POLICY AND ORGANIZATIONAL

CULTURE AFFECTING EMPLOYMENT:

IF EVERYONE IS ALREADY DOING IT,

HOW COME IT NEVER GETS DONE?

TERRY PRATCHETT

"I'll be more enthusiastic about encouraging thinking

outside the box when there's evidence of any

thinking going on inside it. “ 

JOE MARRONEJOE MARRONEINSTITUTE FOR COMMUNITY INCLUSIONINSTITUTE FOR COMMUNITY INCLUSION

School Of Global Inclusion And Social Development

MAIN OFFICE: BOSTON, MAMAIN OFFICE: BOSTON, MA

NW OFFICENW OFFICE::

4517 NE CESAR CHAVEZ BLVD4517 NE CESAR CHAVEZ BLVD

PORTLAND, OR 97211-8124PORTLAND, OR 97211-8124

TELTEL: 503-331-0687: 503-331-0687

CELLCELL: 503-490-2072: 503-490-2072

FAXFAX: 503-961-7714: 503-961-7714

EMAILEMAIL: joseph.marrone@gmail.com: joseph.marrone@gmail.com

WEBWEB:: WWW.COMMUNITYINCLUSION.ORG WWW.COMMUNITYINCLUSION.ORG

IF PEOPLE

CANCAN WORK

PEOPLE

SHOULDSHOULD WORK

SYSTEMS MUST COMMUNICATE CONVICTION THAT:

1.ALL PEOPLE SHOULD WORK SINCE2.PEOPLE W. DISABILITIES HAVE THE CAPACITY TO BECOME EMPLOYED 3.HAVE THE CITIZENSHIP RIGHT TO EQUAL ACCESS TO EMPLOYMENT4.WILL BE ASSISTED TO DO SO BECAUSE

EMPLOYMENT IS A WAY FOR PEOPLE TO BECOME ECONOMICALLY SELF-SUFFICIENT, HEALTHIER, AND FULFILLED.

WORK IS NOT JUST AN OPPORTUNITY TO BE OFFERED PEOPLE TO "TAKE OR LEAVE" AS THEY PREFER;

RATHER, IT IS A RESPONSIBILITY OF CITIZENSHIP.

OUTCOMES THAT SHOULD BE OUTCOMES THAT SHOULD BE SOUGHT IF A HUMAN SERVICE SOUGHT IF A HUMAN SERVICE

SYSTEM IS MORE THAN A SYSTEM IS MORE THAN A POSITIVE SLOGAN POSITIVE SLOGAN

Employment and educational outcomesEmployment and educational outcomes Housing outcomesHousing outcomes Course of illness/disabling conditionCourse of illness/disabling condition Community participation/ citizenship Community participation/ citizenship

(voting, volunteering, criminal (voting, volunteering, criminal recidivism)recidivism)

School completionSchool completion Income supportIncome support Client satisfaction with their own livesClient satisfaction with their own lives Client satisfaction with servicesClient satisfaction with services

OUTCOMES THAT SHOULD BE SOUGHT IN COMMUNITY SERVICES

BECOMING A BETTER PERSON AND BECOMING A BETTER PERSON AND “SELF REALIZATION” IS “SELF REALIZATION” IS

THE CONSUMER’S THE CONSUMER’S RESPONSIBILITY.RESPONSIBILITY.

HELPING PEOPLE GET EMPLOYED, HELPING PEOPLE GET EMPLOYED, GET HOUSING, COMPLETE GET HOUSING, COMPLETE

SCHOOL. STAY OUT OF HOSPITAL (& SCHOOL. STAY OUT OF HOSPITAL (& JAIL) AND REDUCE JAIL) AND REDUCE SYMPTOM IMPACT ARE STAFF’S SYMPTOM IMPACT ARE STAFF’S

RESPONSIBLITIES IN PARTNERSHIP RESPONSIBLITIES IN PARTNERSHIP WITH THE PERSON.WITH THE PERSON.

