Decanting the water cooler: Decanting the water cooler: Exploring the social dimensions Exploring the social dimensions of vocational learning for people of vocational learning for people

with a severe mental illnesswith a severe mental illness

CMHSR Seminar Series CMHSR Seminar Series

John C. Bricout Ph.D. John C. Bricout Ph.D.

Decanting the water coolerDecanting the water cooler

“‘“‘The water cooler effect’ suggests that The water cooler effect’ suggests that conversations that develop in and around conversations that develop in and around a water cooler or in a cafeteria significantly a water cooler or in a cafeteria significantly enables knowledge transfer.” (Sarker, enables knowledge transfer.” (Sarker, Sarker, Nicholson & Joshi, 2002, p. 10)Sarker, Nicholson & Joshi, 2002, p. 10)

Why the Water Cooler Now?Why the Water Cooler Now?

Employment challenges for people with Employment challenges for people with SMISMIEvidence-based approach: supported Evidence-based approach: supported employment as a ‘black box’employment as a ‘black box’– Focus on client capacity Focus on client capacity – Programmatic compensatory strategiesProgrammatic compensatory strategies

Shifting the paradigm: transactional Shifting the paradigm: transactional (Person-environment) social learning (Person-environment) social learning processes processes

What is Supported Employment?What is Supported Employment?

Supported Employment (SE) Individual Supported Employment (SE) Individual Placement and Support (IPS)Placement and Support (IPS)– Integration with MH services Integration with MH services – Assertive community treatment case management Assertive community treatment case management

modelmodel– Individualized, rapid job searchIndividualized, rapid job search– Competitive-wage community jobsCompetitive-wage community jobs– Individually-held positionsIndividually-held positions– Ongoing supports offeredOngoing supports offered– More ‘meaningful’ work More ‘meaningful’ work

What Makes Work Meaningful?What Makes Work Meaningful?

Meaningful WorkMeaningful Work– Work that is satisfyingWork that is satisfying– Work that meets developmental needsWork that meets developmental needs– Work that furthers career growthWork that furthers career growth– Work that enhances capability, sense ofWork that enhances capability, sense of– Work that increases feeling of belongingWork that increases feeling of belonging– Work that meets material needsWork that meets material needs

Efforts to Get More MeaningEfforts to Get More Meaning

SE Delivery System Program and Agency SE Delivery System Program and Agency Variations (Cook, et al., 2005)Variations (Cook, et al., 2005)– IPS (MD, CT) IPS (MD, CT) – ACT (MA) Shared caseload, vocational ACT (MA) Shared caseload, vocational

assessmentassessment– Blended approach (SC) ACT plus IPSBlended approach (SC) ACT plus IPS– IPS plus enhanced natural supports (TX)IPS plus enhanced natural supports (TX)– IPS plus multifamily psychoed and MH IPS plus multifamily psychoed and MH

Employer Consortium (ME) Employer Consortium (ME)

SE Benefits and Limitations SE Benefits and Limitations

SE/IPS BenefitsSE/IPS Benefits– Higher wagesHigher wages– Higher rates of employmentHigher rates of employment– Integrated employmentIntegrated employment– Consumer choice of job enhanced Consumer choice of job enhanced – (Meaningful work) (Meaningful work)

SE/IPS LimitationsSE/IPS LimitationsJob tenureJob tenure (short-term)(short-term)– Low participation rateLow participation rate– Low-wage, part-time jobsLow-wage, part-time jobs

Job Tenure FactorsJob Tenure Factors

Factors related to structure of work or Factors related to structure of work or servicesservicesInherent nature of jobs held (entry-level)Inherent nature of jobs held (entry-level)Entitlement/benefit contingenciesEntitlement/benefit contingenciesFollow-up costly long-term: may need more Follow-up costly long-term: may need more

than a year of supported employment, or may than a year of supported employment, or may be initially uninterested (Saylers, et al., 2004) be initially uninterested (Saylers, et al., 2004)

Job Tenure FactorsJob Tenure Factors

Factors related to the workerFactors related to the workerNeurocognitive functioning (Lehman, et al., Neurocognitive functioning (Lehman, et al.,

2002)2002)Cognitive functioning (McGurk & Mueser, 2004; Cognitive functioning (McGurk & Mueser, 2004;

McGurk, et al., 2003)McGurk, et al., 2003)

Impaired social functioning (Lehman, et al., Impaired social functioning (Lehman, et al., 2002)2002)Social Network Outcomes (Forrester-Jones, et al., Social Network Outcomes (Forrester-Jones, et al.,

2004; Rollins, et al., 2003)2004; Rollins, et al., 2003)

