An Overview of Services to Help Us Return to School and Work

1. An Overview of Services to Help Us Return to School and Work Jay Yudof, MS, CPRP NAMI NEW JERSEY Statewide Consumer Outreach Liaison 866-464-3267 jyudof@hotmail.com

2. Overview of Presentation • Introduce Myself – and the field of Psychiatric Rehabilitation • A little vocabulary • Employment Paradoxes • Are we working? • A few words about benefits • Why aren’t we working? • Why should we work? • What can families do to help us get back to school and work? • What are the “professional” services and supports which can help us get back to school and work? • Q&A

3. Some Limitations • We could do whole talks on • Supported Employment • Supported Education • Computer Skills Enhancement in Mental Health Settings • Financial Skills Training as a peri-vocational intervention • Interventions to overcome transportation gaps • Career Counseling and Assessment • Skills Training • Dealing with Skills and Resume Gaps • ADA and Psychiatric Accommodations • Choose-Get-Keep vs. Rapid Placement & Support • Risks, benefits, and timing of disclosure//visible vs. invisible coaching • Benefits Management • The Partial Hospital/Partial Care Trap • Systems Advocacy to support Increased Education & Employment • Historical aspects • Supports and advocacy for peer providers • SE/S.Ed. For special populations – MI/CA, MI/DD, criminal Hx, Anxiety Dx, Adjustment Dx, consumers with significant pre-morbid credentials

4. Jay Yudof • Advocate for people with mental illness and systems reform • Wellness Dissemination Coordinator @ CSP-NJ • Student and preacher of Psychiatric Rehabilitation • Current/former member of many committees, boards, and workgroups • Including NJDMHS/DVRS joint workgroup to improve employment outcomes • Resume available upon request

5. Psychiatric Rehabilitation • =Psychosocial Rehabilitation • Emerging Field • Assist adults with SMIs in recovery in the community, using collaborative, consumer-focused approaches • Evidence Based Practices are not incompatible with W&R • “If Work Makes People with Mental Illness Sick, What Do Unemployment, Poverty, and Social Isolation Cause?” • Workforce With Diverse Credentials • Education & Credentials Available .. Peer Providers

6. A Little Vocabulary (1 of 4) • Competitive (or integrated) Employment – Jobs not inside the treatment or services system that pay people with and without disabilities competitive wages • In competitive employment and integrated education, people develop natural relationships and use • Natural supports – The kinds of help we all use in our workplace – bosses, friends, helpdesks, etc. • Some of the things we see which are not integrated employment are • Sheltered work – piecework, workshop evaluations, etc. – No research supports that this kind of work leads to integrated employment • Affirmative business – A business by and for people with disabilities – some value to some people • Transitional employment/Internships – Again, appropriate stepping stone for some –not a meaningful end in itself

7. A Little Vocabulary (2 of 4) • Pre-Vocational Programs” – Generally offered in day treatment, “Pre-voc=No-voc.” – No research supports that this kind of work leads to integrated employment • Primary Labor Market – Jobs where we develop skills, tenure, satisfaction…careers • Secondary labor market – Lower paying, lower-skill, short tenure, minimal natural accommodations - low status – what many of us take during high school/college • Americans with Disabilities Act (ADA) – protects people with disabilities in employment, education, public accommodation • Reasonable Accommodation – Things an employee can request an employer to do under the ADA

8. A Little Vocabulary (3 of 4) • Job/Workplace Modification – things that can be done to make a job or workplace more accommodating for someone, based on their identified disability and the reasonable needs of the job itself – examples include headphones, changing hours, splitting a job into 2 separate ones, and more. • Job development – helping to cultivate relationships with employers so that they are willing to make the extra effort to accept a person with a disability and work with the employment provider. • Assistive technology – Objects which can support a person’s employment or education. Voice recorders are a common example of AT for psychiatric disabilities.

9. A Little Vocabulary (4 of 4) • Personal Networks are a way many people with and without disabilities of any kind find jobs. People use social inclusion to expand close networks and extended networks, and build social capital.

