How Working is Promoting Recovery forPeople with Mental Illness

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How Working is Promoting Recovery for People with Mental IllnessPresented BY: SAMHSA SOAR Technical Assistance CenterPolicy Research Associates, Inc.

Under Contract TO: Substance Abuse and Mental Health Services AdministrationU.S. Department of Health and Human Services

Welcome!Kristin Lupfer, LmSW, Project Director,

SOAR Technical Assistance Center,

Policy Research associates, Delmar, New York

Webinar InstructionsMutingRecording availabilityDownloading documentsEvaluationhttp://soarworks.prainc.com/article/soar-webinar-employment

Learning ObjectivesDefine IPS and describe core principals of IPS (Individual Placement and Support) model. Understand how IPS model can support individuals with mental illness who have experienced homelessness seek competitive employment in the community. Provide an example of a SOAR program offering job supports.

AgendaIPS Model: Dartmouth Psychiatric Research Center (PRC), Lebanon, NH Robert E. Drake, M.D., PhD., Professor of Psychiatry and of Community and Family Medicine

Deborah R. Becker, M.Ed., CRC, Director of Supported Employment Programs at the PRC, Associate Research Professor

SOAR Program: Columbus House Inc. / Pathways to Independence, New Haven, CT Thomas Fortuna, Pathways to Independence Manager

Carl Reynolds, Pathways to Independence Employment Services Coordinator

Questions & Answers Facilitated by SOAR TA Center Staff

Poll Question #1Does your SOAR program connect SSA beneficiaries to employment support services?

a. Yes

b. No

c. Unsure

d. Making plans to in the future

Supporting Individuals Experiencing Homelessness with Individual Placement and Support (IPS) Robert Drake, Professor & Deborah Becker, Associate Research Professor

Dartmouth Psychiatric Research Center

Hanover, New Hampshire

Quotes from Workers “When I am working, the noise in my head gets

quieter.” “Working gives me a reason to get up in the

morning. And that is the best medicine.” “The money is nice but I feel good telling my son

that I have to go to work tomorrow.”

Four Main Points Many people with serious mental illness want to

work People with serious mental illness can work IPS Supported Employment Fidelity Scale is a

program road map Work is everybody’s business

Recovery and Work

Competitive EmploymentSay they want to work: 60-70%Are currently working: <15%Are receiving supported employment: <2%

IPS Principles

1. Every Person Interested in Work is Eligible

Zero exclusion People with justice system involvement People who have experienced homelessness People with co-occurring substance use disorders Encouragement about work and school

Focus on Employment “Have you thought about a job?” “Would you like to know about work incentives

(benefits planning)?” “Tell me about your work experience?” “How will you know when you are ready to

work?”

Build a Culture of WorkClients share their back to work stories with other clients and staff, for examples:

Written stories in waiting rooms, newsletters…Speakers at treatment groups, picnics, agency meetings…

Posters and brochures about work

Short Conversations About WorkTalk about work over time.Don’t push; help people explore the possible benefits and costs of employment.“I believe you can work. It’s up to you.”Make sure people have good information about benefits, jobs available, etc.

2. Competitive Jobs are the Goal

Pays at least minimum wage Integrated community setting “Owned” by the worker Not set aside for people with disabilities Part-time or full-time jobs

Competitive Jobs

3. Employment Services & Mental Health Services are Integrated

Team approachHelp team think about work/school for othersConnect with Vocational RehabilitationConnect with families

Team ApproachIPS worker assigned to 1-2 teamsParticipate in weekly team meetingsCommunicate outside of meetingsShare office spaceHelp team think about work/school for othersConnect with Vocational RehabilitationConnect with families

Work is Everybody’s Business

Team members share:

Person strengths, experiences, wellness strategiesIdeas for job typesJob leadsJob support

4. Preferences Are Honored

Individual PreferencesJob typeJob settingWork hoursDisclosureRole of employment specialist with employer contactJob support

Offered to all clients seeking workProvided by specially trained staffImpact on Social Security, Medicaid, other government entitlementsOffered when making changes in work hours and pay

5. Benefits Planning Is Offered

6. The Job Search Occurs Rapidly Avoid lengthy assessment, training, counseling Face-to-face contact with employers within 30 days Investigate job types and settings Employer contacts based on person’s preferences, strengths

7. Systematic Job Development

Develop employer relationships.Employment specialists meet with employers over time to learn about business needs and positions.Specialists make at least 6 contacts with hiring managers each week.

