“Work as a Priority”Strategies for Employing People with Psychiatric and Co-occurring Disabilities who are Homeless

Sponsored byThe California Institute for Mental Health

Facilitated byGary Shaheen

Laura WareAdvocates for Human Potential, Inc.

518-475-9146, ext. 243gshaheen@ahpnet.com

DAY #1 Learning Objectives

Learn about factors resulting from homelessness that affect people’s ability to obtain and retain employment

Understand how recovery and rehabilitation principles and practices can provide the foundation for employment success.

Understand how to address factors of motivation, self esteem, powerlessness that affect employment success

Apply information through scenario exercises

Larry MeredithIn Hooked by Lonny Shavelson 2001

“If we are going to make a difference, then we have to realize that drug abuse & mental health is related to housing is related to health care is related to joblessness is related to poverty. You can’t deal with any one of those without dealing with all of them.”

“RJ”

I have been homeless for five years

I have schizophrenia and have been drug addicted since the age of six

I smoked crack Did some time a few

years back on a burglary charge

I don’t know where I’m going to sleep tonight

Shelters are bad places where they rob you and beat you up. The staff looks the other way.

I am an artist. I could be a millionaire if I could get money to make and sell my paintings

If the Mayor can spend millions building a new city hall he should be able to give us money to help us get jobs and a decent place to live.

Disincentives to Employment……

Distrust Focus on immediate

needs Co-occurring

disabilities Learned helplessness

and emotional instability

Functional limitations Cognitive limitations Illiteracy Communication

deficits Physical/emotional

trauma Poor self-esteem Fragmented or

inadequate services/supports

Mobility Skills mismatch Fear Legal issues: custody

convictions, judgements, probation

Lack of personal documentation

Child care Transportation Earning disincentives Lack of permanent

address and phone # Lack of hope Lack of skills regarding

how to work towards a sustained goal, not just immediate gratification

Program-Level Challenges

Lack of knowledge, experience

“Paradigm paralysis” Different providers

speak different languages and often can’t share much information

Readiness prerequisites

Ethnic/cultural sensitivity

Different outcome expectations

Different roles and ‘turf issues’

Not enough $$ or in the wrong places

Lack of coordination, communication

Promising more than can be delivered

Different systems are not aware of each other, and are resistant to change

Fragmentation-funding sources, priorities, roles, criteria, etc

Political priorities and issues that may prevent effective communication

Stigma Lack of $$ Lack of cross-

systems training EBPs not

understood

Service System Challenges

“Breaking the Cycle”

Trust-building is fundamental Recognize/utilize personal strengths Provide factual information Teach by example Recognize and address complex needs Affirm personal dignity and self-worth Reinforce personal responsibility, choice and

empowerment Facilitate discussions to help individual see

how previous choices and decisions can be done differently

Adapt vocational approaches to meet needs Provide comprehensive, long-term supports

Common Themes

Jobs that people want and can manage well Linking Housing First/Work First Entrepreneurial approaches Clear & reasonable expectations for all parties Flexible outcomes Redefining failure Provide personal service supports No arbitrary time limits Hire consumers as staff Cultural competence/relevance Link to treatment, rehabilitation, recovery

services

Guiding Principles #1

Treat people on the basis of facts and inherent capabilities, not generalizations and stereotypes

Provide genuine, effective, and meaningful opportunity (provide reasonable accommodations and modifications) in integrated mainstream environments

Guiding Principles #2:Social Justice and Equity

XXX% of all people who are homeless are persons of color

Stigma, discrimination is a “triple whammy”- 1) homelessness + mental illness

+ substance abuse + criminal justice issues

2) poverty and disenfranchisement

3) racial stereotyping, prejudice and discrimination

You should consider the impacts of these factors on employment as well!

Guiding Principles #3FULL PARTICIPATION

Involve people in decision-making at the individual, management and systems levels

Ensure informed choice and share information using various mediums

Provide support for self-determination, empowerment and self-advocacy

UPENN RESEARCH-MAJOR FINDINGS

Homelessness is a “Revolving Door” Phenomenon

Point in Time vs. Longer Time Frame

Identified 3 Subgroups * Transient * Episodic * Chronic

CULHANE’ S SUBPOPULATIONS

Transient: 80% of overall population, single, economically caused episode, low rates of illness

Episodic: 10 % of overall population, multiple episodes of homelessness over time

Chronic: 10% of overall population, multiple, complex problems, long term homelessness

Resources

“Changing for Good”-Prochaska, Norcross & DiClemente, 1994

“Motivational Interviewing: Preparing People to Change Addictive Behavior”-Miller & Rollnick, 2002

PATHPROGRAM.COM-Click on “Technical Assistance”

“Implementing Interventions for Homeless Individuals with Co-Occurring Mental Health and Substance Abuse Disorders”-Winarski, 1998

FOUR PHASES OF TREATMENT

• Engagement

• Persuasion

• Active Treatment

• Relapse Prevention

Source: Osher and Kofoed (1989)

STAGES OF TREATMENT

ACTIVE TREATMENT

RELAPSE PREVENTION

• Develop Relationship - Outreach Skills - Interpersonal Skills• Provide Basic Supports• Peer Intervention

