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Practical Tips on Supported Employment

Dartmouth Psychiatric Research Center researchers/trainers respond to participants during their recent web conference on supported employment.

Sarah J. Swanson and Deborah R. Becker, authors of Supported Employment: Applying the Individual Placement and Support Model to Help Clients Compete in the Workforce, answer audience questions from their National Council webinar on vocational support for people with mental health disorders.

Q: With IPS Supported Employment, what is the benefit to employers?

A: The benefit to employers is finding a person who is a good match for the job. Because employment specialists take time to understand the needs of employers before introducing a job candidate, they are able to help employers find candidates who have the skills and attributes each employer is seeking. For example, one manager might want someone who "walks in with a smile on his face" while another manager needs a person who is very reliable. Employers may also be eligible for tax credits such as the Work Opportunities Tax Credit (WOTC). To find out more about this tax credit, go to www.doleta.gov/business/incentives/opptax.

Q: Does competitive employment affect Medicaid status and continued enrollment and support from community mental health service providers?

A: Paid employment can affect Medicaid status depending upon the amount earned and each person's individual situation. We recommend that people meet with a trained benefits specialist, such as a representative from WIPA (Work Incentives Planning Assistance). To find out more about WIPA, go to http://www.ssa.gov/work/wipafactsheet.html. Counselors at Vocational Rehabilitation and One Stop Centers may know of other trained benefits planners.

Q: How is IPS and Supported Employment viewed by Medicaid? We have a waiver in our state and Supported Employment is considered B 3 services. Do you have any tools that crosswalk IPS with Medicaid standards?

A: Medicaid plans vary from state to state. We recommend that you speak with someone from your state Medicaid office.

Q: Does the employment specialist talk about the client being in a program for disabled or the like? Do clients sign a waiver or consent form for sharing information with possible employers? Can the employment specialist just talk in generalities about the type of clients they represent?

A: We recommend that specialists be upfront about who they are and where they work. For instance, the specialist could say, "I'm an employment specialist, and I work for Community Mental Health Agency." The employment specialist should view the employer as a customer, so honesty is important. If a client does not wish to disclose information about his or her disability to employers, then the employment specialist can offer to help from "behind the scenes" with job applications, finding job leads, etc. When an employment specialist begins to develop a relationship with an employer who seems to have the types of jobs that would be a good match for one of her clients, then she must obtain a signed release from the client allowing her to share information about the client with the employer.

Q: When receiving a new referral and the engagement process with the client is taking longer than the suggested rapid 30-day engagement, what are some suggestions as to how other people are handling this issue in meeting their fidelity outcomes?

A: Actually, the 30 days refers to the rapid job search. In other words, after the first meeting between the employment specialist and client, face-to-face contact with employers should occur within 30 days. Some people aren't always interested in applying for a job within 30 days, so they may make employer contacts to find out more information about different types of jobs and work settings. Investigating job types and employers (rather than submitting applications right away) may facilitate the engagement process.

Q: Have there been any studies completed with substance abuse counseling centers, not just mental health / behavioral health centers?

A: The research for IPS supported employment has focused on people who have severe mental illness but who may also have a substance use disorder.

Q: What tools are available to help transition from a day program / sheltered workshop / traditional vocational model to this model?

A: There are many tools and resources available at the Dartmouth website: http://www.dartmouth.edu/~ips/. Under resources, you will also find an Implementation Kit that may be helpful.

Q: How do we work with an individual who has substance abuse issues and repeatedly does not show up or will not engage with us? How much time do you put in outreach and how long would you keep working with someone?

A: Rather than focusing on the length of time spent on providing outreach, try to focus on finding out the reason that the person is not engaging. If you find out that the person has changed his mind about employment, then go ahead and close the person's case. You can always re-open it later on. If the person is encountering other obstacles, such as trouble remembering the appointments, try new strategies to help the person succeed in IPS. For example, you might try calling before appointments, making appointments at the same day and time each week, or helping the person use a calendar for appointments.

Q: Since many employers require drug testing, how do you get around drug screening when trying to help a person get employment who may still be actively using?

A: As an employment specialist, you would let your client know that an employer may screen for drug use. If the person doesn't get the job because of the drug test, then the person has more information about how drugs and/or alcohol are affecting his goals. Some people will decide to cut down on substance use while looking for work, and others may decide to look into treatment options. Still others will decide to try to find employers who don't use drug screening.

Q: How do you keep from "burning" an employer when you are putting clients out there so quickly?

A: Employment specialists take time to learn about each employer's needs before introducing a job seeker, and this work helps to ensure a good job match. Furthermore, specialists stay in close contact with employers after their clients start work. If someone doesn't work out, employers are often willing to work with the specialist again if they feel that the employment specialist was there to provide support along the way. For example, if the employment specialist had been calling or stopping by regularly.

Q: How important is caseload size when working in supported employment?

A: Caseload size is very important. Programs should strive for caseloads of 20 or fewer. If that is not possible, then programs should attempt to have caseloads of no more than 25 (which would be the equivalent of a score of 4 on the fidelity scale).

Q: If we know that a job location has a very bad reputation for drugs, etc., and I have a client that has asked to work at that location what should I do?

A: You might share the information that you have so that your client can make an informed choice about where to work. If your client still wants to work in the area that has a bad reputation, talk to the person about plans for getting to and from work safely. You might also include a case manager or counselor in the support plan if drugs are a problem for your client.

Q: Some of our clients have limited income...With that in mind, is there funding to help clients get ready [for job interviews], such as [programs helping people with their] appearance, clothes, hair, makeup, etc.?

A: Many areas have programs called "Dress for Success" or other resources to provide clothing for a return to work. You could do an Internet search for Dress for Success in your area and also call social service agencies that might know about other options. For example, your state's department of Vocational Rehabilitation, Easter Seals, and Career OneStop Centers may have information about where to obtain clothing for people who are returning to work.

Q: How is this program implemented in rural districts where employment is limited and places where what the client wants to do is not offered? How would we try to match their wants and needs to what is available?

A: If a person wants to drive a bus but there is no public transportation in the area, the employment specialist might begin to talk to others at the mental health agency or at Vocational Rehabilitation to find out whether there are jobs that are similar to driving a bus. She might find out that a program for older adults hires van drivers and that Meals on Wheels hires people to deliver meals. She could take these ideas back to her client for his consideration. Employment specialists can also engage in the job search with their clients. So, if a person wants to work at a hardware store and there is only one in the area, the employment specialist would help him apply at the store (according to his preferences for disclosure) and then ask if he would like to think of other related jobs, such as building supply companies, or wait a bit to find out how things go with the hardware store application.

Q: Is any job development done? Where employment specialists talk to employers in placing the person in the competitive job?

A: Employment specialists spend a significant amount of time on job development each week. In fact, specialists in IPS make at least six face-to-face contacts with hiring managers or business owners each week. They make contacts with businesses that have the types of jobs that their clients are interested in obtaining.

Q: Is there any statistical information about success rates of IPS supported employment during the current economic downturn?

A: In a 13-state project coordinated through Dartmouth Psychiatric Research Center, the percent of people in IPS programs who are employed dropped from 50 percent to 42 percent during the economic downturn. However, some programs continue to achieve rates of employment that are above 50 percent.

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