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

1

Integration of Supported Education and Supported Employment: In search for Utopia?

Chantal Van Audenhove, KU Leuven LUCAS

At 1st European Conference on Supported Education Groningen, November 16-17th 2015

Searching for Utopia (Jan Fabre)

• 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’? 3. Vision on integrated SE& SEd for persons with SMI 4. The users perspective 5. Barriers and success factors

• Towards a new model : Employment Works!
• Conclusions

Content

3

FACTS about education and employment for pw MH problems

4

2

• 56% of adolescents with serious mental health problems

complete highschool

• Even less complete post-secondary education

(Wagner et al., 2006)

• SE for adults is increasingly implemented in Europe, but

what about SEd?

• For example: in Portugal, 14% of MH services offer SEd (Teixeira, Santos,

Abreu, Rogers, 2015)

• Unemployment remains a big problem for the target group

Education of people with mental health problems Employment and unemployment rates (in %)

Source: OECD (2013), Mental Health and Work: Belgium. 10 20 30 40 50 60 70 80 90 NetherlandsNorway Australia US Sweden UK Belgium

Mental disorder No disorder

Employment rate Unemployment rate

2 4 6 8 10 12 14 16 18 20 BelgiumSweden US UK Norway Nether- lands Australia

Mental disorder No disorder

• SEd and SE originally developed as separate programs
• Yet, there are similarities:

– Community based: natural environment – Individual client-driven needs – High level of consumer acceptance

SEd and SE – integration of two separate worlds? (Egnew, 1993)

• SEd:

– is less effective if not linked to vocational goals

• SE:

– success also depends on abilities/skills

• Jobs offered during SE often only require a minimum qualification
• Persons with higher intellectual capacities become frustrated and demoralised

Separation between SEd and SE has disadvantages (Egnew, 1993)

3

• The onset of mental illness often in late adolescence or early

adulthood : transition phase

• An integration of SEd and SE connects easily with transition
• It is more likely to find employment that better fits the education

and competence level (Murphy et al., 2005).

• Increases efficiency (organisation)

– Allows the program to combine the talents of different staff members.

• Increases effectiveness

– Maximize the ability of programs to individualize services

• Offering a broad spectrum of choices/services
• Promotes sense of self-worth and hope.

Advantages of integration SEd and SE (Egnew, 1993)

• Research on integration SEd and SE is lacking
• The combination of “Supported Education” and

“Supported Employment” appears 5 times in titles of scientific articles since 2011

(Google Scholar)

• Start of ESF project

Yet…

Collaboration between: Acknowledgement LUCAS-team SE&SEd Jeroen Knaeps, Ph.D Inge Neyens, Ph.D Veerle De Jaegere, Marian De Groof Iris De Coster Ann DeSmet

4

• Develop a SE & SEd model to fit into the current Flemish

context of services

• Therefore, different information sources were used

Goal of the research project

Integrated SE and SEd model

Local context and legislation Peer review and exchange event Research findings Good practices (visits, project manuals) Long-term goal: Sustainable employment

Research

• Different steps:

– Literature review – 5 study visits – Peer review with Flemish experts – Exchange event to ameliorate the model – Small implementation project

• 5 European programs offering employment and

educational support to people suffering from SMI

Flemish model Clubhouse Finnish Fountain House Helsinki Clubhouse Fountain House Copenhagen Early Detection and Intervention of Psychosis

• Worcestershire health and Care NHS

Trust

• Mental Health NHS Trust South-West

London

• Integrated approach: key ingredients of SE and

SEd are present and aspects of integration

• Support to find regular job and inclusive

education

• Own choice of participant
• Continuity of support
• Experience for some time with integration

(5years)

• Good outcomes: research or monitoring
• Correspondence with Flemisch structures

Inclusion criteria

5

• Research questions during visits:

1. How are SE and SEd components integrated? How do programs ensure an integrative approach? 2. How is collaboration between employers, educational institutes and ‘clients’ stimulated? 3. Vision on working with people with SMI 4. Users perspective: satisfied with the program? Why (not)? 5. What are important barriers and success factors when implementing SEEd (Supported Employment-Supported Education) programs?

• Meetings service manager and staff / two to three clients /

employers or teachers

Visits

– Putting clients’ goals in the center – Both employment and educational goals are assessed at intake – Employment specialists within SE & SEd programs focus on education as a step towards future employment – Clients who reside in a status of student, are stimulated to actively think about their career – Clubhouse: no guidelines concerning the integration of SE and SEd. Clients state that they can easily switch the focus of their support

How are SE & Sed integrated ?

– Employment: Structural (job-scouting) or ad hoc collaboration – Success factors when working with employers:

• Active contact and follow-up, do not wait until problems arise
• Employers must feel supported
• Make them enthusiastic
• Regularly update
• Pay attention to the size of the company

– Educational institutions: most services opt for ad hoc collaboration depending upon the clients’ wishes and the educational institute

Collaboration between employers, educations and clients ?

