if everyone is already doing it, how come it never gets …€¦ · “i feel so miserable without...

PROVIDING SUCCESSFUL EMPLOYMENT SUPPORTS IN A CHANGING ENVIRONMENT:

IF EVERYONE IS ALREADY DOING IT,

HOW COME IT NEVER GETS DONE?

“ A MAN’S WOMENFOLK, WHATEVER THEIR OUTWARD SHOW OF RESPECT FOR HIS

MERIT & AUTHORITY, ALWAYS REGARD HIM SECRETLY AS AN ASS, AND WITH SOMETHING

AKIN TO PITY.”

H. L. MENCKEN

“I feel so miserable without you,

it's almost like having you here."

Stephen Bishop

JOE MARRONE INSTITUTE FOR COMMUNITY INCLUSION

MAIN OFFICE: BOSTON, MA

NW OFFICE:

4517 NE CESAR CHAVEZ BLVD

PORTLAND, OR 97211-8124

TEL: 503-331-0687

CELL: 503-490-2072

FAX: 503-961-7714

EMAIL: [email protected]

WEB: WWW.COMMUNITYINCLUSION.ORG

“ It's so much easier to suggest solutions

when you don't know too much

about the problem. "

MALCOLM FORBES

SYSTEMS ISSUES TO TACKLE

•WHOSE PROBLEM IS IT?– MH, DD, VR OR ALL

•DEFINING “WORK” AND “SUCCESS”

•MAKING EMPLOYMENT AN ADMIN NOT JUST CLINICAL ISSUE

•SHOULD ALL EMPLOYMENT MEET EBP OR BEST PRACTICE STANDARDS?

SYSTEMS ISSUES TO TACKLE

•SHOULD ALL EMPLOYMENT HAVE

VR INVOLVEMENT?

•DISPARITY IN DD, MH & VR

FUNDING

•TTW POSSIBILITIES- MD, OR

STATE EXAMPLES

•MEDICAID ISSUES •USE OF HCBS UNDER

REHAB OPTION (1915[i])

SYSTEMS ISSUES FOR WI

WI ADD Let’s Get to Work project:

Support schools/communities to:

•Improve integrated, community-based

employment for youth w. I/DD

•Focus assets of schools/ communities

•Elevate community expectations

•Expand opportunities youth in HS

IMPACT TO DATE?

SYSTEM CHANGES MADE OR

CONTEMPLATED?

BETTER LINKAGE WITH TRANSITION TYPE SERVICES

BETTER INTEGRATION OF YOUTH AND ADULT MH SERVICES IN TERMS OF PHILSOPHY OF RECOVERY AND TRANSITION TO WORK

PARENTS/ SIGNIFICANT OTHERS SHOULD HOLD MORE SWAY THAT STAFF EVEN IF THEY ARE “WRONG”

YOUTH NEED MORE DIRECTION

PLANNING LESS IMPORTANT THAN ACTION- IMMEDIACY

JOBS THAT WE SHY AWAY FROM FOR ADULTS MORE AND MORE (FOOD, FILTH, FLOWERS ETC ETC) ARE MORE ATTRACTIVE & APPROPRIATE FOR YOUTH

DON’T TRY TO GET YOUTH TO ACT LIKE ADULTS IN TERMS OF JOB/ EMPLOYMENT STABILITY

SPECIFIC EMPLOYMENT PRACTICE ISSUES YOUTH (16-25)

OTHERS FROM LET’S GET TO WORK?

“ ALL CHANGE IS DIFFICULT –NO MATTER HOW LONG YOU

PUT IT OFF. “

------ JOE MARRONE

“ I CAN’T UNDERSTAND WHY PEOPLE

ARE FRIGHTENED OF NEW IDEAS;

I’M FRIGHTENED OF THE OLD ONES.”

JOHN CAGE, COMPOSER

VISION OF LIFE SUCCESS JOE MARRONE

IS WORK THE MOST IMPORTANT PART OF LIFE FOR EVERYONE?

NO. BUT IT IS THE MOST IMPORTANT PART OF LIFE THAT WE IN HUMAN SERVICES ARE

LEAST SUCCESSFUL AT HELPING OUR CONSTITUENCY ACHIEVE.

“LIFE LIVED WITHIN THE CONFINES OF THE HUMAN SERVICE & REHABILITATION

LANDSCAPE IS A LIFE IN WHICH THE FREEDOM TO

BECOME & MAKE YOUR OWN FUTURE IS DIMINISHED”

PATRICIA DEEGAN 20th World Congress Rehab International: Oslo, Norway

– JUNE 2004

ROLE/ LIMITS OF TRAINING?

