Ways to Work Demonstration Programs

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Ways to Work DemonstrationPrograms

• New York Work Exchange
• Coalition of Voluntary Mental Health Agencies

December, 2002
Colleen Gillespie, PhD NYU Wagner Center for
Health and Public Service Research Evaluator
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Background

• The New York Work Exchange, a project of the
  Coalition of Voluntary Mental Health Agencies,
  funded five Ways to Work Demonstration Programs
  beginning in January, 2002.
• The Ways to Work initiative was launched to
  promote the creation of effective new service
  delivery methods targeted at increasing the
  integration and coordination of employment and
  clinical services.
• The overarching goal of Ways to Work is to
  increase the number of people with psychiatric
  disabilities who get and retain competitive
  employment.
• Principles of the Ways to Work Demonstration
  Project include
• Consumers of mental health services can work.
• Work and the role of work are important parts of
  the recovery process.
• Integrating employment and clinical services
  improves consumers employment outcomes.
• Those agencies that were selected for funding
  each proposed innovative and effective means of
  enhancing services by integrating employment
  services into their array of existing Continuing
  Day Treatment and/or Clinic programs.
• The following five agencies were selected through
  the RFP process to develop and implement Ways to
  Work programs
• Brooklyn Bureau of Community Services
• Jewish Board of Family and Childrens Services
• Riverdale Mental Health Association
• Postgraduate Center for Mental Health
• Transitional Services for New York, Inc.

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Evaluation of the Ways to Work Demonstration
Projects

• The two major goals of the evaluation are
• to document the effectiveness of integrating
  employment services with clinical services among
  these pilot projects and
• to use these agencies experiences to show mental
  health service providers throughout the country
  how they can most effectively promote competitive
  employment within clinical settings.
• These objectives stem from the nature of these
  projects as demonstration projects the emphasis
  is on qualitative description and documentation
  of process, rather than on the quantitative
  impact of the programs, given that the
  effectiveness of employment services has been
  well established.  
• Evaluation activities will focus on three major
  components of the projects
• How do agencies design the programs and introduce
  a focus on competitive employment to their
  continuing day treatment programs and clinics?
• How do agencies implement these new programs,
  overcome any barriers that may arise, and sustain
  the programs over time?
• What is the impact of the programs on consumers,
  clinicians, and agencies? What changes are
  associated with the Ways to Work programs?
• The following represents some preliminary
  information on the Ways to Work programs, who
  they serve, how many consumers have participated
  to date, reasons why consumers signed up, and how
  satisfied consumers are when they first start out
  in their Ways to Work programs.

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Agencies with Ways to Work Programs
The agencies vary significantly in terms of size,
mission, target populations served, experience
with employment services and location.
Agency Name Location Description Size
Transitional Services for New York, Inc. (TSI) Queens Provides a continuum of rehabilitative services to enrich the lives of the mentally ill and facilitate their transition to increased levels of independence. 2,000 Served/Yr
Riverdale Mental Health Association (RMHA) Bronx Offers child, adolescent, and adult services, continuing day treatment for post-hospitalized and seriously mentally ill persons, a substance abuse treatment program, supported employment and welfare-to-work programs, mental health consultation and educational programs, a 15-bed supervised community residence, and a supported apartment program. 1,600 Served/Yr
Jewish Board of Family and Childrens Services (JBFCS) Central Offices Manhattan Services All of NYC Operates a diverse network of more than 160 community-based programs serving the adult mentally ill, emotionally disturbed children and adolescents, victims of domestic violence, the homeless, children at risk of abuse and neglect, people with AIDS, substance abusers, Soviet émigrés, the developmentally disabled, and people suffering from trauma and bereavement. 55,000 Served/Yr
Postgraduate Center for Mental Health (PCMH) Manhattan Offers individuals with mental illness a full continuum of care, including outpatient clinic programs, continuing day treatment, intensive psychiatric rehabilitation, a full complement of employment services, a large residential services division, and a division for services to persons living with or affected by AIDS. 4,000 Served/Yr
Brooklyn Bureau of Community Services (BBC) Brooklyn Serves Brooklyn residents with the greatest needs, including adults and adolescents with serious mental illness, adults with physical and developmental disabilities, parents at risk of losing their children to foster care, and children in need of academic support. 15,000 Served/Yr
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CDTPs Associated with Ways to Work Programs
The Ways to Work programs are situated in
Continuing Day Treatment Programs and Clinics
that serve different populations.
Agency CDT Program Participants Age Ethnicity /Race Gender
TSI Jamaica Consultation Center 100 groups TSI has strong vocational focus 98 90 lt 55 yrs 52 African American 24 Latino/a 20 White 4 Asian 32 Women 68 Men
RMHA Continuing Day Treatment Program 40 in RMHA housing 51 18 55 yrs 22 African American 16 Latino/a 55 White 8 Other 71 Women 29 Men
JBFCS Coney Island CSS (4 CDTPs and clinics) adult home residents want to develop vocational expertise 400 26 21 - 39 yrs 26 40 - 49 yrs 37 50 65 yrs 11 65 yrs 20 African American 15 Latino/a 50 White 15 Asian/Other 56 Women 44 Men
PCMH Westside CDTP Westside Outpatient Mental Health Clinic many homeless CDT 177 Clinic 262 31 18 39 yrs 42 40 49 yrs 27 50 yrs 30 African American 18 Latino/a 50 White 2 Asian 37 Women 63 Men
BBCS Project Moving On many young adults 95 95 lt 55 yrs 76 African American 16 Latino/a 7 White 44 Women 56 Men
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Diagnoses of CDT Program Participants at Ways to
Work Agencies
4 Major Depression
10 Bi-Polar
65 Schizophrenia
21 Schizoaffective
21 Schizoaffective