10. Employment Paradoxes • You need an income to get a car to get and keep many jobs • You need work experience to get a decent job • You need a job to get out of poverty and expand the social networks which are a big part of findign a job

11. Are We Working? • Unfortunately, no. Some studies say that no more than 15% of people with persistent mental illness are in the primary labor market, or are earning as much as the Substantial Gainful Activity (SGA) level

12. A Word About Benefits (1 of 3) • Social Security Disability Insurance – SSDI • Paid to people who have worked a certain number of “quarters” before disability when we become disabled – fixed at an annual rate regardless of financial need • Comes with Medicare (after 2 years) • Ticket to Work/Work Incentives are programs designed to help raise the very poor proportions of people who get on SSDI and then get off • Trial work periods, employment services vouchers, rapid reentry • SGA level of $9xx – after trial work periods, working (18 months) above this level, SSDI (plus Medicare) stop

13. A Word About Benefits (2 of 3) • Supplemental Security Income – SSI • The predominant payor for services for people with persistent mental illness • Paid to people who are medically disabled whose income (earned and unearned) is below $600/month, and who have less than $2000 in non-excluded assets • Comes with Medicaid - Good Rx coverage, poor in other areas • After a limited exclusion, SSI reduces by $0.50 for every earned and unearned dollar of income – Creates a disincentive to work for many recipients.

14. A Word About Benefits (3 of 3) • Dual eligibility for some… • Many people consider their benefits a double-edged sword – keeps them out of living in the gutter, but tightly in poverty. • Many receiving SSDI and/or SSI do not trust the information about work incentives, etc. • Most people, including many social workers and rehabilitators, do not understand many of the rules of SSDI & SSI. • The NJ WorkAbility Program offers full New Jersey Medicaid health coverage to people with disabilities who are working, and whose earnings would otherwise make them ineligible for Medicaid. 888-285-3036

15. Why Aren’t We Working? • Ignorance of services & supports • And all of the gaps in those services • Interrupted educations • Timing of onset • Special ed limitations • Staleness of educations, especially computer/tech skills • Stigma/fear of discrimination • Fear/ignorance of the loss of benefits • Fears of relapse • Transportation barriers • Fear & stigma in the workplace • employers’ lack of awareness that employees do develop satisfaction & satisfactoriness & tenure • Current & Historical Discrimination & False Beliefs by Practitioners & the System…

16. Current & Historical Discrimination & False Beliefs by Practitioners & the System • The benefits of pre-vocational programming and sheltered evaluations • Success in pre-vocational settings predicts success in integrated employment, and the contrapositive • Recent hospital care or lack of sobriety is a disqualifier for employment or services • The value of shielding consumers from failure • Fear of the results of access to funds • Along with • Practitioners’ lack of skills, and the system’s lack of appropriate services • Practitioners’ lack of awareness of services and supports, and the value of employment • occasional invidious beliefs, e.g. in the reduction of control you can exert on someone not dependent on benefits and public services

17. Why Should We Work? • Income – counteracting the poverty. • Personal Networks/Relationships – including romantic ones and lifelong friendships. • Sense of identity. • Sense of mastery – even with setbacks, success leads to success. • Work=treatment.

18. What Can Families Do To Help Us Get Back To School & Work? (1 of 2) • Provide encouragement/reject negative messages • Help a person establish appropriate goals • Do not “torpedo” occasional unrealistic goals • Provide appropriate concrete supports • Do not buy into stigma or over-pathologize • Provide continuing supports during employment, and especially during job losses/gaps • Remember that most people getting into the job market have some less-than-ideal jobs, some job losses, etc. – it’s the long-term outcomes that matter • Remember that most of us rely on our families and friends for this kind of support, especially until workplace supports become strong

19. What Can Families Do To Help Us Get Back To School & Work? (2 of 2) • Provide appropriate concrete supports for job finding, getting, and keeping • Transportation help, tuition assistance, college registration supports, computer and financial skills mentoring etc. • Maintain own knowledge about peri-employment issues • Access (and help your loved one access) the trainings provided by • The Career Connections Institute in North Jersey - www.cceri.org • The Integrated Employment Institute of Central & Southern NJ – go to www.shrp.umdnj.edu/smi and click through to “employment institute” • Other sources • Be alert for opportunities to help the larger mental health/vocational community develop jobs and related programs

20. What Are the “Professional” Services & Supports Which Can Help Us Get Back to School & Work? The following list is not “complete,” and is listed in a somewhat logical, but not prioritized order. Unless otherwise noted, all services are part of public systems, and do not charge a fee for their services.

