OHIO SAMI CCOE

SAMI TEAM

EMPLOYMENT SPECIALIST

An employment specialist helps persons with co-occurring mental health and substance abuse disorders gain competitive employment in community-based work settings. The New Hampshire-Dartmouth Integrated Dual Disorder Treatment (IDDT) model emphasizes that employment is an important component of the treatment process. Many service providers have found that consumers who work are less likely to abuse alcohol and other drugs. Service providers have also found that employment helps consumers begin the process of economic independence, which reduces their vulnerability to poverty and their dependence upon social service systems.

There are several service models (or strategies) that service agencies can use to assist consumers with employment. The general term for the evidence-based service model is supported employment. An employment specialist is an integral part of supported employment, which helps consumers become more independent in their lives and less dependent upon community mental health centers. Supported employment models stress that the process of identifying, finding, acquiring, and maintaining competitive employment is a therapeutic activity that helps consumers with the following:

• Increase their economic independence
• Decrease their dependence upon social systems
• Increase their independent living abilities
• Build self-esteem
• Acquire a better understanding and control of symptoms
• Experience more satisfaction with life in general
• Assume greater responsibility for managing their disorders
• Increase motivation to comply with a variety of treatment issues

Supported employment models and the IDDT model are consistent with and support the guiding principles of Ohio’s Recovery Process Model.

COMMUNITY PARTNERSHIPS

Employment specialists equip themselves with a specialized knowledge of employment-related services in the local community. This knowledge enables them to help consumers find the services that will address their particular needs. Employment specialists in Ohio may expand their network of resources by developing partnerships with the following:

• Local Workforce Investment Board
• Local One-Stop Career Center (a comprehensive job-search and training initiative for all residents, with or without disabilities)
• Local employer groups (e.g., Kiwanis, chambers of commerce, organizations of minority business owners, etc.)
• Ohio Rehabilitation Services Commission/Ohio Bureau of Vocational Rehabilitation (RSC/BVR)
• Ohio Rehabilitation Services Commission/Ohio Bureau of Services for the Visually Impaired (RSC/BSVI)

TREATMENT TEAM

Service agencies that utilize the IDDT model typically include an employment specialist as a member of the SAMI treatment team, even though the specialist may be from another department of the public human services system or from another agency within the community. Employment specialists help the treatment team integrate employment services with mental health and substance abuse treatment. Communication between team members occurs formally in team meetings as well as informally in one-on-one conversations. Treatment team members typically include the following:

• Employment specialist, who works directly with consumers to enhance their employment-related skills and assumes team leadership responsibilities with employment issues and employee relationships
• Benefits specialist, who advises the treatment team and consumers about benefit requirements, income ceilings, work incentives, and other employment-benefit related issues and regulations
• Housing specialist, who advises the treatment team and consumers about the availability of housing options in the community that are conveniently located near the consumer's place of employment or located near public transportation networks that enable consumers to travel to and from work
• Case manager, who works directly with consumers to address interpersonal relationship issues and advises the treatment team about effective intervention strategies
• Medical professionals (psychiatrist and nurse), who work directly with consumers to prescribe, administer, and monitor medications; they also advise the treatment team about medical issues, especially the affects of medications and their interactions with mood-altering substances.
• Supervisor/ team leader for case managers, who co-facilitates team meetings or leads the meetings independently
• Other staff and service liaisons, who work directly with consumers and advise fellow treatment team members about a variety of additional issues and other available services (e.g., legal counsel)
• Peer supports that provide consumers with living proof and, therefore, convincing stories that gainful employment is possible and, if planned properly, will not eliminate necessary financial subsidies, such as social security disability insurance (SSDI) and health insurance (medical cards) for physician care and medications

CLIENT-CENTERED APPROACH

With leadership from the employment specialist and the SAMI team leader, all treatment team members encourage each consumer to select a work situation based on his or her preferences, skills, coping strategies, and individual needs (i.e., the personal challenges that he or she would like to address). Work options may include full-time employment, but most often begin with part-time jobs. Treatment teams should realize that many consumers benefit from a work experience that consists of a few hours per week. This provides an opportunity for them to build adequate skills and confidence over time. This process of building confidence will prepare consumers to manage a more demanding schedule in the future.

