RRTC on Workplace Supports & Region III CRP RCEP

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Alberta Stevens
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1 RRTC on Workplace Supports & Region III CRP RCEP Supported Employment & Mental Illness: Addressing Secondary Issues Deborah R. Becker, M.Ed., CRC Dartmouth Psychiatric Research Center IPS Supported Employment: What About Substance Abuse, Homelessness, Criminal Justice, Treatment Non adherence? Deborah R. Becker, M.Ed., CRC Dartmouth Psychiatric Research Center Overview Review of IPS Supported Employment Secondary Issues Substance Abuse Homelessness Criminal Justice Involvement Treatment Non adherence Current Status of SE SE model is simple & effective Other benefits accrue with consistent work Work outcomes improve over time SE is relatively easy to implement IPS Supported Employment Competitive employment Team approach Client choice regarding timing Work incentives planning Rapid job search Job matching based on client preferences On going supports Becker (IPS Fidelity Scale,2008) 1

2 Randomized Controlled Trials of SE In 15 of 16 studies, SE had significantly better competitive employment outcomes than controls Randomized Controlled Trials of SE Mean across studies of consumers working competitively at some time: 60% for supported employment 24% for controls Effect size (d) =.77 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Aust Figure 1. Competitive Employment Rates in 16 Random Controlled Trials of Supported Employment 96 NH 94 NY IL 04 CT 05 HK 06 SC 06 MA (ACT) 99 DC CA 95 IN Supported Employment Control Control 2 EUR 06 QUE 00 NY 97 CA 02 MD Impact on Other Outcomes Improved self esteem, symptom control, quality of life Related to sustained competitive employment No changes with sustained sheltered employment (Bond, 2001) Long Term Outcomes 4 studies with 10 year follow ups (Test, 1989; Salyers, 2004; Becker, 2006; Bush, in prep) Work outcomes improve over time Costs decrease dramatically for consistent workers (Bush, in prep) National EBP Project 5 evidence based practices: SE, IMR, FPE, ACT, IDDT 53 sites in 8 states Programs studied for 2 years 2

3 SE Fidelity Scale M ean Fidelity of SE Programs BL 6 mo. 12 mo. 18 mo. 24 mo. (n = 9) (n = 8) (n = 9) (n = 9) (n = 9) Johnson & Johnson Dartmouth Project Mental health voc rehab collaboration Implement evidence based SE Local programs selected by states (Drake, 2006) Johnson & Johnson Dartmouth Project Dartmouth provides training, consultation, & evaluation First states: CT, DC, KS, MD, OR, SC, VT New states: IL, MN, OH (Drake, 2006) Substance Use Disorder 50% co occurring substance use disorder Complex biopsychosocial disorder Recovery over time Recovery: MI and SUD Stable, safe substance free housing Social network of non substance abusers Trusting relationship with clinician helping with recovery Meaningful daily activities, work (Alverson, 2001) Substance Abuse & Work Similar employment outcomes Encourage employment Substance abuse as part of voc profile Job that supports recovery Money management Team approach to integrate services 3

4 Stages of Change Precontemplation No interest in work Contemplation Considering costs & benefits of work Preparation Intention to work Action Applying for work Maintenance Working with support plan Motivational Interviewing Technique for behavioral change Resolve ambivalence and discrepancies of what people are saying and actually doing (Miller and Rollnick, 2002) Relapse Job ending (DiClemente & Prochaska, 1998) Principles of MI Principles of MI Express empathy Ask open ended questions Develop discrepancy Listen reflectively Summarize Avoid argumentation Roll with resistance Affirm Elicit self motivation statements Support self efficacy Cost benefit matrix Homelessness & Serious Mental Illness: Engagement Build trust Two adults in the room Hl Help person feel lin control Tangible motivation: housing, food Cognitive deficits from substance abuse, TBI Criminal justice involvement Homelessness & Work Stigma Shelters ID cards Social Security Birth certificates State picture ID Medical issues Work history Competitive employment vs. day labor Supervisor role for homeless teams 4

5 Stages of change Motivational interviewing Education andchoices Shared decision making IPS supported employment Criminal Justice Involvement Stigma Lack of self confidence Post 9/11 background checks Disclosure to employers Criminal record Arrests, charges, convictions, incarcerations Probation, parole, pending Criminal Justice Involvement 16% people with MI in jail. 75% inmates w. MI have substance abuse. More likely homeless prior to arrest. 50% incarcerated for non violent crime. Employment helps keep people out of jail. SE Team Strategies Understand state rules Develop positive relationship with probation and parole officers Invite someone from criminal justice system to join SE leadership team Develop employer network On line Access to Criminal Records Varies by state, fees Criminal records, conviction records, incarcerated, probation, parole Know what is on background report, check accuracy Record of Arrest & Prosecution (RAP Sheet), fingerprints On line Access to Criminal Records Expungement record of arrest is removed (if acquittal, supervision, no conviction) Sealing files and records are sealed. Convictions can be sealed. Varies by state Time factor 6 to 8 mos. 5

6 Job Search Know community employers Network with other agencies Employers that won t hire: direct care, banking, child care Job Applications Legal document Employers can ask about convictions Answer honestly and only what is asked Don t leave question blank will discuss Job Interviews Answer honestly, directly Show remorse Express desire to change; ex. of responsibility Role play Treatment Non adherence Medication side effects Education Motivational interviewing Shared decision making Supported Employment Fidelity Scale, item scale Supportedemployment employment fidelity review manual 2008 supported employment fidelity video Resources Dartmouth Voc Publication List karendunn@dartmouth.edu

7 More Resources A Working Life for People With Severe Mental Illness Becker & Drake. Oxford University Press, 2003 Supported Employment: A Practical Guide for practitioners and Supervisors Swanson, Becker, Drake, Merrens. Dartmouth Psychiatric Research Center, April 2008 More Resources Psychiatric Rehabilitation Journal Spring, 2008, special issue SE Supported employment resource kit: Mentalhealth.samhsa.gov Conclusions SE can help people with substance abuse, homelessness experiences, criminal justice involvement, treatment non adherence Engagement is critical Stages of change Conclusions Motivational interviewing Provide information and choices Use shared decision making Supervisors support skill development 7

What are dual disorders?

Evidence Based Practice Clinical skills training presentation Dianne Asher, LSCSW, LCAC What are dual disorders? Mental illness and substance use disorder occurring together in one person 1 Why focus on