IF EVERYONE’S IF EVERYONE’S ALREADY ALREADY DOING IT, DOING IT, HOW COME IT HOW COME IT NEVER GETS NEVER GETS

DONE ???DONE ???

““I feel so I feel so miserable without miserable without you, it's you, it's

almost like almost like having you here."having you here."

Stephen BishopStephen Bishop

JOE MARRONEJOE MARRONEINSTITUTE FOR COMMUNITY INCLUSIONINSTITUTE FOR COMMUNITY INCLUSION

MAIN OFFICE: BOSTON, MAMAIN OFFICE: BOSTON, MA

NW OFFICENW OFFICE::

4517 NE 394517 NE 39THTH AVENUE AVENUE

PORTLAND, OR 97211-8124PORTLAND, OR 97211-8124

TELTEL: 503-331-0687: 503-331-0687

HOME TELHOME TEL: 503-331- 0486: 503-331- 0486

FAXFAX: 503-961-7714: 503-961-7714

EMAILEMAIL: JM61947@AOL.COM : JM61947@AOL.COM

WEBWEB:: WWW.COMMUNITY INCLUSION.ORG WWW.COMMUNITY INCLUSION.ORG

WWW.STATEDATA.INFO

WWW.SELN.ORG

“ “ ALL CHANGE IS DIFFICULT –ALL CHANGE IS DIFFICULT –NO MATTER HOW LONG YOU NO MATTER HOW LONG YOU

PUT IT OFF. “PUT IT OFF. “

------ JOE ------ JOE MARRONEMARRONE

“ “ BEFORE PRACTICING BEFORE PRACTICING VIRTUE FIRST VIRTUE FIRST SECURE AN SECURE AN

INDEPENDENT INDEPENDENT INCOME.“INCOME.“

GREEK PROVERB

“ “ HE WHO SPEAKS HE WHO SPEAKS THE TRUTH SHOULD THE TRUTH SHOULD ALWAYS HAVE KEEP ALWAYS HAVE KEEP

ONE FOOT IN THE ONE FOOT IN THE STIRRUP. “STIRRUP. “

TURKISH PROVERB

MARRONE MARRONE

IN IN

FULL CRANK FULL CRANK

MODEMODE

TERRY PRATCHETT

"I'll be more enthusiastic about encouraging thinking

outside the box when there's evidence of any

thinking going on inside it. “ 

AK COUNSELORAK COUNSELOR

“ “ WE KNOW ALL THIS WE KNOW ALL THIS STUFF. STUFF.

JUST BECAUSE WE JUST BECAUSE WE DON’T DO IT,DON’T DO IT,

DOESN’T MEAN WE DOESN’T MEAN WE DON’T KNOW IT !!! “DON’T KNOW IT !!! “

WORK IS A CITIZENSHIP WORK IS A CITIZENSHIP RESPONSIBILITY NOT RESPONSIBILITY NOT

JUST AN “OPPORTUNITY”JUST AN “OPPORTUNITY”

SOCIAL POLICY OUTCOMES HAVE TO INCLUDE MORE

THAN CLIENT SELF DEFINED QUALITY OF LIFE

INDICATORS

EXAMPLE: DROP OUT PREVENTION EFFORTS

IF EMPLOYMENT IS IF EMPLOYMENT IS FIRST FIRST WHAT IS SECOND?WHAT IS SECOND?

SHOULDN’T WE BEGIN SHOULDN’T WE BEGIN TO SEE EMPLOYMENT TO SEE EMPLOYMENT AS AN OUTCOME NOT AS AN OUTCOME NOT A SERVICE STREAM?A SERVICE STREAM?

WHY DON’T WE SEEK TO WHY DON’T WE SEEK TO HELP AND ENCOURAGE HELP AND ENCOURAGE

PEOPLE TO GET OFF PEOPLE TO GET OFF SSA AND SSA AND

WELFARE?WELFARE?

IF INDIVIDUAL FUNDING IF INDIVIDUAL FUNDING AND FISCAL CONTROL AND FISCAL CONTROL OCCURS SHOULDN’T OCCURS SHOULDN’T

QUALITY ASSURANCE QUALITY ASSURANCE LOSE RELEVANCE? LOSE RELEVANCE?

DO WE WORRY TOO DO WE WORRY TOO MUCH ABOUT MUCH ABOUT VALUES - STIGMA VS VALUES - STIGMA VS

BEHAVIOR - BEHAVIOR -

DISCRIMINATION?DISCRIMINATION?

WHATEVER HAPPENED TO WHATEVER HAPPENED TO A JOB WITHOUT JARGON?A JOB WITHOUT JARGON?

WHY ARE HIGHER WHY ARE HIGHER OUTCOMES/ OUTCOMES/

EXPECTATIONS NOT EXPECTATIONS NOT ENDORSED BY ADVOCATES ENDORSED BY ADVOCATES RATHER THAN FEARED AS RATHER THAN FEARED AS

“CREAMING”?“CREAMING”?

DON’T THERE NEED TO BE DON’T THERE NEED TO BE WINNERS AND LOSERS WINNERS AND LOSERS OR ELSE OR ELSE

HAS ANYTHING HAS ANYTHING CHANGEDCHANGED??