Supported-employment service models have a zero-exclusion policy, which means that all consumers who express the desire to work will meet with an employment specialist. (Treatment team members should encourage consumers who do not want to work to talk about their reservations, especially with other consumers who are currently working.) The treatment team encourages consumers to gain competitive employment as quickly as possible and to acquire on-the-job training, which is more applicable and, therefore, more meaningful than isolated workshop training or lengthy prevocational activities. The treatment team interacts with each consumer at his or her pace. Treatment teams help the consumer build confidence by providing the right amount of support that will lead to a pattern of successes. Replicated clinical trials with random samples in several states have shown that consumers who are involved in supported employment find jobs at a much higher rate and have fewer hospitalizations and less involvement in the criminal justice system than those involved in more traditional forms of rehabilitation.

THERAPEUTIC ACTIVITY

Starting a job usually brings about the need for changes and adjustments in other aspects of treatment. Each work experience can elicit new responses from and new information about the consumer. Therefore, supported employment becomes an essential component of ongoing treatment. Consumers may tell different sides of their employment stories to different staff. Therefore, the staff needs to communicate openly and regularly with one another and the employee in order to achieve the most detailed understanding of the personal challenges and progress of each consumer.

Team members should expect consumers to lose their jobs and to encourage consumers to view job loss as a learning experience. Team members help consumers recover positive feelings by immediately beginning to work with them to identify a better job fit. Together, the consumer and the employment specialist begin the job-placement process again. Even during periods of acute illness and relapse, the treatment team talks to the consumer about work and future plans for employment.

FAMILY INVOLVEMENT

Employment specialists include caregivers (family members and friends) in the employment plan because caregivers often provide emotional and practical support for employment. Some caregivers view the consumer’s return to work as a hopeful sign that the consumer will be able to participate in everyday activities again; however, other caregivers may be fearful that the demands (and stress) of work will increase symptoms of substance use and mental illness. These fears are generally unfounded. Treatment teams provide caregivers with education about the therapeutic benefits of work through one-on-one consultations, or by referring them to support groups, such as those available through the National Alliance for the Mentally Ill (NAMI).

OUTCOMES

Employment specialists should encourage agencies to track the percentage of consumers in competitive jobs and in other meaningful activities and to report this data regularly to service teams. This will keep team members focused on the goal of competitive employment. It is the role of the treatment team to track which consumers are working and the number of hours they have worked each week. The team should keep the tracking system simple. This will insure that accurate, up-to-date information is being collected, analyzed, and reported. Treatment teams should encourage consumers to learn and grow from each employment experience.

WHAT TO EXPECT

Consumers may

• be fearful of a conventional job,
• may require multiple job placements to achieve a successful match,
• want to start slowly, and
• appreciate ongoing support and encouragement.

Employment Specialists should

• maintain a flexible schedule;
• meet with consumers in community locations;
• focus on helping consumers find solutions to the personal challenges that they have defined for themselves;
• build trust through collaboration with consumers;
• learn about consumers through conversations with other reatment team members, family members, and former employers (with permission from the consumer);
• design employment strategies to help consumers begin looking for work soon after they enter the program;
• learn how to effectively engage potential employer groups;
• learn about how alcohol and other substance abuse disorders affect consumer functioning;
• design employment strategies to help consumers learn the skills that they need to retain their jobs;
• promote on-the-job-training;
• meet with treatment teams routinely to share information and to problem solve; and
• provide ongoing support to the consumer for the duration of the job.

Employment Specialists may

• do advanced work for consumers: they may contact employers and work to develop new positions suitable for the consumers;
• learn job tasks to enhance interactions with consumers;
• stay in contact with employers as a way to support the employer, to help the consumer improve performance, and to inform the treatment strategy;
• offer transportation and/or teach the consumer how to use public transportation; and
• find a substitute worker when the symptoms of mental illness and/or substance abuse inhibit the consumer's job performance.

