Transcript Document

Employment, the Final
Frontier
State of the States Conference
The National Association of State
Head Injury Administrators
7/21/2015
Karen Flippo, Brain Injury
Association of America
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Employment, the Final
Frontier
 “In the beginning,
God created the
world….”
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Association of America
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Frontier
 Work is an individual’s strongest tie to
reality.
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Sigmund Freud
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Association of America
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 National Council on Disability recommends
that in reauthorizing Rehabilitation Act, the
Administration and Congress give
consideration to broadening the scope of
resources in the employment area. Society
can no longer afford to consider so-called
“disability issues” in isolation from the broader
dimensions of policy and practice.” NCD A
Progress Report, December 2000-December 2001.
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Frontier
 “A man’s work is his dilemma: his job is
his bondage, but it also gives him a fair
share of his identity and keeps him from
being a bystander in somebody else’s
world.” Melvin Maddocks
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Data drives results!
 Conduct an analysis to identify the
features of successful outcomes and
negative performance in one single
agency. How else will you truly know?
 AND, data drives policy.
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 Research studies
heavily oriented
towards prediction
of success/failure.
 Factors influencing
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employment:
Substance abuse
Gender
Age
Employment history
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 Education
 Professional training
 Family support
 Self-awareness and
ability to regulate
affect.
 Negative correlation
between personality
change and
successful
employment outcome
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Association of America
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Employment-The Final
Frontier
•Research Results
•Unemployment rate of individuals with TBI
ranges from 50-80%.
•Supports are needed for individuals with TBI
and other significant disabilities and
traditional placement models do not work
Wall, et al., 1998; Wehman, 2001
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 Approximately 75% of individuals with TBI
who return to work lose their jobs within 90
days if work supports are not in place.
 Literature shows an alarming lack of effective
models with supported employment one of
the more outcomes-based approach
West, 1995; Oliver, et al. 16; Johnson, et. Al.,
1998;Prigatano, et. Al. 1994; Sander, et al, 1996.
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Association of America
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 39% people with severe injury, 77% of
those with moderate injury and 80% of
those with mild injury return to work within
2 years. Dikmen, et al. 1994
 Important for those who sustain injury to
understand that work is possible early
after injury. Malec
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 One year following TBI:
 Employed persons fell from 69% to
31%.
 Unemployed increased from 11% to
49%.
 Average earned income per month
declined from $1,491 to $726.
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 Assuming study is representative of

national statistics for TBI, first year post
TBI associated with $642 million in lost
wages, $96 million in lost income taxes,
and $353 million in increased public
assistance.
Johnstone et. al. MMBIS (2002)
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 35% - 50% did not have an
employment history. (Corrigan)
 Less than 1/3 of persons employed at
time of injury are able to return to work
afterwards.
 Income highly correlated to life
satisfaction but subjective well being not
correlated to functional independence.
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Results indicated that during 3 to 5-year period
following discharge:
 47% of subjects were referred.
 Average time from rehabilitation discharge to
referral was 5.6 months, median was 2.4 months.
 Of subjects referred, 53% were found eligible and
of those, 29% eventually closed as successful
rehabilitation; another 46% closed
unsuccessfully; and remaining 25% still in
process.
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 The average total cost of services for those
closed successfully was $9,380; the average
for unsuccessful closures was $4,277.
OVC TBIMIS
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 Fraser and Baarslag-Benson (1994)
identified key barriers for return to work:
 Cognitive.
 Emotional concerns.
 Physical and motor impairments.
 Pre-existing character or behavioral
difficulties (might have been in place
prior to injury).
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Frontier
 “After 12 years of university education, I
labor to read a short story, must ask my
high school trained assistant for
instructions on how to do my job, and
use an alarm every three minutes while
driving to get to the correct destination.”
Claudia Osborn, Over My Head, 1998
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 New York University Medical Center
Head Trauma Program
 59 participant characteristics (moderate
to severe head injuries); mean age:
27.14 years; mean education 14.17
years; mean days in coma 36.2;
acceptance variable and successful
vocational outcome was 0.78.
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 Acceptance.
 Active participation in therapeutic community.
 Willingness to own up to problems.
