Transcript Ways to Work Agencies - Coalition

Ways to Work
Demonstration
Programs
New York Work
Exchange
Coalition of Voluntary Mental
Health Agencies
December, 2002
Colleen Gillespie, PhD
NYU Wagner
Center for Health and Public Service Research
Evaluator
Background
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The New York Work Exchange, a project of the Coalition of Voluntary Mental Health Agencies,
funded five Ways to Work Demonstration Programs beginning in January, 2002.
The Ways to Work initiative was launched to promote the creation of effective new service
delivery methods targeted at increasing the integration and coordination of employment and
clinical services.
The overarching goal of Ways to Work is to increase the number of people with psychiatric
disabilities who get and retain competitive employment.
Principles of the Ways to Work Demonstration Project include:
 Consumers of mental health services can work.
 Work and the role of work are important parts of the recovery process.
 Integrating employment and clinical services improves consumers’ employment
outcomes.
Those agencies that were selected for funding each proposed innovative and effective means
of enhancing services by integrating employment services into their array of existing Continuing
Day Treatment and/or Clinic programs.
The following five agencies were selected through the RFP process to develop and implement
Ways to Work programs:
 Brooklyn Bureau of Community Services
 Jewish Board of Family and Children’s Services
 Riverdale Mental Health Association
 Postgraduate Center for Mental Health
 Transitional Services for New York, Inc.
Evaluation of the Ways to Work
Demonstration Projects
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The two major goals of the evaluation are:
 to document the effectiveness of integrating employment services with clinical
services among these pilot projects and
 to use these agencies’ experiences to show mental health service providers
throughout the country how they can most effectively promote competitive
employment within clinical settings.
These objectives stem from the nature of these projects as demonstration projects –
the emphasis is on qualitative description and documentation of process, rather than
on the quantitative impact of the programs, given that the effectiveness of
employment services has been well established.
Evaluation activities will focus on three major components of the projects:
 How do agencies design the programs and introduce a focus on competitive
employment to their continuing day treatment programs and clinics?
 How do agencies implement these new programs, overcome any barriers
that may arise, and sustain the programs over time?
 What is the impact of the programs on consumers, clinicians, and agencies?
What changes are associated with the Ways to Work programs?
The following represents some preliminary information on the Ways to Work
programs, who they serve, how many consumers have participated to date, reasons
why consumers signed up, and how satisfied consumers are when they first start out
in their Ways to Work programs.
Agencies with Ways to Work Programs
The agencies vary significantly in terms of size, mission, target
populations served, experience with employment services and location.
Agency Name
Location
Description
Size
Queens
Provides a continuum of rehabilitative services to enrich the lives of the
mentally ill and facilitate their transition to increased levels of
independence.
2,000
Served/Yr
Riverdale Mental
Health
Association
(RMHA)
Bronx
Offers child, adolescent, and adult services, continuing day treatment
for post-hospitalized and seriously mentally ill persons, a substance
abuse treatment program, supported employment and welfare-to-work
programs, mental health consultation and educational programs, a 15bed supervised community residence, and a supported apartment
program.
1,600
Served/Yr
Jewish Board of
Family and
Children’s
Services
(JBFCS)
Central
Offices:
Manhattan
Services:
All of NYC
Operates a diverse network of more than 160 community-based
programs serving the adult mentally ill, emotionally disturbed children
and adolescents, victims of domestic violence, the homeless, children
at risk of abuse and neglect, people with AIDS, substance abusers,
Soviet émigrés, the developmentally disabled, and people suffering
from trauma and bereavement.
55,000
Served/Yr
Postgraduate
Center for
Mental Health
(PCMH)
Manhattan
Offers individuals with mental illness a full continuum of care, including
outpatient clinic programs, continuing day treatment, intensive
psychiatric rehabilitation, a full complement of employment services, a
large residential services division, and a division for services to
persons living with or affected by AIDS.
4,000
Served/Yr
Serves Brooklyn residents with the greatest needs, including adults
and adolescents with serious mental illness, adults with physical and
developmental disabilities, parents at risk of losing their children to
foster care, and children in need of academic support.
15,000
Served/Yr
Transitional
Services for
New York, Inc.
(TSI)
Brooklyn
Bureau of
Community
Services (BBC)
Brooklyn
CDTPs Associated with Ways to Work Programs
The Ways to Work programs are situated in Continuing Day
Treatment Programs and Clinics that serve different populations.
CDT
Program
#
Participants
Age
Jamaica
Consultation
Center
98
90% < 55 yrs
52% African American
24% Latino/a
20% White
4 % Asian
32% Women
68% Men
51
18 – 55 yrs
22% African American
16% Latino/a
55% White
8% Other
71% Women
29% Men
400
26% 21 - 39 yrs
26% 40 - 49 yrs
37% 50 – 65 yrs
11% 65+ yrs
20% African American
15% Latino/a
50% White
15% Asian/Other
56% Women
44% Men
CDT: 177
Clinic: 262
31% 18 – 39 yrs
42% 40 – 49 yrs
27% 50+ yrs
30% African American
18% Latino/a
50% White
2 % Asian
37% Women
63% Men
95
95% < 55 yrs
76% African American
16% Latino/a
7% White
44% Women
56% Men
Agency
TSI
100+ groups
TSI has strong
vocational focus
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RMHA
Continuing Day
Treatment Program

JBFCS
Coney Island CSS
(4 CDTPs and
clinics)