• Most of the consumers participating in the
  Continuing Day Treatment Programs and Clinics at
  Ways to Work agencies have a psychiatric
  diagnosis of schizophrenia.
• The proportions of diagnoses represented are very
  similar across the five Ways to Work agencies.

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How the Ways to Work Programs Work
Determine Who Wants To Work Consumer
Choice (e.g., sign-up list)
Other Supports Psychosocial Clubs Family
Education Housing Benefits Counseling
CDTP Participants
Ways to Work Program
Assessment Job Profile Career Interests/Goals
Rapid Job Search Job Development (Client
Specific) Individualized Job Placement
Job Support (Follow Along Supports) Job
Coaching Peer Support Family Support

• On-the-Job Assessment
• Regular Communication
• Management of
• Medications
• Symptoms

Work Incorporated Into All TX Goals/Plans

• Integration of Work Clinical Goals
• Team Meetings/Case Conferences
• Regular Communication

Integration with CDTP and Mental Health
Treatment Services
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What is Competitive Employment

• The goal is to assist consumers in obtaining
  competitive and satisfying jobs in community
• The work pays at least minimum wage
• People are employed in a work setting that
  includes non-disabled co-workers
• Service agency provides ongoing support
• Intended for consumers with a desire to work
• Includes people with the most severe disabilities

• Eligibility for Supported Employment services is
  based on consumer choice
• Consumer preferences are important
• Supported employment is integrated with mental
  health treatment
• Competitive employment is the goal
• Job search process starts soon after a consumer
  expresses interest in working
• Follow-along supports are continuous for employed
  consumers

Evidence-Based Practices Project (SAMHSA, CMHS,
Robert Wood Johnson Foundation, West Family
Foundation Johnson Johnson Corporate
Contributions Community Relations)
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Distinguishing Features of Each Ways to Work
Program
Each agencys approach to promoting employment
within their clinical settings is based on agency
philosophy, staffing and employment options.
Approach/ Philosophy Staffing ( What Does Ways to Work Finance?) Employment Innovations
TSI/ JCC Ways to Work tracks added on after CDTP Involvement of both CDTP Vocational staff Job Developer and Supported Employment Specialist Supervised by Dir of Vocl Services and Clinical Dir Half-time each Job Developer Employment Specialist Seasonal positions
RMHA Job and Career Clubs incorporated into CDTP Importance of integration On-site and off-site job development Employment Specialist performs all Ways to Work activities, with assistance from Job Coach Reports to CDT Program Director and Director of Employment Services Full-Time Employment Specialist Work try-outs Disclosure encouraged
JBFCS CI CSS Importance of belief in ability to work Importance of self-management in relation to work Role of Peer Counselors in providing support, role modeling, and especially motivation Focus on educating clinicians about employment Job Developer and Peer Counselors/Job Coaches Need to develop work experience (to help identify work interests and goals)
PCMH Directed job search with individualized support Program physically located in CDTP/Clinic Employment Specialist performs all Ways to Work activities, with assistance from Job Coach Reports to Employment Services Director Full-Time Employment Specialist Role for affirmative businesses Disclosure discouraged
BBCS/ PMO Importance of assessment (Workplace Center, Columbia Univ. School of Social Work) Employment programming co-located on-site with CDTP Ways to Work Coordinator performs all activities while working closely with clinical staff Reports to Director of CDTP and Director of Psychiatric Rehabilitation Services Coordinator with some Job Developer/Coach time Community-based opportunities Importance of training/certification
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Ways to Work Participants Enrolled Monthly
(Jan 2002 Sept 2002)
102 Ways to Work Participants Enrolled in First 9
Months

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Reasons Why Ways to Work Participants Signed Up
Not surprisingly, most consumer sign up for the
Ways to Work program because they want to work
however, others cite both more practical concerns
() and more recovery-focused concerns (to get a
better life, improve self-esteem).
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Sociodemographic Characteristics of Ways to Work
Participants
Asian
Latino/a
Female
White
Male
African American
Gender
Race/Ethnicity
College Graduate
Less Than HS
Some College or Post HS
HS Grad
Education
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Initial Satisfaction with Ways to Work
Employment Services
Very Satisfied
Somewhat Satisfied
Not At All Satisfied
Overall, consumers are pretty satisfied with the
services they receive early on as part of the
Ways to Work program.