 Willingness to endorse staff
recommendations.
 Compliance with program routines and
objectives.
Ezrachi et. Al., 1991
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 Lack of awareness of injury, inability to
read others’ emotions, disinhibition and
emotional lability all were associated
negatively with success at the
workplace (Making it difficult to discuss
accommodation with an employer).
Dikmen, et al. 1994.
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 Attempt to focus on medical
complications can hinder rehabilitative
efforts to improve cognition and only
prolongs adjustment to injury.
Holzberg, 2000
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 Successful return to work related to
youthfulness, higher education and
professional training, and access to a
voc rehab counselor throughout the
hospital phase of rehabilitation .
Crisp, 1992
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 Extensive literature review found:
 Weak representation of programs that focus
on career planning and job readiness or
programs with a focus on getting a job!
Holzberg, 2000
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 Dichotomy between research studies
and employment practice values.
 Disability versus ability.
 Labels versus actual behavior.
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 “Best Employment Practice”
 Believe that a person with a disability can
work, if that is their choice. Choose Work!
 Through career planning process, identify job
goals, roles and responsibilities and
timelines.
 Situational assessments follow goal
identification.
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Work
Defines WHO we are, WHAT we can
become, HOW we will lead a selfdetermined life.
 For individuals with TBI, work is a
means toward rehabilitation.
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 And money makes
the world go round.
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Association of America
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Frontier
 TBI and the VR System (RSA/RTI Longitudinal
Study, 2002). Only 1.8% of those served in VR
have a TBI.
 Similarities in work history for those with and
without TBI although more individuals with
TBI receive SSDI.
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 Motivation to Apply for VR services
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Medical treatment
AT devices/services
Counseling/psychotherapy
SSA requirement
Referral from other agency
Friend/family member
Help in getting/keeping job
Help for voc training/college
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TBI
8.4
8.5
22.8
3.8
44.9
5.3
69.8
96.7
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All VR clients
16.5
17.4
24.9
4.7
46.7
29.4
76.0
74.6
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 Overview of VR services
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Time in service
 Cost of purchased service
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TBI
21.5 mos.
$3.279
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Association of America
All VR clients
20.7
$3,489
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 Types of Services Received
 Assessment Services
% of TBI Consumers
 Medical Eval.
66
44.1
38
31.9
12.6
 Voc assessment
 Psych/assessment
 Neuropsych eval.
 Ed. status assessment
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 Types of Services Received
 Medical/psych services
% of TBI Consumers
 Medical Treatment
18.2
12.3
30.5
 Psychological/psychiatric
 Counseling
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 Types of Services Received
 Ed emp/dev. services % of TBI Consumers
 Business/voc. Trng.
 Job placement
 Supported employment
 Job development
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15.2
13.4
12.8
10.6
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 Types of Services Received
 Mobility/other support
% of TBI Consumers
 Transportation
24.6
17.4
12.6
 AT services
 Physical therapy
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 Factors that Predict Employment
Outcomes (RSA)
 Consumers perceptions regarding
quality of the consumer/counselor
relationship.
 Receipt of job placement services.
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 Individuals with TBI had a higher hourly
earnings at exit, one year later, and two
years later than all consumers.
 Example: $8.03/hr vs. $7.33 (at exit)
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Examples of Best Practices
 Team orientation—one person doesn’t have
all of the answers!
 Situational assessments—paper and pen
tests don’t give the true picture. DOL allows
215 hours of non-paid situational
assessment.
 Use MAPS, PATH, or any personal centered
planning process to obtain a comprehensive,
complex, historic and future context of the
individual and their choices.
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 Keep current on changes in regulation and
policy—state and federal. (SSA, Ticket to
Work-2003, PASS Plans, IWRE, SGA),
Medicaid Waivers, TANF, Voc Rehab, CMS
Real Choice Systems Change Grants).
 Understand how resource facilitation works,
and undertake blended funding for people
you serve.
 Purchase services from vendors who get
results and believe in employment.