HASN’T THERE BEEN MORE HASN’T THERE BEEN MORE CHANGE IN CHANGE IN

WELFARE REFORM IN LESS WELFARE REFORM IN LESS THAN A DECADE THAN IN THAN A DECADE THAN IN

SUPPORTED EMPLOYMENT SUPPORTED EMPLOYMENT IN 20+ YEARS?IN 20+ YEARS?

WHY WEREN’T GROUPS WHY WEREN’T GROUPS LIKE APSE FULLY BEHIND LIKE APSE FULLY BEHIND DOING AWAY WITH SUB DOING AWAY WITH SUB MINIMUM WAGE (E.G., MINIMUM WAGE (E.G.,

AZ)?AZ)?

WHY CAN’T MH AND DD WHY CAN’T MH AND DD SYSTEM ADVOCATES WORK SYSTEM ADVOCATES WORK

TOGETHER MORE ON TOGETHER MORE ON EMPLOYMENT - BIAS ON EMPLOYMENT - BIAS ON

BOTH SIDES (W.SAME POOR BOTH SIDES (W.SAME POOR RESULTS = 20-25%)?RESULTS = 20-25%)?

DO WE HAVE TOO MANY DO WE HAVE TOO MANY PLANS AND SUMMITS AND PLANS AND SUMMITS AND

CENTERS OF CENTERS OF EXCELLENCE AND NOT EXCELLENCE AND NOT

ENOUGH SIMPLE MEASURES ENOUGH SIMPLE MEASURES OF SUCCESS TO GUIDE US?OF SUCCESS TO GUIDE US?

WHAT TYPES OF EMPLOYMENT OPTIONS SHOULD WE

ENCOURAGE?

ANY? SOME? ALL?

KEYS ARE REAL ECONOMIC ENGAGEMENT, RESOURCES, AND CITIZENSHIP NOT JUST SERVICE INTERVENTIONS

YOU CAN HAVE YOU CAN HAVE A JOB A JOB

WITHOUT A CAREER WITHOUT A CAREER BUT BUT

YOU YOU CAN’T HAVE CAN’T HAVE

A CAREER A CAREER WITHOUT A JOB! WITHOUT A JOB!

(YOU CAN’T DISCOVER (YOU CAN’T DISCOVER WHAT ISN’T THERE)WHAT ISN’T THERE)

REMAINING UNEMPLOYED IS REMAINING UNEMPLOYED IS WORSE FOR YOU THAN BEING WORSE FOR YOU THAN BEING EMPLOYED IS GOOD FOR YOU.EMPLOYED IS GOOD FOR YOU.

AVOIDING LONG TERM AVOIDING LONG TERM UNEMPLOYMENT IS A BETTER UNEMPLOYMENT IS A BETTER

OPTION THAN WAITING FOR AN OPTION THAN WAITING FOR AN IDEAL OR PERFECT JOB MATCH.IDEAL OR PERFECT JOB MATCH.

“ I CAN’T UNDERSTAND WHY PEOPLE ARE FRIGHTENED OF NEW IDEAS; I’M FRIGHTENED

OF THE OLD ONES.”

JOHN CAGE, COMPOSER

VISION OF INCLUSIONVISION OF INCLUSIONJOE MARRONE

IS WORK THE MOST IMPORTANT PART OF LIFE FOR EVERYONE?

NO. BUT IT IS THE MOST IMPORTANT PART OF LIFE

THAT WE IN HUMAN SERVICES ARE LEAST SUCCESSFUL AT

HELPING OUR CONSTITUENCY ACHIEVE.

VISION OF RECOVERYVISION OF RECOVERY

““Increasing employment Increasing employment for people with mental for people with mental illness is one of the illness is one of the most urgent priorities in most urgent priorities in today’s mental health today’s mental health system” system” Mike HoganMike Hogan

((excerpted from the Ohio Employment excerpted from the Ohio Employment Leadership Alliance brochureLeadership Alliance brochure).).

““LIFE LIVED WITHIN THE LIFE LIVED WITHIN THE CONFINES OF THE HUMAN CONFINES OF THE HUMAN

SERVICE & SERVICE & REHABILITATION REHABILITATION

LANDSCAPE IS A LIFE IN LANDSCAPE IS A LIFE IN WHICH THE FREEDOM TO WHICH THE FREEDOM TO BECOME & MAKE YOUR BECOME & MAKE YOUR

OWN FUTURE IS OWN FUTURE IS DIMINISHED”DIMINISHED”

PATRICIA DEEGANPATRICIA DEEGAN20th World Congress Rehab International: Oslo, 20th World Congress Rehab International: Oslo,

Norway – JUNE 2004Norway – JUNE 2004

I WORRY ABOUT:I WORRY ABOUT:

DISCRIMINATION NOT STIGMA BEHAVIOR NOT ATTITUDE CITIZENSHIP/CIVIL RIGHTS NOT

CONSUMERISM POWER/CONTROL NOT

CONSUMERISM COMPETENCY NOT COURTESY ECONOMIC ENAGAGEMENT/

JOBS/ CAREERS NOT VOCATIONAL PROGRAMMING

OUTCOMES THAT SHOULD BE OUTCOMES THAT SHOULD BE SOUGHT IF INCLUSION IS MORE SOUGHT IF INCLUSION IS MORE

THAN A SLOGAN THAN A SLOGAN

“ Transparent and measurable indicators of care indicators of care

should be used as a basis for should be used as a basis for quality quality improvement and improvement and

for accountability.” for accountability.”

