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Comparative Employment Strategies for Serving Individuals with Significant or Most
Significant Disabilities:
Customized Employment and Evidence-based Supported
Employment
David W LyndeSupported Employment Consultant
Michael CallahanMarc Gold & Associates (MG&A)
November 7, 2012
Evidence – Based Supported Employment
David W Lynde, MSW
Supported Employment Consultant
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
3
Overview
• Principles of Evidence Based Supported Employment
• Supported Employment/Individual Placement and Support as an Evidence Based Practice
• Supported Employment Fidelity Scale Items
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
4
Principles of Supported Employment
• Helping people obtain competitive employment is the goal
• Participating in SE is based on each person’s own choice
• SE is integrated with other mental health services
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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Principles of Supported Employment
• Each person has access to good work incentive planning information
• SE helps people find real jobs soon after they start the program, not requiring lengthy assessments or job trials
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
6
Principles of Supported Employment
• Each person’s goals and preferences regarding work are honored
• SE helps people to be successful at work through follow along supports
• Employment specialists use systematic job development strategies
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
7
Definition of Competitive Employment
• A job in the competitive labor market that is performed on a full-time or part-time basis in an integrated setting; and
• For which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals who are not disabled
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
8
Competitive Employment Is the Goal
• Each person is helped to find their own competitive job, one that they own, where they receive the paycheck directly from the employer
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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Competitive Employment Is the Goal
• People are not steered into accepting jobs in pre-arranged job slots
• People are not directed into sheltered workshops, lengthy vocational assessments or working in job enclaves
• Jobs are identified or developed to fit each person’s individual job goals and job preferences
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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Participating in SE: A Person’s Own Choice
• SE services are provided to all people who identify themselves as having competitive employment as a recovery goal
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
11
Low Expectations
Research about the low expectations of mental health professionals in relation to people with mental health conditions gaining employment is now very well documented. These expectations are often underpinned by concern about issues of risk, stress and relapse. Such low expectations … can result in them and their families receiving very cautious messages from mental health professionals about gaining employment. Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and
employment: A review. International Review of Psychiatry
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
12
Participating in SE: A Person’s Own Choice
• People are not excluded from SE because of diagnosis, symptoms or other agency imposed rules
• People are not excluded because of the mental health providers own biases about who is and who is not ready for employment
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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“Work Ready”
“I was going to a day treatment program forever. I was waiting to be anointed by someone that I was ‘work ready’.”
Maureen Marrin
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
14
Supported Employment Is Integrated with Mental Health Treatment
Each person in SE receives integrated mental health services. Employment specialists work in an integrated way with the other members of the person’s mental health treatment team (for example, case manager, peer supports, therapist, psychiatrist, etc…).
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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“I want to live my life not my disability”
Pat Deegan
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
16
People Access IndividualizedWork Incentive Planning
• Each person in SE has access to good, accurate work incentive planning that is based on their individual situation
• Work incentive planning helps people to determine what role benefits will play in their recovery
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
17
People Access IndividualizedWork Incentive Planning
• People are empowered to make their own choices about benefits and are not directed to “earn less than SGA”
• What works best for the person is their own personal choice
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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People Receive Timely Job Search Services
• When people start SE, their goals to obtain competitive jobs are respected
• People are not required to participate in pre-employment assessments, job-hardening activities, or trial work periods
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
19
Each Person’s Goals and Preferences are Honored
• People are helped to find work that matches with their individual work goals, preferences, strengths, and work experiences
• People are not directed into other pre-vocational tasks to prove they want to work
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
20
Employed People Receive Follow-Along Supports
• The employment specialist and the mental health center help employed people to be successful at work by providing follow along supports for employment
• Follow along supports are based on each individual’s unique situation and needs
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
21
Systematic Job Development
• Employment specialists develop direct relationships with employers, based upon clients’ work goals, by meeting face-to-face over multiple visits in the community
• Employment specialists learn about the work environment and the employers’ work needs in order to match clients with employers
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TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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Supported Employment
An Evidence-Based Practice for Adults with Mental Illness
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
23
Evidence Based Practice Definition (Mental Health Practices)
