From Disability to Employment <ul><li>Daniel Michael  </li></ul><ul><li>May 26, 2010 </li></ul>
Who is Daniel Michael? <ul><li>Director and founder of the RAMS Hire-Ability program </li></ul><ul><li>24 years of experie...
Who is Daniel Michael? <ul><li>Currently is CEO of Thrive-Ability, LLC. a startup that networks nonprofit & government job...
What we will cover: <ul><li>Employment is a stabilizing force  </li></ul><ul><li>The three levels of vocational services &...
1. Getting people into jobs is the most effective way to promote mental health of patients2. Unemployment increases the ri...
Symptom Management in Employment Symptoms impair ability to work Provider: IOP, VR sheltered workshops Symptoms effect abi...
Symptom Management in Employment Symptoms impair ability to work Provider: IOP, VR sheltered workshops Recommended  Servic...
Symptom Management in Employment Symptoms effect ability to work Provider: VR training programs <ul><li>Vocational program...
Symptom Management in Employment Symptoms can be managed at work Provider: VR Follow-up services, EAP Recommended  Service...
Starting Vocational Rehab (Job Prep) <ul><li>A client in the workshop has a delusion that they are from an alien planet </...
Connecting to employment: (Job Development & Carving) <ul><li>A client with chronic undifferentiated Schizophrenia, flat a...
Accommodations in the Workplace (Job Coaching) <ul><li>An employer calls and says that Tom is ready to be fired for taking...
Daniel’s steps to assist  unemployed  psychiatric patients into employment:  <ul><li>Determine the level of work impairmen...
Daniel’s steps to assist  employed or recently employed  psychiatric patients:  <ul><li>Determine the level of work impair...
Vocational services in your area: <ul><li>Alameda County Social Services - Employment Services Dept. </li></ul><ul><li>Ala...
Dept. of Rehabilitation:  FREMONT BRANCH(Greater East Bay District affiliate)(510) 794-2458 (VOICE)39155 Liberty St., Suit...
Benefits Planner Service Area:  Southern & Eastern Alameda CountyKelly M. Harp, M.A.Community Resources for Independent Li...
Myths  <ul><li>If someone’s mental illness is not under control, they are not job ready.  </li></ul><ul><li>The stress of ...
Myths (part 2) <ul><li>A person with mental illness always needs specialized disability resources to get a job.  </li></ul...
Case Conferences: Meetings should include the patient, vocational staff, treatment staff (case manager, therapist, psychia...
Individual Placement & Support   (IPS) Model Robert Drake, M.D., Ph.D. <ul><li>Rehabilitation is considered an integral co...
<ul><li>5.  Time-unlimited support from mental health team </li></ul><ul><li>6.  Services are based on client choice rathe...
Practice Guidelines for Clinicians Working In Programs Providing Integrated Vocational And Clinical Services For Persons w...
Practice Guidelines for Clinicians Working In Programs Providing Integrated Vocational And Clinical Services For Persons w...
Union City Demographics <ul><li>43.3%  Asian  (18.8% being Filipino and 8.6% being Indian) </li></ul><ul><li>20.4%  White ...
Issues in vocational cultural competency: <ul><li>Vocational programs make little effort to recruit and retain a represent...
<ul><li>Gate keeping and service authorization for API consumers is usually performed by non-API staff. </li></ul><ul><li>...
<ul><li>Integrating primary health care, mental health, school, substance abuse and other social services in the vocationa...
Other Cultural Issues: <ul><li>Work is defined differently in different cultures </li></ul><ul><li>Asian family pressures ...