Case Management - Planning - Linking - Advocating

• Hospitalization• Outpatient Treatment• Residential Treatment - Medication - Individual Therapy - Group Therapy - Peer Support• Psycho-education• Drug-education• Rehabilitation Skills for Supported - Housing Education Employment• Peer Interventions

• Community/Peer Support• Individual/Group Therapy• Psycho-education• Identify Signs/Triggers for Relapse• Rehabilitation Skills for: Supported - Housing Education Employment• Peer Interventions

ENGAGEMENT

PERSUASION

• Develop Relationship - Outreach Skills - Interpersonal Skills• Provide Basic Supports• Develop Readiness - Enhance Motivation• Peer Intervention

RECOVERY:

A

UNIFYING

CONCEPT

Consumer Self-Report of Items Important to Recovery (Ralph,R) Ability to have hope Trusting my own thoughts Enjoying my environment Feeling alert and alive Increased self-esteem, spirituality Knowing I have a tomorrow Having a job

How MH Professionals Help (Ralph,R)

Encourage my independent thinking Treat me like an equal in planning my

services Give me freedom to make my own

mistakes Listen to me and believes what I say Recognize my abilities Work with me to find the

resources/services that I need

UNDERSTANDING RECOVERY

• Recovery Occurs for All People

• Recovery Occurs at Multiple Levels and at Variable Rates: The Centrality of Loss

• Recovery Follows a Non-Linear Course

Source: Winarski and Dubus (1995)

FACILITATING RECOVERY

• Create Environments that are Conducive to Recovery.

• Attend to Motivational States.

• Respond to Mental Health & Substance Use Disorders Simultaneously.

• Create Community.

• Define Expectations.

Source: Winarski and Dubus (1995)

Role Recovery is….

Obtaining and sustaining a valued role as a: Worker Family-member Friend Homeowner/tenant Partner, etc

By overcoming personal losses, setbacks, obstacles, and limitations

Obtaining the skills and trust from others needed to perform that role

Educating others re: personal abilities

Using natural and professional supports as needed

Worker Role Recovery-Two Dimensions

INSIGHT DEVELOPMENT

Identify values preferences, choices

Prepare for change – personal and environmental

Honest self-assessment

Trust in self and others

Hope for the future

SKILL DEVELOPMENT

Setting work goals Testing work

preferences Evaluating skills,

personal strengths and supports against goals

Skills Teaching: tasks and work habits, as well as pursuing, obtaining and managing success

Support Service planning

ASSESSM

ENT

ASSESSMENT IS ON-GOING

• Longitudinal approach: collect and interpret information during each contact.

• Focus on signs and symptoms rather than making diagnosis.

• Comprehensive assessments may take many weeks and/or months.

THE ASSESSMENT PROCESS IS INTEGRATED WITH THE HELPING RELATIONSHIP

• Assessment takes place concurrently with activities that facilitate connection to the program.

• Information is most effectively gathered in the context of a trusting relationship.

• Gather information in an environment free from distractions.

ASSESSMENT PROCESS

Observe/

Listen

Collect and Interpret

Information

Ask Critical

Questions

Source: Bassuk (1994)

Tips for Effective Interviewing

Choose between open-ended and closed-ended questions.

Avoid leading questions.

Structure chronological answers.

Divide the experience into parts.

Share experiences by generalized feelings.

Be aware of ‘non-verbal communication

Conclude the interview.

Common Errors in Interviewing

Imposing values. Offering false reassurance. Asking double questions. Interrupting answers. Discouraging or forbidding the

expression of real feelings. Saying “I understand”

inappropriately.

Techniques for Identifying Dual Disorders

Screen-expectation not an exception. Increase the “Index of suspicion”.

Self-report Signs and Symptoms Chemical testing Collateral information Correlates or predictors of substance use

disorders Indirect measures (e.g. Family history -

Car accidents).

Source: Drake (1993) Assess 1

At Outreach/EngagementInformation about work

Conversations about work“Standing offer of Work”

Purpose:Develop Trust, Awareness & Motivation

Brief Intake/AssessmentInterviews

Situational AssessmentsPurpose:

Develop Initial Goal/Plan

Discovery OptionsPart-time/Transitional

WorkSocial EnterprisesPerson-centered

planningEducation

Volunteer WorkPurpose:

Further Define ChoicesDevelop

Confidence/Skills/Trust

Supported Employment EBP

OptionsRapid Job Placement in

Open Market JobsEmployer-sponsored

Training and Credentialing

Time-Unlimited SupportOngoing Assessment

Purpose:Get, Keep, Advance

Ongoing Contact with Employment

Specialist

Ongoing Support as Needed for Re-Placement, Job Acquisition, Advancement

Employment-Centered Outreach

Make work part of the conversation about engaging in services

Prompt and listen to people’s stories about jobs they had and jobs they may want

Encourage stories that help the individual to see unidentified yet transferable skills

Provide information Assess the value of an offer of

work as a ‘hook’ to influence positive change

Understand the ‘stages of change’

