Mental Health News, June 2008

Mental Health News

June 2008

Mental Health News

Career Development Initiative; A Creative Approach to Employment Possibilities

By Carol Blessing, LMSW Cornell University and John Allegretti-Freeman, LCSW-R New York State Office of Mental Health

H ow can we all work together and share responsibility to exceed the traditional employment outcomes that are really unacceptable? That is the question that is being asked by staff across the state who are involved in the Career Development Initiative.

In “Achieving the Promise” (July 2003) the President’s New Freedom Commission reports that individuals with psychiatric disabilities are among the least likely to obtain employment opportunities. The national employment rate for these individuals tends to hover around 15% regardless of what services are provided despite the fact that about 70% of these individuals report a desire to work(Achieving the Promise, 2003).. The barriers to employment are huge including financial disincentives, stigma, and perceived limitations.

Joe Marrone (Institute for Community Inclusion, MA), a leading advocate in the field, states that employment is an expectation of everyone in our society, except for those with mental illness. For some reason, a “pass” is given to this population, despite the fact that, when asked, they express a desire to participate in the community and share work responsibilities. Denise Bissonette , an employment services trainer from Canada, states that “any employer will hire any employee as long as the potential to increase revenue exists”. The art is in assisting individuals in creating employment opportunities that match their skills and interests which also meet the needs of employers. Connie Ferrell (Integrated Services, Inc.), a pioneer in Supported Employment, has long stated that there is a unique job match for everyone.

As New York State began looking more closely at evidence-based models of treatment, supported employment as a methodology gained more prominence. Supported Employment was one of the evidence based models that New York chose to highlight (Winds of Change, 2000). Furthermore, the evidence supports that evidence based models are best done in combination (Fallon).

The Career Development Initiative (CDI) is an approach that the New York State Office of Mental Health has undertaken within its 16 adult facilities to address the issue of poor employment outcomes. CDI was born out of a desire to focus on work as a major aspect of recovery. In 2002, OMH partnered with the Cornell University School of Industrial and Labor Relations’ Employment and Disability Institute to design a new approach to assisting individuals achieve their employment goals.

The initial phases of CDI involved agreement on common language and terms as to what constituted integrated employment. Given that there were so many models in the field (sheltered work,enclaves, affirmative business, transitional employment, supported employment), there was little consistency or agreement as to what a real job was.

Agreeing to utilize the national standard definitions allowed the project to more forward on common ground.

Traditional approaches to addressing the “employment problem” have been to train vocational staff in job development and to send them out to develop “job slots”. Although the development of job placement skills along with other technical vocational rehabilitation skills is a part of the supported employment approach, we fail to consider the individual when we look for “job slots” alone. Traditional approaches see Creative Approach on page 32approaches yield traditional results.

In order to achieve the CDI goal, it is important to remember that evidence – based practices are enhanced when used in combination. CDI choose a theme of “Work: It’s Everybody’s Business” in 2006 to support this fact and to encourage everyone’s involvement in the process. In choosing this theme, we were identifying the value and contribution of everyone toward employment goals. The clinician , psychiatric nurse, psychiatrist, family member, and individual receiving services, along with the vocational counselor all have an important role in helping an individual realize his/her goal of employment.

Each facility was asked to identify barriers that they faced in making sure that work was considered a part of everyone’s recovery process. Barriers such as lack of administrative buy-in, clinical skepticism of the role of work might play in the recovery process, and the level of job development and coaching skills of staff who were to provide these services were identified. From this, each facility was challenged to target an area of intervention which would help place them in strategic positions to begin to achieve more positive employment outcomes.

Learning communities were established to bring staff involved in the project together to discuss issues they were facing, to be exposed to new ideas and approaches and to develop a network of support among facilities. This forum allowed the staff to identify the supports that were needed for them to move their goals forward and to learn from one another’s experiences. These communities have met quarterly since the program started.

In order to address staff skill needs, “Foundations to Recovery”, a catalogue of specific training and technical assistance programs designed to meet specific competency objectives offers support to facilities as they address their identified targeted CDI goal areas.. These training opportunities are offered to facilities based on the connection to their specific facility goals. Programs are not offered as training for training sake. CDI representatives are encouraged to think beyond traditional participants and invite staff from other areas of the facility as well as their community partners to attend the quarterly meetings; participate in the annual conference; and/or attend CDI sponsored training sessions.

The team’s next challenge was to “Shake It Up”, across the facility in ways that would expand the existing acceptance of typical approaches used to achieve vocational goals. Facility staff were encouraged to identify alternative methods to helping people using recovery-oriented services think about and move toward employment. This requires looking at employment in different ways. It involved challenging treatment teams to consider the role of employment in recovery and to look beyond traditional job development in assisting individuals secure work.

In response, facilities began to advocate for the role of employment in recovery with their administration as well as with the clinical teams. Employment fairs were held in various locations to increase the visibility of work, newsletters were started, and some vocational service programs changed course to secure more competitive employment opportunities rather than relying solely on traditional non-integrated forms of work. Some facilities began exploring the world of self-employment with individuals desiring to start their own businesses. Small start-up grants were offered to individuals with sound business plans. Employment proposals, rather than traditional resumes, have been popping up to market the unique skills of the individuals we serve.

Currently, the CDI is focused on “Extending the Table”, reaching out within and outside the traditional walls to discuss employment and share approaches with clinical staff as well as our community partners who share this journey with us. At the last annual conference in March, many community partners joined the CDI teams to look more closely at the work we are embarking on and to return to the soul of our work. Returning to the reasons we, as providers, got into this work in the first place is a key to genuinely connecting with the spirit of each individual we work with to get at their passion and how to connect that passion to the world of work. In the end, it is not only about money that can be poured into developing work outcomes, but it is really the relationship to the individual and his/her dream that is essential to achieving employment success.

Standing side-by-side an individual, understanding the personal reasons for work and maintaining a positive perspective are essential in helping get and keep employment. We believe the inclusive approach of the CDI is a positive step toward achieving success.

For more information, you are welcome to contact your local state facility CDI representative in their Rehabilitation Department to see how you can connect to what has become an exciting and dynamic process.

Carol Blessing, LMSW is a member of the faculty of the Employment Disability Institute of Cornell University. John Allegretti- Freeman, LCSW-R is Director of Community and Rehabilitation Services, State Facility Operations at the New York State Office of Mental Health.