Building Bridges for Building Bridges for EmploymentEmployment

Presented byPresented byAndy Sink, Liam McNabb and Jill Dorsi, NYS Office of Mental HealthAndy Sink, Liam McNabb and Jill Dorsi, NYS Office of Mental Health

Dan O’Shea, ACCES-VRDan O’Shea, ACCES-VR&&

Crystal Collins, Northeast Career Planning/PROS on BroadwayCrystal Collins, Northeast Career Planning/PROS on BroadwayAPSE Conference, May 2014APSE Conference, May 2014

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• 78% of people who are diagnosed with a 78% of people who are diagnosed with a serious mental illness are unemployed serious mental illness are unemployed

(2006)(2006)• This rate is lower than for people with other This rate is lower than for people with other

disabilities disabilities (30% employed vs 22%)(30% employed vs 22%)

• Stigma and misunderstanding of mental Stigma and misunderstanding of mental illness present a significant barrier to illness present a significant barrier to

employmentemployment

Employment and Mental IllnessEmployment and Mental Illness

SAMSHA Employment Intervention SAMSHA Employment Intervention Demonstration Program Demonstration Program

5 year study of employment programs 5 year study of employment programs nationwide evaluated a variety of supported nationwide evaluated a variety of supported employment approachesemployment approaches

Most successful outcomes occurred when:Most successful outcomes occurred when:programs integrated mental health services with programs integrated mental health services with

vocational servicesvocational services focused on rapid placement into jobs of the focused on rapid placement into jobs of the

person’s choiceperson’s choicecollaboration between the support providers and collaboration between the support providers and

the businesses employing the individualsthe businesses employing the individuals

Source: Supported Employment: a guide for mental health planning and advisory councils. www.samsha.gov

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Through integration and collaboration multiple Through integration and collaboration multiple barriers to employment can be overcomebarriers to employment can be overcome

Updates on Collaboration EffortsUpdates on Collaboration Efforts

Improved lines of communication between VR Improved lines of communication between VR Counselors and PROS practitionersCounselors and PROS practitioners

Worked together to update PROS Guidance Worked together to update PROS Guidance Documents for implementing ACCES-VR Documents for implementing ACCES-VR supports in combination with PROS Servicessupports in combination with PROS Services

ACCES-VR staff have presented at OMH Field ACCES-VR staff have presented at OMH Field Offices and with PROS providers and PROS staff Offices and with PROS providers and PROS staff have provided training to VR Counselorshave provided training to VR Counselors

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What we discovered…What we discovered… PROS is able to integrate mental health PROS is able to integrate mental health

supports in conjunction with supports supports in conjunction with supports provided to people through ACCES-VRprovided to people through ACCES-VR

Liaison connections between the PROS Liaison connections between the PROS and ACCES-VR office are essential to and ACCES-VR office are essential to seamless integrationseamless integration

How to coordinate ACCES-VR CRS How to coordinate ACCES-VR CRS Milestone Payments with PROS Ongoing Milestone Payments with PROS Ongoing Rehabilitation and Supports (ORS)Rehabilitation and Supports (ORS)

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What is PROS?What is PROS? Personalized Recovery-Oriented ServicesPersonalized Recovery-Oriented Services

Rehabilitation program with a treatment componentRehabilitation program with a treatment component

Core Value: Recovery is a reality for people with Core Value: Recovery is a reality for people with severe and persistent mental illnesssevere and persistent mental illness

PROS provides individualized services and PROS provides individualized services and interventions to support employmentinterventions to support employment

PROS Services and ACCES-VR Supports can work PROS Services and ACCES-VR Supports can work together to achieve employment goalstogether to achieve employment goals

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PROS Services that can be used PROS Services that can be used to support employmentto support employment

Intensive Rehabilitation Goal AcquisitionIntensive Rehabilitation Goal AcquisitionBenefits and Financial ManagementBenefits and Financial ManagementMedication ManagementMedication ManagementIntensive Relapse PreventionIntensive Relapse PreventionBasic Living Skills Basic Living Skills Structured Skill DevelopmentStructured Skill DevelopmentClinical Treatment Services/Health Clinical Treatment Services/Health

AssessmentAssessment

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Supporting PROS Participants Supporting PROS Participants who don’t have Medicaidwho don’t have Medicaid

Lack of Medicaid coverage DOES NOT prevent a Lack of Medicaid coverage DOES NOT prevent a person from receiving PROS Servicesperson from receiving PROS Services