Program Factors on FunctioningProgram Factors on Functioning

Opening up the Programmatic Black BoxOpening up the Programmatic Black Box

“…“…a need to better understand how specific a need to better understand how specific models of vocational rehabilitation work, models of vocational rehabilitation work, including their interactions with cognitive including their interactions with cognitive functioning and symptoms.” (McGurk & functioning and symptoms.” (McGurk & Mueser, 2004, p. 160)Mueser, 2004, p. 160)

Program Factors on Functioning Program Factors on Functioning

Program Handling of Cognitive LimitationsProgram Handling of Cognitive Limitations

““Different vocational programs may have Different vocational programs may have different approaches for dealing with the different approaches for dealing with the problem of cognitive impairment in problem of cognitive impairment in program participants, resulting in different program participants, resulting in different associations between cognitive functioning associations between cognitive functioning and work” (McGurk & Mueser, 2004, p. and work” (McGurk & Mueser, 2004, p. 151) 151)

Program Factors on FunctioningProgram Factors on Functioning

Program Design of Social EnvironmentProgram Design of Social Environment

““These mental health centers provided a These mental health centers provided a culture in which work is valued and culture in which work is valued and consumers are expected to work…” consumers are expected to work…” (Saylers, et al., 2004, p. 306)(Saylers, et al., 2004, p. 306)

Bridging Concept – Social LearningBridging Concept – Social Learning

Links labor-market potential and Links labor-market potential and employability in a knowledge societyemployability in a knowledge society

Links cognitive functioning, social Links cognitive functioning, social networks and work functioningnetworks and work functioning

Implies a transaction between the worker Implies a transaction between the worker and the social environment in which the and the social environment in which the capacities of each individually, and both capacities of each individually, and both co-jointly are increased co-jointly are increased

Vocational Social LearningVocational Social Learning

‘‘Vocational’ social learning is how I refer to Vocational’ social learning is how I refer to the processes of social learning in the processes of social learning in vocational rehabilitation settingsvocational rehabilitation settings

Examples of social learningExamples of social learningAdvice-givingAdvice-givingInstrumental aidInstrumental aidFeedbackFeedbackGuidanceGuidance

Vocational Social LearningVocational Social Learning

Learning is Situated and ActiveLearning is Situated and Active

““Learning about only requires the Learning about only requires the accumulation of knowing that, which accumulation of knowing that, which confers the ability to talk a good game but confers the ability to talk a good game but not necessarily to play one.”not necessarily to play one.”

(Duguid, 2005, p. 113)(Duguid, 2005, p. 113)

Vocational Social LearningVocational Social Learning

Tacit (Tacit (howhow, apprenticed) knowledge critical , apprenticed) knowledge critical to taking action to taking action

Knowing Knowing thatthat can be codified and can be codified and modeled, but that strains out the knowing modeled, but that strains out the knowing howhow that makes knowledge actionable that makes knowledge actionable

Unpacking Social LearningUnpacking Social Learning

Exploring socialization to work – learning Exploring socialization to work – learning how to work (Pilot One) how to work (Pilot One)

Exploring socialization at work – learning Exploring socialization at work – learning how to work how to work here here (Pilot Two)(Pilot Two)

Pilot ProjectsPilot Projects

Pathways to employment pilotPathways to employment pilot– Three focus groups at independence centerThree focus groups at independence center– Evaluation data on members and staff by categoryEvaluation data on members and staff by category– Participant observation data on preparatory ‘Edge Participant observation data on preparatory ‘Edge

workshopworkshop– Evaluation data on places of employmentEvaluation data on places of employment

Self-disclosure feasibility pilotSelf-disclosure feasibility pilot– Independent employment (IE) worker and paired co-Independent employment (IE) worker and paired co-

worker interviews on the social environment at work worker interviews on the social environment at work and self-disclosureand self-disclosure

What is Independent Employment ?What is Independent Employment ?

Clubhouse Adaptation of SEClubhouse Adaptation of SE– Roughly congruent with IPS but varies on:Roughly congruent with IPS but varies on:

Degree of ongoing supports Degree of ongoing supports

Clubhouse integrates mental health, psychosocial Clubhouse integrates mental health, psychosocial and vocational supportsand vocational supports

Clubhouse members are exposed to ‘pre-Clubhouse members are exposed to ‘pre-vocational training’ and may not make rapid vocational training’ and may not make rapid assessments and placement assessments and placement

What is Transitional Employment?What is Transitional Employment?