– All services incorporate a focus on rehabilitation, empowerment and person-centeredness – IPS-models

• Employment/educational goals are important
• Clients’ preferences are crucial
• Social network is important
• Cognitive therapy, motivational interviewing

– Clubhouse

• No ‘clients’, but members (=staff + clients)
• Equality between members
• Diagnosis is unimportant
• Attractive location
• Focus on social support

The vision of the projects ?

6

• Positive aspects

– Overall positive elements:

• Attention given to employment and education by staff
• Support from staff and employment specialists
• Support is flexible and individualized
• Support by peers is important

– Clubhouse members add:

• Group cohesion and social interactions
• Staff is not pushy, does not have specific expectations
• Feeling of being equal, respect for privacy
• Work ordered day offers structure en experience
• Benefits from study support (how to study)

The clients’ perspective

• Barriers

– Clubhouse:

• Too slow, too few expectations, without obligations
• Identity: ‘I am a Clubhouse member’ implicates having mental

health problems

– EIDP (The Netherlands):

• Support of multiple professionals is not always perceived as an

added value: ‘it can be too much !’

The clients’ perspective

– Establish a shared mission statement, vision – Create a network of participating partners – Actively create a positive image in society – Trained staff, supervisors, research partners – Strong personal involvement of staff – Regular communication and interpersonal support – Sufficient financial resources – One service states that the inclusion/selection of target group as key to offer the most effective services

Determinants of success

– Financial resources are often not stable/sufficient – Legislation can be hindering – Stigma and attitude of no risk-taking – Difficult transition to competitive employment – Difficult transition to regular education

Experienced barriers

7

Employment works! Werkwerkt!

An integrated SE and SEd model based on the results of the study

Employment works! model

Educational services (Higher education and university) Employment services

Employment / educational therapist + Employment / educational specialist

Mental health care provider Coordinator and supervisor

• Big gap between world of MHCare and work/education
• Like in the VETE model in Australy two experts are

chosen:

– An expert in care (therapist) – An expert in the field of work or education (specialist)

• Involvement of education remains difficult because

each university/high school has its own system

• No policy center for SEd
• Therefor: the employment therapist an specialist need

to have attention for education as well.

• CF ‘Adapting SE for emerging adults’ (Ellison et al.,

2014)

Why two experts ?

• The “therapist” offers long-term support, coaching and

counseling, in a.o.:

– anxiety management techniques – stress management – Problem-solving skills training – Learning to cope with job loss or failing on a test – Support in making decisions – Relapse prevention – Social skills training – Support in coping with stigma and ‘disclosure’ – Learning to handle cognitive impairment – Teaching how to handle Activities of Daily Living, life roles and commitments (Davis & Rinaldi, 2004; Sherring et al., 2010; Waghorn et al., 2011)

Employment/educational therapist

8

Support concerning activities related to finding a job/education

• supporting the service user and the employer/teachers

during employment (Sherring et al., 2010).

• to guide the client carefully and in consultation with the

therapist towards and on the job/education

• Job/education search activities:

– looking for jobs/courses – support with job interviews – negotiations about adjustments – supporting the employee/student on the job – supporting the employer/teacher

• client-oriented, dependent on individual needs (Rinaldi et al.,

2010)

Employment/educational specialist

Specific Measurable Relevant Time limited

Reaching the target population

Support = team member working together with the client to explore or achieve vocational and/or educational goals (active support as well as longer- duration follow-up) Number of clients who were supported Time in the project Monitoring SE principles of zero- exclusion and obtain information on caseload After 6 months After 12 months After 24 months At end of project

Obtain new employment

• r education

Ranking of employment=

• Regular paid employment
• Regular education
• Regular unpaid work

experience or volunteer work

• Work in sheltered or

protected setting

• Unemployed, inactive

Number of clients who find a job (minimum 1 day / minimum 4 weeks unless for temporary work) Consistent with SE and SEd goals of striving towards regular paid jobs and regular education After 6 months After 12 months After 24 months

Completing education

Education = any course that leads to a regular degree and increases chances of regular employment Completing = obtaining diploma Number clients that successfully completed their education Main goal in SEd At end of project

Overview of project targets and outcomes

Specific Measurable Relevant Time limited

Employment retention

Retention = to have a form of employment after certain period (not necessarily in same job) Number of clients still at employed SE does not only focus

• n obtaining a job, but

also in maintaining employment After 12 months After 24 months At end of project

Experience of recovery Recovery = client perception that personal growth and development are possible despite

• disabilities. The client

learns to handle the disabilities and is in control of his life. Number of clients who: believe in future; feel capable to do things they want; are capable to reach self-determined goals; take roles in society; exercise higher self-care (health, nutrition, exercise, … ) Vocational rehabilitation is essential part of recovery process continuously Reduce hospital admissions Admission = spending night in psychiatric care Number (re-) admissions Duration of admissions (days) SE does not cause clinical impairment continuously

Overview of project targets and outcomes

• It takes time to build bridges between mental health care

and employment services

• It takes even more time to integrate MH care with

educational systems

• This is linked with problematic position of AMHC
• Results of ADOCARE project

Conclusions

9

Availability of services Quality of services

Adolescent Mental Health Care

Needs of adolescents

Workshop in Rome 31 end‐users 20 adolescents with MH problems

If I ruled the world:

• More jobs should be created for young people to help them integrate into

society.