Principles/Practices #1:Linking Employment and

HousingChallenges

People may not be interested in services once they are in the housing unit

They are not sure what they want to do and avoid staff

They are engaged in behavior they are trying to hide from staff

Staff try to “over –engage” or overstep boundaries and push participants away

Staff may not maintain proper boundaries with participants, especially if he/she can relate to a particular challenge or situation

Lack of cultural sensitivity to the background, needs, challenges and goals of a specific participant

Suggested Responses

Offer incentives in order to develop their interest

Keep the conversation focused on what the participant is thinking or feeling, and what he/she wants to do about it

Be aware of how your body language or other non-verbal communication

Remember that the staff role is to guide and support, not direct, over-invest, “mother “ a participant, or become emotionally involved

Suggest meeting in an open space such as outdoors or in a private space such as a counseling room

Try to never force an interaction unless absolutely necessary, or unless someone’s safety is at risk

“Vocationalize” the housing environment by having a variety of available activities that offer opportunities for engagement around work

Vocationalizing

Creating a culture that expects work - verbally, mentally, environmentally and literally.

Arranging things, activities and resources to include and/or support employment.

Assign accountability for employment outcomes to all staff.

Develop and maintain organizational policies and practices that support client employment

Begin tracking employment outcomes.

“Mary”

Mary accepts housing but refuses to consider employment. Even though the Personal Services Coordinator reminds her that the program is offered only to those who want to work as well as get a place to live, she says she is “not ready” and won’t discuss it any further.

What are some ways you might help Mary address motivation

to work?

Principles and Practices #4Helping “Mary” Develop Motivation

for Work

Typical Challenges

Sense of hopelessness about vocational goals based on experience to date

Numerous setbacks in general or negative work or other vocational experiences

Many think of jobs or tasks that have historically been available without a great deal of creativity

Some may be struggling with depression or other clinical/medical issues that make it difficult to get motivated

Current stresses in life that make feeling motivated difficult

Negative consequences of work such as child support payments, credit debts, SSI/DI disincentives, etc

Suggested Responses

Motivation as a State not a Trait: it can change over time and be influenced

Ambivalence is Good: Tease out both sides, help tip balance towards change

“Resistance” is not a Force to be Overcome-Roll with it

Focus on Person as Ally, not Adversary

Recovery, Change and Growth are intrinsic to being Human

Remember that People who have suffered many losses may relinquish hope to survive

Paint a picture of immediate incentives that can trigger motivational thinking

STAGES OF BEHAVIOR CHANGE

Pre-contemplation: No awareness of problem or need to change

Contemplation: Emerging Awareness, ambivalence

Preparation: Identify, anticipate “hot spots”, planning, rehearsal, identify skills, supports

Action: Plan implementation with feedback loop

Maintenance: Reinforce what works Relapse Prevention: Anticipate and

plan for relapse, viewed as learning opportunity

FACTORS THAT INLUENCE CHANGE READINESS Perception of Need: Person’s

experience of discrepancy between the pain of the present and the potential for future improvement

Belief that Change is Possible: Positive outcome is achievable in reasonable time period

Sense of Self Efficacy: Believes they can succeed

Makes Stated Intention to Change

MOTIVATIONAL TASKS Pre-contemplation: educate, raise

doubt re: perception of risk, identify other areas of high motivation

Contemplation: Tip the Balance- evoke reasons to change and risk of not changing

Preparation: Choose best strategies, anticipate difficulties, plan, rehearse

Action: Frequent monitoring of progress and ongoing lessons

Relapse: Help reframe as learning opportunity, not failure, plan

Describe a time in your life you attempted change-how difficult?

Who helped? Outcome?

Principles and Practices #2Integrated Team Planning

Typical Challenges

Developing effective relationships with staff of other partners, especially when they are located elsewhere

Creating a “project culture” that encourages joint decision making

Effectively documenting services for overall reporting, informational and evaluation purposes

Seeing regular , consistent meetings as crucial, useful and a priority

Developing centralized systems and procedures for intake, assessment, r intervention, communication processes, follow-up, referral, contacts with outside community

Avoiding “turf” issues

Suggested Responses

Clarify for all staff and organizational partners, in writing, who is responsible for each role and component of the project

Sponsor a series of “shadowing” or “job switching” opportunities

Include discussion of partner and staff roles in regular staff meetings

Facilitate regular “case meetings”, at which all staff working with a specific participant are present and asked to share information as well as next steps

Create opportunities for staff to talk about successes and challenges, and for other staff to assist in problem-solving

Designate a team leader

“John”

John says that there is no use in trying to find a job, because all he will do is fail at it anyway. He used to be a good carpenter but that was many years ago. Years of living on the street has eroded those skills and reduced his stamina. He says he feels hopeless of ever finding anything better than dishwashing or carrying out garbage.

How would you help John develop an employment goal?