“You can teach a turkey to climb a tree, but it’s

easier to hire a squirrel.”

FROM

Spencer M. Lyle Jr., McClelland C. David, Spencer M. Signe (1994) Competency Assessment Methods. History and state of the art. Paper first presented at the American Psychological Association Annual Conference, Boston, MA P. 8

OUTCOMES THAT SHOULD BE SOUGHT IF A HUMAN SERVICE

SYSTEM IS MORE THAN A POSITIVE SLOGAN

Employment and educational outcomes

Housing outcomes

Course of illness

Community participation/ citizenship (voting, volunteering, criminal recidivism)

School completion

Income support

Client satisfaction with their own lives

Client satisfaction with services

OUTCOMES THAT SHOULD BE SOUGHT IN COMMUNITY SERVICES

BECOMING A BETTER PERSON AND “SELF REALIZATION” IS

THE CONSUMER’S RESPONSIBILITY.

HELPING PEOPLE GET EMPLOYED, GET HOUSING, COMPLETE SCHOOL. STAY OUT OF HOSPITAL (& JAIL) AND

REDUCE SYMPTOM IMPACT ARE STAFF’S RESPONSIBLITIES IN

PARTNERSHIP WITH THE PERSON.

TERRY PRATCHETT

"I'll be more enthusiastic about encouraging

thinking outside the box when there's evidence of any thinking going

on inside it. “

IF PEOPLE

CAN WORK

PEOPLE

SHOULD WORK

HOW PATIENT SHOULD WE BE?

“TIME IS JUST AS IMPORTANT TO PEOPLE WITH DISABILITIES AS IT

IS TO THE REST OF US”- GERALD PROVENCAL

“ A JOURNEY OF 1000 MILES BEGINS WITH THE FIRST STEP–

UNFORTUNATELY A JOURNEY OF 3 STEPS BEGINS THE SAME WAY-

MARRONE APHORISM

KEN MILLER

“The length of a minute is relative,

depending on which side of the bathroom

door you are on.”

From

WE DON’T MAKE WIDGETS

A ship in harbor is safe -- but that is not what ships

are built for.

John A. Shedd Salt from My Attic, 1928

REMAINING UNEMPLOYED IS WORSE FOR YOU THAN BEING EMPLOYED IS GOOD FOR YOU.

AVOIDING LONG TERM

UNEMPLOYMENT IS A BETTER OPTION THAN WAITING FOR AN

IDEAL OR PERFECT JOB MATCH.

“IT IS NEARLY IMPOSSIBLE TO MAKE YOUR OWN

FUTURE WHEN YOU ARE NOT PART OF

THE ECONOMIC FABRIC

OF THE CULTURE YOU LIVE IN”

PATRICIA DEEGAN 20th World Congress Rehab International: Oslo, Norway

– JUNE 2004

WORK IS A CITIZENSHIP RESPONSIBILITY NOT JUST AN

“OPPORTUNITY”

SOCIAL POLICY OUTCOMES HAVE TO INCLUDE MORE THAN

CLIENT SELF DEFINED QUALITY OF LIFE INDICATORS INCLUDING CQL OUTCOMES

EXAMPLE: DROP OUT PREVENTION EFFORTS

MARRONE

IN

FULL CRANK

MODE:

QUESTIONS I PONDER, SOME, NOT ALL,

I KNOW THE ANSWERS TO

LILY TOMLIN

“No matter how cynical you

become, it's never enough

to keep up.”

MARRONE EASY QUESTION

IS IT BETTER TO WORK 2-3 HOURS A WEEK AT SOMETHING A PERSON LIKES THAN

15-20 HOURS WEEK (OR MORE) JUST TO MAKE A LIVING?

SIMPLE ANSWER: NO

HOW DO YOU ANSWER THIS QUESTION FOR YOURSELF OR YOUR LOVED ONES?

DO WE WORRY TOO MUCH ABOUT VALUES - STIGMA VS

BEHAVIOR - DISCRIMINATION?

ISN’T A JOB THE OUTCOME WE WANT RATHER THAN

OFFERING CUSTOMIZED OR SUPPORTED EMPLOYMENT

(PROCESS) ?

WHY CAN’T MH AND DD SYSTEM ADVOCATES WORK

TOGETHER MORE ON EMPLOYMENT -

BIAS ON BOTH SIDES (W.SAME POOR RESULTS = 20-25% OF

TOTAL NOT SELECTED)?

DO WE HAVE TOO MANY PLANS AND SUMMITS AND

CENTERS OF EXCELLENCE AND NOT ENOUGH SIMPLE MEASURES

OF SUCCESS TO GUIDE US?