Changing stereotypes through the media
Thank You and now it’s time for Q & A:
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From Disability To Employment

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From Disability To Employment

  1. 1. From Disability to Employment <ul><li>Daniel Michael </li></ul><ul><li>May 26, 2010 </li></ul>
  2. 2. Who is Daniel Michael? <ul><li>Director and founder of the RAMS Hire-Ability program </li></ul><ul><li>24 years of experience in the mental health field. </li></ul><ul><li>Specialized in developing & administrating vocational rehabilitation programs for individuals with psychiatric disabilities. </li></ul><ul><li>Developed job placement programs State Department of Rehabilitation, PIC, County Mental Health, State Personnel Board, MHSA and others. Established CARF accredited programs in Supported Employment, Vocational Assessment, Work Adjustment, Employment Service and Job Coaching. </li></ul>
  3. 3. Who is Daniel Michael? <ul><li>Currently is CEO of Thrive-Ability, LLC. a startup that networks nonprofit & government job placement specialists to place people with barriers to employment into jobs. </li></ul><ul><li>Independent Service Provider for Dept. of Rehab. </li></ul><ul><li>Consultant for Careers in Horticulture in SF Bayview </li></ul><ul><li>Member of the SF Jobs Group, BACED (South & North Bay, East Bay & Marin County Job Developer’s Association </li></ul>Current:
  4. 4. What we will cover: <ul><li>Employment is a stabilizing force </li></ul><ul><li>The three levels of vocational services & how to assign patients to these levels </li></ul><ul><li>Vocational case examples </li></ul><ul><li>Steps to assist psychiatric patients into employment </li></ul><ul><li>Resources in your area </li></ul><ul><li>Vocational myths </li></ul><ul><li>Case management & IPS model </li></ul><ul><li>Culture competency in vocational </li></ul>
  5. 5. 1. Getting people into jobs is the most effective way to promote mental health of patients2. Unemployment increases the risk of clinical depression3. Approximately 3 million people (age 18-69) have mental illness. 70 to 90% are unemployed. 4. Understanding how psychiatric disabilities effect employment is critical to effective patient care. Lehtinen V, Riikonen E, Lehtinen E. Promotion of mental health on the European agenda. STAKES National Research & Development Centre for Welfare and Health, 1998.Dooley D et al. Depression and unemployment: panel findings from the Epidemiologic Catchment Area Study. Journal of Community Psychology, 1994, 22(6):745-765.National Alliance for the Mentally Ill (NAMI). Fact sheet. Facts about mental illness and work. August 1999 ( www.nami.org ).
  6. 6. Symptom Management in Employment Symptoms impair ability to work Provider: IOP, VR sheltered workshops Symptoms effect ability to work Provider: VR training programs Symptoms can be managed at work Provider: VR Follow-up services, EAP JOB Job Coaching JOB TRAINING Soft & Hard Skill training JOB PREPARATION IOP Treatment & Soft Skill Training
  7. 7. Symptom Management in Employment Symptoms impair ability to work Provider: IOP, VR sheltered workshops Recommended Services: <ul><li>Volunteer programs </li></ul><ul><li>Sheltered workshops </li></ul><ul><li>Pre-vocational program </li></ul><ul><li>Job readiness classes </li></ul><ul><li>Enclaves </li></ul>Vocational Specialist: Vocational Counselor JOB PREPARATION IOP Treatment & Soft Skill Training
  8. 8. Symptom Management in Employment Symptoms effect ability to work Provider: VR training programs <ul><li>Vocational programs </li></ul><ul><li>Career-specific training </li></ul><ul><li>Job skills & resumes </li></ul><ul><li>Job development </li></ul>Recommended Services: Vocational Specialist: Job Developer JOB TRAINING Soft & Hard Skill training
  9. 9. Symptom Management in Employment Symptoms can be managed at work Provider: VR Follow-up services, EAP Recommended Services: <ul><li>Job Coaching </li></ul><ul><li>Job Carving </li></ul><ul><li>Accommodations </li></ul><ul><li>HR intervention </li></ul>Vocational Specialist: Job Coach JOB Job Coaching
  10. 10. Starting Vocational Rehab (Job Prep) <ul><li>A client in the workshop has a delusion that they are from an alien planet </li></ul>
  11. 11. Connecting to employment: (Job Development & Carving) <ul><li>A client with chronic undifferentiated Schizophrenia, flat affect, disheveled and no job experience wants to work with children </li></ul>
  12. 12. Accommodations in the Workplace (Job Coaching) <ul><li>An employer calls and says that Tom is ready to be fired for taking too many breaks </li></ul><ul><li>Sally calls and says that she is going to be fired. </li></ul>
  13. 13. Daniel’s steps to assist unemployed psychiatric patients into employment: <ul><li>Determine the level of work impairment </li></ul><ul><li>Identify those involved (parents, case managers, etc.) </li></ul><ul><li>Refer to the DOR office in Fremont, CA </li></ul><ul><li>If impairment is severe, as DOR to refer to specialized vocational program in the area </li></ul><ul><li>Collaborate with vocational treatment team </li></ul><ul><li>Advocate for rapid placement and support services </li></ul>