2008 Interim Report 2008 Interim Report NY Statewide Comprehensive Plan NY Statewide Comprehensive Plan for Mental Health for Mental Health

ServicesServices

OUTCOMES THAT SHOULD BE OUTCOMES THAT SHOULD BE SOUGHT IF INCLUSION IS MORE SOUGHT IF INCLUSION IS MORE

THAN A SLOGAN THAN A SLOGAN

Employment and educational outcomesEmployment and educational outcomes Housing outcomesHousing outcomes For people w. MI: For people w. MI:

Course of illness, including Course of illness, including hospitalizations & distressing symptoms hospitalizations & distressing symptoms and/ or self - injurious behaviorand/ or self - injurious behavior

Community participation/ citizenshipCommunity participation/ citizenship Less Public Income supportLess Public Income support Client satisfaction with their own livesClient satisfaction with their own lives Client satisfaction with servicesClient satisfaction with services

PETER DRUCKERPETER DRUCKER

“ THE MOST IMPORTANT THING

IN COMMUNICATION IS TO HEAR WHAT IS

NOT BEING SAID”

OUTCOMES THAT SHOULD BE SOUGHT IN COMMUNITY SERVICES

BECOMING A BETTER PERSON AND BECOMING A BETTER PERSON AND “SELF REALIZATION” IS “SELF REALIZATION” IS

THE PERSON’S THE PERSON’S RESPONSIBILITY.RESPONSIBILITY.

HELPING PEOPLE GET EMPLOYED, HELPING PEOPLE GET EMPLOYED, GET HOUSING, STAY OUT GET HOUSING, STAY OUT

OF HOSPITAL (& JAIL) AND OF HOSPITAL (& JAIL) AND REDUCE SYMPTOM IMPACT ARE REDUCE SYMPTOM IMPACT ARE

STAFF’S RESPONSIBLITIES IN STAFF’S RESPONSIBLITIES IN PARTNERSHIP WITH THE PERSON.PARTNERSHIP WITH THE PERSON.

CHARLES MCCABE

"Any clod can have the facts, but

having opinions is an art."

 

IF PEOPLE

CANCAN WORK

PEOPLE

SHOULDSHOULD WORK

MARRONE EASY QUESTION

IS IT BETTER TO WORK 2-3 HOURS A WEEK IS IT BETTER TO WORK 2-3 HOURS A WEEK AT SOMETHING A PERSON LIKES AT SOMETHING A PERSON LIKES THAN 15-20 HOURS WEEK (OR THAN 15-20 HOURS WEEK (OR

MORE) JUST TO MAKE A MORE) JUST TO MAKE A LIVING?LIVING?

SIMPLE ANSWER: SIMPLE ANSWER: NONO

HOW DO YOU ANSWER THIS QUESTION FOR HOW DO YOU ANSWER THIS QUESTION FOR YOURSELF OR YOUR LOVED ONES?YOURSELF OR YOUR LOVED ONES?

“ “ Ships are safe in harbor,Ships are safe in harbor,but that is not but that is not

what ships are built for. “what ships are built for. “

------ Anonymous------ Anonymous

• MOST CRPS PROVIDED WORK/ NONWORK MAJORITY OF EMPLOYMENT SERVICES - - INTEGRATED AND FACILITY-BASED INDIVIDUALS WITH DD/ID MOST LIKELY IN:

1] FACILITY-BASED WORK (41%)2] NONWORK SERVICES (33%)3] INTEGRATED EMPLOYMENT (26%).

Metzel, Boeltzig, Butterworth, Sulewski, and Gilmore (2007) Achieving Community Membership Through Community: Rehabilitation Provider Services: Are We There Yet?Intellectual And Developmental Disabilities, 45[3],149–160

• MOST CRPS PROVIDED WORK/ NONWORK MAJORITY OF EMPLOYMENT SERVICES - - INTEGRATED AND FACILITY-BASED INDIVIDUALS WITH DD/ID MOST LIKELY IN:

1] FACILITY-BASED WORK (41%)2] NONWORK SERVICES (33%)3] INTEGRATED EMPLOYMENT (26%).

Metzel, Boeltzig, Butterworth, Sulewski, and Gilmore (2007) Achieving Community Membership Through Community: Rehabilitation Provider Services: Are We There Yet?Intellectual And Developmental Disabilities, 45[3],149–160

US MH SYSTEMS EMPLOYMENT FIGURES 2006

OVERALL = OVERALL = 21-21-22%22%

18 - 20 YO = 17.9%18 - 20 YO = 17.9%

21- 64 = 21- 64 = 23%23%

65+ = 65+ = 6.8%6.8%

Poverty Rates by Poverty Rates by DisabilityDisability

In 2006, people with mental In 2006, people with mental disabilities had a poverty rate of disabilities had a poverty rate of 32.5% compared to 24% for people 32.5% compared to 24% for people with any type of disability and 9.1% with any type of disability and 9.1% for people without disabilities.for people without disabilities.

