Friday, March 27, 2009

Minnesota's Employment First Movement in Mental Health


Editorial Note: I recently wrote this newsletter article for Minnesota APSE-The Network on Employment. It will be featured soon in our State Chapter's quarterly newsletter issue. However, I thought I would share it here with my blog readers as well.

The State of Minnesota recently issued its annual report for 2008 to the State legislature concerning the employment status of Minnesotans living with serious mental illnesses (SMI). Although we have a long way to go, this status report is rich with data and supports the progress Minnesota is making in clearing pathways to the workforce for its residents with SMI.

One of the most exciting trends identified in this 2008 report is Minnesota’s gradual transformation to evidence-based practice, supported employment (EBP-SE) to improve the quality of employment outcomes in the State. EBPs are specific service interventions documented to support success in recovery from SMI through clinical research trials.

EBP-SE is one of six EBPs in psychiatric rehabilitation identified by Dartmouth’s Psychiatric Rehabilitation Center (PRC) and the federal Substance Abuse and Mental Health Services Administration (SAMHSA). EBP-SE is characterized by an individualized job placement and support (IPS) strategy and focuses on bringing integrated employment in the workforce at competitive wages and benefits into the lives of working-age adults with SMI. Also, EBP-SE requires a practical framework for imbedding supported employment services within a mental health treatment milieu due to the demonstrated benefits of integrated work in illness management recovery.

In 2006, Dartmouth’s PRC and the Johnson and Johnson Foundation (J&J), a philanthropic grants organization, awarded Minnesota a four-year, systems-change grant to transform its mental health and workforce development system to an EBP-SE model. The J&J initiative in Minnesota led to the funding of six pilot demonstration programs in local communities with a goal of adopting EBP-SE practices. These six new projects have already served 270 individuals with excellent results.

Why is EBP-SE so important to Minnesota? National research documents between 50-60% of consumers with SMI are successful in obtaining competitive employment when supported by EBP-SE programs. EBP-SE program performance is far superior to traditional employment approaches that lead to competitive employment for less than 20% of their enrollees. Also, EBP-SE research has documented superior outcome performance to other approaches regardless of geographic location, race or ethnicity, gender, age, or disability status.

My own organization, Rise, Incorporated, is one of the six providers participating in Minnesota’s EBP-SE initiative. Rise is working with Family Life Mental Health Center (FLMHC) and other collaborators in Anoka County including Minnesota Rehabilitation Services, affordable housing and supported living providers, mental health self-advocates, Anoka County Social Services, and others to better integrate EBP-SE practices within a mental health treatment and recovery team model.

What have we learned? The principles underlying EBP-SE are different from conventional supported employment services in a number of ways:
  • Zero Exclusion Policy. Eligibility for EBP-SE is driven by a mental health consumer’s interest in working. There are no protocols for engaging participants in traditional “job readiness” type activities.
  • Mental health treatment and supported employment services are fully integrated. This is accomplished by establishing multi-disciplinary treatment teams that meet and coordinate their core mental health, housing, community support, and supported employment services regularly. An employment specialist is a critical member of the team and works full-time on the development and sustainability of high quality competitive employment.
  • Competitive employment is the goal. All participants supported by an EBP-SE program work in regular, individualized jobs at competitive wages and benefits in the community’s labor force.
  • Rapid engagement and job search. EBP-SE programs promote an assertive outreach process to engage unemployed individuals who express an interest in working. Also, it engages others who need ongoing job support to stabilize their community living and long-range goals for career advancement. In addition, there are no delays in beginning a competitive job search process for EBP-SE participants. The goal is to begin planning individualized job placement goals and contacting employers within 30 days of enrollment.
  • Job placement outcomes are driven by preferences and interests of the individual. The quality of job matching is fundamental to achieving personal satisfaction and long-term employment success. Therefore, EBP-SE programs focus on participants’ interests and preferences including job type, industry sector, business location, work schedule, and position duties or responsibilities.
  • Job follow-along supports are continuous. Participants of an EBP-SE program have access to job support on a time-unlimited basis. The EBP-SE mental health treatment team and employment specialist are in regular contact with the individual to maintain job success and assist with career progression goals. Also, the employment specialist may have direct contact with business leaders periodically if desired or requested by the employee.
  • Benefits Planning. The number fear about entering the competitive workforce by adults with SMI is the potential loss of disability and health care benefits. The impact of earned income through competitive employment is examined carefully and discussed with each participant before implementing a job search to allay fears and engage appropriate strategies. The mental health treatment team and employment specialist in an EBP-SE program share information about work incentives and monitor wage earnings once a participant chooses to engage in remunerative work.

    Minnesota APSE—The Network on Employment and Minnesota’s Employment First Coalition (MEFC) are excited about this emerging opportunity to transform policies and promote professional development training to expand EBP-SE services on a statewide basis. The reason for this excitement is EBP-SE is highly consistent with the articulated goals of Minnesota’s fast growing Employment First movement.

    To illustrate this point, EBP-SE focuses on assertive, rapid engagement of integrated employment at competitive wages and benefits. This concept is congruent with core recommendations identified in Minnesota’s Employment First Manifesto published in 2007. Also, the proponents of EBP-SE are working to build on existing service systems strengths to promote the job preferences of Minnesotans with SMI and meet the workforce objectives of their employers.

    Finally, EBP-SE promotes the engagement of community action teams (i.e., mental health treatment teams) to transform local policies, infuse researched practices, and increase the number and quality of competitive employment outcomes of mental health consumers. Indeed, a majority of EBP-SE’s core principles are complementary to the stated goals of MEFC.

    Minnesota’s vision to become an Employment First State means embracing an “employment for all” philosophy so no one is left behind. And it’s abundantly clear working-age adults with SMI are one of the largest underrepresented groups in Minnesota’s workforce. For these reasons, Minnesota APSE and MEFC see great wisdom in working jointly with State agency leaders, policymakers, and local community mental health teams and providers to pursue mutually shared goals.

    Together, we can do much more to increase public awareness about the employability of Minnesotans with SMI. And together, we can make sweeping changes in service policies and practices so competitive employment is routinely recognized and accepted as the first choice of Minnesotans with SMI.

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