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Frontier
 On the job training
conducted by
business gives
supervisors a
greater sense of
control and
responsibility
Curl and Chisholm, 1993
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 Supported employment is one of the
more successful approaches to
placement and retention of individuals
with TBI
 Self-employment--Persons with
disabilities have higher rates of selfemployment than persons without
disabilities. 7.8% vs. 12.2% Presidential Task
Force on Employment of Adults with Disabilities 1999
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 Brain Injury Association of America and
University of Montana, Rural Institute on
Disabilities.
 Self-Employment Research and Development
Project for Individuals with TBI.
 3 years, 3 sites (Utah, Virginia and
Minnesota).
 20 individuals receive extensive training and
support to operate their own businesses.
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 Business speaks…
 “The nation needs a new clarity in
defining both what is expected of
workers and what they have a right to
expect in return: Hard work and
personal responsibility must remain the
foundation of our economy, and people
who work should not be poor.
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 “Workers should be flexible and expect
to shift jobs and careers. Workers
should be responsive to the needs of
employers, co-workers and customers,
and work should improve, not detract
from, the lives of families.
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 “Business and government must make
an unprecedented commitment to
develop new training and skills-building
strategies….Industry is better equipped
than government to anticipate needed
skills and train workers accordingly.
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 “Employers need more tax support for
training.
 Federal and state governments should allow
some welfare recipients to participate in
training directly related to employers and
specific jobs rather than go immediately to
work, in some cases.
David T. Ellwood, Exec. Dir, Aspen Institute’s Domestic Strategy
Group, September 2002
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 Bring employers into the employment
process; brainstorm with them what will
work for them and for the applicant.
 Collaboration with P&As, AT projects.
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 Use a variety of staffing approaches-
depends on preference of employee
and employer, such as natural supports
(paid or unpaid coworker) or
employment consultant.
 Explore a variety of employment
approaches, volunteer, AmeriCorps, job
sharing.
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 Program Without Walls-NY (TBI caseload)
 State VR counselor is fully accountable and
does not transfer responsibility to anyone
else!
 Build a team of experienced contractors and
vendors to provide services.
 Two key components: situational assessment
and service coordination.
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 Outcomes-higher rates of placement and
rehabilitation versus other counselors.
 Higher rates of rehabilitation are achieved
without negative impact on hours worked,
earnings, placement type.
 Cost of PWW is not significantly higher than
standard services
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 Do research results create a challenge that is
too difficult?
 Find the Rainbow.
 Creativity, coordinated systems, long-term
service, replication, and evaluation.
 Qualified, competent, and values-based
providers who are true advocates and
partners with focus person in employment
process.
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 Identify training needs; state agencies and
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universities can respond.
Identify barriers, strategies to remove barriers
and also WHAT WORKS.
Understand role of coordinator, purchaser of
service, and ADVOCATE.
Utilize blended funding, VR, waiver, PASS,
Small Business tax credits, education.
Make employment a state priority.
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 Ultimately, the result will depend in large
part on the QUALITY and STRENGTH
of the relationships between the person
being served, service provider and
or/employer and coworker .
 Most important is the ongoing natural
support at the work place.
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 For those with mild and moderate brain
injuries, it is necessary to become early
identified so services can be provided and the
concept of work is integrated into rehab.
 Work with neuropsychologists and other
medical professionals who know about
employment.
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 Important to use a variety of compensatory
strategies.
 Facilitate interagency partnerships to develop
state systems that promote employment.
 When possible, utilize assistive technology
such as screen readers, devices for memory
and organization, wearable computers.
 When employed, access natural supports and
EAPS as a way to join the workforce.
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 Replication of what works.
 Importance of holistic approach (living,
socializing, community participation)
with employment.
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 VR needs brain injury specialists (only
50% of states have them now).
 And belief in the value that people with
brain injury can work and have
productive careers.
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 Fund public/private partnership projects
to research real world work factors that
influence employment and retention (i.e.
apprenticeships and internships).
 Focus on careers not jobs (long-range
and discovery).
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 Seek employment in
companies/positions with long term
benefits and more job stability.
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 Training of employment/TBI personnel.
 Risk is a part of life.
 Advocate to change Social Security
Ticket to Work Provisions to ensure that
people with severe disabilities are
served in employment networks.
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 “There is no medicine like hope, no
incentive so great, and no tonic so
powerful as expectation of something
tomorrow.”
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