PROJECT GOALS
This is a process
evaluation of five demonstration projects that are seeking to implement,
in clinical settings (e.g., day treatment, clinic programs), the best-practices
associated with fostering competitive employment among adults with serious
mental illnesses. It is funded
through the New York Work Exchange as part of a program called Ways to Work,
a program jointly funded by NYSOMH and NYCDMH.
The main
objective is to document and describe how the employment innovations are
implemented, how the culture of clinical settings is changed so as to promote
employment, how staff respond to and adapt “best practices”, and how these
innovations fare over time in different clinical settings and environments.
In particular, the projects focus on integrating employment and clinical
services in traditional outpatient mental health settings.
RESEARCH ACTIVITIES AND RESULTS
The
mid-year (Year 2 of 3) evaluation report was completed and shared with program
participants for feedback. This report focused on the process of maintaining
the momentum of the new programs after the first, start-up year.
Data collection activities included quarterly updates on participant
job status, characteristics, and job-related goals and activities, a quarterly
survey of challenges and facilitators of program implementation, focus groups
with employment specialists, and individual interviews with program administrators
and leadership.
In
general, findings on the rate of employment among the CDT programs in Year
2 were similar to those in Year 1, with about 20% of participants finding
competitive employment. Sociodemographic
and mental health variables once again did not predict success in obtaining
employment. Qualitative data described
the implementation and maintenance process during Year 2. Overall,
the Ways to Work programs are continuing to serve their mission. Participants are enrolling in the programs
and a substantial number of them are finding jobs. Success generally doesn’t happen overnight as suggested by our finding
that the time between initial participation and finding a job averages more
than 8 months. Concern about a “sophomore
slump” is legitimate as there is some evidence that agencies are investing
less time and effort into the Ways to Work programs compared with when there
was more enthusiasm and motivation during the first year of the program.
In addition, our data provides evidence that helping consumers in
continuing day treatment and clinic programs find competitive employment
may get harder over time. The most motivated and capable consumers tend
to find jobs fairly quickly; those left behind may require more assistance
and need more time in order to be motivated to take on the challenge of
work.
The process evaluation also documents a number of successes that are
less quantifiable than jobs obtained but may have equally important long-term
consequences. These include real
breakthroughs in integration where Employment Specialists now routinely
not only sit in on but are equal partners in clinical team meetings.
Clinicians at the five Ways to Work agencies are thinking about work
and employment for all of their clients and have learned that those that
succeed in finding jobs might not be those they would have predicted.
Clinicians and Employment Specialists have learned how to work together
in finding the right mix and balance of supports to help consumers keep
their jobs and have learned how feedback from the world of work can serve
clinical goals as well vice versa. Consumers
have experienced work successes or seen their peers achieve such successes
leading to greatly enhanced expectations about what continuing day treatment
program participants can achieve.
As these demonstration programs enter their third and final year of
funding, they all must figure out how to build-in financial and structural
support to sustaint the new services and approaches made possible by the
Ways to Work funds. Many are now
looking to the NYS Office of Mental Health’s Personalized Recovery-Oriented
Services (PROS) initiative as a one way of continuing the integration of
employment services. PROS will permit
medicaid billing for rehabilitation services that move consumers toward
their attaining their individualized goals, including employment.
SIGNIFICANCE OF FINDINGS/ POLICY
IMPLICATIONS
One
important preliminary finding is the centrality of the Employment Specialist
role in promoting employment in clinical settings.
Integrating employment into Continuing Day Treatment programs appears
to require one person whose main function is to serve as a champion of employment,
reminding clinicians to consider employment, bringing up employment issues
in groups and team meetings, and serving as the repository of employment expertise. Another result that has policy implications
concerns the degree to which negative attitudes about the ability of individuals
with serious mental illness to obtain competitive employment withstand education
and training. Despite substantial
investment in technical assistance it was not until clinicians actually saw
consumers whom they would never have thought could succeed get and keep competitive
jobs that they began to endorse and embrace the principles of supported employment.
Many of our results have implications
for the PROS initiative and I will be meeting with PROS leadership from the
NYS Office of Mental Health in October, 2004 to discuss those implications.
PLANS
In addition, the results will also be
shared with a practice audience through the New York Work Exchange’s Fall
“Program of Study” – designed for mental health, rehabilitation, and recovery
services staff working in employment services and with the aim of providing
participants with practical, skill-oriented training that assists them in
their efforts to help people with serious mental illness acquire and sustain
meaningful work. The presentation
will be presented in combination with a technical assistance project that
sought to assist programs in infusing work and recovery-based concepts and
activities into programs.
Lessons
learned from this process evaluation will be shared at a workshop entitled
“Integrating Employment Services with Community-Based Clinical Programs:
"Lessons Learned from the Ways
to Work Demonstration Project” at the New York Association of Psychiatric
Rehabilitation Services (NYAPRS) Annual Conference in September, 2004: "The Recovery Revolution: Reformation
and Transformation Through Collaboration."
“Ways
to Work and Recovery: Practicing Rehabilitation and Recovery in an
Integrated Setting.” Colleen Gillespie,
Ph.D. and Jessica Wolf, Ph.D. Program of 'Study, New York Work
Exchange, Coalition of Voluntary Mental Health Agencies.
At
the end of the final and third year of the demonstration projects (ending
December 31, 2004), the lessons learned from this process evaluation will
be written up in an article format and submitted for publication.