IF EMPLOYMENT IS FIRST WHAT IS SECOND?

SHOULDN’T WE BEGIN TO SEE EMPLOYMENT AS AN OUTCOME NOT A

SERVICE STREAM?

WHY DON’T WE SEEK TO HELP AND ENCOURAGE

PEOPLE TO GET OFF SSA AND WELFARE?

IF INDIVIDUAL FUNDING AND FISCAL CONTROL OCCURS SHOULDN’T QUALITY ASSURANCE

LOSE RELEVANCE?

WHY ARE HIGHER OUTCOMES/

EXPECTATIONS NOT ENDORSED BY ADVOCATES RATHER THAN FEARED AS

“CREAMING”?

DON’T THERE NEED TO BE WINNERS AND LOSERS

OR ELSE HAS ANYTHING

CHANGED?

“The nature of passive resistance within a

nonprofit setting is at levels that could teach

Gandhi lessons.” Reynold Levy

President of Lincoln Center for the Performing Arts, and former president of International Rescue Committee

“ BEWARE THE CONTINUOUS

IMPROVEMENT OF THINGS NOT WORTH

IMPROVING “

W. EDWARDS DEMING

Thom Hartman “ADD, An Alternate View”

“I am not inattentive,

you are just boring.“

WHAT TYPES OF EMPLOYMENT OPTIONS SHOULD WE

ENCOURAGE?

ANY? SOME? ALL?

KEYS ARE REAL ECONOMIC ENGAGEMENT, RESOURCES, AND CITIZENSHIP NOT JUST SERVICE INTERVENTIONS

JERRY GARCIA

“ SOMEONE HAS TO DO SOMETHING AND IT’S PRETTY PATHETIC IT’S GOT TO BE ONE OF US “

HASN’T THERE BEEN MORE CHANGE IN

WELFARE REFORM IN LESS THAN A DECADE THAN IN SUPPORTED EMPLOYMENT

IN 20+ YEARS?

AMBROSE BIERCE

“ PATIENCE:

A MINOR FORM OF DESPAIR ---

DISGUISED AS A VIRTUE.”

HELPING PEOPLE (AND SYSTEMS)

CHANGE:

HOPE,

HELP,

AND

HASSLING

COLLABORATION

DON’T ASK BEFORE YOU GIVE SOMETHING FIRST

ALWAYS SAY YES TO FIRST

LEVELS OF CHANGE: • YOURSELF

• YOUR ORGANIZATION

• OTHER SYSTEMS

EDWARD ABBEY

One man alone can be pretty dumb sometimes,

but for real bona fide stupidity,

there ain't nothin' can beat teamwork.

WHAT PEOPLE DO

VALUES- ATTITUDES

CULTURE

SHOOK, J. (2010) HOW TO

CHANGE A CULTURE.

MIT SLOAN MGMT REVIEW,

51 (2), 62-68

ORGANIZATIONAL CHANGE

INTERNAL

WANT TO CHANGE


EXTERNAL

NEED TO CHANGE

CRISIS OR PRESSURE


VISION and VALUES

KNOW WHAT TO CHANGE TO

5 SIGNS TO RECOGNIZE SYSTEM CHANGE:

Grieff, D., Proscio, T., & Wilkins, C. (2003). Laying a new foundation: Changing the systems that create and sustain supportive housing. Oakland, CA: Corporation for Supportive Housing


CHANGE IN POWER: Designated positions—people with formal authority—responsible for the new activity (not just individuals who care about it).


CHANGE IN MONEY: Routine funding is earmarked for the new activity in a new [new money, shift in existing funding, or new priorities & criteria for accessing money].


CHANGE IN HABITS:

Participants in a system interact with each other to carry out the new activity as part of their normal routine not just respond to special initiatives, demonstrations, or projects.


CHANGE IN TECHNOLOGY

OR SKILLS: Growing cadre of skilled practitioners at most levels in the delivery chain, practicing methods not previously common or considered desirable. Practitioners are now expert in skills that new system demands & have set a standard for effective delivery of results.


CHANGE IN IDEAS

OR VALUES: New definition of performance or success, & often a new understanding of the people to be served & the problem to be solved [i.e., new goals]. The new definition & understanding are commonly held among most actors in the system, & are no longer in great dispute

“ YOU NEED A LITTLE LOVE IN YOUR LIFE & FOOD IN YOUR STOMACH BEFORE YOU CAN HOLD STILL FOR SOME DAMN

FOOL’S LECTURE ABOUT HOW TO BEHAVE.”

BILLIE HOLIDAY

John P. Kotter (1998).

Leading change: why transformation efforts fail.

