EMPLOYMENT FIRST: Making Competitive Employment A Priority For all People Served by the

1. EMPLOYMENT FIRST: Making Competitive Employment A Priority For all People Served by the Department of Mental Health

2. Viewed by many as an essential part of recovery/self-determination • Most individuals want to work • A typical role for adults in our society • Cost-effective alternative to day services Why Focus on Employment?

3. Increased substance abuse • Increased physical problems • Increased psychiatric disorders • Reduced self-esteem • Loss of social contacts • Alienation and apathy • (Warr, 1987) Negative Effects of Unemployment in General Population

4. Higher self-esteem • Better control of psychiatric symptoms • More satisfaction with finances and with leisure (Bond et al., 2001) • Valued roles in the community Positive Outcomes from Competitive Work

5. As compared to what? • Joe Marrone, an employment trainer: “If you think work is stressful, try unemployment.” • Stresses of work do not translate into higher rates of hospitalization Is Work Too Stressful?

6. Mainstream job in community • Pays at least minimum wage • Work setting includes people who do not have disabilities • Service agency provides ongoing support • Intended for people with most severe disabilities Definition of Evidence Based Supported Employment

7. Employment specialists coordinate services with the individual’s planning team, (for example, service coordinator, therapist, psychiatrist, nurse, etc.) Supported Employment is Integrated with Other Needed Services

8. Diagnosis/Disability • Substance Use • Symptoms • Medication “Compliance” • Hospitalization History • Treatment “Compliance” • Gender Which Factors Predict Better Employment Outcomes? Better Employment Outcomes

9. Job finding is based on the individual’s preferences, strengths, and work experiences, not on a pool of jobs that are available. Individual Preferences Are Important

10. In order to effectively provide Supported Employment, all staff providing mental health services, need to believe that people with mental illness can and do recover. “Recovery” Beliefs for Supported Employment

11. 2008 (Substance Abuse and Mental Health Services Administration-National Outcomes Measure) US ADULT Mental Health OVERALL Employment = 21% 18 – 20 = 17.9% 21- 64 = 22.7% 65+ = 6.9% POOR performance of MH System on employment outcomes

12. CPS Division • ADA Division • DD Division • 13% employed • 33.4% employed • 8% employed People Served by Missouri DMH

13. MISSOURI 2009 Division of Developmental Disabilities 29,000 Served Division of Vocational Rehabilitation 30,000 Adults Served 2,496 overlap

14. MISSOURI 2009 Division of Vocational Rehabilitation 30,000 Adults Served Division of Comprehensive Psychiatric Services 60,000 Adults Served 4,175 overlap

15. MISSOURI 2009 Division of Vocational Rehabilitation 30,000 Adults Served Division of Alcohol and Drug Abuse 70,000 Served 3,302 overlap

16. Missouri2009 Adults Served by Department of Mental Health 159,000 Division of Vocational Rehabilitation 30,000 Adults Served 9,973 overlap

17. Partnerships are essential to support someone in employment. • Vocational Rehabilitation (they can’t do it all) • DMH Providers • Social Security Administration and other programs • Workforce Development Centers • YOU “IT TAKES A VILLAGE”

18. Creation of a Central Office Employment Team, with representatives from all 3 divisions • Acting on a series of recommendations to raise the profile of employment such as: • Data collection improvements • Creating clear policy on how to pay for employment services • Focus on Transition youth • Benefit planning activity What the department is doing:

19. Recovery, Self-Determination, & Hope “If people are treated as capable, they often surprise everyone and live up to expectations.” • Ken Steele, “The Day the Voices Stopped”

20. Division of Developmental Disabilities: Connecting to Employment Resources & Creating Opportunities

21. 2007 - DD transforming the system • 2008 • Director of Employment and Training • State Employment Leadership Network • 2009 - Employment Coordinators & State Plan • 2010-Employment First Policy Getting Started

22. Coordinators in the DD Regions Kansas City Hannibal Springfield Joplin Albany Central MO Rolla Kirksville St Louis (2) Sikeston Poplar Bluff EMPLOYMENT RESOURCE/YOUTH TRANSITION COORDINATORS

23. Creating a culture which focuses on employment: • New Planning Requirements & Monitoring • New Waiver Definitions • Rate Restructuring • Success Stories : http://dmh.mo.gov/dd/spotlight/spotlight.htm DMH Employment Coordinators

24. Training and Technical Support • Career Discovery Guide – www.mpcdd.com • Benefits Planning • MPACT Transition Mentors EMPLOYMENT RESOURCE/YOUTH TRANSITION COORDINATOR

25. Multi-system / Community Collaboration – Building relationships \ providing expertise EMPLOYMENT RESOURCE/YOUTH TRANSITION COORDINATOR

26. Promotes expansion of effective employment alternatives EMPLOYMENT RESOURCE/YOUTH TRANSITION COORDINATOR

27. A group of individuals with an active interest in ensuring that students with disabilities have opportunities to achieve the futures they see for themselves. - Developing ways to meet transition planning needs in their community. • Improving outcomes of young adults with disabilities (e.g., employment, independent living, community involvement, and post secondary education/training). • The essence of transition teams is that they take advantage of the unique strengths of their own communities while working to solve common problems. (Transition Coalition, University of Kansas). Department of Elementary and Secondary Education Collaboration:What is a community transition team (CTT)?