Clubhouse-run Employment Program Clubhouse-run Employment Program – Jobs held by Clubhouse (Clubhouse Jobs held by Clubhouse (Clubhouse

responsible)responsible)– Time limitedTime limited– Jobs contracted by ClubhouseJobs contracted by Clubhouse– Enclave settingEnclave setting– Worker MH status widely knownWorker MH status widely known

Member Placement CharacteristicsMember Placement Characteristics

Transitional placements = 44Transitional placements = 44 Transitional employers = 11Transitional employers = 11 TE jobs: mailroom clerk, assemblerTE jobs: mailroom clerk, assembler------------------------------------------------------------------------------------------------------

Shared TE/IE placements = 6Shared TE/IE placements = 6------------------------------------------------------------------------------------------------------ Independent placements = 92Independent placements = 92 Independent employers =68Independent employers =68 Self-employment = 1Self-employment = 1 IE Jobs: clerical, food preparation IE Jobs: clerical, food preparation

Pathways Pilot RationalePathways Pilot Rationale

Explore the workplace socialization process for Explore the workplace socialization process for clubhouse members taking two paths to IE: a clubhouse members taking two paths to IE: a direct path and one preceded by TEdirect path and one preceded by TE

Explore the nature and role of Clubhouse Explore the nature and role of Clubhouse philosophy and practices in fostering competitive philosophy and practices in fostering competitive employment-relevant habits of mind, employment-relevant habits of mind, expectations and competencies expectations and competencies

Explore how the Clubhouse initially and over Explore how the Clubhouse initially and over time shapes the worker role and ‘being’ for time shapes the worker role and ‘being’ for membersmembers

Sampling FrameSampling Frame

Member Employment Statistics 2000-2005Member Employment Statistics 2000-2005

Independent plus transitional = 43Independent plus transitional = 43

Independent employment only = 35Independent employment only = 35

Clubhouse Vocational Staff Statistics 2005Clubhouse Vocational Staff Statistics 2005

Unit Staff/Placement Managers = 18Unit Staff/Placement Managers = 18

Employment Staff = 6 Employment Staff = 6

Focus Group CharacteristicsFocus Group Characteristics

Pathways to Employment Focus GroupsPathways to Employment Focus Groups– Members in I.E. only (N=6)Members in I.E. only (N=6)

Range of time in workforce: 3-20 yearsRange of time in workforce: 3-20 years

Time in current job: 0-4yearsTime in current job: 0-4years

– Members in I.E. with T.E. experience (N=8)Members in I.E. with T.E. experience (N=8)Range of time in workforce: 3-20 yearsRange of time in workforce: 3-20 years

Time in current job: 0-1 yearTime in current job: 0-1 year

– Vocational staff members Vocational staff members (N=11)(N=11)

IE Focus Group ThemesIE Focus Group Themes

The clubhouse fosters trust in self and in The clubhouse fosters trust in self and in staffstaff

Clubhouse teaches you getting along Clubhouse teaches you getting along Clubhouse is more flexible than employersClubhouse is more flexible than employersKnowing your strengths and weaknesses Knowing your strengths and weaknesses

is importantis importantKnowing what supports you need at work Knowing what supports you need at work

is importantis important

TE to IE Focus Group ThemesTE to IE Focus Group Themes

Clubhouse support indispensableClubhouse support indispensable Clubhouse members are an important Clubhouse members are an important

part of that support, as well as staffpart of that support, as well as staff Clubhouse provides a sense of Clubhouse provides a sense of

belonging and place belonging and place Clubhouse a training ground for skills Clubhouse a training ground for skills

important to stressful work situationsimportant to stressful work situations Family members and co-workers also Family members and co-workers also

have important support roles have important support roles

Staff Focus Group ThemesStaff Focus Group Themes

Relationships—both with members and Relationships—both with members and staff—are key confidence-builders and staff—are key confidence-builders and supports in illness timessupports in illness times

Clubhouse has unique, intentional, non-Clubhouse has unique, intentional, non-judgmental approach to workjudgmental approach to work

Clubhouse teaches how to learn to workClubhouse teaches how to learn to workClubhouse generates work peer pressureClubhouse generates work peer pressureCritical workplace supports hinge on Critical workplace supports hinge on

degree of clubhouse participation/connectdegree of clubhouse participation/connect

Focus Group ConclusionsFocus Group Conclusions

Clubhouse structure and philosophy aim to Clubhouse structure and philosophy aim to enhance member vocational self-efficacy, enhance member vocational self-efficacy, collective efficacy (as a person with a psychiatric collective efficacy (as a person with a psychiatric disability) and learning how to be a workerdisability) and learning how to be a workerSocietal prejudices and demands vitiate Societal prejudices and demands vitiate Clubhouse learning, perspectives and habitsClubhouse learning, perspectives and habitsThe unique ‘bubble’ of Clubhouse learning may The unique ‘bubble’ of Clubhouse learning may be more beneficial readying members for the be more beneficial readying members for the world of work than maintaining them thereworld of work than maintaining them thereThe real-world-Clubhouse expectations The real-world-Clubhouse expectations disconnect suggests transitioning disconnect suggests transitioning