Job Finding TechniquesFirst meeting, schedule a 15-minute appointment.Meet with employer for 15 minutes to learn about the business and hiring preferences.Go back to talk about the strengths of a person who would be a good fit for that business. Ask for an interview.

8. Job Supports are ContinuousOngoing as needed and desiredIndividualized

Ongoing Job SupportFace-to-face before job startDay of job startWeekly contactTransition out of IPS

Individualized Job Support

Individualized supportEmployer supportCareer developmentEnhanced team support

IPS Supported Employment Guidelines

8 Practice Principles 25-item Fidelity Scale

Wellness and RecoveryWellness moves the focus from thinking one needs treatment forever to capitalizing on the strengths and abilities of the individual and his/her family and community.

M. Swarbrick, CSPNJ

What People Say“When you are working, you are part of the real world. You feel connected. Having a job gives me stability. I have something to look forward to every day.”

“In the past, people might have used labels to describe me such as ‘homeless,’ ‘mentally ill,’ and ‘welfare mother.’ Now my titles are ‘financial administrator,’ ‘college student,’ and ‘working mom.’”

Resourceshttp://www.dartmouthips.org

ASK Online courses for practitioners and supervisors IPS Supported Employment: A Practical Guide

A Few Facts 70% of people with mental health issues want to

work IPS can help 60% or more to become competitively

employed Most people work about half-time, like their jobs, and

benefit in many ways from employment

Controlled Trials 22 Randomized Controlled Trials (RCTs) of Individual Placement and Support (IPS):

Best evidence available on effectiveness RCTs are gold standard in medical research

Controlled Trials: Findings

Overall Findings for 22 RCTs

Every study showed a significant advantage for IPS Mean competitive employment rates: 56% for IPS 23% for controls

HomelessnessBaltimore study

Majority recently homeless 27% vs. 7% employment

Washington, DC studyMajority recently homeless71% vs. 9% employment

Combined NH, DC, CT, and IN studies Over 20% recently homelessEmployment outcomes unrelated

2 Long-Term IPS StudiesSalyers (2004)

Becker (2007)

Combined

Currently Working 47% 71% 59%

Worked During Follow-up

92% 82% 87%

Worked > 50% Follow-up

33% 71% 52%

Length of Follow-up

10 years 8-12 years 10 years

Samples Size 36 38 74

IPS Is Effective for a Wide Variety of Subgroups

Contact InformationDartmouth Psychiatric Research Center

Lebanon, NH (603)448-0263

http://www.dartmouthips.org

Robert E. Drake, M.D., PhD.Professor of Psychiatry and of Community and Family Medicine

Robert.E.Drake@dartmouth.edu

Deborah R. Becker, M.Ed., CRCDirector of Supported Employment Programs at the PRC, Associate Research Professor

Deborah.r.becker@dartmouth.edu

Poll Question #2What is one myth our presenters debunked?

a. Most people work about half-time, like their jobs, and benefit in many ways from employment

b. Most people with mental illness do not wish to work.

c. IPS can help 60% or more to become competitively employed

Income=Empowerment:The Pathways to Independence ProgramThomas Fortuna, Manager andCarl Reynolds, Employment Services CoordinatorColumbus House Inc./Pathways to IndependenceNew Haven, Connecticut

Pathways to Independence

Combining SOAR & employment incomes with a holistic approach to recovery, housing and community reintegration. Using holistic, recovery-based incentives to support individuals to engage in employment.Targeted services for individuals experiencing homelessness and a disabling condition.

Our Core Mission and Values

Mission StatementTo increase housing, income and health security for individuals

who are homeless and experiencing a behavioral health and/or substance use disorder.

ValuesPathways to Independence promotes Hope, Personal Responsibility,

Education, Self-Advocacy and Support, helping to provide opportunities, skills, and the education necessary to become independent and productive.

