tasks of original job;

• Job negotiation – creating a new job from various tasks from potentially parts of several jobs;

• Job creation – creating a new job based on unmet workplace needs;

• Job sharing – two or more people sharing the same job; and

• Self employment, including use of a micro enterprise.(Griffin et al. 2008)

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Why Natural Supports?

• People with SMI experience limited scope and availability of formal services

• Formal services are vulnerable to shifts in politics and funding patterns.

• Natural supports promote normalcy

(Walsh & Connelly, 1996).

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Natural Supports: Co-workers

• Natural supports can be co-workers, supervisors and other supportive people in the job setting who can assist with learning and maintaining job skills and integrating into the workplace.

• There is an emphasis on social integration at work.

• Belief is that using people from the workplace is better than bringing someone in from outside (ex: a job coach)

(Storey, 2003).

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Natural Supports: Co-workers - 2

• Thought that having a job coach in the workplace decreases/inhibits the person from interacting with others on the job (Storey, 2003).

• Research has shown that co-workers can successfully give feedback, praise, verbal instructions, physical prompts and can model behaviors (Storey & Garff, 1997, 1999).

• Employees with severe disabilities trained under a mentor model had more interactions with non-disabled co-workers than employees trained with a job coach (Lee, Storey, Anderson, Goetz, Zivolich, 1997).

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Natural Supports: Co-workers - 3

• When asked what constitutes good quality of life, people who were hospitalized with SMI, e.g., schizophrenia on a psychiatric unit said having social relationships and having a job.

• For people with SMI, supportive relationships with people at work are associated with higher subjective quality of life ratings (Ruesch, Graf, Meyer, Rossler, & Hell, 2004).

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Natural Supports: Family

• Participants were 65 clients of a vocational rehabilitation services center for people with mental illness in Australia.

• Clients said that family members represented the largest portion (46-55%) of their support network.

• 60% of clients said that they had a reciprocal relationship with family members and friends. Clients had the perception that they played useful

roles in their social network, they didn’t always hold the role of someone who had to be helped (Shankar & Collyer, 2002).

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Natural Supports: Family - 3

• The authors concluded that family-dominated support networks can contain valuable resources and can enhance voc rehab outcomes.

• Strong family dominated support networks are good because they may provide support and decrease feelings of isolation, thus decreasing the risk of relapse (Shankar & Collyer, 2002).

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Job Coaching for People with SMI

• Job support (on-site counseling, support and problem-solving) is positively correlated w/ length of first paid job.

(Leff et al. 2005)• High per cent of reasonable accommodations for people

w/ SMI require human assistance in form of a job coach and

• Social and cognitive functional limitations most common for people w/ SMI most often require human assistance accommodations

(MacDonald-Wilson et al. 2008)

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Job Coaching for People with SMI - 2

• Reasonable accommodations for people w/ SMI shows that greater functional limitations that are social and cognitive in nature involve more on-site human assistance, e.g., job coaching, as well as co-worker and supervisor support.

• Focus mitigating limitations of SMI: learning job tasks, memory, attention, social interactions and executive functions (e.g., instructions, problem solving) particularly cognitive that require more accommodations.

(MacDonald-Wilson et al. 2008; MacDonald & Farkas, 2010)

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LT Supports Using IPS

Research on follow along supports & job tenure-

• Job tenure at 1st job = 10 mos: twice the mean job tenure reported in literature

• Norm was 1 contact/mo. once client stabilized on the job

• 70% received IPS contacts for all 2 yrs. of follow up

• Among clients who lost initial job, 64% continued to receive IPS support for entire 2 yr. follow up

(Bond & Kukla, 2010)

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LT Supports Using IPS – 2(Bond & Kukla, 2010)

• LT contact by employment specialists is norm in high fidelity IPS programs

• Ongoing IPS contact is associated with longer duration of paid employment

• Monthly face-to-face check ins may be sufficient most of the time

• Face-to-face IPS contacts were most predictive of cumulative duration of employment (all jobs)

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LT Supports Using IPS – 3(Bond & Kukla, 2010)

Since ongoing contact predicts better job outcomes

• Retention of LT supports is especially important for clients who lose an initial job

• IPS supported employment should focus on retention strategies

• IPS should increase support contact at times of job loss and job starts

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Definition of Peer Support

• Peer-delivered services are delivered by a person in recovery of SMI, for the primary purpose of helping others w/ SMI, e.g., warm line support or other community support can be provided by peers (Solomon, 2004)

• A system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful (Mead, 2009)