Principles and Practices #3Helping “John” Create

Employment GoalsTypical Challenges

Many people have not thought about having vocational or employment goals, since their first goal on the streets has been survival

Many are focused on immediate gratification, such as earning a bit of money or paying off a debt

They may have had negative vocational or employment experiences because of the barriers they face

They have trouble thinking about small steps that will lead to achieving a vocational or employment goal

Some may not be currently motivated to pursue vocational or employment activities, and are content to maintain current status or activities

Some may need help to identify how current interests, activities or desired participation can be seen as vocationally-oriented

Suggested Responses

Create opportunities in which they can have a sense of immediate success or achievement

Focus on a person’s perceived or inherent strengths, gifts, skills and interests

Work with them to acknowledge all achievements (including survival on the streets) and make them visible to them as sources of strengths and knowledge that may have a job application,

Focus on immediate goals first, and how these can lead to a larger goal.

Give timeframes to specific goals as a way of motivating participant and yourself as a staff

Make sure all goals are developed or agreed-to by the participant

Make sure goals of any type are clearly defined and fleshed out by the participant and staff so that they are real and true

Principles and Practices #6Implementing a Standing Offer of

Work (In-House Jobs)

Typical Challenges

Changing attitudes and expectations of all parties

Acquiring jobs with built-in flexibility and opportunities for growth and transition

Finding effective partners and employers-internal/external

Resolving alcohol/substance abuse and mental health issues affecting work

Staff and new worker training

Providing supervision and support

Fulfilling employment services contract/performance requirements

Funding the effort “Fit” with SE Evidence

based practices

Suggested Responses

Assume employability All staff supports peoples’

desire to work Look internally as well as

externally for $$ Provide direct, tangible

workplace-based support to break down barriers

Avoid lengthy prerequisites –rapid access to a low-impact job

Allow multiple work options-one job does not fit all

Understand peoples’ needs, abilities and values

Communicate your work expectations

Celebrate all degrees of success

Weave in conversations and support for the next step

LAMP Village527 S. Crocker, Los Angeles, CA 90013 (213) 488-0031

Drop-in Center/Crisis Shelter Lamp Lodge-50 unit permanent housing

VILLAGE INDUSTRIES:

- Linen Services

- Public Laundromat

- Public Showers &Toilets 1/3 of staff are consumers

Employs 35 people per day

Principle # - Connecting to MH/SA Treatment Services

Typical Challenges

People may not be ready to accept treatment

People are fearful of treatment

Their friends are not good influences and may disapprove of a person’s decision to enter treatment

Stigma Side effects

Suggested Responses Establish referral

relationships so that the services are accessible to participants when needed

Help people understand the implications on goals they chose and commit to achieving

Enlist the support of peers to help people understand the positive effects of accepting treatment

Be clear about the rules regarding substance abuse on site at HUD housing

“Step-Back/Step-Out/Step-Up”

A Practical Strategy for Keeping the Door Open for Employment

WHAT IT IS: a) A strategy for helping

people address their treatment issues and impact on work

b) A way of keeping people involved in employment services while they deal with their substance use and/or MH treatment issues

c) A plan for putting together a support plan emphasizing growth

WHEN: At engagement, involvement, continuation

WHO: Implemented by staff, peers

WHERE: Shelters, employment programs, housing sites

“Step Back”

Offer alternatives to terminating program involvement for people when substance use interferes with their ability to get or keep employment

Focus on how substance use prevents someone from getting or keeping a job, not the behavior itself.

Provides alternative ‘step-down’ employment-related services that do not risk the safety of the person or others

Step downs still require people to be substance-free while they participate

Examples: employment counseling, presentations by peers or staff, resume writing, low-impact, P/T, time-limited in-house work experience, shadowing, P/T volunteer work

Expected Outcomes: Maintain connection, use stages of change strategy to change behaviors, show consequences (eg: person may lose job but staff “never go away”)

“Step Out”

Some people may not be ready to deal with their treatment issues that affect their jobs and they may need to “step out” of the

program.

Although you may have to get to the place of reinforcing rules of

enrollment-try to maintain contact (through outreach staff, shelter staff, peers, friends, etc) and let them know that the door is open

for them to try again.

“Step Up”

The job placement is only the first success Dealing with treatment issues affecting work is an

ongoing process ‘owned’ by the individual Advancement and stepping out of poverty is the

goal and is negatively affected by job and housing loss due to treatment issues

Ongoing, follow-along support by an IST to support both treatment and work goals

Support needs to accommodate for success as well as address challenges

Involve peers as counselors or mentors showing how people can overcome fears of change and advancement and maintain balance

Expect relapses and have a plan in place that deals with them

Expected Outcomes: Staff realize the job doesn’t end at placement; participants see the benefits of treatment and job retention and advancement; they have access to wrap around supports 24/7

Day #1 Summary:Breaking the “Readiness

Model”

Assume employability All staff supports peoples’ desire

to work Avoiding lengthy prerequisites

and rigid sequencing Allow multiple options-one ‘best

practice’ does not fit all Understand peoples’ needs,

abilities and values Understand what employers want Understand how to make a good

job fit Celebrate all degrees of success

Day #2Learning Objectives

Learn about employment services practices being used throughout the country

Understand tools and strategies for helping people choose, get, keep and advance in jobs

Understand how to use partnerships to improve program delivery

Learn about critical staff competencies for providing employment services

Address challenges and strategies using scenarios and exercises

“Customization” of Employment Best Practices-

A Challenge for the Field Why?