Team Leaders and Supervisors should

• encourage optimism;
• reward persistence;
• ensure that employment specialists are contacting employers on a regular basis;
• review the list of non-working consumers during supervision and work with team members to develop plans for engaging consumers in discussions about work and for persuading them to set work goals;
• use team meetings to report outcomes and reward successes; and
• teach staff to manage their frustrations, especially when consumers do not reach their work goals or relapse.

EMPLOYMENT PROCESS

TThe employment specialist and treatment team members should consider using these steps in their employment programs:

Encourage and accept referrals from the SAMI team
Build a relationship with the consumer
Compose a vocational profile
Develop individual employment plans (IEPs)
Assist consumers in applying for benefits
Compose a benefits plan: Consumers may be reluctant to pursue employment because they are afraid that an income from a job may reduce or make them ineligible for public assistance, such as rent subsidies, food stamps, supplemental security income (SSI), social security disability insurance (SSDI), and medical insurance for physician services and medication. A benefits plan will help consumers make informed choices about employment and work incentives from SSI/SSDI that will enable them to earn an income and remain eligible for some forms of assistance.
Search for competitive jobs with consumers
Help consumers obtain employment
Provide follow-along support
Assist with job transitions
Link treatment-team services with state vocational rehabilitation services (see Community Partnerships section above)
Measure consumer outcomes

PROGRAM DEVELOPMENT PROCESS

Add work/supported employment to the service agency's mission statement
Evaluate existing employment/ vocational rehabilitation resources
Plan the supported-employment program
Add the supported-employment program to agency's organizational chart
Commit financial and human resources
Staff the program
Provide ongoing agency-wide training
Contact and utilize state-wide benefits-planning-assistance-and-outreach personnel
Locate the office of the employment specialist in the same space as the treatment team
Integrate employment activities with the SAMI team
Celebrate small and large successes
Encourage an agency culture that views employment as a key element of good community services

CONTRIBUTORS

This section of the Ohio SAMI CCOE Web site was written by excerpting content from pages 175 to 195 of Substance Abuse Treatment for People with Severe Mental Disorders: A Program Manager's Guide, by Carolyn Mercer-McFadden and Robert E. Drake, et al, New Hampshire-Dartmouth Psychiatric Research Center, Concord, NH, 1998. Send purchase requests to: New Hampshire-Dartmouth PRC, 105 Pleasant Street, Concord, NH 03301.

This section of the Ohio SAMI CCOE Web site was written with contributions from the following:

Deborah R. Becker and Robert E. Drake, A Working Life: the Individual Placement and Support (IPS) Program, New Hampshire-Dartmouth Psychiatric Research Center, Concord, NH, 1993. Send purchase request to: New Hampshire-Dartmouth PRC, 105 Pleasant Street, Concord, NH 03301.

Doug Bailey, Community Employment Program Manager, Ohio Department of Mental Health

JoAnne Haber, Director of Occupational Therapy, Heartland Behavioral Healthcare, Massillon, Ohio

Sarah Swanson, Director of Rehabilitation Services, W.G. Nord Center, Lorain, Ohio.

RESOURCES

Ohio Employment Action Plan

Doug Bailey, Community Employment Program Manager
Ohio Department of Mental Health
614.466.9989
baileyd@mhmail.mh.state.oh.us.

Employment Intervention Demonstration Program Coordinating Center (EIDP)
www.psych.uic.edu/eidp

International Association of Psychosocial Rehabilitation Services (IAPSRS)
www.iapsrs.org

Ohio Dept of Job and Family Services – Labor Market Information
lmi.state.oh.us/

Ohio Rehabilitation Services Commission
www.state.oh.us/rsc/

New Hampshire – Dartmouth Psychiatric Research Center
www.dartmouth.edu/dms/psychrc/

Center for Psychiatric Research – Boston University
www.bu.edu/cpr/

Presidential Task Force on Employment of Adults with Disabilities www.dol.gov/sec/programs/ptfead/main.htm

Social Security Administration Office of Employment Support Programs www.ssa.gov/work/