HIGH PERFORMING STATES – ICI HIGH PERFORMING STATES – ICI SELNSELN

1] 1] Leadership2] Strategic goals and operating policy3] Financing and contracting methods4] Training and technical assistance 5] Interagency collaboration/ partnership6] Services and service innovation7] Performance measurement and data management

SHOOK, J. (2010) HOW TO CHANGE A CULTURE. MIT SLOAN MGMT REVIEW, 51 (2), 62-68

SHOOK, J. (2010) HOW TO CHANGE A CULTURE. MIT SLOAN MGMT REVIEW, 51 (2), 62-68

ROLE/ LIMITS OF TRAINING?ROLE/ LIMITS OF TRAINING?

““You can teach a turkey You can teach a turkey to climb a tree, but it’s to climb a tree, but it’s

easier to hire a squirrel.”easier to hire a squirrel.”

FROM FROM

Spencer M. Lyle Jr., McClelland C. David, Spencer M. Lyle Jr., McClelland C. David, Spencer M. Signe (1994) Competency Spencer M. Signe (1994) Competency Assessment Methods. History and state of the Assessment Methods. History and state of the art. Paper first presented at the American art. Paper first presented at the American Psychological Association Annual Conference, Psychological Association Annual Conference, Boston, MA  P. 8Boston, MA  P. 8

SYSTEMS ISSUES TO SYSTEMS ISSUES TO TACKLETACKLE

•WHOSE PROBLEM IS IT?– MH, DD, VR OR ALL

•DEFINING “WORK” AND “SUCCESS”

•MAKING EMPLOYMENT AN ADMIN NOT JUST CLINICAL ISSUE

•SHOULD ALL EMPLOYMENT MEET EBP OR BEST PRACTICE STANDARDS?

SYSTEMS ISSUES TO SYSTEMS ISSUES TO TACKLETACKLE

•SHOULD ALL EMPLOYMENT HAVE VR INVOLVEMENT?•DISPARITY IN DD, MH & VR

FUNDING•TTW POSSIBILITIES- REAL OR NOT?•MEDICAID ISSUES •USE OF HCBS UNDER REHAB OPTION (1915[i])

BETTER LINKAGE WITH TRANSITION TYPE SERVICES BETTER INTEGRATION OF YOUTH AND ADULT MH/DD

SERVICES IN TERMS OF PHILSOPHY OF “EMPLOYMENT FIRST”, RECOVERY AND TRANSITION TO WORK

PARENTS/ SIGNIFICANT OTHERS SHOULD HOLD MORE SWAY THAT STAFF EVEN IF THEY ARE “WRONG”

YOUTH NEED MORE DIRECTION PLANNING LESS IMPORTANT THAN ACTION - IMMEDIACY JOBS THAT WE SHY AWAY FROM FOR ADULTS MORE

AND MORE (FOOD, FILTH, FLOWERS ETC ETC) ARE MORE ATTRACTIVE & APPROPRIATE FOR YOUTH

DON’T TRY TO GET YOUTH TO ACT LIKE ADULTS IN TERMS OF JOB/ EMPLOYMENT STABILITY

SPECIFIC EMPLOYMENT PRACTICE ISSUES YOUTH (16-25)

Improving developmentally appropriate strategies Improving developmentally appropriate strategies for VR counseling and service deliveryfor VR counseling and service delivery

Modifying traditional approach to IPE development Modifying traditional approach to IPE development to incorporate a “work and career development” to incorporate a “work and career development” phasephase

Vocational supports unique to youth built on but Vocational supports unique to youth built on but not replicating heavily researched adult evidence not replicating heavily researched adult evidence based practice of SE/ IPSbased practice of SE/ IPS

VR service interventions for youth that use greater VR service interventions for youth that use greater variety of employment models, especially those variety of employment models, especially those based on experiential, work- based learningbased on experiential, work- based learning

Models of youth vocational peer supportModels of youth vocational peer supportMarrone, J & Taylor, S. (2013) Serving Youth with Psychiatric Disabilities

in the Vocational Rehabilitation System. Focal Point, 27 (1), p.37-39.

VR ISSUES ESPECIALLY FOR YOUTH

Developing system interactive pathways focusing on Developing system interactive pathways focusing on speed and rapid engagement that swiftly include speed and rapid engagement that swiftly include youth in concrete experiential services rather than youth in concrete experiential services rather than long periods of assessment or verbal discussions long periods of assessment or verbal discussions about planningabout planning

Enhancing transition services that support Enhancing transition services that support attachment to adult services where needed or attachment to adult services where needed or possibly divert youth from them provided possibly divert youth from them provided appropriate transition age interventions enhance appropriate transition age interventions enhance adult life successadult life success

Fostering increased use of social media to engage Fostering increased use of social media to engage youth in a variety of work options and in vocational youth in a variety of work options and in vocational rehabilitation services.rehabilitation services.