• “Adolescents who emigrated from another country should be treated with more

respect and receive more support”

• Teachers generally have little knowledge about MH issues, they are busy with

teaching.

• Every school should have a psychologist where young people can go to.
• School shouldn’t put too much pressure on adolescents: education is important, but

feeling good is equally important.

• When a young person is feeling bad, he should be able to talk about this with

persons in his natural environment such as a teacher or school nurse.

• At school young people should get a class on mental health, so they learn how to

deal with difficult situations and problems

• When programs or services for adolescents are being developed, adolescents

should have a voice. They know best what their needs are.”

Integrated SE&Sed: foot on the wall ?

Thanks for your attention

Chantal.Vanaudenhove@Med.kuleuven.be www.kuleuven.be/LUCAS

36

10

References

• Bond, G.R. et al. (2001). Does competitive employment improve nonvocational
• utcomes for people with severe mental illnesss? Journal of Consulting and Clinical

Psychology, 69, 489-501.

• Bond, G.R. (2004). Supported Employment: evidence for an evidence-based
• practice. Psychiatric Rehabilitation Journal, 27, 345.
• Bush, P.W. et al. (2009). The long-term impact of employment on mental health

service use and costs. Psychiatric Services, 60, 1024-1031.

• De Jaegere, V. et al (2011). Integratie begeleid werken en begeleid leren: een

transnational project. ESF project : KU Leuven LUCAS. http://www.kuleuven.be/lucas/pub/publi_upload/2011_rapportESF_Geintegreerdetra jectenMMPP.pdf

• Davis, M., & Rinaldi, M. (2004). Using an evidence-based approach to enable

people with mental health problems to gain and retain employment, education and voluntary work. The British Journal of Occupational Therapy, 67(7), 319-322.

• Egnew, R. C. (1993). Supported education and employment: An integrated
• approach. Psychosocial Rehabilitation Journal, 17(1), 121.
• Ellison, M. L., Klodnick, V. V., Bond, G. R., Krzos, I. M., Kaiser, S. M., Fagan, M. A.,

& Davis, M. (2015). Adapting supported employment for emerging adults with serious mental health conditions. The journal of behavioral health services & research, 42(2), 206-222.

• Lal, S., & Mercier, C. (2008). Intersectoral action to employ individuals with mental

illness: lessons learned from a local development initiative. Work (Reading, Mass.), 33(4), 427-437.

• Loprest, P., & Maag, E. (2003). The Relationship between Early Disability Onset

and Education and Employment. Urban Institute (NJ1).

• Murphy, A. A., Mullen, M. G., & Spagnolo, A. B. (2005). Enhancing individual

placement and support: Promoting job tenure by integrating natural supports and supported education. American Journal of Psychiatric Rehabilitation, 8(1), 37-61.

• OECD. (2013). Mental health and work.
• Parrish, C. (2009). MH supported education literature review. Department of

Behavioral Health and Mental Retardation Services Research and Information Management.

• Porteous, N., & Waghorn, G. (2007). Implementing evidence-based employment

services in New Zealand for young adults with psychosis: progress during the first five years. The British Journal of Occupational Therapy, 70(12), 521-526.

• Rinaldi, M., Killackey, E., Smith, J., Shepherd, G., Singh, S. P., & Craig, T. (2010).

First episode psychosis and employment: a review. International Review of Psychiatry, 22(2), 148-162.

• Sherring, J., Robson, E., Morris, A., Frost, B., & Tirupati, S. (2010). A working reality:

evaluating enhanced intersectoral links in supported employment for people with psychiatric

• disabilities. Australian Occupational Therapy Journal,57(4), 261-267.
• Teixeira, C., Santos, E., Abreu, M. V., & Rogers, E. S. (2015). Current Status of Psychiatric

Rehabilitation in Portugal: A National Survey. Psychiatric rehabilitation journal.

• Thornicroft, G., Brohan, E., Rose, D., Sartorius, N., Leese, M., & INDIGO Study Group.

(2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. The Lancet, 373(9661), 408-415.

• Timmons, J. C., Cohen, A., & Fesko, S. L. (2004). Merging cultural differences and

professional identities: Strategies for maximizing collaborative efforts during the implementation of the Workforce Investment Act. Journal of Rehabilitation Washington, 70(1), 19-27.

• Wagner, M., & Davis, M. (2006). How are we preparing students with emotional disturbances

for the transition to young adulthood? Findings from the National Longitudinal Transition Study—2. Journal of Emotional and Behavioral Disorders, 14(2), 86-98.

• Waghorn, G., Chant, D., Lloyd, C., & Harris, M. (2011). Earning and learning among

Australian community residents with psychiatric disorders. Psychiatry Research, 186(1), 109- 116.

• Wheat, K., Brohan, E., Henderson, C., & Thornicroft, G. (2010). Mental illness and the

workplace: conceal or reveal?. Journal of the royal society of medicine,103(3), 83-86.