• Practice is manualized
• Practice has a fidelity scale
• Practice has demonstrated success helping consumers with their goals in published research trials
• Research trials have been done by more than one researcher with good outcomes
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TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
24
16 Trials of Supported Employment
• 4 conducted before Individual Placement and Support (IPS) model was developed
• 11 used full implementation of IPS
• 1 studied supported employment on an ACT team
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TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
25
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Competitive Employment Rates in 16 Randomized Controlled Trials of Supported Employment
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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www.samhsa.gov
Search Supported Employment Toolkit
SAMSHA’S National Health Information Center
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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Dartmouth Supported Employment Web Site
http://www.dartmouth.edu/~ips/
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TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
28
Evidence Based Supported Employment Fidelity Scale
Overview
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
29
Fidelity Scale Structure
3 Components1. Staffing
2. Organization
3. Services
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
30
Fidelity Scale Structure - Staffing
1. Caseload Size • Maximum is 20 clients
2. Vocational Services• Primarily provide SE services only
3. Vocational Generalists• Provide all phases of employment process
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
31
Fidelity Scale Structure - Organization
1. Integration of rehabilitation with mental health thru team assignment
2. Integration of rehabilitation with mental health thru frequent team member contact
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
32
Fidelity Scale Structure - Organization
3. Collaboration between employment specialists and Vocational Rehabilitation counselors
4. Vocational unit Meets at least once a week
5. Role of employment supervisor Supervisors team members, sets goals
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
33
Fidelity Scale Structure - Organization
6. Zero exclusion criteria
7. Agency focuses on competitive employment
8. Agency leadership team provides support for SE
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
34
Fidelity Scale Structure - Services
1. Work incentives planning
2. Disclosure decisions about job search and supports
3. Ongoing, work-based vocational assessment Develop Vocational Profiles with clients
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
35
Fidelity Scale Structure - Services
4. Rapid search for competitive job Within about one month
5. Individualized job search
6. Job development—Frequent employer contact Minimum 6 contacts per week
7. Job development—Quality of employer contact
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
36
Fidelity Scale Structure - Services
8. Diversity of job types
9. Diversity of employers
10. Competitive jobs
11. Individualized follow-along supports Based on person’s needs and challenges
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
37
Fidelity Scale Structure - Services
12.Time-unlimited follow-along supports Until client not longer needs supports
13.Community-based services 65% of employment specialist time in the
community
14.Assertive engagement and outreach by integrated treatment team
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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Assuring that “All” means All:Customized, Supported
Employment
A concept and process for insuring access to successful employment for all
Michael CallahanMarc Gold & Associates (MG&A)
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
39
Customized Employment
Customized Employment provides a business-friendly strategy to assist job seekers with significant disabilities, who find competitive demand a barrier to paid work in the community, a process that avoids job openings in favor of a negotiated relationship based on mutual benefit.
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
40
Customized Employment
According to US/DOL:Customized employment means individualizing the employment relationship between employees and employers in ways that meet the needs of both.
It is based on an individualized determination of the strengths, needs, and interests of the person with a disability, and is also designed to meet the specific needs of the employer.
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
41
Unbundling demand
Employers have typically met needs by bundling demands into job descriptions.
Job seekers with complex lives often don’t have the “whole package” to offer.
Customized Employment allows employers to “unbundle” demand and to take advantage of discrete competencies.
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
42
Customized Employment History
• Started in late 1980’s through projects by United Cerebral Palsy and others who recognized demand employment as a barrier.
• Based on Job Carving and Restructuring
• During the 1990’s CE was referred to as Negotiated Supported Employment
• The term Customized Employment was coined by ODEP/USDOL in 2001
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
43
Customized Employment History
• ODEP funded 36 national projects from 2001 -2007 that featured CE as the central theme
• WestStat completed research on the ODEP CE projects 2007
• ODEP funded ICF to research the KSAO’s (knowledge, skills , abilities and other characteristics)of CE in 2009
• Wisconsin DVR included CE process in its technical specifications for supported employment in 2010
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
44
The Job Seeker’s side of the Equation
• Conditions for Success
• Interests toward an aspect of the Labor Market
• Potential Contributions to Employers
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
45
The Employer Side: Needs/Benefits Analysis
Unmet Workplace Needs:This area focuses on tasks that need to get done but are not getting done in the way the employer would like. It also can include tasks that have not been performed but need to be.Tasks better performed by others:This area focuses on aspects of jobs that might better be performed by others at a lower pay grade. This option can directly save money for employers.Specific Benefit/ Productivity:This area focuses on workplace needs for additional productivity in specific tasks. It must be matched with job seeker’s specific competencies.
