Comparative Employment Strategies for Serving Individuals with Significant or Most Significant...

Comparative Employment Strategies for Serving Individuals with Significant or Most

Significant Disabilities:

Customized Employment and Evidence-based Supported

Employment

David W LyndeSupported Employment Consultant

Michael CallahanMarc Gold & Associates (MG&A)

November 7, 2012

Evidence – Based Supported Employment

David W Lynde, MSW

Supported Employment Consultant

TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012

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Overview

• Principles of Evidence Based Supported Employment

• Supported Employment/Individual Placement and Support as an Evidence Based Practice

• Supported Employment Fidelity Scale Items


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Principles of Supported Employment

• Helping people obtain competitive employment is the goal

• Participating in SE is based on each person’s own choice

• SE is integrated with other mental health services


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• Each person has access to good work incentive planning information

• SE helps people find real jobs soon after they start the program, not requiring lengthy assessments or job trials


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• Each person’s goals and preferences regarding work are honored

• SE helps people to be successful at work through follow along supports

• Employment specialists use systematic job development strategies


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Definition of Competitive Employment

• A job in the competitive labor market that is performed on a full-time or part-time basis in an integrated setting; and

• For which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals who are not disabled


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Competitive Employment Is the Goal

• Each person is helped to find their own competitive job, one that they own, where they receive the paycheck directly from the employer


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Competitive Employment Is the Goal

• People are not steered into accepting jobs in pre-arranged job slots

• People are not directed into sheltered workshops, lengthy vocational assessments or working in job enclaves

• Jobs are identified or developed to fit each person’s individual job goals and job preferences


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Participating in SE: A Person’s Own Choice

• SE services are provided to all people who identify themselves as having competitive employment as a recovery goal


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Low Expectations

Research about the low expectations of mental health professionals in relation to people with mental health conditions gaining employment is now very well documented. These expectations are often underpinned by concern about issues of risk, stress and relapse. Such low expectations … can result in them and their families receiving very cautious messages from mental health professionals about gaining employment. Rinaldi, Miles, Killackey, Eoin; et al. First episode psychosis and

employment: A review. International Review of Psychiatry


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Participating in SE: A Person’s Own Choice

• People are not excluded from SE because of diagnosis, symptoms or other agency imposed rules

• People are not excluded because of the mental health providers own biases about who is and who is not ready for employment


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“Work Ready”

“I was going to a day treatment program forever. I was waiting to be anointed by someone that I was ‘work ready’.”

Maureen Marrin


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Supported Employment Is Integrated with Mental Health Treatment

Each person in SE receives integrated mental health services. Employment specialists work in an integrated way with the other members of the person’s mental health treatment team (for example, case manager, peer supports, therapist, psychiatrist, etc…).


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“I want to live my life not my disability”

Pat Deegan


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People Access IndividualizedWork Incentive Planning

• Each person in SE has access to good, accurate work incentive planning that is based on their individual situation

• Work incentive planning helps people to determine what role benefits will play in their recovery


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People Access IndividualizedWork Incentive Planning

• People are empowered to make their own choices about benefits and are not directed to “earn less than SGA”

• What works best for the person is their own personal choice


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People Receive Timely Job Search Services

• When people start SE, their goals to obtain competitive jobs are respected

• People are not required to participate in pre-employment assessments, job-hardening activities, or trial work periods


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Each Person’s Goals and Preferences are Honored

• People are helped to find work that matches with their individual work goals, preferences, strengths, and work experiences

• People are not directed into other pre-vocational tasks to prove they want to work


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Employed People Receive Follow-Along Supports

• The employment specialist and the mental health center help employed people to be successful at work by providing follow along supports for employment

• Follow along supports are based on each individual’s unique situation and needs


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Systematic Job Development

• Employment specialists develop direct relationships with employers, based upon clients’ work goals, by meeting face-to-face over multiple visits in the community

• Employment specialists learn about the work environment and the employers’ work needs in order to match clients with employers

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Supported Employment

An Evidence-Based Practice for Adults with Mental Illness


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Evidence Based Practice Definition (Mental Health Practices)