  14. 14. Daniel’s steps to assist employed or recently employed psychiatric patients: <ul><li>Determine the level of work impairment </li></ul><ul><li>Identify any existing EAP, HR or support services </li></ul><ul><li>Identify those involved (parents, case managers, etc.) </li></ul><ul><li>Refer to the DOR office in Fremont, CA </li></ul><ul><li>If impairment is severe, as DOR to refer to specialized vocational program in the area </li></ul><ul><li>Collaborate with vocational treatment team </li></ul><ul><li>Advocate for rapid placement and support services </li></ul>
  15. 15. Vocational services in your area: <ul><li>Alameda County Social Services - Employment Services Dept. </li></ul><ul><li>Alameda County Vocational Program </li></ul><ul><li>Asian Community Mental Health Services </li></ul><ul><li>BACS-Employment Program: </li></ul><ul><li>BAYC </li></ul><ul><li>Catholic Charities of the East Bay - Refugee Employment Services </li></ul><ul><li>East Bay Innovations </li></ul><ul><li>EastBay Works </li></ul><ul><li>GoodWill Industries of the Greater East Bay, Inc. </li></ul><ul><li>Rubicon Incorporated </li></ul><ul><li>Self-Help For The Elderly </li></ul>
  16. 16. Dept. of Rehabilitation: FREMONT BRANCH(Greater East Bay District affiliate)(510) 794-2458 (VOICE)39155 Liberty St., Suite F630Fremont, CA 94538-1513 http://www.rehab.cahwnet.gov
  17. 17. Benefits Planner Service Area: Southern & Eastern Alameda CountyKelly M. Harp, M.A.Community Resources for Independent LivingTri-Cities Branch Office39155 Liberty St., Suite A100Fremont, CA 94538(510) 794-5735 (Phone)(510) 881-0218 (TTY)(510) 881-1593 (FAX)
  18. 18. Myths <ul><li>If someone’s mental illness is not under control, they are not job ready. </li></ul><ul><li>The stress of working is likely to cause relapses for someone with severe mental illness. </li></ul><ul><li>A person with mental illness who states he/she is not ready to enter the world of work is obviously not ready. </li></ul><ul><li>If consumers request or need help to get a job, they are not ready to work. </li></ul>Marrone, J., Balzell, A., Gold, M. (1995). Employment Supports for People with Mental Illness. Psychiatric Services 46(7), 707-711.Marrone, J., Gandolfo, C., Gold, M., Hoff, D. (1998). Just Doing It: Helping People with Mental Illness Get Good Jobs. Journal of Applied Rehabilitation Counseling, 29 (1), 37-48.Marrone, J., Gold, G. (1994). Supported Employment for People with Mental Illness: Myths & Facts. Journal of Rehabilitation, 60 (4), 38-47.National Alliance for Mentally Ill ( www.nami.org
  19. 19. Myths (part 2) <ul><li>A person with mental illness always needs specialized disability resources to get a job. </li></ul><ul><li>If a person with mental illness is really motivated to work he/she should be willing to try out any job. </li></ul><ul><li>A person with a mental illness should only work at low stress jobs that require no interpersonal contact. </li></ul><ul><li>Since it seems impossible to find a job listing that fits a particular customer, it is unlikely he/she will be able to find any appropriate job </li></ul>Marrone, J., Balzell, A., Gold, M. (1995). Employment Supports for People with Mental Illness. Psychiatric Services 46(7), 707-711.Marrone, J., Gandolfo, C., Gold, M., Hoff, D. (1998). Just Doing It: Helping People with Mental Illness Get Good Jobs. Journal of Applied Rehabilitation Counseling, 29 (1), 37-48.Marrone, J., Gold, G. (1994). Supported Employment for People with Mental Illness: Myths & Facts. Journal of Rehabilitation, 60 (4), 38-47.National Alliance for Mentally Ill ( www.nami.org
  20. 20. Case Conferences: Meetings should include the patient, vocational staff, treatment staff (case manager, therapist, psychiatrist, psychologist), DOR Counselor, family member, residential provider and other providers. These meetings can be called when there is a service concern, a disagreement on approach to services, plan change, and/or to update on participant progress on goals. Employer Family Patient Voc. Staff Treatment Providers
  21. 21. Individual Placement & Support (IPS) Model Robert Drake, M.D., Ph.D. <ul><li>Rehabilitation is considered an integral component of mental health treatment, rather than a separate service </li></ul><ul><li>Goal is competitive employment </li></ul><ul><li>Clients are expected to obtain jobs directly </li></ul><ul><li>Vocational services are continuous & based on real work experiences </li></ul>
  22. 22. <ul><li>5. Time-unlimited support from mental health team </li></ul><ul><li>6. Services are based on client choice rather than provider’s judgments </li></ul><ul><li>“ Employment specialists coordinate clinical and vocational efforts by joining the clinical team in regular meetings, by developing plans in conjunction with clinicians as well as consumers, by dividing up responsibilities for supporting the employment plan and by regular communication” </li></ul>Individual Placement & Support (IPS) Model Robert Drake, M.D., Ph.D.