In: Harvard Business Review on Change. Cambridge: Harvard Business School

Press.

Error #1: Not establishing a great enough sense of urgency.

In the eyes of stakeholders, how important

and urgent is the adoption of a community employment model?

Are people so comfortable with the status quo that they will not want to take the effort and risks associated with change?

Are a significant portion of the key “stakeholders” (i.e., people with authority or influence or ideally both) honestly convinced that “business as usual” is totally unacceptable?

Bottom line: Is there a system-wide perception of urgency?

Error #2: Not creating a powerful enough guiding coalition.

Which stakeholders are driving the system

redesign? Which stakeholder groups are indifferent? Which are opposed?

Do the people “pushing the change” have the means to create incentives and modify the organizational infrastructure to support the system redesign?

Who are the strong, credible, and assertive leaders who will communicate the need for change to all in the system?

Bottom line: Do the people driving change have the means to make it happen?

Error #3: Lacking a vision

Is there a clearly articulated vision of what

we are doing and why?

Does the vision easily translate into actions?

Is the vision concise and easily understandable (The “rule”: If you can’t explain it easily within 3 – 5 minutes, you don’t really know it)?

Is there a clear link between the vision and each specific system redesign activity?

Bottom line: Is there a clear theme and blueprint showing how the various system redesign initiatives relate to a vision, or is system redesign perceived as a collection of disparate activities with no central theme?

Error #4: Undercommunicating vision by a factor of ten.

How has the vision been communicated? Do people “get it”?

Are day-to-day actions of the system’s leadership & the guiding coalition consistent with the vision? Are we practicing what we preach?

Are we using every possible communication channel to communicate the vision?

Are we willing & able to displace nonessential, generic training programs & devote resources to training specific to community employment for people with significant disabilities?

Bottom line: How effectively have we communicated the vision?

Error #5: Not removing obstacles to new vision.

Have we identified the obstacles?

Are we willing to make changes in the existing organizational structures if those structures do not support system redesign?

How will the system handle administrators, supervisors, and/or managers that do not support change and make demands on their employees that undermine system redesign?

Bottom line: Are we willing and able to take the actions necessary to manage organizational and personnel obstacles?

Error #6: Not systematically planning for and creating short-term wins.

What are some potential short-term wins that would get system redesign off to a positive start?

Do we have the commitment to devote resources to creating short-term wins?

Bottom line: Are we willing and able to do what it takes to create short-term wins?

Error #7: Declaring victory too soon.

Does the system have the long-term perspective to maintain the system redesign initiative over time?

Do the stakeholders recognize that change requires years, not months?

Bottom line: Is there a plan to orchestrate a series of short-term wins so that momentum is sustained?

Error #8: Not anchoring changes in the organization’s culture.

How can we create an employment “culture”

within the local system?

How can we develop a broad base of support so that community employment efforts are not restricted to a small circle of advocates?

Bottom line: How do we make community employment such an integral part of the development disabilities system so that it is self-sustaining?

“ ANY TIME YOU THINK YOU HAVE INFLUENCE,

TRY ORDERING AROUND SOMEONE ELSE’S DOG”

SO WHAT USUALLY GETS IN THE WAY OF CHANGE

AT ANY LEVEL?

ANY DEAD HORSES IN YOUR ORGANIZATION?

(TAKEN FROM MATERIAL FROM ARTHUR EVANS, PH.D., FORMER DEPUTY COMMR, CT DMHAS),

NOW MH DIRECTOR, PHILA MH

Dakota tribal wisdom says that when you discover you are riding a dead horse, the best strategy is to dismount. However, in

human services, we often try other strategies with dead horses, including the

following:

* Saying things like “This is the way we have always ridden this horse.” or from a Native American Tribal Saying: "If we don't turn around now, we just may get where we're going."

* Appointing a committee to study the horse. * Harnessing several dead horses together for greater performance * Providing additional funding to increase the horse’s performance * Arranging to visit other sites to see how they ride dead horses

* Increasing the standards to ride dead horses * Creating a training session to increase our riding ability * Changing the requirements; declaring “this horse is not dead.” * Declaring the horse is “better, faster and cheaper” dead * Promoting the dead horse to a supervisory position

Finding a consultant knowledgeable about dead horses.

OLD YIDDISH PROVERB

If 1 person calls you a jackass, ignore him;

If a second person calls you a jackass, think about it;

If a third person calls you a jackass- get a saddle.

" There is nothing you can say in answer to a compliment. I have

been complimented myself a great many times, and they always

embarrass me

-- I always feel they have not said enough. "

Mark Twain

if everyone is already doing it, how come it never gets …€¦ · “i feel so miserable without...

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