Replace staff-driven employment services with more person-centered approaches

How? Modify existing practices like:

TEP: Each time-limited job is individually negotiated/the person AND the job can change

What Outcomes? Improve outcomes-satisfaction,

tenure, growth

Transitional Employment (TEP) (Est. 1964 Fountain House, NYC)

Primary vocational services of Clubhouses

Time-Limited Part-Time Competitive

Negotiate job slots set aside for rotating workers

Usually entry level jobs

Agency guarantees the job will be done

On and Off-Site Job Coaches, peer supports

Disadvantages: Time limitations Agency is

responsible for performing the job

Dependency issues

ACT/PACT

Continuous 24 hour treatment planning approach

Employment specialist is member of multi-disciplinary Team

Rapid placement, continuous follow-along and reassessment

Recognizes that work is integral to the community treatment process

Focus on “work first” – on-the job learning, adaptation and accommodation

Clash between short-term funding and long-term support needs

Customized Employment (NCWD)

Individualizing the employment relationship between job seekers and employers to meet the needs of both.

Determine the strengths, requirements, and interests of a person with a complex life.

It is not a program, but rather a set of principles and strategies that result in employment.

Builds on supported employment and results in individually designed services, supports, and jobs negotiated to fit the needs of a specific job seeker or employee.

Customized Employment (NCWD)

Customized Planning Profiles, portfolios, etc to capture,

organize, and represent the information that was collected during exploration

Negotiating Negotiating job duties and

employee expectations. Can include job carving, negotiating a job description, job creation, job sharing, etc.

Self-Employment A recognized CE option

Career Mapping-A New Approach to Assessments and Job Planning

(Based on materials developed by Sowers, McLean and Shelton Empowerment for Life Project-Portland, OR)

Recognizes the complex impacts of homelessness and disability on employment

Seeks to bridge issues of trust Uses interactive group or individual

techniques Results in pictographs (“maps”) that

are the basis for referral to career services

Assumes the result is mainstream employment with support services planning

Key Elements of Mapping

LIFE HISTORY -draw correlations to past experiences. Identify patterns over their life span and recognize reoccurring themes, interests, and passions

STRENGTHS, GIFTS and CAPACITIES - Identify what they are able to do, what they enjoy doing, and what they have done in the past to develop a job goal

WHAT WORKS - Create a list of job characteristics that work well for them and those that do not work well for them

POSSIBLE RESOURCES - Community-based resources available to them, as well as resources within the One Stop system

POSSIBLE JOBS - List of possible jobs for themselves using strengths, gifts and capacities and what works as the only criteria

REFFERAL – Work with staff to develop a plan to get the job they want

A ‘Map in Progress’

Strengths, Gifts, CapacitiesJoker, dreamer, water ski, fix cars, traveler, bikes, large machines-forklift, guitar player, quick, curious, learner, bowler, great balance, basketball, coordinated, snappy dresser

Possible Jobs

Truck driver, Dancing instructor, Physical Ed teacher, Tour guide, Researcher, Writer, Mechanic, Furniture maker, Welder, Pilot, Travel agent, Personal

trainer

WorksDoesn’t WorkSpiritualityFear of dyingEarly morningsPushy peopleHands on learningNight workExercise dailyNoisy settingsRight medicationsWrong medications

SAMHSA’S MODEL FOR EBPs

SAMHSA National Registry of Effective Programs and Practices (NREPP) http://modelprograms.samhsa.gov

Evidence-Based Programs•Conceptually sound and internally consistent

•Program activities related to conceptualization•Reasonably well implemented and evaluated

Promising•Some positive outcomes

Effective•Consistently positive outcomes

•Strongly implemented and evaluated

Model•Availability for dissemination

•Technical assistance available from program developers

Why Use Evidence Based Approaches?

Evidence based practices yield better outcomes

Evidence based programs have fidelity measures

SAMHSA acknowledges that the evidence base is limited in some areas

SAMHSA supports promising practices where evidence of effectiveness is based on: Formal consensus among

recognized experts Evaluation studies not yet

published

IPS/SE Fidelity (Bond 2003)

Fidelity is important because programs that faithfully implement evidence based practices have better outcomes.

Fidelity Scales assess the adequacy of implementing an evidence based practice

Supported Employment EBP (Drake, et al)

Basis for SAMHSA Toolkit on Supported Employment

Blending of assertive case management and supported employment

Has been used to replace continuing/day treatment

Work is considered both treatment and outcome

Employment specialist is member of tx. Team Vocational assessment is continuous and

obtained from multiple sources Focus on “work first” - learning through doing Services in the community on flexible

schedule Has established a fidelity scale with

staff/customer ratios

Social Enterprises“Meeting the Market with a

Mission”

Businesses which affirmatively employ persons with disabilities and who have been homeless and/or other disadvantages

Achieve social change:

More people get jobs Achieve Economic Change:

Build healthy business

communities

Social Enterprises

Characteristics Agency-sponsored businesses

employing people with disabilities, people who have been homeless and/or other disadvantages