People with mental disabilities have People with mental disabilities have the highest rate of poverty than any the highest rate of poverty than any other disability group listed in the other disability group listed in the American Community Services dataset American Community Services dataset from the U.S. Census.from the U.S. Census.

Source: Houtenville, 2006Source: Houtenville, 2006

Employment Rates of Employment Rates of People with Mental People with Mental DisabilitiesDisabilities

In 2004, 28.8% of In 2004, 28.8% of people with mental people with mental disabilities were disabilities were employedemployed

In 2004, 37.7% of In 2004, 37.7% of people with any people with any disability were disability were employedemployed

In 2006, 79.7% of In 2006, 79.7% of people without a people without a disability were disability were employedemployed

Source Houtenville 2006 Source Houtenville 2006 Disability Status Disability Status ReportReport

Full-Time Full Year Full-Time Full Year EmploymentEmployment In 2006, 13.7% of people with mental disabilities In 2006, 13.7% of people with mental disabilities

were employed compared to 21.7% of people were employed compared to 21.7% of people with any type of disability and 56.6% of people with any type of disability and 56.6% of people without disabilities.without disabilities.

Median HOUSEHOLD income for people with Median HOUSEHOLD income for people with mental disabilities was $28,700 in 2006 mental disabilities was $28,700 in 2006 compared to $65,400 for people with any compared to $65,400 for people with any disability and $35,000 for people without a disability and $35,000 for people without a disability HOWEVER…disability HOWEVER…

Median INDIVIDUAL income for people with Median INDIVIDUAL income for people with mental disabilities was $26,900 compared to mental disabilities was $26,900 compared to 30,000 for people with any disability and $37,000 30,000 for people with any disability and $37,000 for people without a disability. for people without a disability.

Source Houtenville, 2006 Disability Status ReportSource Houtenville, 2006 Disability Status Report

(DOWN FROM 2004 !)

UNEMPLOYMENT UNEMPLOYMENT IS IS

BAD FOR YOU !!!BAD FOR YOU !!!

““IT IS NEARLY IMPOSSIBLE IT IS NEARLY IMPOSSIBLE TO MAKE YOUR OWN TO MAKE YOUR OWN FUTURE FUTURE

WHEN WHEN YOU ARE NOT PART OF THE YOU ARE NOT PART OF THE ECONOMIC FABRIC ECONOMIC FABRIC OF THE CULTURE OF THE CULTURE

YOU LIVE IN” YOU LIVE IN”

PATRICIA DEEGANPATRICIA DEEGAN20th World Congress Rehab International: Oslo,

Norway – JUNE 2004

IS WORK GOOD FOR YOUR HEALTH & WELLBEING?

WADDELL, G. & BURTON, K. (2006) Cited in:

FINDING & KEEPING WORK: ISSUES, ACTIVITIES, &

SUPPORT FOR THOSE WITH MENTAL HEALTH NEEDS

BOOTH, D., FRANCIS, S., & JAMES, D. (2007)

JOURNAL OF OCCUPATIONAL PSYCHOLOGY, EMPLOYMENT, & DISABILITY

V 9, NO. 2, AUTUMN 2007

BEING IN RIGHT TYPE OF WORK GOOD FOR:

HEALTH, QOL, SELF ESTEEM – APPLIES TO ALL AGE GROUPS

UNEMPLOYMENT:MORE SICKNESS, DISABILITY,

OBESITY, USE OF MEDS, USE OF MED SERVICES, DECREASED

LIFE EXPECTANCY

RETURNING TO WORK AFTER UNEMPLOYMENT IMPROVES HEALTH

BY AS MUCH AS UNEMPLOYMENT DAMAGES IT

Dooley, D., Fielding, J., & Levi, L. (1996). Health and unemployment. Annual Review of Public Health

Kasl, S. V., Rodriguez, E., & Lasch, K. E. (1998). The impact of unemployment on health and well-being. In B. Dohrenwend, (Ed.). Adversity, Stress and Psychopathology

Lennon, M. C. (1999). Work and unemployment as stressors. In A. Horwitz, & T. Scheid, (Eds.). A Handbook for the Study of Mental Health: Social Contexts, Theories and Systems

Bruffaerts, R, Sabbe, M., Demyttenaere, K. (2004) Effects of Patient & Health-System Characteristics on Community Tenure of Discharged Psych Inpatients Psych Serv 55:685-690, June 2004-- increases in rehospitalization

Dooley, D., Catalano, R., & Hough, R. (1992).Dooley, D., Catalano, R., & Hough, R. (1992). Unemployment and alcohol disorders in 1910 and 1990: Unemployment and alcohol disorders in 1910 and 1990: Drift versus social causation. Journal of Occupational & Drift versus social causation. Journal of Occupational & Organizational PsychOrganizational Psych ----- increases alcohol use----- increases alcohol use

Linn, M. W., Sandifer, R., & Stein, S. S. (1985). Linn, M. W., Sandifer, R., & Stein, S. S. (1985). Effects of unemployment on mental and physical health. Effects of unemployment on mental and physical health. American Journal of Public HealthAmerican Journal of Public Health ---- increases in anxiety---- increases in anxiety