28. Students with disabilities • Family members • School personnel • Adult service agency personnel • Employers • Community members, etc. • Individuals with a vested interest in the transition outcomes of youth with disabilities. Composition of a CTT?

29. Some CTT Activities • Transition Fairs • Educational Pamphlets about Transition • resources • Local needs assessments: ex: • Soft Skills training for Students

30. Employment Network • Data Collection • Consistent Statewide Training on New Waiver Services • Other Options (Micro – Enterprise) • VR / DD Partnerships The Future

31. Division of Comprehensive Psychiatric Services

32. Mental Health/Vocational Rehabilitation collaboration Implement evidence-based IPS Supported Employment Model Dartmouth provides training, consultation, and evaluation Participating states: CT, DC, IL, KS, KY, MD, MN, MO, OH, OR, SC, VT, WI Johnson & Johnson-Dartmouth IPS SE Project

33. Seven Principles of IPS 1: Every Interested Person Is Eligible. Every person is encouraged to consider work, and can be included.

34. Seven Principles of IPS 2: Benefits Planning Is Offered People are offered an opportunity to meet with a trainedbenefits planner before going to work and as they consider changes in their jobs. Employment Benefits

35. Seven Principles of IPS 3: Employment Services and Mental Health Services are integrated Employment specialists and mental health providers meet weekly.

36. Seven Principles of IPS 4: The job search occurs rapidly The employment specialist and/or job seeker makes face-to-face contact within a month of joining the IPS program.

37. Seven Principles of IPS 5: Competitive jobs are the goal Regular jobs at regular wages. Jobs that anyone can apply for, regardless of disability status.

38. Preferences may be related to type of job, work hours, job location… Seven Principles of IPS 6: Preferences are honored

39. Seven Principles of IPS 7: Job supports are continuous Job supports are provided for as long as the person needs and wishes to receive IPS services. Typically for about a year. Eventually, a mental health practitioner, such as a case manager, may be chosen to provide supports.

40. Partner with implementation sites to: Educate NAMI Family Advocates Provide family input Member of Site Employment Steering Committee Assist with site-defined needs Educate NAMI families about IPS ES Educate Physicians about IPS SE Educate families & physicians about benefits reviews Educate and refer employers to Employment Specialists NAMI Missouri IPS SE Family Advocacy

41. Government Policy Advocacy People with disabilities need cash, health insurance, and a job They do not need to be assigned to a lifetime of unemployment and poverty in order to get healthcare Legislative change is critical Employment is part of the treatment plan and recovery NAMI Missouri IPS SE Family Advocacy

42. Sites participating with State Grant Funding: Tri-County Mental Health Services – David Vesco Kansas City, MO 64119 BJC Behavioral Health – Jenise Woolf St. Louis, MO 63103 Independence Center – Amy Clinton St. Louis, MO 63108 Truman Medical Center Behavioral Health – Gino Taylor Kansas City, MO 64111 Arthur Center – Options Unlimited – Marlene Day Fulton, MO 65251 Pathways Community Behavioral Healthcare, Inc. – Jeff Bozarth Clinton, MO 64735 Places for People– Michelle Fassler St. Louis, MO 63110 Missouri IPS SE Implementation Sites

43. Division of Alcohol and Drug Abuse

44. Employment:An essential piece of recovery

45. Do a background check • Help job seekers meet face-to-face with employers • Help the employer see the person, not a felon. Don’t ask, “Do you hire people with felonies?” • Differentiate between hard policies and opinions. Opinions can change as the employer reacts to individual job seekers. Dartmouth Psychiatric Research Center – Expert Employment Specialist Project, 5/10 Helping Individuals with Criminal Histories Find Employment

46. Include: • a brief statement about the conviction • a statement that shows that the person takes ownership for her actions • an explanation of what the person has done to change his life • an explanation of how the person would be a good employee Dartmouth Psychiatric Research Center – Expert Employment Specialist Project, 5/10 Practice interviews with job seekers

47. QUESTIONS