Overcoming Barriers to Employment: Creative Programming and Parallel Processes

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Overcoming Barriers to Employment Creative
Programming and Parallel Processes

• RWCA All Titles Conference
• August 30, 2006
• Karen Escovitz, MSS
• Karen.escovitz_at_hhinc.org

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Introduction

• My background in HIV and Work
• KEEP Project
• Working Positive Summit Conference
• National Working Positive Coalition
• www.workingpositive.org
• Journal articles, training, technical assistance,
  program evaluation, etc.
• Related work in the MH field.

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Why are we talking about Work?

• Advances in medical treatments and successes of
  RWCA services mean more PLHA are able, needing
  and wanting to consider employment.
• We cannot count on the indefinite availability of
  public benefits.
• Changing experiences of HIV? PLHA need services
  that include FUTURES oriented planning for
  optimized autonomy and quality of life.

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Good News

• Recent advances in knowledge about how PLHA can
  be effectively supported in considering,
  obtaining and maintaining employment.
• HIV-specific employment services are available in
  some communities.
• PLHA can be helped to access and utilize public
  Vocational Rehabilitation (VR) services in almost
  ANY community.

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This presentation will cover

• The value of work for PLHA
• Barriers to employment commonly experienced by
  PLHA
• Strategies that help people over come barriers
• What youre already doing as RWCA grantees that
  can help
• Things you might not have thought of yet...
• What you might add if you happen to have other
  funds available

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What people tell us work means to them

• ---gt more resources and choices.
• Meaningful activity.
• Distraction from symptoms / illness.
• Normalizing experience.
• Increased independence.
• Improved self-esteem.
• Sense of future and growth.
• Staying active, busy, fully alive.

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The Value of Work for PLHAEconomic

• People get trapped in the world of disability
  benefits, which keeps them poor.
• Income also represents other choices and access
  to other resources.
• In particular, income can be the key factor in
  stabilizing housing and good self care, as well
  as providing for/contributing to ones family.

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Value of Work - Purpose

• Work improves peoples sense of purpose.
• Boredom and stagnation is NOT good for people.
  People need to grow.
• When they feel reasonably well, most people want
  to DO something.
• Work provides structure to ones time.
• A lot of PLHA want to give back and seek
  fulfilling, socially meaningful activity.

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Value of Work- Social Integration

• Work is the single most normative adult activity.
  People kept from working will always be
  marginalized.
• PLHA are at risk of social isolation due to
  stigma of HIV
• This may be exacerbated by concurrent issues
• Work provides opportunities for social
  interaction and development of relationships.
• Allows/requires people to move in the
  non-HIV-identified world.

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Value of Work Health and Mental Health

• If you think work is stressful, try NOT working!!
• Work improves self-esteem, structures time,
  provides opportunities for learning and growth.
• Studies show improved Quality of Life and sense
  of well-being.
• No evidence that work in and of itself results in
  getting sick
• Risks include exposure to OIs, stress,
  difficulty balancing with medical care, etc.
• ALL risks are diminished by access to support and
  good disability management education

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FURTHERMORE

• Lets look at RWCA successes
• Treatment
• Self-care
• Nutrition
• Housing
• Income
• Prevention
• MH services
• DA treatment

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If we

• dont help people develop the means to sustain
  them independently
• dont connect people to future-oriented,
  developmental, non-marginalized, non-isolative
  activity
• perpetuate social, developmental and economically
  depressed stasis
• ALL OF THESE GAINS ARE AT RISK!!!

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Paradigm Shift

• HIV Service System was set up for indefinite
  service dependency.
• This is neither sustainable by the system nor
  good for people. We must invest in / support
  self-sufficiency when possible.
• Stabilization and Maintenance must be
  understood as the starting point of a recovery
  process, and NOT as an indefinite end state in
  which a person will live the rest of his/her life.

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MY MAIN POINTS TODAY

• WORK is an important aspect of life, a need, a
  desirable and achievable life goal, and a key to
  a sustainable future for many PLHA.
• ALL providers of services can play a part in
  supporting a persons interest in and ability to
  work.
• Most RWCA funded services already play a part by
  doing what they already do.
• AND there is more that can be done

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Barriers to Employment-Individual

• Direct Barriers
• Symptoms related to compromised immune system.
• HIV is non-static and unpredictable
• Indirect Barriers
• Issues related to medications such as side
  effects, scheduling, timing with meals, etc.
• Issues related to treatment such as need for
  medical appointments

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Indirect Barriers (contd)

• Interrupted Vocational Development
• Gap in work history
• Interrupted career development
• Skills may be atrophied or outdated
• Experience of illness also
• Can profoundly affect ones sense of FUTURE
• Shifts the priority of attention necessarily to
  ones health, and away from work and other life
  priorities.