Net deficit fundingNet deficit funding: PROS providers receive : PROS providers receive funding to offset providing supports to individuals funding to offset providing supports to individuals

without Medicaidwithout Medicaid

Sliding fee scalesSliding fee scales: PROS providers must charge : PROS providers must charge for PROS Services but can use a sliding scale to for PROS Services but can use a sliding scale to

make services affordablemake services affordable

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Managing Benefits to Support Managing Benefits to Support EmploymentEmployment

PROS Service: Benefits and Financial PROS Service: Benefits and Financial Management can provide informationManagement can provide information

Learn about SSI -budgeting protocol includingLearn about SSI -budgeting protocol includingPASS: Plan to Achieve Self SupportPASS: Plan to Achieve Self SupportIRWE: Impairment Related Work ExpensesIRWE: Impairment Related Work ExpensesMedicaid Buy-in: Allows individuals to work Medicaid Buy-in: Allows individuals to work

and continue to access Medicaid health and continue to access Medicaid health coveragecoverage

Hand-out: web addresses for more informationHand-out: web addresses for more information

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ACCES-VR MILESTONES & ACCES-VR MILESTONES & PROS ORSPROS ORS

How do the new ACCES-VR Milestone How do the new ACCES-VR Milestone Supported Employment payments work with Supported Employment payments work with PROS ORS?PROS ORS?

Assuring milestone payments are billed before Assuring milestone payments are billed before any ORS (extended services) are providedany ORS (extended services) are provided

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Quality Outcome PaymentsQuality Outcome Payments Incentive payment for providers Incentive payment for providers

Bonus to provider for obtaining Bonus to provider for obtaining employment at higher hourly wage employment at higher hourly wage and/or more than 30 hours/weekand/or more than 30 hours/week

Bonus payment and ORS: conflicts?Bonus payment and ORS: conflicts?

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Coordinating Supports Coordinating Supports through “non-PROS” Agenciesthrough “non-PROS” Agencies What happens when a non-PROS agency What happens when a non-PROS agency

provides ACCES Intensive Supports and provides ACCES Intensive Supports and a PROS provides ongoing supports?a PROS provides ongoing supports?

Example: Putnam CountyExample: Putnam County

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Additional ACCES-VR ServicesAdditional ACCES-VR Services Education: college tuition and room and board; Education: college tuition and room and board;

vocational training vocational training – Work Try-Outs (WTO) & On The Job Training (OJT) Work Try-Outs (WTO) & On The Job Training (OJT)

Career counseling & guidanceCareer counseling & guidance Rehabilitation & assistive technologyRehabilitation & assistive technology Assessment to identify skills, interests, abilities, Assessment to identify skills, interests, abilities,

and limitationsand limitations Job placement and job retentionJob placement and job retention

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Best Practices: Best Practices: Northeast Career PlanningNortheast Career Planning

Identifying point person/liaison at ACCES-VR Identifying point person/liaison at ACCES-VR local office: makes collaboration easier and local office: makes collaboration easier and more effectivemore effective

Referrals go both ways: PROS to ACCES-VR; Referrals go both ways: PROS to ACCES-VR; ACCES-VR to PROS: identify barriers to ACCES-VR to PROS: identify barriers to employment and necessary supportsemployment and necessary supports

Invite local ACCES-VR office into PROS to share Invite local ACCES-VR office into PROS to share information with participants and practitionersinformation with participants and practitioners

Providing ORS to people who don’t have Providing ORS to people who don’t have MedicaidMedicaid

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PRINCIPLES INFORMING PRINCIPLES INFORMING PRACTICEPRACTICE

For the first time, the OMH model of For the first time, the OMH model of choice is a rehabilitation modelchoice is a rehabilitation modelImplementing IPS and Supported Implementing IPS and Supported Employment principles in your PROS is Employment principles in your PROS is not only possible, it’s a must! not only possible, it’s a must! Unique opportunity for doing Unique opportunity for doing real real rehab…rehab…

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Overlapping Circles of SupportOverlapping Circles of Support PROS and PROS and

Supported Supported Employment Employment programs overlap programs overlap

No wrong door of No wrong door of entryentry

PROS and ACCES-PROS and ACCES-VR Services can VR Services can be simultaneousbe simultaneous

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SOCIALSUPPORTS

HOUSINGSUPPORTS

SOCIALIZE

LIVE

PROSEMPLOYMENTSERVICES WORK EDUCATION

SUPPORTSLEARN

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Working together improves employment outcomes

Discussion & CommentsDiscussion & Comments