• Practice is manualized

• Practice has a fidelity scale

• Practice has demonstrated success helping consumers with their goals in published research trials

• Research trials have been done by more than one researcher with good outcomes

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16 Trials of Supported Employment

• 4 conducted before Individual Placement and Support (IPS) model was developed

• 11 used full implementation of IPS

• 1 studied supported employment on an ACT team

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Competitive Employment Rates in 16 Randomized Controlled Trials of Supported Employment


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www.samhsa.gov

Search Supported Employment Toolkit

SAMSHA’S National Health Information Center

http://www.samhsa.gov/


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Dartmouth Supported Employment Web Site

http://www.dartmouth.edu/~ips/

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Evidence Based Supported Employment Fidelity Scale

Overview


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Fidelity Scale Structure

3 Components1. Staffing

2. Organization

3. Services


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Fidelity Scale Structure - Staffing

1. Caseload Size • Maximum is 20 clients

2. Vocational Services• Primarily provide SE services only

3. Vocational Generalists• Provide all phases of employment process


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Fidelity Scale Structure - Organization

1. Integration of rehabilitation with mental health thru team assignment

2. Integration of rehabilitation with mental health thru frequent team member contact


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3. Collaboration between employment specialists and Vocational Rehabilitation counselors

4. Vocational unit Meets at least once a week

5. Role of employment supervisor Supervisors team members, sets goals


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6. Zero exclusion criteria

7. Agency focuses on competitive employment

8. Agency leadership team provides support for SE


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Fidelity Scale Structure - Services

1. Work incentives planning

2. Disclosure decisions about job search and supports

3. Ongoing, work-based vocational assessment Develop Vocational Profiles with clients


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4. Rapid search for competitive job Within about one month

5. Individualized job search

6. Job development—Frequent employer contact Minimum 6 contacts per week

7. Job development—Quality of employer contact


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8. Diversity of job types

9. Diversity of employers

10. Competitive jobs

11. Individualized follow-along supports Based on person’s needs and challenges


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12.Time-unlimited follow-along supports Until client not longer needs supports

13.Community-based services 65% of employment specialist time in the

community

14.Assertive engagement and outreach by integrated treatment team


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Assuring that “All” means All:Customized, Supported

Employment

A concept and process for insuring access to successful employment for all

Michael CallahanMarc Gold & Associates (MG&A)


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Customized Employment

Customized Employment provides a business-friendly strategy to assist job seekers with significant disabilities, who find competitive demand a barrier to paid work in the community, a process that avoids job openings in favor of a negotiated relationship based on mutual benefit.


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According to US/DOL:Customized employment means individualizing the employment relationship between employees and employers in ways that meet the needs of both.

It is based on an individualized determination of the strengths, needs, and interests of the person with a disability, and is also designed to meet the specific needs of the employer.


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Unbundling demand

Employers have typically met needs by bundling demands into job descriptions.

Job seekers with complex lives often don’t have the “whole package” to offer.

Customized Employment allows employers to “unbundle” demand and to take advantage of discrete competencies.


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Customized Employment History

• Started in late 1980’s through projects by United Cerebral Palsy and others who recognized demand employment as a barrier.

• Based on Job Carving and Restructuring

• During the 1990’s CE was referred to as Negotiated Supported Employment

• The term Customized Employment was coined by ODEP/USDOL in 2001


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Customized Employment History

• ODEP funded 36 national projects from 2001 -2007 that featured CE as the central theme

• WestStat completed research on the ODEP CE projects 2007

• ODEP funded ICF to research the KSAO’s (knowledge, skills , abilities and other characteristics)of CE in 2009

• Wisconsin DVR included CE process in its technical specifications for supported employment in 2010


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The Job Seeker’s side of the Equation

• Conditions for Success

• Interests toward an aspect of the Labor Market

• Potential Contributions to Employers


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The Employer Side: Needs/Benefits Analysis

Unmet Workplace Needs:This area focuses on tasks that need to get done but are not getting done in the way the employer would like. It also can include tasks that have not been performed but need to be.Tasks better performed by others:This area focuses on aspects of jobs that might better be performed by others at a lower pay grade. This option can directly save money for employers.Specific Benefit/ Productivity:This area focuses on workplace needs for additional productivity in specific tasks. It must be matched with job seeker’s specific competencies.