21. The NJ Division of Vocational Rehabilitation Services • is responsible for helping any citizen with a disability return to work. They often pay for career training, tests and assessments, some contracted job coaching, and assistive technology. Many DVRS employees do not do that well with psych disabilities, and lean towards sheltered work and assessments. They occasionally cover costs of things needed to get back to work, like Rx or transportation help or interviewing clothes. They very rarely cover the part-time college educations many of us need. DVRS can and sometimes does exclude people who are not in treatment/have used addictive substances in the past 3 months/who do not have a doctor’s approval. DVRS officially never has a waiting list for services. • 1510 Hooper Avenue, Suite 120 • Toms River, - 732-255-0836

22. The One Stop Career Centers • is responsible for helping any resident with finding work. They have job banks, computer settings for polishing your resume or doing on-line applications, some training in basic language, math, and computer skills, help accessing educational benefits, and more. They do not “pay for” external services, and will often refer SMI clients to DVRS. • 1027 Hooper Ave. Bldg. 6 - (732) 286-56161959 Route 9 - (732) 286-6446 X261Hours: Mon. – Fri. 8:30am – 4:30pm

23. A Job Coach • Can be provided by DVRS/contractors, other employment support practitioners, etc. S/he she should be providing a returning worker who has a disability help in interviewing and integrating on the job, then tapering as the workplace takes over. S/he can also help with job/workplace modification and selection and training on assistive technology, and should be involved with job development. S/he provides skill training as required, and may be “visible” or “invisible” (i.e., provide offsite/telephone support).

24. Supported Employment (SE) Services (1 of 2) • can and should • Be providing anyone with a mental illness who wants to get back to work with job search and job coaching and related services, including extended post-placement • Be following the research-based nationally-adopted evidence-based practice (EBP) in psychiatric SE (see http://mentalhealth.samhsa.gov/ cmhs/communitysupport/toolkits/employment/) • Be providing “unbundled” services to anyone in the county who requests them, without requiring them to be using other services, or be referred by another agency, or meet some standards of readiness. • Work with DVRS to get funding for services they do not provide in-house, such as vocational and related assessments and skills training. • Have a job development function • Be interacting with a client’s mental health providers, with the client’s permission.

25. Supported Employment Services (2 of 2) • Regrettably, SE services in NJ • Are underfunded and often staffed below funding, so they have waiting lists. • Often do not do well following the EBP, and exclude or terminate clients, and sometimes push clients to positions in the secondary labor market • Often are limited in their job development abilities, and therefore lack the inventories of positions which help maximize client choice • Often do not do well with job/workplace modification, assistive technology, and assisting people with seeking reasonable accommodations. • Are not contracted to provide direct Supported Education services. • Preferred Behavioral Health - 700 Airport Road - 732-367-5439

26. Supported Education (S.Ed.) Services • employ an evidence-based model to help us choose, get, and keep college or other educational resources similar to supported employment. • Supported Education Service @ Preferred Behavioral Health • Campus-based prep preparatory programs at Kean University and Richard Stockton College • Multi-campus S.Ed. for students in the UMDNJ Department of of Psychiatric Rehabilitation

27. Campus Disability Offices • Exist by law at all colleges and universities, and comparable functions can be found in many trade, vocational, and adult ed schools and programs. They can assist students with disabilities in: • The application, registration, testing, and counseling processes. • Obtaining special accommodations from the school, or from the student’s teachers. • Locating specialized financial ed. • Locating tutoring resources.

28. A Few More Campus Issues/Resources • School counseling centers can offer some specific services, but are sometimes not integrated with the disability services. • Disclosure is a double-edged sword in the “post-Virginia-Tech” world. • The emerging “NAMI on Campus”/Active Minds on Campus groups are another resource where they are found.

29. Your Psychiatrist or Psychiatric Nurse Practitioner • Should be supportive of your integrated education/employment goals • Should be prepared to sign paperwork to help you get back to school/work/employment services • Should be willing to work with you to make Rx adjustments to suit your education/employment needs, e.g., reduce sleepiness or tremors, provide sufficient alertness so you can drive. If you encounter a practitioner who disparages or blocks work, it may be time to fire him or her!