Dooley, D., Catalano, R., & Wilson, G. (1994).Dooley, D., Catalano, R., & Wilson, G. (1994). Depression and unemployment: Panel findings from the Depression and unemployment: Panel findings from the Epidemiologic Catchment Area study. Epidemiologic Catchment Area study. American Journal of Community PsychologyAmerican Journal of Community Psychology ----- increases in depression----- increases in depression

Mathers, C. and Schofield, D. (1998) Mathers, C. and Schofield, D. (1998)‘The Health Consequences of ‘The Health Consequences of

Unemployment: The EvidenceUnemployment: The Evidence’, Medical Journal of Australia, 168 (4), pp. 178–82 – general health deteriorates

Murphy, G.C. & Athanasou, J.A (1999)Murphy, G.C. & Athanasou, J.A (1999). . The Effect of unemployment on mental health. The Effect of unemployment on mental health. Journal of Occupational and Organizational PsychologyJournal of Occupational and Organizational Psychology--- large effect size for employment positive, smaller effect size for --- large effect size for employment positive, smaller effect size for unemployment as bad.unemployment as bad.

Darity, W.A. (2003). Darity, W.A. (2003). Employment Discrimination, Segregation, and Health. Employment Discrimination, Segregation, and Health. American Journal of Public Health 93[2], 226-231.American Journal of Public Health 93[2], 226-231.--- bouts of unemployment lead to lower self esteem, lower --- bouts of unemployment lead to lower self esteem, lower motivationmotivation

Darity, W.A. (1999). Darity, W.A. (1999). Who Loses from unemployment. Who Loses from unemployment. Journal of Economic IssuesJournal of Economic Issues--- cross national data: greater spousal abuse and suicide--- cross national data: greater spousal abuse and suicide

Winefield, A.H., Tiggemann, M., Winefield, H.R., & Goldney, R.D. (1993). Growing up with unemployment: A longitudinal study of its psychological impact.--- youth with similar characteristics in school after long term unemployment more depression and anxiety

Claussen, B. (1999). Claussen, B. (1999). Alcohol disorders and re-Alcohol disorders and re-employment in a 5-year follow-up of long-term employment in a 5-year follow-up of long-term unemployedunemployed. . Addiction, 94Addiction, 94(1), 133.--- unemployment (1), 133.--- unemployment lead to drinking not vice versalead to drinking not vice versa

Comino, E. J., Harris, E., Silove, D., Manicavasagar, Comino, E. J., Harris, E., Silove, D., Manicavasagar, V., & Harris, M. F. (2000). V., & Harris, M. F. (2000). Prevalence, detection and Prevalence, detection and management of anxiety and depressive symptoms in management of anxiety and depressive symptoms in unemployed patients attending general practitionersunemployed patients attending general practitioners. . Australian & New Zealand Journal of Psychiatry, 34Australian & New Zealand Journal of Psychiatry, 34(1), (1), 107.--- unemployed greater anxiety and depression107.--- unemployed greater anxiety and depression Weich, Scott, and Glyn Lewis.Weich, Scott, and Glyn Lewis. "Poverty,  "Poverty, unemployment, and common mental disorders: unemployment, and common mental disorders: population based cohort study."population based cohort study."  British Medical British Medical JournalJournal 317.n7151 (July 11, 1998): 115(5) -- long term  317.n7151 (July 11, 1998): 115(5) -- long term financial strain/ poverty increase amount/duration of financial strain/ poverty increase amount/duration of MI . MI . 

Jin RL, Shah CP, Svoboda TJ. Jin RL, Shah CP, Svoboda TJ. The impact of The impact of unemployment on health: a review of the evidenceunemployment on health: a review of the evidence. . Canadian Medical Association Journal. 1995;153:529–Canadian Medical Association Journal. 1995;153:529–540. -- strong positive association between 540. -- strong positive association between unemployment and poor healthunemployment and poor health

Benavides, F. G., Garcia, A. M., Saez-Benavides, F. G., Garcia, A. M., Saez-Lloret, I., & Librero, J. (1994). Lloret, I., & Librero, J. (1994). Unemployment Unemployment and health in Spain: The influence of socio-and health in Spain: The influence of socio-economic environment.economic environment. The European Journal The European Journal of Public Health, 4of Public Health, 4(2), 103.--- Relationship (2), 103.--- Relationship between unemployment, ill health and more between unemployment, ill health and more use of health services use of health services

Crawford, A., Plant, M. A., Kreitman, N., & Crawford, A., Plant, M. A., Kreitman, N., & Latcham, R. W. (1987). Latcham, R. W. (1987). Unemployment and Unemployment and drinking behaviour: Some data from a general drinking behaviour: Some data from a general population survey of alcohol use.population survey of alcohol use. Addiction, Addiction, 8282(9), 1007-1016.– Unemployed greater binge (9), 1007-1016.– Unemployed greater binge drinking & adverse resultsdrinking & adverse results

Montgomery, S. M., Cook, D. G., Bartley, Montgomery, S. M., Cook, D. G., Bartley, M. J., & Wadsworth, M. E. J. (1999). M. J., & Wadsworth, M. E. J. (1999). Unemployment pre-dates symptoms of Unemployment pre-dates symptoms of depression and anxiety resulting in medical depression and anxiety resulting in medical consultation in young men.consultation in young men. International International Journal of Epidemiology, 28Journal of Epidemiology, 28, 95., 95.--- Unemployment risk factor for psychological --- Unemployment risk factor for psychological symptoms depression requiring medical symptoms depression requiring medical attention even w/o prior issues attention even w/o prior issues

Goldberg, R. W., Lucksted, A., McNary, S., Goldberg, R. W., Lucksted, A., McNary, S., Gold, J. M., Dixon, L., & Lehman, A. (2001). Gold, J. M., Dixon, L., & Lehman, A. (2001). Correlates of long-term unemployment among Correlates of long-term unemployment among inner-city adults with serious and persistent inner-city adults with serious and persistent mental illness.mental illness. Psychiatric Services, 52Psychiatric Services, 52(1), 101.(1), 101.