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Balancing the Customized Equation

Customized employment seeks to balance the equation between Job Seekers and Employers

Job Seeker

• Conditions

• Interests

• Contributions

Employer

• Unmet needs

• Tasks better performed by others

• Specific benefit

=


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The Employment Matrix

There are job seekers who will not need either SE or CE to become employed and to stay employed

There are job seekers who will need CE to become employed but will not need SE to stay employed

There are job seekers who will not need CE to become employed but who will need SE to stay employed

There are job seekers who will need both CE to become employed and SE to stay employed

Natural Supports and Reasonable

Accommodation only

Supported Employment and Natural Supports

Competitive Employment



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Features of Customized Employment

• Based on discovery of the applicant more than on evaluative/comparative processes

• Driven by a customized plan developed by the applicant’s strengths, needs and interests

• Focuses on tasks rather than job titles to negotiate essential responsibilities


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• Specific job duties are negotiated with employers, voluntarily, to customize the job

• Occurs in regular community workplaces or in self-owned businesses

• Involves pay of at least the minimum wage up to prevailing wage


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• Applicable to all users of workforce system

• Includes on-going supports and reasonable accommodations, as appropriate

• Starts with the individual as the source of information and direction to labor force


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Customized Process

• Discovery• Capturing discovery through profiles• Customized, person-centered planning• Portfolio/visual resume development• Job development and negotiation

Here, CE dovetails with Supported Employment

• Job site analysis, accommodations, support


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CE: An outcome based process

Each aspect of the CE process is designed to be compatible with evidence-based research and outcome-based payment systems.

Outcome products, how-to materials, step-by-step procedures, narrative manuals and support materials and data collection processes have been developed, implemented and studied.


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Outcome products of CE

• Discovery: Discovery logs, discovery notes• Profiles: Profile forms, samples and guides• Customized Planning Meeting: Plan worksheets,

proposed blueprint for job development, proposed task list, specific employer list

• Representational materials: Visual Resume, Agency Portfolio

• Job Development and Negotiation: Employer needs analysis form and sample, employer contact sheets, blueprint indicating features of actual job developed


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Sample Outcome Payments of CE

• Discovery: $600 - $1,000• Profile: $200 - $300• Customized Plan for Employment: $250• Visual Resume Development: $250• Employer Needs Analysis: $250• Job Development Calls based on Plan:

$75/each• Job Development Outcome payment at Day

One: $1,000 - $1,500


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Final Analysis

Although to this point Customized Employment has not been studied with the rigor to indicate its status as an evidence-based process, the years of successful utilization coupled with the outcome-based structure presented here merits its use as an effective approach to employment for those who fail assessments and are excluded from demand job openings.


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Comments & Questions


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5757

Thank You


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Contact Information

David W LyndeSupported Employment ConsultantEmail: [email protected]

Michael CallahanMarc Gold & Associates (MG&A)Email: [email protected]


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Education CreditsCRCC Credit - (2.0)Approved by Commission on Rehabilitation Counselor

Certification (CRCC) • By November 17, 2012, participants must score 80%

or better on a online Post Test and submit an online CRCC Request Form via the MyTACE Portal.

My TACE Portal: TACEsoutheast.org/myportal


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6060

Southeast TACE Region IV

Toll-free: (866) 518-7750 [voice/tty]

Fax: (404) 541-9002

Web: TACEsoutheast.org

My TACE Portal: TACEsoutheast.org/myportal

Email: [email protected]


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Disclaimer

This presentation was developed by the Southeast TACE Center: Region IV ©2012 with funds from the U.S. Department of Education, Rehabilitation Services Administration (RSA) under the priority of Technical Assistance and Continuing Education Projects (TACE) – Grant #H264A080021. However, the contents of this presentation do not necessarily represent the policy of the RSA and you should not assume endorsement by the Federal Government [34 CFR 75.620 (b)].

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