Objectives Exposure and experience, skills

development Add to the available jobs in the

marketplace Advantages

Agency “owns the jobs” “Business to business” potential

Disadvantages High risk-requires sound business

planning Can create numerous issues of roles and

boundaries for staff and clients

COMMUNITY VOCATIONAL ENTERPRISES 1425 Folson St., San Francisco, CA 94103 (415) 544-0424

Training and employment for persons with mental illness& other people withdisadvantages

Service Master Partnership Transitional employment in

4 agency-run businessesProfessional development seminars

Support services/Case management Enrolls +200 persons/year. 50-70 persons

employed at any one time

Supported Self Employment

Characteristics Consumer owned and operated

businesses Objectives

Self-sufficiency through owning one’s means of livelihood

Advantages Consumer “owns the job” Self-reliance, independence, “role shift”

from consumer to entrepreneur Disadvantages

High risk-requires sound business planning

Complications re: benefits are different from other employment scenarios

“The buck stops here”

Homelessness and Choosing a Job

Need to address considerable “concrete” barriers, i.e., access to laundry, showers, clothing

Lack of fixed address for mail or telephone to receive and return messages

Personal humiliation about current homelessness and past record, such as criminal histories

Poor employment histories and track record regarding employment

Access to transportation Focus on immediate needs vs. longer term

goals Impact of change Managing housing stability/recovery and work Unclear expectations/inadequate information Physical limitations

Getting a Job: What Level of support is

needed?

? Work while

choosing or job goal first?

Identify values Identify strengths

and gifts Identify preferences:

type of work, location, hours of work, wage scale

Identify resources: postings, ads, friends, family, staff

Why this job? Why now?

Sustained assistance regarding set-backs

Support services-on and off job

Principles and Practices #7Employer Marketing

Typical Challenges

Devalued group of people with stigma

Multiplicity of physical, psychological problems that could affect work

Lack of recent solid work history

Appearance and mannerisms

Few resources (e.g. transportation, child care, etc)

Poor self-image and lack of confidence, fear

May not be a clear ‘job match’-negotiation may be necessary

Employers’ understanding of the features/benefits

Employers’ fears of accident liability

Suggested Responses

Assess employer needs and concerns

Represent the job seeker Develop and use marketing

tools –brochures, testimonies, videos, etc.

Develop sustained relationships with employers that allow for more non-traditional “job matches”

Consider sectoral approaches

Becoming familiar with the current labor market to make an informed match

Guide job seekers on disclosure of disability and options for requesting reasonable accommodations.

Provide information about work site accommodations to employers

Guide job seekers on ways to address a record of conviction/incarceration

Support successful job seeker interviews

Principles and Practices #8Job Development and

PlacementTypical Challenges

Force-fitting to meet program outcomes

‘Passive job development’

Not following up on a regular basis with active and potential employers

Focusing on the disability rather than the ability

Starting with tax incentives

Promising “two for one” Guaranteeing 100%

productivity or attendance Offering to do all the

training and supervision Failing to plan for the

next step (advancement, transition)

Suggested Responses

Be creative- you want the same thing

Offer examples to employers of ways part time, negotiated or carved jobs has helped an employer in the past

Review the assessment information on an ongoing basis and update as needed

Help the job seeker break down the job development process into attainable steps

Select, train and support mentors

Offer to provide disability sensitivity training to employers’ staff

Include benefits planning as an ongoing part of the process

Highlights: Who Does What?

USDOL

Governor

LOCAL WIBs

ONE-STOPS/SATELLITES

Legislative, regulatory framework for WIA

5Yr plan, policies, LWIB jurisdictions, responsible for state performance

State WIB

Appoint, convene SWIB, discretionary $$, priority pops

Local plans, priority pops, administer 1 Stops, contracts for priority pops

Core, intensive, training services, house VR services, DPNs,

One Stop Services

Core services: - Available to any job seeker- Self-service job search, resume

development- Use of One Stop facilities, job fairs,

employer presentations, etc Intensive services:

For those not successful in Core services Vocational counseling, remedial

education and skills and support development, guided job search, enrollment into WIA funded training programs, etc

Training services: Enrollment in classes, specialized trades

training, etc

Principles and Practices #5Connecting to Mainstream

EmploymentTypical Challenges

Mismatch between customer’s readiness and the self-guided core services at a one stop

Participants feel uncomfortable in One-Stop environments

One Stop staff feel uncomfortable working with people who are chronically homeless

Different goals regarding employment placement

Different languages and expectations

No history of coordination

Suggested Responses

Have information of relevance to people who are homeless at the One Stop

Develop partnerships for targeted outreach

Cross-train staff Use the resources of the

DPN Review services forms

and documents to determine how they are consistent with each other, and where they contradict each other

Introduce people to One Stop services as a normal part of the employment process

Example #1: CTWorks-Bridgeport, CT

Operated by Career Resources, Inc., Partnerships with LWIB, Bridgeport

Continuum of Care, the CT Division of Rehabilitation Services, the CT Department of Mental Health and Addiction Services and the Veterans Employment Service.

50+ corporate donors, the United Way, US Department of Education grant ,DOL Work Incentive Grant and Disability Program Navigator funding

CT Works!- Why?