PCMH
adult home residents
 want to develop
vocational expertise
Westside CDTP
Westside
Outpatient Mental
Health Clinic

BBCS
40% in RMHA
housing
many homeless
Project Moving On
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many young adults
Ethnicity
/Race
Gender
Diagnoses of CDT Program Participants
at Ways to Work Agencies
4% Major
Depression
10% Bi-Polar
21% Schizoaffective
65%
Schizophrenia
21%
Schizoaffective
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Most of the consumers participating in the Continuing Day
Treatment Programs and Clinics at Ways to Work agencies have
a psychiatric diagnosis of schizophrenia.
The proportions of diagnoses represented are very similar
across the five Ways to Work agencies.
How the Ways to Work Programs Work
CDTP
Participants
Determine Who
Wants To Work
Consumer Choice
(e.g., sign-up list)
Other Supports
Psychosocial Clubs
Family Education
Housing
Benefits
Counseling
Ways to Work Program
Assessment
Job Profile
Career
Interests/Goals
Work
Incorporated
Into All TX
Goals/Plans
Rapid Job Search
Job Development (Client Specific)
Individualized Job Placement
Integration of Work & Clinical Goals
• Team Meetings/Case Conferences
• Regular Communication
Job Support
(Follow Along Supports)
Job Coaching
Peer Support
Family Support
On-the-Job Assessment
• Regular Communication
• Management of
Medications
Symptoms
Integration with CDTP and
Mental Health Treatment Services
What is Competitive Employment*
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The goal is to assist
consumers in obtaining
competitive and satisfying
jobs in community
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The work pays at least
minimum wage
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People are employed in a
work setting that includes
non-disabled co-workers
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Service agency provides
ongoing support

Intended for consumers
with a desire to work

Includes people with the
most severe disabilities
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Eligibility for Supported
Employment services is
based on consumer choice
Consumer preferences are
important
Supported employment is
integrated with mental
health treatment
Competitive employment is
the goal
Job search process starts
soon after a consumer
expresses interest in
working
Follow-along supports are
continuous for employed
consumers
*Evidence-Based Practices Project
(SAMHSA, CMHS, Robert Wood Johnson Foundation, West Family Foundation
Johnson & Johnson Corporate Contributions & Community Relations)
Distinguishing Features of Each
Ways to Work Program
Each agency’s approach to promoting employment within their clinical settings
is based on agency philosophy, staffing and employment options.
Approach/
Philosophy
Staffing
($: What Does Ways to Work Finance?)
Employment
Innovations
TSI/
JCC
Ways
to Work tracks
added on after CDTP
Involvement of both CDTP
& Vocational staff
Job
Developer and Supported Employment Specialist
Supervised by Dir of Voc’l Services and Clinical Dir
$:Half-time each Job Developer + Employment Specialist
Seasonal
RMHA
Job
and Career Clubs
incorporated into CDTP
Importance of integration
On-site and off-site job
development
Employment
Specialist performs all Ways to Work
activities, with assistance from Job Coach
Reports to CDT Program Director and Director of
Employment Services
$: Full-Time Employment Specialist
Work
JBFCS
CI CSS
Importance
of belief in
ability to work
Importance of selfmanagement in relation to
work
Role
of Peer Counselors in providing support, role
modeling, and especially motivation
Focus on educating clinicians about employment
$: Job Developer and Peer Counselors/Job Coaches
Need
PCMH
Directed
job search with
individualized support
Program physically located
in CDTP/Clinic
Employment
Specialist performs all Ways to Work
activities, with assistance from Job Coach
Reports to Employment Services Director
$: Full-Time Employment Specialist
Role
BBCS/
PMO
Importance
Ways
Community-based
of assessment
(Workplace Center,
Columbia Univ. School of
Social Work)
Employment programming
co-located on-site with CDTP
to Work Coordinator performs all activities while
working closely with clinical staff
Reports to Director of CDTP and Director of Psychiatric
Rehabilitation Services
$: Coordinator with some Job Developer/Coach time
positions
try-outs
Disclosure
encouraged
to develop
work experience (to
help identify work
interests and goals)
for affirmative
businesses
Disclosure
discouraged
opportunities
Importance of
training/certification
# Ways to Work Participants Enrolled Monthly
(Jan 2002 – Sept 2002)
102 Ways to Work Participants Enrolled in First 9 Months
23
25
20
15
15
10
7
10
11
10
9
10
7
5
…
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Reasons Why Ways to Work
Participants Signed Up
Not surprisingly, most consumer sign up for the Ways to Work
program because they want to work – however, others cite both
more practical concerns ($) and more recovery-focused
concerns (to get a better life, improve self-esteem).
50%
40%
30%
20%
10%
0%
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Sociodemographic Characteristics of
Ways to Work Participants
3% Asian
11%
Latino/a
43%
46%
Female
White
57%
Male
39%
African American
Gender
College
5%
Graduate
Race/Ethnicity
36%
Less
Than HS
29%
Some
College
or Post HS
31%
HS Grad
Education
Initial Satisfaction with
Ways to Work Employment Services
Very
Satisfied
3.00
2.50
2.45
2.38
Somewhat
Satisfied 2.00
1.50
Not At All
1.00
Satisfied
Help in Finding Job
Help in Preparing for Job
Overall, consumers are pretty satisfied with the services they
receive early on as part of the Ways to Work program.