Self-Disclosure Pilot Rationale Self-Disclosure Pilot Rationale

Examines the role of self-disclosure in context of Examines the role of self-disclosure in context of social networks, workgroup member social networks, workgroup member interdependence, mutuality and respect interdependence, mutuality and respect

Tests feasibility of recruiting and questioning Tests feasibility of recruiting and questioning paired third-parties in the workgrouppaired third-parties in the workgroup

Examines correspondence of IE worker and Examines correspondence of IE worker and workgroup member perspectives on workgroup workgroup member perspectives on workgroup

Exploratory QuestionsExploratory Questions

Topics for explorationTopics for exploration– What is the nature of their social networks? What is the nature of their social networks? – Is self-disclosure more prevalent in work Is self-disclosure more prevalent in work

environments characterized by more environments characterized by more interdependence?interdependence?

– Are better relationships with co-workers Are better relationships with co-workers related to the prevalence of self-disclosurerelated to the prevalence of self-disclosure

For follow-upFor follow-up– Is self-disclosure part of at least one pattern Is self-disclosure part of at least one pattern

of fostering social learning at work?of fostering social learning at work?

Interview StructureInterview Structure

Two structured interviews aimed at assessing Two structured interviews aimed at assessing the feasibility of collecting data from an IE the feasibility of collecting data from an IE worker and co-worker on how workgroup worker and co-worker on how workgroup members treat one another, the nature of IE members treat one another, the nature of IE worker self-disclosure, and the degree of worker self-disclosure, and the degree of workgroup member interdependence. workgroup member interdependence.

The IE worker interview is substantially longer The IE worker interview is substantially longer because it includes an idiosyncratic section on because it includes an idiosyncratic section on workplace social networks; apart from those workplace social networks; apart from those items the two questionnaires roughly parallel items the two questionnaires roughly parallel one another.one another.

Interview Items Interview Items

Member (IE Worker) Interview: 88 items. Member (IE Worker) Interview: 88 items. Twenty-eight items developed for this Twenty-eight items developed for this project. Ten items are part of a project. Ten items are part of a standardized social network measure that standardized social network measure that is repeated 6 times for different people.is repeated 6 times for different people.

Co-Worker interview: 18 items developed Co-Worker interview: 18 items developed for this projectfor this project

Ethical IssuesEthical Issues

Ethical ChallengesEthical Challenges– Risks to IE workerRisks to IE worker

Confidentiality breachConfidentiality breach

Peace of mindPeace of mind

Employment statusEmployment status

Co-worker relationshipsCo-worker relationships

Ethical ImperativesEthical Imperatives– Cost of exclusionCost of exclusion

Justice issue – participationJustice issue – participation

Respect for persons – capacity to consent/participateRespect for persons – capacity to consent/participate

Ethical DesignEthical Design

Changes to DesignChanges to Design– Sampling frame ‘protections’ – agency vetting Sampling frame ‘protections’ – agency vetting

of sites and sampleof sites and sample– Nomination process replaced by direct IE Nomination process replaced by direct IE

worker contact of co-workerworker contact of co-worker– Consent and interview process isolated from Consent and interview process isolated from

workplaceworkplace– Consents warn of confidentiality risksConsents warn of confidentiality risks– Co-worker knowledge pre-assessed Co-worker knowledge pre-assessed

Sampling FrameSampling Frame

Current StatusCurrent Status– Agency vocational staff have identified seven Agency vocational staff have identified seven

work-stable IE workers in ‘safe environments’ work-stable IE workers in ‘safe environments’ who have agreed to be contacted by who have agreed to be contacted by researcher for the IE Worker (Member) researcher for the IE Worker (Member) interview, three more in processinterview, three more in process

Conclusion Conclusion

Need measurement development (observational, Need measurement development (observational, self-report, archival) for vocational social self-report, archival) for vocational social learninglearningThe relationship of vocational social learning The relationship of vocational social learning needs to be investigated with job fit, satisfaction, needs to be investigated with job fit, satisfaction, job performance and vocational developmentjob performance and vocational developmentVocational social learning conceptually Vocational social learning conceptually integrates individual-focused, transpersonal and integrates individual-focused, transpersonal and organizational efforts at improving the organizational efforts at improving the employability of persons with a psychiatric employability of persons with a psychiatric disabilitydisability