Marrone, J & Taylor, S. (2013) Serving Youth with Psychiatric Disabilities in the Vocational Rehabilitation System. Focal Point, 27 (1), p.37-39.

VR ISSUES ESPECIALLY FOR YOUTH

VISION OF LIFE VISION OF LIFE SUCCESSSUCCESS

JOE MARRONE

IS WORK THE MOST IMPORTANT PART OF LIFE FOR EVERYONE?

NO. BUT IT IS THE MOST IMPORTANT PART OF LIFE

THAT WE IN HUMAN SERVICES ARE LEAST SUCCESSFUL AT

HELPING OUR CONSTITUENCY ACHIEVE.

REMAINING UNEMPLOYED IS REMAINING UNEMPLOYED IS WORSE FOR YOU THAN BEING WORSE FOR YOU THAN BEING EMPLOYED IS GOOD FOR YOUEMPLOYED IS GOOD FOR YOU

(MORE DATA LATER).(MORE DATA LATER).

AVOIDING LONG TERM AVOIDING LONG TERM UNEMPLOYMENT IS A BETTER UNEMPLOYMENT IS A BETTER

OPTION THAN WAITING FOR AN OPTION THAN WAITING FOR AN IDEAL OR PERFECT JOB MATCH.IDEAL OR PERFECT JOB MATCH.

““IT IS NEARLY IMPOSSIBLE IT IS NEARLY IMPOSSIBLE TO MAKE YOUR OWN TO MAKE YOUR OWN FUTURE FUTURE

WHEN WHEN YOU ARE NOT PART OF THE YOU ARE NOT PART OF THE ECONOMIC FABRIC ECONOMIC FABRIC OF THE CULTURE OF THE CULTURE

YOU LIVE IN” YOU LIVE IN”

PATRICIA DEEGANPATRICIA DEEGAN20th World Congress Rehab International: Oslo,

Norway – JUNE 2004

WORK IS A CITIZENSHIP WORK IS A CITIZENSHIP RESPONSIBILITY NOT RESPONSIBILITY NOT

JUST AN “OPPORTUNITY”JUST AN “OPPORTUNITY”

SOCIAL POLICY OUTCOMES HAVE TO INCLUDE MORE

THAN CLIENT SELF DEFINED QUALITY OF LIFE INDICATORS INCLUDING

CQL OUTCOMESEXAMPLE: DROP OUT

PREVENTION EFFORTS

MARRONE MARRONE

IN IN

FULL CRANK FULL CRANK

MODE:MODE:

QUESTIONS I PONDER, QUESTIONS I PONDER, SOME, NOT ALL, SOME, NOT ALL, I KNOW THE I KNOW THE ANSWERS TO ANSWERS TO

LILY TOMLINLILY TOMLIN

“No matter how No matter how cynical you cynical you

become, become, it's never it's never enough to keep enough to keep

up.up.”

MARRONE EASY QUESTION

IS IT BETTER TO WORK 2-3 HOURS A WEEK IS IT BETTER TO WORK 2-3 HOURS A WEEK AT SOMETHING A PERSON LIKES AT SOMETHING A PERSON LIKES THAN 15-20 HOURS WEEK (OR THAN 15-20 HOURS WEEK (OR

MORE) JUST TO MAKE A MORE) JUST TO MAKE A LIVING?LIVING?

SIMPLE ANSWER: SIMPLE ANSWER: NONO

HOW DO YOU ANSWER THIS QUESTION FOR HOW DO YOU ANSWER THIS QUESTION FOR YOURSELF OR YOUR LOVED ONES?YOURSELF OR YOUR LOVED ONES?

DO WE WORRY TOO MUCH DO WE WORRY TOO MUCH ABOUT VALUES - STIGMA ABOUT VALUES - STIGMA

VS VS BEHAVIOR - BEHAVIOR -

DISCRIMINATION?DISCRIMINATION?