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Systemic Barriers

• Benefits
• People are desperately afraid of losing benefits,
  especially medical coverage.
• SS Work Incentives rules are complicated. It is
  hard to know who to trust for good info.
• People may feel penalized for trying to work.
• Most part-time and entry level jobs dont come
  with benefits.
• Workplaces
• Can be rigid re schedule, and other policies
• Burden for requesting accommodations is on the
  individual

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Environmental Barriers

• Employment is off the radar of many ASOs
• Lack of general knowledge re HIV, and prevalence
  of stigma, discrimination, etc.
• Lack of info for PLHA about employee rights, ADA,
  reasonable accommodations, etc.
• Lack of info for PLHA about the Vocational
  Rehabilitation systems and resources
• Lack of info for VR about HIV and needs of PLHA
• Lack of linkage and collaboration between ASOs
  and VR.

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AND, of course

• Additional barriers to employment that are
  related to many common co-occurring
  circumstances
• Addiction
• MH issues
• Issues related to sexual orientation and/or
  gender identity
• Immigration status
• Incarceration and/or forensic history
• Domestic violence
• Need for education and/or training

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Strategies-ASOs already help by

• Ensuring access to treatment
• Teaching self-care and empowerment to understand
  HIV and make choices
• Ensuring access to nutrition and supports
• Making sure people have housing
• Ensuring continuity of income, generally via
  benefits
• Teaching and promoting prevention
• Linkage to MH services, DA treatment

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What else can ASOs do??

• Develop understanding of and connections with
  existing Vocational Rehabilitation resources!
• The RWCA assumes use of existing systems
• Much effort has gone into accessing and educating
  other systems about HIV, but not so with VR!
• It is time to develop OUR knowledge of these
  systems AND
• To actively seek opportunities to inform VR
  service providers about the capabilities and
  needs of PLHA

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The State-Federal Vocational Rehabilitation System

• Primarily funded by the Rehabilitation Services
  Administration (RSA) of the US Dept. of
  Education.
• Available to people with disabilities that result
  in a substantial impediment to employment.
• Provides help with job searching.
• Can provide funds for job specific training or
  education.
• Can provide resources for/access to assistive
  technology.
• VR subcontracts with other agencies to provide
  services to specialized populations (e.g. Mental
  Health).

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Challenges for PLHA

• VR providers may or may not be knowledgeable
  about HIV and the work-related needs of PLHA, or
  sensitive to populations most affected.
• The VR system was designed for people with static
  disabilities, and not for people with
  episodic/unpredictable disabilities.
• VRs goal is 90 days of continuous employment.
  There are few post-employment supports available.
• PLHA may not think of themselves as disabled.
• Asymptomatic PLHA may not be eligible.
• VRs average employment rate is 18-20 across
  groups.

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ASOs can

• Develop relationships with your local VR
  providers
• Learn how clients become eligible for VR services
• Learn what the VR system can / cannot offer
  consumers
• Learn how to navigate the VR system, and how to
  help consumers navigate the system
• Provide a VR system coach/advocate
• Provide training for DoR staff about HIV and the
  employment-related strengths and needs of PLHA.

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Social Security (SS) Work Incentives

• Provide ways for people receiving SS benefits to
  work and keep some disability income and all
  medical coverage.
• Provide ways to Plan for Achieving Self
  Sufficiency.
• Are intended to support peoples interest in
  working and reduce the drain on benefits.

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Challenges for PLHA

• To get SS benefits you have to prove you CANT
  work.
• System is too big and inflexible to respond to
  people with changing conditions.
• Work Incentives are very complicated.
• People feel punished for trying.
• People are afraid to lose what they have.
• People are afraid of what they dont understand.
• Less than .5 of people receiving SS benefits
  ever leave them behind.

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ASOs can

• Make sure to have up-to-date, reliable
  information about the Work Incentives.
• Or linkage to someone who does
• EVERY area has a BPAO provider
• Make sure benefits counseling is available that
  includes this information.
• Be sure NOT to contribute to the myth that
  working automatically results in lost benefits!

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WIA One Stop Career Centers

• Largely funded by the US Dept. of Labor under
  the Workforce Investment Act of 1998 (WIA).
• Combine all federal jobs programs under one roof.
• Assistance and training to wide spectrum of
  people (not just low-income).
• Access to computers, databases, employers, job
  search support, assessment and referrals

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Challenges for PLHA

• First line of services is self-serve. Staff
  allocated only when this fails.
• Anyone with a disability is usually referred to
  State Vocational Rehabilitation services.
• Anyone with literacy problems, limited computer
  skills, limited understanding of the work world
  and job market may have trouble using these
  resources.

