and Supported Employment : In search for Utopia? Chantal Van - PDF document

Searching for Utopia (Jan Fabre) Integration of Supported Education and Supported Employment : In search for Utopia? Chantal Van Audenhove, KU Leuven LUCAS At 1 st European Conference on Supported Education Groningen, November 16-17 th 2015 Content  The need for integration SE&Sed  An exploration of 5 models in Europe  What did we learn ? 1. How to integrate SE and SEd components ? 2. How to collaborate between employers, educations and ‘clients’? FACTS about education and 3. Vision on integrated SE& SEd for persons with SMI employment for pw MH problems 4. The users perspective 5. Barriers and success factors  Towards a new model : Employment Works!  Conclusions 3 4 1

Education of people with mental health problems Employment and unemployment rates (in %) Mental disorder No disorder Mental disorder No disorder  56% of adolescents with serious mental health problems 90 complete highschool 20 80 18  Even less complete post-secondary education 16 70 (Wagner et al., 2006) 14 60  SE for adults is increasingly implemented in Europe, but 12 50 what about SEd? 10 40  For example: in Portugal, 14% of MH services offer SEd (Teixeira, Santos, 8 Abreu, Rogers, 2015) 30 6 20 4  Unemployment remains a big problem for the target group 10 2 0 0 BelgiumSweden US UK Norway Nether- NetherlandsNorway Australia US Sweden UK Belgium Australia lands Employment rate Unemployment rate Source: OECD (2013), Mental Health and Work: Belgium. SEd and SE – integration of two separate worlds? Separation between SEd and SE has (Egnew, 1993) disadvantages (Egnew, 1993)  SEd and SE originally developed as separate programs  SEd: – is less effective if not linked to vocational goals  Yet, there are similarities:  SE: – success also depends on abilities/skills – Community based: natural environment – Individual client-driven needs – High level of consumer acceptance  Jobs offered during SE often only require a minimum qualification  Persons with higher intellectual capacities become frustrated and demoralised 2

Advantages of integration SEd and SE Yet… (Egnew, 1993)  The onset of mental illness often in late adolescence or early  Research on integration SEd and SE is lacking adulthood : transition phase  An integration of SEd and SE connects easily with transition  The combination of “Supported Education” and  It is more likely to find employment that better fits the education and competence level (Murphy et al., 2005). “Supported Employment” appears 5 times in  Increases efficiency (organisation) titles of scientific articles since 2011 – Allows the program to combine the talents of different staff members.  Increases effectiveness (Google Scholar) – Maximize the ability of programs to individualize services • Offering a broad spectrum of choices/services  Promotes sense of self-worth and hope.  Start of ESF project Acknowledgement LUCAS-team SE&SEd Jeroen Knaeps, Ph.D Collaboration between: Inge Neyens, Ph.D Veerle De Jaegere, Marian De Groof Iris De Coster Ann DeSmet 3

Goal of the research project Research  Develop a SE & SEd model to fit into the current Flemish  Different steps: context of services – Literature review  Therefore, different information sources were used – 5 study visits Flemish model – Peer review with Flemish experts – Exchange event to ameliorate the model Peer review and Research findings exchange event – Small implementation project  5 European programs offering employment and educational support to people suffering from SMI Integrated Local context and Good practices (visits, SE and SEd legislation project manuals) model Long-term goal: Sustainable employment Inclusion criteria Clubhouse Finnish Fountain House  Integrated approach: key ingredients of SE and Helsinki SEd are present and aspects of integration Clubhouse Fountain House  Support to find regular job and inclusive Copenhagen education Early Detection and  Own choice of participant Intervention of Psychosis  Continuity of support  Experience for some time with integration (5years) • Worcestershire health and Care NHS  Good outcomes: research or monitoring Trust • Mental Health NHS Trust South-West  Correspondence with Flemisch structures London 4

Visits How are SE & Sed integrated ?  Research questions during visits: 1. How are SE and SEd components integrated? How do programs – Putting clients’ goals in the center ensure an integrative approach? – Both employment and educational goals are assessed at intake 2. How is collaboration between employers, educational institutes and ‘clients’ stimulated? – Employment specialists within SE & SEd programs focus on 3. Vision on working with people with SMI education as a step towards future employment 4. Users perspective: satisfied with the program? Why (not)? – Clients who reside in a status of student, are stimulated to actively 5. What are important barriers and success factors when implementing SEEd (Supported Employment-Supported think about their career Education) programs? – Clubhouse: no guidelines concerning the integration of SE and SEd. Clients state that they can easily switch the focus of their support  Meetings service manager and staff / two to three clients / employers or teachers Collaboration between employers, educations and The vision of the projects ? clients ? – Employment: Structural (job-scouting) or ad hoc collaboration – All services incorporate a focus on rehabilitation, empowerment – Success factors when working with employers: and person-centeredness • Active contact and follow-up, do not wait until problems arise – IPS-models • Employers must feel supported • Employment/educational goals are important • Clients’ preferences are crucial • Make them enthusiastic • Social network is important • Regularly update • Cognitive therapy, motivational interviewing • Pay attention to the size of the company – Clubhouse – Educational institutions: most services opt for ad hoc collaboration • No ‘clients’, but members (=staff + clients) • Equality between members depending upon the clients’ wishes and the educational institute • Diagnosis is unimportant • Attractive location • Focus on social support 5

The clients’ perspective The clients’ perspective  Positive aspects  Barriers – Overall positive elements: – Clubhouse: • Attention given to employment and education by staff • Too slow, too few expectations, without obligations • Support from staff and employment specialists • Identity: ‘I am a Clubhouse member’ implicates having mental • Support is flexible and individualized health problems • Support by peers is important – Clubhouse members add: • Group cohesion and social interactions – EIDP (The Netherlands): • Staff is not pushy, does not have specific expectations • Support of multiple professionals is not always perceived as an • Feeling of being equal, respect for privacy • Work ordered day offers structure en experience added value: ‘it can be too much !’ • Benefits from study support (how to study) Determinants of success Experienced barriers – Establish a shared mission statement, vision – Financial resources are often not stable/sufficient – Create a network of participating partners – Legislation can be hindering – Actively create a positive image in society – Trained staff, supervisors, research partners – Stigma and attitude of no risk-taking – Strong personal involvement of staff – Difficult transition to competitive employment – Regular communication and interpersonal support – Sufficient financial resources – Difficult transition to regular education – One service states that the inclusion/selection of target group as key to offer the most effective services 6

Employment works! model Coordinator and supervisor Employment works! Educational services Employment (Higher education and / Werkwerkt! university) educational therapist Mental health + care provider An integrated SE and SEd model Employment / based on the results of the study Employment services educational specialist Why two experts ? Employment/educational therapist  The “therapist” offers long-term support, coaching and  Big gap between world of MHCare and work/education counseling, in a.o.:  Like in the VETE model in Australy two experts are – anxiety management techniques chosen: – stress management – An expert in care (therapist) – Problem-solving skills training – An expert in the field of work or education (specialist) – Learning to cope with job loss or failing on a test  Involvement of education remains difficult because – Support in making decisions each university/high school has its own system – Relapse prevention  No policy center for SEd – Social skills training – Support in coping with stigma and ‘disclosure’  Therefor: the employment therapist an specialist need – Learning to handle cognitive impairment to have attention for education as well. – Teaching how to handle Activities of Daily Living, life roles and  CF ‘Adapting SE for emerging adults’ (Ellison et al., commitments 2014) (Davis & Rinaldi, 2004; Sherring et al., 2010; Waghorn et al., 2011) 7