ISN’T A ISN’T A JOBJOB THE OUTCOME THE OUTCOME WE WANT RATHER THAN WE WANT RATHER THAN

OFFERING CUSTOMIZED OR OFFERING CUSTOMIZED OR SUPPORTED EMPLOYMENT SUPPORTED EMPLOYMENT

(PROCESS) ?(PROCESS) ?

IF EMPLOYMENT IS IF EMPLOYMENT IS FIRST FIRST WHAT IS SECOND?WHAT IS SECOND?

SHOULDN’T WE BEGIN SHOULDN’T WE BEGIN TO SEE EMPLOYMENT TO SEE EMPLOYMENT AS AN OUTCOME NOT AS AN OUTCOME NOT A SERVICE STREAM?A SERVICE STREAM?

IF YOU THINK IF YOU THINK WORK IS BAD FOR WORK IS BAD FOR

PEOPLE WITH PEOPLE WITH MENTAL ILLNESS,MENTAL ILLNESS,

THEN WHAT ABOUT THEN WHAT ABOUT POVERTY, POVERTY,

UNEMPLOYMENT, UNEMPLOYMENT, AND AND

SOCIAL SOCIAL ISOLATION?ISOLATION?

THOMAS THOMAS EDISONEDISON

“ “ RESULTS! RESULTS!

WHY, I’VE GOTTEN A WHY, I’VE GOTTEN A LOT OF RESULTS. LOT OF RESULTS.

I KNOW SEVERAL I KNOW SEVERAL THOUSAND THINGS THOUSAND THINGS

THAT WON’T WORK. “THAT WON’T WORK. “

US AND MO MH SYSTEMS /EMPLOYMENT FIGURES 2012

ADULTS WITH ANY EMPLOYMENT IN FY 2012 = US:16.9%;

MO:10.9%

ADULTS IN LABOR FORCE (I.E., EMPLOYED OR LOOKING FOR

WORK) = US:33.7%; MO:11.7%

ACCESS TO EBP SE =US: 1.7%; MO: 0.9%

US AND MO DD SYSTEMS /EMPLOYMENT FIGURES 2012

ADULTS IN INTEGRATED EMPLOYMENT IN FY 2012 = US:18%; MO:11%

INTEGRATED EMPLOYMENT RATE PER 100K GEN POP:

US:35; MO: 9

YOU CAN HAVE YOU CAN HAVE A JOB A JOB

WITHOUT A CAREER WITHOUT A CAREER BUT BUT

YOU YOU CAN’T HAVE CAN’T HAVE

A CAREER A CAREER WITHOUT A JOB! WITHOUT A JOB!

(YOU CAN’T DISCOVER (YOU CAN’T DISCOVER WHAT ISN’T THERE)WHAT ISN’T THERE)

WHY DON’T WE SEEK TO WHY DON’T WE SEEK TO HELP AND ENCOURAGE HELP AND ENCOURAGE

PEOPLE TO GET OFF PEOPLE TO GET OFF SSA AND SSA AND

WELFARE?WELFARE?

IF INDIVIDUAL FUNDING IF INDIVIDUAL FUNDING AND FISCAL CONTROL AND FISCAL CONTROL OCCURS SHOULDN’T OCCURS SHOULDN’T

QUALITY ASSURANCE QUALITY ASSURANCE LOSE RELEVANCE? LOSE RELEVANCE?

WHAT TYPES OF EMPLOYMENT OPTIONS SHOULD WE

ENCOURAGE?

ANY? SOME? ALL?

KEYS ARE REAL ECONOMIC ENGAGEMENT, RESOURCES, AND CITIZENSHIP NOT JUST SERVICE INTERVENTIONS

JERRY GARCIAJERRY GARCIA

“ SOMEONE HAS TO DO SOMETHING AND IT’S PRETTY PATHETIC IT’S GOT TO BE ONE OF US “

HELPING PEOPLE (AND SYSTEMS) CHANGE:

HOPE,HOPE,

HELP, HELP,

ANDAND

HASSLINGHASSLING

DAVID KAHNEMANNDAVID KAHNEMANNPsychologist – Psychologist –

EconomistEconomist““I am not very optimistic I am not very optimistic about people’s ability to about people’s ability to change the way they change the way they think, think, BUTBUT

I am fairly optimistic about I am fairly optimistic about their ability to detect the their ability to detect the mistakes of others.”mistakes of others.”