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ASOs can

• Become familiar with what the One-Stops have to
  offer and refer people who can use these
  resources.
• Use buddies or mentors to help people make use of
  One-Stop resources.
• Help consumers access resources for developing
  literacy skills, GEDs, and computer skills.

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What else??

• Help people address these four domains, one at a
  time, and provide relevant support for informed
  decision-making.
• MEDICAL
• LEGAL
• PSYCHOSOCIAL
• VOCATIONAL

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Medical

• Help PLHA discuss employment and pre-employment
  activities with medical providers
• Docs are often used to helping people get out of
  work, not prepare for it be assertive if thats
  what the person wants.
• Encourage PLHA to increase activity levels and
  interests not related to HIV
• This can be as gradual a process as needed.
• Focus on building physical and emotional capacity
• Think in terms of recovery, not just maintenance.

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Financial/Legal

• Help PLHA understand the option to work and keep
  benefits.
• Educate PLHA about legal rights and protections,
  and in particular about employee rights and
  protections.
• Provide/refer for immigration assistance.
• Provide/refer for credit/debt assistance.

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Psychosocial

• Support groups help alleviate depression and
  isolation. Employment-specific peer support can
  be very powerful.
• Referrals for counseling and therapy and recovery
  assistance.
• Hopelessness is one of the biggest barriers. Help
  people develop a positive vision of their own
  futures.
• Fear is the other big one. Provide support for
  people to deal with their fears and pursue their
  goals. Exposure to others who have done so is
  extremely powerful.

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Vocational

• Without providing a full range of Employment
  Services, ASOs CAN
• Promote a change in mindset from a primary focus
  on surviving HIV/AIDS to thriving with HIV/AIDS
  (as health permits).
• Promote a context of service delivery that
  incorporates planning for a future and aspiring
  toward personal goals.
• Help people pursue education and training.

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Vocational Issues

• People living with HIV experience variations in
  health status and multiple barriers to
  employment.
• Dont assume anyone with HIV is too sick to
  work.
• Dont assume a person with HIV is perfectly well
  if you cant see a problem.
• Help the person manage HIV-related barriers in
  the workplace.

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Vocational IssuesFor those who are working

• Setbacks are NORMAL provide encouragement and
  support to persevere.
• Help clients develop self-care and self-advocacy
  skills to handle logistical, personal and social
  challenges of working.
• Help clients adapt to changes in
• job demands, conditions and co-workers
• health
• personal life, relationships, life circumstances
• Help people stay on the job as long as they want
  to and are able to.

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Provide opportunities

• Many HRSA grantees can or already provide work
  opportunities for PLHA
• Volunteering
• Internships
• Temp Jobs
• Part-time Jobs
• These should be structured.
• When possible, build in opportunities for growth
  / advancement.

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What people tell us they need most.

• Clear accurate information.
• Help navigating benefits systems and negotiating
  job accommodations.
• Peer support.
• Employer and Co-worker education.
• Flexible schedules.
• Access to job training and re-training.
• Concrete supports e.g. child care,
  transportation, housing, benefits, etc.

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Guidelines for Action

• Seven Steps That Can Be Taken Now To Reduce
  Barriers To Employment
• (without changing a word of legislation or
  spending a dime on employment services)

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1 Add Employment to Case Management

• Develop case management and/or client advocacy
  standards of care which incorporate ongoing
  assessments related to client need, interest, and
  ability to enter/re-enter the workforce.

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2 Coordinate with VR WD

• Develop greater coordination with Vocational
  Rehabilitation and Workforce Development
  providers and service delivery systems.
• Monitor responsiveness of services for PLHA

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3 Support Well-Informed Decisions with
Benefits Information

• Provide access for PLHA to counseling on the
  impact of work-related activity on income and
  health insurance benefits, as well as other
  social services.

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4 Evaluate HIV Services for Work Disincentives

• Evaluate existing programs for work DISincentives
  (e.g. housing).
• Advocate for policies to reduce work
  disincentives and increase work incentives.

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5 Maintain Services While Clients Are In
Transition

• Provide service bridges during work attempts and
  expedited reinstatement of benefits during
  periods when PLHA are unable to work.

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6 Promote Vocational Development

• Create structured volunteer opportunities for
  professional development of PLHA.
• Prioritize recruitment of PLHA for paid
  positions.

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7 Promote Further Research on Employment

• Support and engage in research designed to better
  understand health and prevention outcomes of
  employment and employment services.

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Going Further

• Develop a joint SPNS grant with the
  Rehabilitation Services Administration (RSA) of
  the Department of Education.
• Support training and technical assistance
  regarding work-related needs of PLHA for HRSA
  grantees, VR, DoL, HOPWA, SSA, CDC and any other
  relevant service system.
• Support a means to centralize knowledge about HIV
  and Employment.