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About Advance Employment Inc. Integrated Employment Project – Evidence Based Practice Service Delivery Model Presentation Overview.

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Presentation on theme: "About Advance Employment Inc. Integrated Employment Project – Evidence Based Practice Service Delivery Model Presentation Overview."— Presentation transcript:


2 About Advance Employment Inc. Integrated Employment Project – Evidence Based Practice Service Delivery Model Presentation Overview

3 A Disability Employment Network (DEN) member – 4 STAR Rating Specialising in Mental Health in the Townsville region (Qld, Australia). Funded by the Department of Education, Employment and Workplace Relations (DEEWR). About Advance Employment Inc.

4 Where is Advance Employment?

5 Townsville



8 Staff

9 Mental Health & Employment What are your thoughts?

10 “Advance Employment will promote encourage, assist and support job seekers to improve their mental health in order to achieve meaningful, open employment through employment related opportunities”. Mission Statement

11 Mental health focuses on emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life's inevitable challenges. Mental Illness focuses on negative symptoms and personal deficits. Mental Health vs Mental Illness

12 Dr William Glasser, 2003 defines mental health or happiness as… “enjoying the life you are choosing to live, getting along well with the people near and dear to you, doing something with your life you believe is worthwhile, and not doing anything to deprive anyone else of the same chance of happiness you have”. What is Mental Health?

13 Little distinction between management, staff and job seekers, other than to respect individuality and remember who is the job seeker and who is the service provider. See past disability/label/diagnosis and focus on the value & strengths of the human being. Treat job seekers with dignity & respect at all times Resist making value judgements Nurture job seekers to foster self value and belief Educate regarding rights and responsibilities Provide appropriate & empowering opportunities to encourage & facilitate educated & informed choices Organisational Culture

14 Communicating to convey information i.e. listening with curiosity & an open mind when it is not your turn to talk… hence…conversing-to-convey. Resist communicating with the emphasis on convincing the other that you are right hence.. the goal is to convince - to be right. Thom Rutledge 2002 Communication Strategy

15 Create partnerships across industry sectors within the local labour market to maximise open and meaningful employment opportunities for Job Seekers. Direction Statement 1

16 Create a quality organisation, by maintaining & improving core business, professional development and empowerment opportunities within the organisation. Direction Statement 2

17 Create collaboration across mental health services to provide maximum opportunities to assist job seekers to achieve their employment and life goals. Direction Statement 3

18 Ensure that the management structure meets the growth requirements of the organisation using a lead management approach. Direction Statement 4

19 Employment Assistance Outcomes

20 Employment Maintenance Outcomes

21 How competitive/open employment facilitates recovery… Reduces stigma and marginalisation Reduces disabilities secondary to the illness Helps people reclaim a valued place in society Few other things can be done for 8 or more hours a day Strengthens self-efficacy and self esteem Validates recovery progress through real measurable accomplishments Increases opportunities for positive regard from others Greater opportunities for social inclusion and acceptance by the wider community Geoff Waghorn & Meredith Harris (QCMHR University of Queensland) Integrated Employment Project

22 Labour force activity by psychiatric disorder (Australian Bureau of Statistics SDAC 2003, n=36,000) Australians aged 15-64 yrsNot in the labour force Looking for work (%) Employed part time or full time (%) Healthy Australians18.84.278.0 Anxiety Disorders48.74.646.8 Depression (excluding post- natal) 51.96.541.6 Schizophrenia73.510.715.9 Source: Waghorn, Chant & Harris, in review Integrated Employment Project

23 Psychiatric Disabilities are the most challenging for Disability Employment Services (DEN) Australian DEEWR unpublished data 2006 Of the 12 disability categories assisted by DEN, psychological/psychiatric had the poorest job retention 25% of workers with psychological/psychiatric disabilities accumulated 26 weeks of employment 35% of all DEN workers attained this milestone Geoff Waghorn & Meredith Harris QCMHR Integrated Employment Project

24 What works best for people with mental health conditions... Most effective approach targeting individual career development is the Drake-Becker Individual Placement and Support approach (SE-IPS) SE most similar to DEN services in Australia and New Zealand Evidence includes 6 day treatment conversions and 16 Random Control Trials (RCTs) RCTs are the strongest scientific design for evaluating whether an intervention works 16 qualifying RCTs to date:  12 in USA  1 in Hong Kong  1 in Canada  1 in Europe (6 European Countries)  1 in Australia (in press with BJP) Geoff Waghorn & Meredith Harris QCMHR Integrated Employment Project

25 7 Evidence-Based Principles 1. Eligibility is based on consumer choice 2. Supported/Open Employment is integrated with treatment 3. Competitive employment is the goal 4. Rapid job search (within 4 weeks) 5. Job finding is individualised 6. Follow-along supports are continuous 7. Financial planning is provided Geoff Waghorn & Meredith Harris QCMHR Integrated Employment Project


27 RCTs of High Fidelity Supported Employment – Individual Placement & Support  11 of 16 RCTs compared high fidelity IPS services to the best available local services (IPS vs controls)  Job retention remains the major challenge Any competitive employment (11 studies)62% (IPS) vs 25% (controls) 20 or more hours per week (4)43.6% of all participants (66% of workers) vs 14.2% Days to first job (6)144.5 vs 214.0 days Accumulated employment among workers, following commencement of first job 24.5 vs 25.0 weeks Weeks worked at longest jobMean 22.0 (IPS) vs 16.3 weeks; Range 10-36.8 vs 10-32.7 weeks Geoff Waghorn & Meredith Harris QCMHR Integrated Employment Project