30. Programs of Assertive Community Treatment (PACT) • (only for the 1900 NJ peers served by these 31 teams) • The team has a vocational specialist ,who should be providing you with job coaching and related services, and helping his/her colleagues so the same.

31. Partial Hospital/Partial Care (PH/PC) • (non-profit and profit-making programs in every county) • By law, every person in these programs should have an Individual Recovery Plan (IRP), and it should identify the person’s specific current goals in a major life area (living, learning, working, or socializing). All services delivered should be focused on that plan. Pre-vocational services can include skills training (e.g., computer, financial, travel), resume and interviewing, readiness enhancement, etc. Each program which provides pre-vocational services must have a credentialed pre-vocational specialist. Specific educational services (e.g., GED courses) are not, by law, part of PH/PC. THERE IS NO EVIDENCE THAT LONG-TERM PH/PC ACTUALLY IMPROVES EMPLOYMENT OR OTHER INTEGRATED OUTCOMES, AND MANY PEOPLE STAY IN THESE PROGRAMS DUE TO FEAR, IGNORANCE, DIFFUCLTY ACCESSING UNBUNDLED SERVICES, OR DUE TO THE BUSINESS CONSIDERATIONS OF THE PROVIDER.

32. State Hospital Occupational Therapy Departments • should work with longer-term stay patients at the hospital (e.g., consumers in forensic status) around: • Skills development • GED and other educational preparations • Other interventions to help maintain/develop employability. Department of Veterans’ Affairs (VA) has some employment preparation and training resources for eligible vets. Call 877-222-VETS.

33. New Jersey Work Incentive Network Support (NJWINS) • provides counseling to people with all kinds of disabilities who are receiving SSI and/or SSDI and considering or actually are getting back to work. NJWINS helps people understand how to maximize their cash and medical benefits during the transition, and to access other services. www.njwins.org. • 866-WINS-4NJ

34. Transportation • is a frequent barrier for returning to work. • You should be aware of: • NJ Transit reduced fare identification cards available to individuals who are disabled. No requirement to be receiving SSI/SSDI or any other benefits. 973-378-6401. • Disabled residents are eligible for paratransit and/or subsidized shared-ride cab services) transportation for work and medical appointments. Services in every county.. • Individuals who cannot travel by regular bus or train and live within ¾ mile of a bus route or train station may be eligible for AccessLink, a door-to-door Paratransit service managed by NJTransit. Call 800-955-ADA1. • Some self-help centers have livery/rideshare services to supprot employment, and there is a plan to increase this type of service. • Medicaid recipients can purchase car insurance for $30/month.

35. Peer Provider Resources support people living with mental illness who are interested in careers in the field. • Consumer Connections is a state-funded non-academic training program with some related services . 800-367-8850. www.mhanj.org. • The Consumer Provider Association in NJ is an organization of people working in or training for consumer-provider roles. www.cpanj.org. • The UMDNJ Department of Psychiatric Rehabilitation notes that a sizable proportion of students in its certificate, associates, bachelors', and graduate programs identify as having a mental illness. www/shrp.umdnj.edu/smi. • Many peer providers enter the field through volunteer/stipended roles at local self-help centers.

36. Self-Help Resources • such as NAMI groups can play a valuable role by giving us places to interact with people who are working and providing continuity of support when we transition treatment to work. • Peer Employment Support groups now running twice monthly @ Freehold Self-Help Center (732-625-9485), CARE Self-Help Center (732-455-5358).

37. Volunteer Work • while not a predictably successful route to competitive employment, is chosen by many consumers as a way to increase valued roles , build social networks, and establish current workplace experience. Sources include: • NAMI and other mental health organizations we are involved in. • “Volunteer Centers” offered in many counties, often through the local United Way or 211. • Local hospitals. • One’s own communities of interest, whether religious or social.

38. Collaborative Support Programs NJ • and its subsidiary, Community Enterprises Corporation provides supportive/housing services to many consumers, and also operates 22 of NJ’s 30 self-help centers. Some of the relevant services which these agencies provides include: • Financial literacy training • Individual Development Accounts, so consumers can save towards a car, tuition, or other major expenses which may be part of a plan to resume school or work • Tax preparation assistance • Start-up and operating assistance for consumer owned small businesses • Employment at an “affirmative business,” the “Unleashed” “pet sitting service • 732-780-1175 - www.cspnj.org

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