  23. 23. Practice Guidelines for Clinicians Working In Programs Providing Integrated Vocational And Clinical Services For Persons with Severe Mental Disorders <ul><li>Clinicians can help their clients and clinical teams have realistic vocational expectations </li></ul><ul><li>Clinicians can coordinate their clients clinical and rehabilitation plans and interventions </li></ul><ul><li>Clinicians can provide basic support and problem solving to clients </li></ul><ul><li>Clinicians can contribute their insight to appropriate job matches that will support their clients illness management as well as vocational needs </li></ul>Psychiatric Rehabilitation Journal Torrey, W.C. Becker, D.R. & Drake, R.E. (1998)
  24. 24. Practice Guidelines for Clinicians Working In Programs Providing Integrated Vocational And Clinical Services For Persons with Severe Mental Disorders (continued) <ul><li>Clinicians can help clients manage their illnesses </li></ul><ul><li>Clinicians can help clients manage their substance abuse </li></ul><ul><li>Clinicians can help clients manage their interpersonal issues on the job </li></ul><ul><li>Clinicians can help clients interact with familial and non-familial social networks </li></ul><ul><li>Clinicians can help support their clients’ long-term rehabilitation efforts by keeping a positive frame of mind. </li></ul>Psychiatric Rehabilitation Journal Torrey, W.C. Becker, D.R. & Drake, R.E. (1998)
  25. 25. Union City Demographics <ul><li>43.3% Asian (18.8% being Filipino and 8.6% being Indian) </li></ul><ul><li>20.4% White </li></ul><ul><li>6.7% African American , 1.3% Native American , 0.9% Pacific Islander , 11.5% from other races , and 6.7% from two or more races. Hispanic or Latino of any race were 24% of the population. </li></ul>
  26. 26. Issues in vocational cultural competency: <ul><li>Vocational programs make little effort to recruit and retain a representative percentage of culturally compentent staff. </li></ul><ul><li>Salaries in vocational rehabilitation are too low to attract culturally competent staff. </li></ul><ul><li>Many vocational rehabilitation programs lack culturally competent services and programs to address the special needs of the API members. </li></ul><ul><li>Vocational programs many not be based in the API communities and are not located in a geographically assessable area. </li></ul><ul><li>The State Department of Rehabilitation’s information regarding covered services and procedures for accessing and utilizing services are not in API’s primary language(s). Also, the conventional means of dissemination are not reaching many of our API communities. </li></ul><ul><li>Treatment modality is usually based on the individual and places emphasis on the medical model. </li></ul>
  27. 27. <ul><li>Gate keeping and service authorization for API consumers is usually performed by non-API staff. </li></ul><ul><li>Services tend to be based on a short-term crisis intervention model. The length of services is based on reducing financial costs rather than clinical need. </li></ul><ul><li>Vocational services usually do not include complimentary or traditional healers as providers. </li></ul><ul><li>API families often value family involvement in the treatment of a client. However, family therapy sessions are often not covered emphasized by case managers and vocational programs. </li></ul><ul><li>Services are usually not accessible to API members, especially the monolingual clients. </li></ul>Issues in vocational cultural competency (part 2):
  28. 28. <ul><li>Integrating primary health care, mental health, school, substance abuse and other social services in the vocational plan increases the potential that API consumers will receive more comprehensive and more accessible treatment services. In reality, integration and collaboration efforts are very fragmented. Cross-system alliances for purposes of integrated service delivery are lacking in many areas. </li></ul><ul><li>Outcome measures are largely designed based on mainstream models. </li></ul><ul><li>Very few API are involved in agency governance or leadership positions. </li></ul><ul><li>API population is not just the fastest growing but also the most diverse group. For example, the API population has more than 50 ethnic groups which primarily has more than 30 different languages. API community agencies find it extremely difficult to meet the linguistic needs of their community. </li></ul><ul><li>Community education and outreach are very much needed because of cultural factors (e.g. Shame and Stigma). However, mostly no funding is available for such activities. </li></ul>Issues in vocational cultural competency (part 3): 1997: Lee, E. (ed.) Working with Asian-Americans - A Clinical Guide, Guilford Press, New York.
  29. 29. Other Cultural Issues: <ul><li>Work is defined differently in different cultures </li></ul><ul><li>Asian family pressures towards “respected” job or those families that have “given up” </li></ul><ul><li>“ Ghetto-izing”: looking for jobs only in Chinatown, Japan town, etc. </li></ul><ul><li>Employers who take advantage of language or cultural issues </li></ul>
  30. 30. Changing stereotypes through the media
  31. 31. Thank You and now it’s time for Q & A:

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