Meets people who are homeless with services ‘where they are at’

Developed a “Career Coach” mobile One Stop with the technology on board to connect people who are homeless to core services

Important partner is HVRP to connect Vets to core, intensive, training services

Visionary Leadership! Public/private funding

mix

Example #2: SEARCH-Houston, TX

Active member of the local Continuum of Care

Permanent and transitional housing, daily lunch for 250, a food pantry, mobile outreach, day care, medical assistance and psychological evaluations, and a one-stop career center for the homeless

Received JTPA and WIA Adult funding for employment services for homeless

SEARCH Works! Why?

Realized it could not ‘go it alone’

Offers on-site occupational skills training (computers, etc) for growth jobs

Understands it needs to braid/blend funding to provide support services and intensive counseling

Ending Chronic Homelessness Partnerships

HUD, ODEP, ETA, VETS funded x 5 years

5 Cities: LA, Boston, SF, Indianapolis, Portland, OR

297 people housing + jobs

Lead applicant is workforce development

Progress so far…….. Through 9/30/05

Number served 357

# full or part time competitive jobs: 113

Employment rate (# placed in housing: # entering employment) = 43%

Innovations (one stop satellite; career mapping strategy, mobile “one-stop”)

Accessing Mainstream Resources for Employment

Medicaid (www.cms.hhs.gov) 1619(b) Buy-In Rehab Option

HUD (www.hud.gov) Section 8 CDBG ESG ROSS/Hope VI Tenant-Based

Rental Assistance

USDOL (www.dol.gov) WIA

SSA (www.ssa.gov) Ticket to Work SSA Work

Incentives Dept. of Agriculture (

www.usda.gov) FSET

RSA/VR (http://www.ed.gov/offices/OSERS) State VR

HHS (http://www.acf.hhs.gov/programs/ocs/dcdp/joli/welcome.htm) JOLI

Job Search Planning

Assessment-skills/resources/supports Person-centered planning-

preferences/goals, job expectations Researching employer(s) Complete/modify resume, cover letters,

applications; Obtain transcripts, credentials,

references Resolve disclosure issue Address criminal justice involvement Identify “hot buttons and plan response Practice interviews and how to deal

with surprises Develop a schedule and plan

Disclosure: A Personal Choice

Disclosure of disability can occur:- At the time of the job application (by

the applicant or by their representative)- During the interview- After the job is accepted- After adjusting to the job,

demonstrating competency and prior to the need for reasonable accommodation

- When asking for an accommodation- Never- Sometimes it is optimal to discuss the

disability in terms of behavior and resulting behaviors

Menu of “Keep” Services

Job Coaching & Follow-Along

Educational, Professional, Peer, Natural Job Supports

Professional, Peer, Natural Housing, Recovery Supports

Benefits Management & Advocacy

Growth and Career Planning

Principles and Practices #9Job Retention and

AdvancementTypical Challenges

Having $$ New

friendships/disengaging from problematic old relationships

Managing new structure, scheduling and time demands

Pressures to share new funds or luxuries with less fortunate neighbors

New routines New lifestyle Co-worker, supervisor

relationships “Threat of success”

Suggested Responses

Tools and Activities: Utilizing Natural Workplace Supports

Job coach as training consultant, not trainer

Utilize typical employee orientation and training process and resources

Assist to understand workplace culture, cues, politics

Don’t “switchboard” questions & feedback

Help people develop skills to establish their own natural workplace supports

Explore possibility of “training the employer” to facilitate the best results for everyone

Understanding and Addressing Work-Related Triggers Having $$ New friendships/disengaging from

problematic old relationships Managing new structure, scheduling

and time demands Pressures to share new funds or

luxuries with less fortunate neighbors New routines New lifestyle Co-worker, supervisor relationships “Threat of success”

Scenario Questions “Choosing, Getting and

Keeping a Job” What are this person’s strengths and assets? What employment goal(s) do you think they

might choose? What employment program option might they

prefer and why? What concrete barriers may arise or exist that

need to be addressed? How would an integrated services team proceed with the participant?

Will this person choose to disclose their disability or not?

Describe how the plan for job search might look

What natural supports does this person have available?

What triggers will affect job retention? What are some of the elements of the

employment support plan?

For Systems/Programs For People

CULTURE

CAPACITY

HOPE FOR THE

FUTURE

SKILLS/SUPPORTS

OPPORTUNITY

Building a Culture Supporting Employment – Some Examples

Employment is part of our Mission Statement Targeted increases in rate of employment is an

agency priority Consumers are included in program decision-

making Skill building of participants is an integral part of

all service delivery – teaching the participants how to meet their own needs

We hire consumers as staff We have ongoing staff training on employment Consumers are clear on why they are

participating in employment programs Staff support consumer involvement, dignity,

choice and community integration Consumers, their families and staff express

hope that employment is possible All staff throughout the organization are

interested in and committed to employment opportunities for participants

Formal vendors and outside partners are viewed as potential employers for participants

Developing Capacity-Examples

We have employment program written policies and procedures

We have clear employment outcome measures

We have the goal of assisting participants in relevant ways with employment goals in the job descriptions of all staff

We have a dedicated budget for employment We have a process for resource development

and business planning We have employment specialists on staff We are risk-takers We have a strong management team We are culturally competent We have experience with developing

partnerships We think of all partners and vendors as

potential employers of our participants

Opportunities-Examples

We are aware of local hiring and economic development trends

We look for non-mental health funding sources as part of our employment funding mix

We have staff assigned to resource development and program growth

We build coalitions among families, mainstream resources and institutions, peers and professionals to address stigma

We are members of Chambers of Commerce We initiate and participate in the development

of access to new employment sectors for our participants, i.e. hotel industry, specific unions, etc.