• Sharing their story - lived experience – they’ve “been there”

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Role of Peer Specialists

National Association of Peer Specialists • Peer counseling • Education/outreach• Transportation assistance• Crisis intervention• Independent living services/skills training• Vocational assistance• Medication training and support• Resource connecting and service coordination

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Qualifications of Peer Specialist

• Solomon (2004) Experience with Mental Health service delivery system *Stable and in recovery Not current substance abuser or dependent

*No uniform definition: screening would be critical (Chinman et al. 2006)

• Medicaid allow reimbursement for “peer provider” who are certified by State Medicaid agency and supervised by a competent mental health professional

• Training & supervision also deemed important to structure and success of consumer providers (Chinman et al. 2006)

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Models of peer support

• Psychosocial clubhouse• Assertive Community Treatment programs• Mental health support• Benefits counseling• Jail diversion• Employment programs*

* Multiple settings where CPS are working in varying capacities; less in community as within agencies ; more working with peers than families; emerging in vocational rehabilitation/clubhouses. (Salzer et al. 2010)

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Texas Pilot Using Peers

• Goal: Successful employment that supports recovery

• MHMR Centers in Ft Worth and Dallas

• Texas VR offices designated counselors

• Eligibility-desire to work

• Supported employment training for initial team

• Joint VR and Treatment meetings

• Peer support

• WRAP

• Advisory committee

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Principles Guiding Disclosure(Hoff, Gandolfo, Gold & Jordan, 2000)

• Describe person by job qualification/not disability• Stress positive current activity; avoid negative past

experiences if possible• Don’t volunteer negative info about consumer• Avoid use of medical terms (e.g., Bipolar) or jargon (e.g.,

job coach, task analysis, supported employment or benefits) which can confuse and potentially scare employers (use applicant, job description, work force- all terms that relate to employers)

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Recommendations for Rehabilitation Counselors• Be well-versed with the ADA and how it applies to

individuals with SMI• For job creation know your client and the employer’s

needs, not just the current job descriptions• Involve the community- family, friends, CRPs• Job coaching is a most effective, critical accommodation

for people w/ SMI • Provide ongoing long-term supports to improve job

retention• Natural supports including the use of peers, have a lot to

offer

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References - 1

Bond, G. & Kukla, M. (2010). Impact of follow along support on job tenure and evidence-

based supported employment, VCU-RRTC.Bond, G. (2004). Supported employment: evidence for an evidence-

based practice. Psychiatric Rehabilitation Journal, 27(4), 345-359.Chinman, Young Hassell & Davidson, (2006) Toward implementation

of consumer-provider mental health services. Journal of Behavioral Health Sciences Research, 32 (2), 176-195.

Condon, C., Enein-Donovan, L., Gilmore, M., & Jordan, M. (2004). When existing jobs don’t fit: A guide to job creation. http://www.communityinclusion.org/article.php?article_id=126

Griffen, C., Hammis, D., Geary, T. & Sullivan, M. (2008). Customized employment: Where we are; and where we’re headed. Journal of Vocational Rehabilitation 28, 135-139.


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References - 2

Griffen, C., Hammis, D., Geary, T. & Sullivan, M. (2008). Customized employment: Where we are; and where we’re headed. Journal of Vocational Rehabilitation 28, 135-139.

Hoff, D., Gandolfo, C., Gold, M. & Jordan, M. (2000). Demystifying Job Development: Filed Based Approaches to Job Development for People with Disabilities. St. Augustine, FL: Training Resource Network, Inc.

Lee, M., Storey, K., Anderson, J., Goetz, L., & Zivolich, S. (1997). The effect of mentoring versus job coach instruction on integration in supported employment settings. Journal of the Association for Persons with Severe Handicaps, 22, 151-158.

Leff, H.S. , Cook, J.A. , Gold, P.B., Toprac, M., Blyer, C., Goldberg, R.W. . . . Rabb, B. (2005). Effects of job development and job support on competitive employment of persons with severe mental illness. Psychiatric Services, 36 (10), 1237-1244.


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References - 3

MacDonald-Wilson, K. & Farkas, M. (2011). What does research tell us about accommodations for persons with psychiatric disabilities. Center for Psychiatric Rehabilitation, Boston University through funding by NIDRR & CHMS/DHHS.

MacDonald-Wilson, K., Rogers, E.S. & Massaro, J. (2008). Indentifying relationships between functional limitations, job accommodations and demographic characteristics of persons with psychiatric disabilities, Journal of Vocational Rehabilitation , 18, 15-24.