Program GoalsMaximize our client’s access to income

Employment and SOAR assistance (dual screening)Employment Network: Ticket to WorkWorkFare

Provide connection to healthcare providersFacilitate and nurture opportunities for client employmentEducational support and assistance for client’s financial stability and improved quality of lifeIdentify and secure housing options in the community

Program ComponentsHousing Services Employment Services Financial Literacy, Employment Training (EEC) Enrollment into Benefit Programs (SOAR)Representative PayeeHealthcare Referral

**All Individuals Served Participate in EEC**

Employment and Enrichment CenterFunded in part by the United Way of Greater New Haven

Through Education, Enrichment and Employment, graduates will discover: Greater Self-Esteem Stronger Recovery from addiction Better control of psychiatric symptoms Greater Confidence Greater Life Satisfaction Enjoy a life worth living Have a life worth saving

Instructors are certified Recovery Support Specialists

Also facilitated through a relationship with a local community bank: START

Employment and Enrichment Center Curriculum: 90 hours,

classes include:

Extra Curricular ClassesRegular Classes: Monday through Friday, 9:00 AM to 12:00 PMJobs Club: Tuesday and Thursday 1 PM to 3 PM

Focus on interviewing skills, online applications, and gaining field work/experience outside of the classroom

Computer Lab: Monday and Friday 1 PM to 3 PM Housing Resource Class: Wednesday 1 PM – 3 PM

Resources on tenancy, fair housings rights, etc.

Additional Resources Provided

Interview clothing including suits and shoesTransportation including bus passes and ridesGift cards for personal necessitiesConsistent phone and computer access to streamline the job-hunt process

Dress for a Successful Interview!

The End Result=Employment

Community Partners

WORKFARE trains people facing homelessness for careers in the custodial trades and the food service industry so they can obtain stable full time employment.

Learn how to write a résumé and cover letter, attend interviews, develop a personalized Action Plan, and gain basic computer and job-search tools.

Free Hands-On training at Columbus House facilities, where you work alongside talented professional staff and volunteers.

Great for Ticket to Work program participants!

Columbus HouseWORKFARE

Want a Job? We Can Help!

WorkFare Benefits Certificates: Receive a Certificate valued by employers to show you have

successfully completed the training.

Job Search: Meet with job search counselors, learn how to fill out applications, go to interviews, use email, and find jobs on the internet and through commercial publications.

Graduate Support: Graduates may attend additional sessions for regular ongoing job advice, employment search assistance, and help with a variety of other social service resources.

Also includes a guaranteed and extended shelter bed stay for Emergency Shelter occupants

Employment Network (EN)

Employment Network designation Generates revenue to support and sustain PTI Direct connection to the SSA = Streamlined communication

Ticket to Work program In house, collaborative resources for SSA Beneficiaries

Access to Employment & Enrichment Center, Jobs Club, Employment Specialist Services

PTI Program Results: Looking Back

SOAR 77 applications approved over 3.5 years

Over $1.5 Million in cumulative income

Employment 104 Individuals Hired and Retained

3.5 years

Over $3.5 Million in Earned Income

EEC Results: Last 12 months

• 89 Attended Initial Orientation• 63 Completed the Program• 31 Employment Placements• Average Wage: $10.25• 67 Referred to External Programs: GED

prep, occupational training, local community college enrollment

Over 3.5 yearsHoused: 205 IndividualsRep Payee: 53 Enrolled

Supportive Services for Veteran Families (SSVF)Employment ServicesSOAR ServicesHousing ServicesCase ManagementHomelessness PreventionDirect Financial Assistance

Homeless Veterans Reintegration Program (HVRP)

Employment ServicesEmployment & Enrichment Center

Additional Columbus House Programs

The Benefits of Working and Providing SupportCarl Reynolds, Employment Services Coordinator

Columbus House Inc./Pathways to Independence

New Haven, CT

Providing SupportPeer ExperienceEmployment SpectrumJob DevelopingEmployment and TrainingEEC Trainings

Contact InformationColumbus House, Inc./Pathways to Independence

592 Ella T Grasso Blvd New Haven, CT 06519

Fax 203-772-4097

Thomas Fortuna, Pathways to Independence Manager 203-772-4200 ext. 2139

tfortuna@columbushouse.org &

Carl Reynolds, Pathways to Independence Employment Services Coordinator (203)772-4200 ext. 2117

creynolds@columbushouse.org

Questions and Answers Facilitated By:

SAMHSA SOAR Technical Assistance Center Policy Research Associates, Inc.

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