We build upon the principles of the Americans with Disability Act, New Freedom Initiative, Olmstead Decision, TTW/WIA and local hiring goals/requirements for new program development

We help to make sure employment is on the agenda for State Policy Academies

Working with your VR Agency: Challenges Time-limited nature

of VR services Incentives for VR

case closures Demonstrate how

VR, One Stop, agency staff and participant can build a partnership for success

Mutual suspicion & misunderstanding

Staff training issues Incentives for

collaboration Funding limitations

Working with your VR Agency: Best Practices for Partnerships

Make people with mental illness and co-occurring disorders a priority

Staff training Define milestones

for payment relevant to the population

Role definition and clarity

Hire consumers as VR staff

Co-location of counselors

Non-traditional providers

Involve employers in these partnerships

Business Improvement Districts

Convergence of need Resources for outreach, engagement Job development Anti-stigma Opportunity for developing better

understanding of community needs – employers and participants

Staff competencies

KnowledgeSkillsAttitudesCultural sensitivity

Staff Competencies:

Knowledge

Job Market (current and projected) Job features, credentials and skills (hard and

soft) requirements Entitlement systems and related work

incentives Strong understanding of vocational

rehabilitation practices throughout all delivery of services

Mainstream community organizations, natural supports, self-help & peer supports, non-traditional (eg. Faith-based) resources

Employer associations, Chambers, One-Stops, WIBs, VR

Other potential employers – small businesses and community-based organizations

Agency purchasing procedures/services they are contracting-out

Homeless services and coalitions Asset development strategies-IDAs, ITAs, etc

Staff Competencies:

Skills

Active Listener Good Communicator (verbal,

written, and telephone) Able to integrate vocational

growth into all service delivery Consistent follow-through Networker and strong

relationship-builder (Giant Rolodex)

Teacher Negotiator

Staff Competencies:

Attitudes

Shared values Flexible Self-confident Outgoing Patient Respectful and

Tolerant Well-trained and

conscious about cultural differences

“Hands-on” Tenacious Inventive

Some More Important Questions………………..

How are you involving consumer leaders in employment program development?

What funding sources are you using to address employment?

What partnerships are necessary to increase employment?

What advocacy tools do you use to promote employment?

What skills must staff know to provide/support employment?

How do you approach employers to achieve greatest number of opportunities?

What do you need to do differently to increase employment?

Resources on the Web

www.dol.gov/odep www.mentalhealthpractices.org www.redf.org http://www.psych.uic.edu/eidp/eidptoolkit.h

tm www.ahpnet.com www.csh.org www.hud.gov/offices/fheo/section3/section

3brochure.cfm

Baker’s Dozen “To-Do’s”/”Who Does?”

Leadership for employment within the disability services systems

Unified vision re: employment as a priority across service systems

Share best practices Visible consumer

leadership Develop a toolkit for

employment implementation

Work with employers and develop knowledge of employers throughout process

Statewide training initiative to improve staff competencies

Develop individual outcome measures

Develop program accountability measures

Develop local partnerships-business, FCBOs, One-Stops, VR, employer and labor sectors, etc.

Help other systems understand employment and recovery

Train housing staff on employment and recovery

Use State purchasing power to support employment

Picturing a Champion

Recognized leader “Big and small”

picture knowledge Technical skills Community

organizer Collaborator Familiar with and

committed to issue and population

Responsive Resources/

resourceful Risk taker Passionate

commitment Representative

Providing Services

What are your challenges in providing effective, quality outcomes for job-seekers with psychiatric disabilities who are homeless?

What strategies are you using to achieve those outcomes?

What resources do you have and use to achieve those outcomes?

What resources do you need to achieve those outcomes?

What training opportunities would be especially important and useful?

Building Systems

Who are your local partners? Describe the plan/steps for developing

stakeholders for employment of people with psychiatric disabilities who are homeless

What does each stakeholder, including employers and employment sectors, bring to the table that helps meet those outcomes?

What challenges do you anticipate in developing partnerships and collaborations?

What training, technical assistance and support do you need to develop and sustain these partnerships/collaborations?

“Culture-Capacity-Opportunity” What are the tools and activities you

need to utilize to develop and/or improve the organizational Culture that supports employment in your agency, government unit, community and employment sectors?

What resources and/or knowledge must you as a practitioner and your agency as a provider acquire to build your Capacity to implement employment?

What Opportunities do you see to support and expand employment services, and how do you propose to address challenges that could impede your ability to take advantage of these opportunities? (e.g.: funding, public policy, local hiring plans, employer tax incentives, Medicaid, DMH initiatives, initiatives by other sectors (faith-based, DOL, etc.)