PRIMARILY EPIDEMIOLOGICAL

SUPPORTING DATA ON SEPARATE PPT

“ “ WHAT DRIVES ME UP THE WALL IS WHAT DRIVES ME UP THE WALL IS THE INTENTIONAL TEACHING OF THE INTENTIONAL TEACHING OF FEAR OF HAVING ANY KIND OF FEAR OF HAVING ANY KIND OF

MEANINGFUL LIFE BECAUSE ‘YOU MEANINGFUL LIFE BECAUSE ‘YOU WILL DECOMPENSATE’ OR WILL DECOMPENSATE’ OR ‘ YOU ARE STRESS ‘ YOU ARE STRESS

SENSITIVE’. THE MOST SENSITIVE’. THE MOST STRESSFUL THING IN THE WORLD STRESSFUL THING IN THE WORLD IS BEING A COUCH POTATO WITH IS BEING A COUCH POTATO WITH NOTHING TO DO, NOTHING TO DO, NO WHERE TO GO, AND NO WHERE TO GO, AND NO ONE TO TALK NO ONE TO TALK

TO. “TO. “

ED KNIGHT, PH.D.ED KNIGHT, PH.D.

“ “ BEWARE THE BEWARE THE CONTINUOUS CONTINUOUS

IMPROVEMENT OF IMPROVEMENT OF THINGS NOT THINGS NOT

WORTH IMPROVING WORTH IMPROVING “ “

W. EDWARDS DEMING

HELPING PEOPLE (AND SYSTEMS) CHANGE:

HOPE,HOPE,

HELP, HELP,

ANDAND

HASSLINGHASSLING

KEN MILLER“The length of a minute is The length of a minute is

relative, relative,

depending on which side depending on which side of the bathroom door you of the bathroom door you

are on.”are on.”From

WE DON’T MAKE WIDGETS

SO WHAT USUALLY GETS SO WHAT USUALLY GETS IN THE WAY OF IN THE WAY OF

IMPROVING IMPROVING EMPLOYMENT OR EMPLOYMENT OR

CHANGE AT ANY LEVEL?CHANGE AT ANY LEVEL?

ANY DEAD HORSES IN YOUR ANY DEAD HORSES IN YOUR ORGANIZATION?ORGANIZATION?

(TAKEN FROM MATERIAL FROM ARTHUR EVANS, (TAKEN FROM MATERIAL FROM ARTHUR EVANS, PH.D., FORMER DEPUTY COMMR, CT DMHAS), PH.D., FORMER DEPUTY COMMR, CT DMHAS),

NOW MH DIRECTOR, PHILA MHNOW MH DIRECTOR, PHILA MH

Dakota tribal wisdom says that when Dakota tribal wisdom says that when you discover you are riding a dead you discover you are riding a dead

horse, the best strategy is to horse, the best strategy is to dismount. However, in human dismount. However, in human

services, we often try other strategies services, we often try other strategies with dead horses, including the with dead horses, including the

following:following:

** Saying things like “This is the Saying things like “This is the way we have always ridden this way we have always ridden this horse.”horse.” or or from a Native American from a Native American Tribal Saying:Tribal Saying:

"If we don't turn around now, we "If we don't turn around now, we just may get where we're going."just may get where we're going."

* Appointing a committee to study the horse. * Harnessing several dead horses together for greater performance * Providing additional funding to increase the horse’s performance * Arranging to visit other sites to see how they ride dead horses

* Increasing the standards to ride dead horses * Creating a training session to increase our riding ability * Changing the requirements; declaring “this horse is not dead.” * Declaring the horse is “better, faster and cheaper” dead * Promoting the dead horse to a supervisory position

Finding a consultant knowledgeable about dead horses.

" There is nothing you can say " There is nothing you can say in answer to a compliment. I in answer to a compliment. I

have been have been complimented myself a great complimented myself a great many times, and they always many times, and they always

embarrass me embarrass me

-- I always feel they have not -- I always feel they have not said enough. "said enough. "

Mark TwainMark Twain