Kessell, E. R., Catalano, R. A., Christy, A., & Kessell, E. R., Catalano, R. A., Christy, A., & Monahan, J. (2006). Monahan, J. (2006). Rates of unemployment and Rates of unemployment and incidence of police-initiated examinations for incidence of police-initiated examinations for involuntary hospitalization in Florida.involuntary hospitalization in Florida. Psychiatric Psychiatric Services, 57Services, 57(10), 1435.--- Involuntary admissions (10), 1435.--- Involuntary admissions increase with greater unemployment in labor increase with greater unemployment in labor marketmarket

Lerner, D., Adler, D. A., Chang, H., Lapitsky, Lerner, D., Adler, D. A., Chang, H., Lapitsky, L., Hood, M. Y., Perissinotto, C., et al. (2004). L., Hood, M. Y., Perissinotto, C., et al. (2004). Unemployment, job retention, and productivity Unemployment, job retention, and productivity loss among employees with depression.loss among employees with depression. Psychiatric Services, 55Psychiatric Services, 55(12), 1371 (12), 1371

Lattimore, R. (2007),Lattimore, R. (2007), Men Not at Work: An Men Not at Work: An Analysis of Men Outside the Labour Force, Analysis of Men Outside the Labour Force, Australian Australian Productivity Commission Paper -- over Productivity Commission Paper -- over longer term, prolonged labor force inactivity longer term, prolonged labor force inactivity associated with associated with poorer overall health, poorer overall health, independent of prior health status independent of prior health status

SIDE EFFECTS OF UNEMPLOYMENT SIDE EFFECTS OF UNEMPLOYMENT IN THE GENERAL POPULATIONIN THE GENERAL POPULATION

Increased substance abuse

Increased physical problems

Increased psychiatric disorders

Reduced self-esteem

Loss of social contacts

Alienation and apathy

Warr, P.B. (1987), Work, Unemployment and

Mental Health, Clarendon Press, Oxford

John GalbraithJohn Galbraith

“Given a choice between changing and proving that it is not

necessary, most people get busy with the

proof.”

WHAT’S KEY IN WHAT’S KEY IN ORGANIZATIONAL ORGANIZATIONAL

CHANGE?CHANGE?

ORGANIZATIONAL CHANGEORGANIZATIONAL CHANGE

INTERNAL WANT TO CHANGE

ORGANIZATIONAL CHANGEORGANIZATIONAL CHANGEEXTERNAL NEED TO CHANGE CRISIS OR PRESSURE DO NOT FUND WHAT YOU

DO NOT WANT

ORGANIZATIONAL CHANGEORGANIZATIONAL CHANGE

VISION and VALUES KNOW WHAT TO CHANGE TOKNOW WHAT TO CHANGE TO

FROM “THE ART OF DEMOTIVATION” FROM “THE ART OF DEMOTIVATION” WWW.DESPAIR.COMWWW.DESPAIR.COM

CONSULTATION:

IF YOU’RE NOT PART OF THE SOLUTION,

THERE IS STILL GOOD MONEY TO BE MADE FROM PROLONGING

THE PROBLEM

5 SIGNS TO RECOGNIZE SYSTEM

CHANGE:  Grieff, D., Proscio, T., & Grieff, D., Proscio, T., &

Wilkins, C. (2003). Wilkins, C. (2003). Laying a new foundation: Changing the systems that create and sustain supportive housing. Oakland, CA: Corporation for Supportive Housing

5 SIGNS TO RECOGNIZE SYSTEM

CHANGE:  CHANGE IN POWER: :

Designated positions—Designated positions—people with formal people with formal authority—responsible authority—responsible for the new activity for the new activity (not just individuals (not just individuals who care about it). who care about it).

5 SIGNS TO RECOGNIZE SYSTEM

CHANGE:  CHANGE IN MONEY:

Routine funding is Routine funding is earmarked for the new earmarked for the new activity in a new way activity in a new way [new money, shift in [new money, shift in existing funding, or new existing funding, or new priorities & criteria for priorities & criteria for accessing money]. accessing money].

5 SIGNS TO RECOGNIZE SYSTEM

CHANGE:  CHANGE IN HABITS:

Participants in a system Participants in a system interact with each other to interact with each other to carry out the new activity as carry out the new activity as part of their normal routine part of their normal routine not just respond to special not just respond to special initiatives, demonstrations, initiatives, demonstrations, or projects. or projects.