28 Implications for Australian service development Australian DEN services characterised by... Segregation from mental health treatment and care Difficulty with zero exclusion Difficulty with rapid job search Difficulty with financial counselling Demand often exceeds places available Otherwise a highly suitable type of service for people with severe mental health conditions Geoff Waghorn & Meredith Harris QCMHR Integrated Employment Project

29 Qld Health Multi-Site 2 year Outcome Evaluation HSDEC’sEthicsEC Start Date Data Collection Research Design Cairns & Hinterland1 Near approvalDec 07Not yetRCT 2 Townsville2 ApprovedMay 07 Sept 08 Not yetRCT 2 PCH –Chermside1 ApprovedJan 08CommencedParrallel Control PCH – Pine Rivers1 ApprovedMay 08CommencedParrallel Control Inner North Brisbane RBWH 1 ApprovedApril 08Not yetDescriptive PAH Mt Gravatt1 ApprovedJan 08CommencedRCT 2 West Moreton & South Burnett 2 ApprovedFeb 07 April 07 CommencedRCT 2 Gold Coast2 Near approvalMay 08 June 08? Not yetRCT 2 Geoff Waghorn & Meredith Harris QCMHR

30 Advance Employment – Kirwan Total Clients DiagnosisTotal Job Seekers % Employed 4 Week Outcome 13 Week Outcome 26 Week Outcome Total % Employed 21Schizophrenia1338.46% 100%60%40% 61.9% Bi Polar4100% 75% Depression Anxiety 2100% 50% PTSD10%---

31 Choice Theory Reality Therapy Lead Management Service delivery that is focussed on encouraging and teaching job seekers the skills required to interact effectively & meaningfully within relationships. Service Delivery Model

32 Current World How do you see your life at this point in time? What is your current situation? Reality Therapy Application Interview

33 Quality World Who are the people that are important in your life? What are things, activities or events that are important in your life? What is a belief that you hold? Reality Therapy Application Interview

34 What do you want? How would you like your life to be? (work or personal) What would this mean to you? What difference would this make for you? How do you see me/Advance Employment helping you to move forward? Reality Therapy Application Interview

35 What are you Doing? What does a day look like for you? Who is someone that you can get to support you? Where do you go for fun & enjoyment? Reality Therapy Application Interview

36 Is what you are doing getting you what you want, or taking you in the direction that you want to go?  Yes  No If Yes – how? If No – What would you need to do things differently? Reality Therapy Application Interview

37 Are you willing to do something else?  Yes  No What would that be? What is your first step? Where will this take you? What is your Plan? Reality Therapy Application Interview

38 Choice theory states that… All we do is behave, That almost all behaviour is chosen, and That we are driven by our genes to satisfy 5 basic needs… 1. Survival 2. Love and Belonging 3. Power 4. Freedom 5. Fun The most important need is love and belonging, as this is a requisite for satisfying all of the needs. Dr William Glasser – The William Glasser Institute The greatest power that a person possesses is the power to choose! J. Martin Choice Theory

39 Survival Somewhere to live, something to eat, money & personal safety Love & Belonging Connectedness with work colleagues, friends & family and being a part of something meaningful Power Recognition, appreciation & purpose Fun Continued growth, learning & enjoying life Freedom Choice of job/home, decision making skills & independence Dr William Glasser – The William Glasser Institute 5 Basic Needs & Employment

40 7 Caring/Connecting Habits 1. Supporting 2. Encouraging 3. Listening 4. Accepting 5. Trusting 6. Respecting 7. Negotiating differences Dr William Glasser – The William Glasser Institute 7 Deadly/Disconnecting Habits 1. Criticizing 2. Blaming 3. Complaining 4. Nagging 5. Threatening 6. Punishing 7. Bribing, rewarding to control Choice Theory

41 The only person whose behavior we can control is our own. All we can give another person is information. All long-lasting psychological problems are relationship problems. The problem relationship is always part of our present life. What happened in the past has everything to do with what we are today, but we can only satisfy our basic needs right now and plan to continue satisfying them in the future. Dr William Glasser – The William Glasser Institute 10 Axioms of Choice Theory

42 We can only satisfy our needs by satisfying the pictures in our Quality World. All we do is behave. All behaviour is Total Behavior i.e. Acting, Thinking, Feeling and Physiology. All Total Behavior is chosen – we have direct control over acting and thinking. Feeling and physiology is controlled indirectly through chosen actions and thoughts. All Total Behavior is designated by verbs e.g. not “he made me unhappy” but “I am choosing unhappiness” Dr William Glasser – The William Glasser Institute 10 Axioms of Choice Theory

43 Reality Therapy is… A method of counselling/interviewing based on Choice Theory and is aimed at helping individuals gain more effective control over their lives. The process of developing effective counselling and management skills. Based on the belief that we all choose what we do with our lives and that we are responsible for these choices. Responsibility is defined as learning to choose behaviours that satisfy one’s needs and, at the same time do not deprive others of a chance to do the same. Reality Therapy

44 Reality Therapy is used to work with Job Seeker’s to... Focus on the present - avoid discussing symptoms and complaints Focus on what the job seeker can do directly - act and think. Avoid criticizing, blaming and/or complaining Remain non-judgmental and non-coercive Teach the job seeker that legitimate or not, excuses stand directly in the way of their making needed connections Focus on specifics Help the job seeker to make specific, workable plans to reconnect with the people they need, and then help self evaluation of progress Be patient and supportive but keep focusing on the source of the problem - the disconnectedness Reality Therapy

45 1. Encourages honest discussion regarding both quality and the cost needed for the organisation to be successful. 2. Models expected outcomes from the top down and the bottom up. 3. Understands that the individual knows best what high quality work is and how to produce it at the lowest possible cost. 4. Teaches that the essence of quality is continual improvement. Lead Management

46 ? Questions

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