Supported Employment: Nuts and Bolts

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Supported EmploymentNuts and Bolts
u

• Integrated Employment Institute
• UMDNJ
• Gary R. Bond
• Indiana U. - Purdue U. Indianapolis
• 11/28/01

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Outline

• What does a team look like?
• What does the team do?
• What are the major challenges?

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Hiring

• Positive energy probably more important than
  job-specific training
• BUT job-specific competencies also important
• Need to define profession better

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What Kinds of People Make Effective Employment
Specialists?

• High energy
• Optimistic
• Likes to met new people
• Good listener
• Knows the community
• Creative
• Knowledgeable about mental illness

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What Are the Roles of an Employment Specialist?

• Problem-solver
• Team player
• Networker
• Employment specialist
• Customer-oriented
• Community-oriented
• Outcome-oriented

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Gaps in Training Most Critical Training Needs

• Working with unmotivated clients
• Assessing voc needs
• Job retention strategies
• Funding under managed care
• Job development strategies
• Benefits and entitlements
• Shafer (1999) Survey of 395 Employment
  Specialists

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Basic Philosophy of SE

• Common sense approach How would you help your
  sister get a job?
• Made to order Get jobs one-by-one
• Long-term commitment Commitment is to person,
  not to placements
• Holistic You need to look at total picture

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Evidence-Based Principles

• Supported employment is integrated with treatment
• Competitive employment is the goal
• Rapid job search is used
• Job finding is individualized
• Eligibility is based on consumer choice
• Follow-along supports are continuous

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Supported Employment TeamRecommended Basic
Structure

• Minimum of 3 full-time staff
• Staff devoted exclusively to SE
• Full-time team leader/supervisor who also
  provides employment services
• SE team physically located in mental health center

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Work of Team

• Individual caseloads, but help each other (with
  job leads, etc.)
• Caseloads of about 20 consumers
• Weekly team meetings individual supervision

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Should Employment Specialist (ES) Help with
Housing, Crisis Intervention, and Clinical Issues?

• Supported employment works best when ES roles are
  well-defined
• ES should be alert to case management
  responsibilities and clinical issues and refer
  them to treatment team
• Effective supported employment is not feasible if
  clinical services not available

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Supported Employment Integrated with Mental
Health Treatment

• Employment specialists meet frequently with the
  mental health treatment team.
• Attend weekly treatment team meetings
• Have daily contact with clinicians

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Where Do Employment Specialists Spent Most of
Their Time?

• Out in the community! (at least half of time)
• If staff worker is a desk jockey Not a good job
  fit

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The Dreaded Paperwork

• Comes with territory
• As much as feasible, supervisor should protect
  staff from busy work
• Important paperwork
• Vocational profiles
• Employment plans
• Fidelity checks on
• program implementation
• Monitoring outcome

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Separate Roles for Each Employment Specialist?

• Should staff specialize -- one staff worker do
  all the intakes, another the job development?
• Or should all team members involved in all
  aspects of work (intake, job development,
  placement, ongoing support)?

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Role Specialization Within Team?

• Research has not established which is best way
• Becker recommends generalist model All staff do
  all functions
• Important point Keep everyone in the loop

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Competitive Employment Is the Goal

• Employment specialists role is to help consumers
  obtain permanent jobs
• Implications for staff and for job search
• Staff do not have other job duties (e.g.,
  part-time at day treatment program)
• Sheltered workshops, temporary jobs, volunteer
  jobs usually not an option

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What About Supported Education?

• Consumer choice always a primary consideration
• Education and training expand options
• SE program should help consumers enroll in
  community programs (GED classes, colleges,
  technical schools)

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What About Job Creation at Mental Health Center?

• Rule of thumb The goal is to aim for regular
  jobs jobs that any person (with or without a
  disability) can hold
• Creating set-aside jobs within agency is contrary
  the spirit of SE
• An exception prosumer roles consumers who
  work as providers can be legitimate jobs

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Rapid Job Search Is Used

• Rule of thumb First job application within one
  month after program entry
• Formal initial assessment need not be lengthy
• Informal assessment is continuous

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Continuous and Comprehensive Assessment

• Informal common-sense methods may work best
• Listen carefully to clients
• Gather information from actual work experiences

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What About Job Club Activity?

• Many programs have classes to do career
  exploration, resume-writing, job interviewing
• Research evidence Lengthy skills training (more
  than a couple of weeks) is ineffective
• Recommendation Give this help informally

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How Do I Get a Job for a Person Before I Know
Them?

• Relationship-building a key element in any
  helping relationship
• Employment specialist role includes engagement,
  outreach, encouragement, problem-solving
• Mental health treatment team should be involved

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Consumer Ambivalence About Work

• Should address the total picture
• Benefits counseling extremely critical
• SSA and Medicaid changes suggest need for
  additional training

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Eligibility Is Based on Consumer Choice

• Consumers are not excluded because they are not
  ready or because of prior work history,
  hospitalization history, substance use, symptoms,
  or other characteristics.

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Job Finding Is Individualized

• Job finding is based on consumers preferences,
  strengths, and work experiences, not on a pool of
  jobs that are available.

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How Do You Find Jobs?

• One-by-one (rather than looking for an employer
  who will hire many consumers)
• Personal networks may work best
• Meet with employers
• Beyond Job Development (Bissonnette)

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Finding Suitable JobsCase Examples

• What would be your strategy with a consumer
• with poor hygiene
• who drinks
• who is restless, cant stand still
• who has great training, but there are no jobs in
  his area

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Case Example (Bissonnette)

• Consumer wants a job to driving a delivery truck
• Would you look for job in newspaper?

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Becker (1996) What is best way to identify job
preferences among undecideds?

• Change in preferences were more likely after job
  tryout than after career counseling.
• Implication Actual job experience is better
  way to learn than talking about it.

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Bakery Vignette

• Jane had always loved baking and dreamed or
  working in a bakery.
• Her employment specialist got her a job at local
  bakery.
• After one week on job, Jane quit. She found out
  work started at 3 am and she wasnt a morning
  person.

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Follow-Along Supports Are Continuous

• Follow-along continued indefinitely
• Usually not at employment site
• Flexible -- what does client need?
• Supports come from whole (treatment and
  employment) team
• May also involve family and others

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Job Support Includes Interventions with

• Consumer
• Consumers support network (friends, family,
  clinicians)
• Employer, coworkers, and others at workplace

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Common Job Accommodations (MacDonald-Wilson, 2000)

• Cognitive (e.g., learning job, concentrating)
• Social (e.g., interacting, reading social cues)
• Emotional (e.g., managing symptoms, tolerating
  stress)
• Physical (e.g., stamina)

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Case ExampleJob Accommodation

• John starts a job as a bagger at grocery
• He likes work, except he hates asking customers
  what kind of bags they want
• What would you do?

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What If A Consumer Loses a Job?

• Each job viewed as learning experience
• Initially, employment specialist usually
  encourages consumer to stick it out
• Job transitions are considered normal
• With a job loss, consumer and entire (SE and
  treatment) team strategize for next step

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Issue of Disclosure

• Disclosure is an individual decision
• What, how, when, and to whom you disclose are
  critical aspects of decision
• Gervey research Disclosure on interview led to
  greater job retention
• Becker Disclosure more frequent as consumer
  gains experience

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Overcoming Barriers to Employment

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Examples of Ways to Overcome Barriers

• lack of motivation
• lack of stamina
• poor skill transfer
• chronicity of illness
• symptoms
• stigma

• assertive outreach
• part-time work
• situation-specific training
• long-term support
• job accommodations
• advocacy