5 SIGNS TO RECOGNIZE SYSTEM

CHANGE: 

CHANGE IN TECHNOLOGY OR SKILLS:

Growing cadre of skilled practitioners at most levels in the delivery chain, practicing methods not previously common or considered desirable. Practitioners are now expert in skills that new system demands & have set a standard for effective delivery of results.

5 SIGNS TO RECOGNIZE SYSTEM

CHANGE: 

CHANGE IN IDEAS OR VALUES:

New definition of performance or success, & often a new understanding of the people to be served & the problem to be solved [i.e., new goals]. The new definition & understanding are commonly held among most actors in the system, & are no longer in great dispute

“ “ BEFORE PRACTICING BEFORE PRACTICING VIRTUE, FIRST VIRTUE, FIRST

SECURE AN SECURE AN INDEPENDENT INDEPENDENT

INCOME. “INCOME. “

GREEK PROVERBGREEK PROVERB

Clear Policy statement from funding authority and Clear Policy statement from funding authority and program administration that:program administration that:

Assisting people to enter employment is integral to Assisting people to enter employment is integral to the overall mission of agency/ providers and thus the overall mission of agency/ providers and thus

inherent in the responsibilities of all its staff & inherent in the responsibilities of all its staff & providers,providers,

even those not explicitly charged with employment even those not explicitly charged with employment service responsibilityservice responsibility

NOT JUST EMPLOYMENT FIRST IN PLAN BUT NOT JUST EMPLOYMENT FIRST IN PLAN BUT EMPLOYMENT OUTCOMES EMPLOYMENT OUTCOMES

SO WHAT SHOULD SYSTEM/ PROGRAM ADMINISTRATORS

DO ???:

LINK WITH EMPLOYMENT AT TIME OF ENTRY INTO SERVICES (PART OF INTAKE AND INITIAL APPT)

DELINK CLINICAL APPROVAL FROM EMPLOYMENT ACTIVELY ENCOURAGE EMPLOYMENT AT MGMT/ CLINICAL

LEVELS IN TERMS OF HOW ADMINISTRATORS INTEGRATE IT INTO TOTAL SERVICE SYSTEM

CONSUMERS ACTIVELY SOUGHT FOR JOBS AT ALL LEVELS NOT JUST PEER ROLES (MODELING FOR BUSINESS)

EMPLOYMENT ON ALL SERVICE PLANS IF PERSON UNEMPLOYED AT LEAST 3 MONTHS

ALL STAFF RECEIVE /ORIENTATION AND SOME TRAINING NOT JUST ON EMPLOYMENT BUT ALSO DANGERS OF UNEMPLOYMENT

FOCUS ON EMPLOYMENT NOT JOB RETENTION

SO WHAT SHOULD SYSTEM/ PROGRAM ADMINISTRATORS

DO ???:

EMPLOYMENT OUTCOMES IDENTIFIED FOR SYSTEM AS A WHOLE NOT JUST FOR EMPLOYMENT PROGRAMS

OUTCOMES TRACKED AND DISSEMINATED TO BOTH THE PROGRAM AND COMMUNITY AT LARGE

RESULTS GET COMPARED TO PEOPLE WITHOUT DISABILITIES IN TERMS OF WAGES, UNEMPLOYMENT RATE, POVERTY

TRACK WAGES IN TERMS OF WEEKLY WAGES NOT HOURS X HOURLY WAGE

SO WHAT SHOULD SYSTEM/ PROGRAM ADMINISTRATORS DO ???:

OUTCOME BASED FUNDING/ MILESTONESSYSTEM CREATES INCENTIVES FOR

EMPLOYMENT AND DISINCENTIVES FOR NOT ADDRESSING UNEMPLOYMENT – ULTIMATELY UNLESS THERE ARE FUNDING WINNERS AND LOSERS NOT MUCH HAS CHANGED

PEOPLE SHOULD BE ENCOURAGED TO THINK OF GETTING OFF SSA OR TANF AS A SUCCESS, NOT A DISINCENTIVE

BE CLEAR THAT MOTIVATION IS STAFF’S JOB

SO WHAT SHOULD SYSTEM/ PROGRAM ADMINISTRATORS DO ???:

HOPE,HOPE,

HELP, HELP,

ANDAND

HASSLINGHASSLING

HELPER’S RESPONSIBILITY TO ENGAGE & MOTIVATE

HOPEHOPE VS.VS. OPTIMISM? OPTIMISM? --- ---

PAT ON BACK VS. PAT ON BACK VS.

COMMUNICATINGCOMMUNICATING THAT: THAT: YOU YOU CARECARE

YOU YOU UNDERSTANDUNDERSTAND

YOU WILL YOU WILL BE THEREBE THERE

YOU HAVE YOU HAVE IDEAS & IDEAS & HELPHELP TO OFFER TO OFFER

“ “ YOU NEED A LITTLE LOVE YOU NEED A LITTLE LOVE IN YOUR LIFE & FOOD IN IN YOUR LIFE & FOOD IN YOUR STOMACH BEFORE YOUR STOMACH BEFORE

YOU CAN HOLD STILL FOR YOU CAN HOLD STILL FOR SOME DAMN FOOL’S SOME DAMN FOOL’S

LECTURE ABOUT HOW LECTURE ABOUT HOW TO BEHAVE.”TO BEHAVE.”