Rollins, A., Mueser, K., Bond, G. & Becker, D. (2002). Social relationships at work: Does the employment model make a difference? Psychiatric Rehabilitation Journal, 26 (1), 51-61.

Solomon, P. (2004). Peer support/peer provided services underlying processes, benefits and critical ingredients. Psychiatric Rehabilitation Journal, 27, 392-402.

Salzer, M., Bruzilovskiy, E. & Schwenk, E. (2010) Certified peer specialist roles and activities: Results from a national survey. Psychiatric Services, 61, 520-523


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References - 4

SAMHSA (2010). Individual Placement Services: An Evidence-based Practice. Knowledge Information Transfer (KIT) for Supported Employment.

SAMHSA (2008). Self-disclosure and it’s impact on individuals who receive mental health services. Department of Health & Human Services, Community Mental Health Services/SAMHSA.

Shankar, J., & Collyer, F. (2002). Support needs of people with mental illness in the vocational rehabilitation programs—The role of social support. The International Journal of Psychosocial Rehabilitation, 7, 15-28.

Storey, K. (2003). A review of research on natural support interventions in the workplace for people with disabilities. International Journal of Rehabilitation, 26(2), 79-84.

Storey, K., & Garff, JT. (1997). The cumulative effect of natural support strategies and social skills instruction on the integration of a worker in supported employment. Journal of Vocational Rehabilitation, 9, 143-152.


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References - 5

Storey, K., & Garff, JT. (1999). The effect of co-worker instruction on the integration of youth in transition in competitive employment. Career Development for Exceptional Individuals, 22, 69-84.

Tsang, H. Wing-Hong. (2001) Applying social skills training in the context of vocational rehabilitation for people with schizophrenia. The Journal of Nervous and Mental Disease, 189 (2), 90-98.

Walsh, J., & Connolley, PR., (1996). Supportive behaviors in natural support networks of people with SMI. Health and Social Work, 21(4), 296-303.


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Resources Links

• www.samhsa.gov/shin

• http://www.psych.uic.edu/eidp/default.htm

• http://www.dartmouth.edu/~ips/

• http://www.communityinclusion.org/article.php?article_id=126


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Comments & Questions


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Contact InformationCharlie Bernacchio

Assistant Professor, Coordinator Rehabilitation Counseling - University of Southern MaineEmail: [email protected]

Eileen BurkerAssociate Professor/Director, Rehabilitation Counseling & Psychology- University of North Carolina at Chapel HillEmail: [email protected]


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Archived WebinarsImproving Employment Outcomes for Individuals with

Mental Health Disabilities • Adults w/ Severe Mental Illness (SMI)

http://tacesoutheast.org/webinars/2011/100611/index.php

• Adults with SMI, Substance Use/Abuse and Corrections - Part 1http://tacesoutheast.org/webinars/2011/120111/index.php

• Adults with SMI, Substance Use/Abuse and Corrections - Part 2http://tacesoutheast.org/webinars/2012/011212/index.php

• Career Exploration, Development and Planning for Consumers w/ SMI - Part 1http://tacesoutheast.org/webinars/2012/020212/index.php

• Career Exploration, Development and Planning for Consumers w/ SMI - Part 2http://tacesoutheast.org/webinars/2012/030912/index.php

• Job Development, Placement & Support Strategies for Consumers w/ SMI - Part 1http://tacesoutheast.org/webinars/2012/033012/index.php


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Education CreditsCRCC Credit - (1.0)Approved by Commission on Rehabilitation Counselor

Certification (CRCC) • By April 27, 2012, participants must score 80% or

better on a online Post Test and submit an online CRCC Request Form via the MyTACE Portal.

My TACE Portal: TACEsoutheast.org/myportal


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THANK YOU!


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Southeast TACE (Region IV)Toll-free: (866) 518-7750 [voice/tty]

Fax: (404) 541-9002

Web: TACEsoutheast.org

My TACE Portal: TACEsoutheast.org/myportal

Email: [email protected]


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DisclaimerThis presentation was developed by the

TACE Center: Region IV ©2011 with funds from the U.S. Department of Education, Rehabilitation Services Administration (RSA) under the priority of Technical Assistance and Continuing Education Projects (TACE) – Grant #H264A080021. However, the contents of this presentation do not necessarily represent the policy of the RSA and you should not assume endorsement by the Federal Government [34 CFR 75.620 (b)].

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Job Development, Placement & Support Strategies for Consumers w/SMI- Part 2 Improving Employment Outcomes for Individuals with Mental Health Disabilities