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
46
Balancing the Customized Equation
Customized employment seeks to balance the equation between Job Seekers and Employers
Job Seeker
• Conditions
• Interests
• Contributions
Employer
• Unmet needs
• Tasks better performed by others
• Specific benefit
=
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
47
The Employment Matrix
There are job seekers who will not need either SE or CE to become employed and to stay employed
There are job seekers who will need CE to become employed but will not need SE to stay employed
There are job seekers who will not need CE to become employed but who will need SE to stay employed
There are job seekers who will need both CE to become employed and SE to stay employed
Natural Supports and Reasonable
Accommodation only
Supported Employment and Natural Supports
Competitive Employment
Customized Employment
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
48
Features of Customized Employment
• Based on discovery of the applicant more than on evaluative/comparative processes
• Driven by a customized plan developed by the applicant’s strengths, needs and interests
• Focuses on tasks rather than job titles to negotiate essential responsibilities
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
49
Features of Customized Employment
• Specific job duties are negotiated with employers, voluntarily, to customize the job
• Occurs in regular community workplaces or in self-owned businesses
• Involves pay of at least the minimum wage up to prevailing wage
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
50
Features of Customized Employment
• Applicable to all users of workforce system
• Includes on-going supports and reasonable accommodations, as appropriate
• Starts with the individual as the source of information and direction to labor force
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
51
Customized Process
• Discovery• Capturing discovery through profiles• Customized, person-centered planning• Portfolio/visual resume development• Job development and negotiation
Here, CE dovetails with Supported Employment
• Job site analysis, accommodations, support
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
52
CE: An outcome based process
Each aspect of the CE process is designed to be compatible with evidence-based research and outcome-based payment systems.
Outcome products, how-to materials, step-by-step procedures, narrative manuals and support materials and data collection processes have been developed, implemented and studied.
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
53
Outcome products of CE
• Discovery: Discovery logs, discovery notes• Profiles: Profile forms, samples and guides• Customized Planning Meeting: Plan worksheets,
proposed blueprint for job development, proposed task list, specific employer list
• Representational materials: Visual Resume, Agency Portfolio
• Job Development and Negotiation: Employer needs analysis form and sample, employer contact sheets, blueprint indicating features of actual job developed
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
54
Sample Outcome Payments of CE
• Discovery: $600 - $1,000• Profile: $200 - $300• Customized Plan for Employment: $250• Visual Resume Development: $250• Employer Needs Analysis: $250• Job Development Calls based on Plan:
$75/each• Job Development Outcome payment at Day
One: $1,000 - $1,500
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
55
Final Analysis
Although to this point Customized Employment has not been studied with the rigor to indicate its status as an evidence-based process, the years of successful utilization coupled with the outcome-based structure presented here merits its use as an effective approach to employment for those who fail assessments and are excluded from demand job openings.
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
56
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
56
Comments & Questions
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
57
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
5757
Thank You
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
58
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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Contact Information
David W LyndeSupported Employment ConsultantEmail: [email protected]
Michael CallahanMarc Gold & Associates (MG&A)Email: [email protected]
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
59
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
59
Education CreditsCRCC Credit - (2.0)Approved by Commission on Rehabilitation Counselor
Certification (CRCC) • By November 17, 2012, participants must score 80%
or better on a online Post Test and submit an online CRCC Request Form via the MyTACE Portal.
My TACE Portal: TACEsoutheast.org/myportal
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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Southeast TACE Region IV
Toll-free: (866) 518-7750 [voice/tty]
Fax: (404) 541-9002
Web: TACEsoutheast.org
My TACE Portal: TACEsoutheast.org/myportal
Email: [email protected]
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
61
TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012
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Disclaimer
This presentation was developed by the Southeast TACE Center: Region IV ©2012 with funds from the U.S. Department of Education, Rehabilitation Services Administration (RSA) under the priority of Technical Assistance and Continuing Education Projects (TACE) – Grant #H264A080021. However, the contents of this presentation do not necessarily represent the policy of the RSA and you should not assume endorsement by the Federal Government [34 CFR 75.620 (b)].