BILLIE HOLIDAYBILLIE HOLIDAY

BETTER LINKAGE WITH TRANSITION TYPE SERVICES

YOUTH NEED MORE DIRECTIONPLANNING LESS IMPORTANT THAN ACTION-

IMMEDIACYJOBS THAT WE SHY AWAY FROM FOR ADULTS

MORE AND MORE (FOOD, FILTH, FLOWERS ETC ETC) ARE MORE ATTRACTIVE & APPROPRIATE FOR YOUTH

DON’T TRY TO GET YOUTH TO ACT LIKE ADULTS IN TERMS OF JOB/ EMPLOYMENT STABILITY

SPECIFIC ISSUES FOR YOUTH (16-25)

“ “ BEWARE THE BEWARE THE CONTINUOUS CONTINUOUS

IMPROVEMENT OF IMPROVEMENT OF THINGS NOT THINGS NOT

WORTH IMPROVING WORTH IMPROVING “ “

W. EDWARDS DEMING

MARRONE'S RULE # 1MARRONE'S RULE # 1

NEVER GET MAD AT NEVER GET MAD AT SOMEONE SOMEONE

FOR NOT DOING FOR NOT DOING SOMETHINGSOMETHING

YOU HAVEN'T ASKED THEM YOU HAVEN'T ASKED THEM

TO DO.TO DO.

MARRONE'S RULE # 2MARRONE'S RULE # 2

SOMETIMES YOU CAN SOMETIMES YOU CAN

ONLY DOONLY DO

THE BEST YOU CAN DO, THE BEST YOU CAN DO,

NOTNOT THE BEST THAT CAN BE THE BEST THAT CAN BE DONE.DONE.

BUT, ALWAYSBUT, ALWAYS

KNOW AND STATE THE KNOW AND STATE THE DIFFERENCEDIFFERENCE..

“ “ BEFORE PRACTICING BEFORE PRACTICING VIRTUE, FIRST VIRTUE, FIRST

SECURE AN SECURE AN INDEPENDENT INDEPENDENT

INCOME. “INCOME. “

GREEK PROVERBGREEK PROVERB

Thom HartmanThom Hartman“ADD, An Alternate View”

“I am not I am not inattentive, inattentive,

you are just you are just boring.boring.“

So why have So why have Employment Outcomes Employment Outcomes not improved enough not improved enough

given the level of attention given the level of attention of groups like APSE?of groups like APSE?

ANY DEAD HORSES IN YOUR ANY DEAD HORSES IN YOUR ORGANIZATION?ORGANIZATION?

(TAKEN FROM MATERIAL FROM ARTHUR EVANS, (TAKEN FROM MATERIAL FROM ARTHUR EVANS, PH.D., FORMER DEPUTY COMMR, CT DMHAS), PH.D., FORMER DEPUTY COMMR, CT DMHAS),

NOW MH DIRECTOR, PHILA MHNOW MH DIRECTOR, PHILA MH

Dakota tribal wisdom says that when Dakota tribal wisdom says that when you discover you are riding a dead you discover you are riding a dead

horse, the best strategy is to horse, the best strategy is to dismount. However, in human dismount. However, in human

services, we often try other strategies services, we often try other strategies with dead horses, including the with dead horses, including the

following:following:

** Saying things like “This is the Saying things like “This is the way we have always ridden this way we have always ridden this horse.”horse.” or or from a Native American from a Native American Tribal Saying:Tribal Saying:

"If we don't turn around now, we "If we don't turn around now, we just may get where we're going."just may get where we're going."

* Appointing a committee to study the horse. * Harnessing several dead horses together for greater performance * Providing additional funding to increase the horse’s performance * Arranging to visit other sites to see how they ride dead horses

* Increasing the standards to ride dead horses * Creating a training session to increase our riding ability * Changing the requirements; declaring “this horse is not dead.” * Declaring the horse is “better, faster and cheaper” dead * Promoting the dead horse to a supervisory position

Finding a consultant knowledgeable about dead horses.

“ ANY TIME YOU THINK YOU HAVE

INFLUENCE, TRY ORDERING

AROUND SOMEONE ELSE’S

DOG”

OLD YIDDISH PROVERBOLD YIDDISH PROVERB

If 1 person calls you a If 1 person calls you a jackass, ignore him; jackass, ignore him;

If a second person calls If a second person calls you a jackass, think you a jackass, think about it; about it;

If a third person calls you If a third person calls you a jackass- get a saddle.a jackass- get a saddle.

" There is nothing you can say " There is nothing you can say in answer to a compliment. I in answer to a compliment. I

have been have been complimented myself a great complimented myself a great many times, and they always many times, and they always

embarrass me embarrass me

-- I always feel they have not -- I always feel they have not said enough. "said enough. "

Mark TwainMark Twain

““Some cause happiness Some cause happiness wherever they go; wherever they go; others, others,

whenever they go.whenever they go.””OSCAR WILDEOSCAR WILDE

“ “ DON’T LET IT END DON’T LET IT END LIKE THIS. LIKE THIS.

TELL THEM I SAID TELL THEM I SAID SOMETHING.”SOMETHING.”

LAST WORDS OF PANCHO VILLALAST WORDS OF PANCHO VILLA (1915)(1915)