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3. NYS OMH Commissioner Michael Hogan targeted improving employment outcomes for people with psychiatric disabilities. The NYS Most Integrated Setting Coordinating Council (MISCC) formed an employment sub- committee to focus on integrated and competitive employment for people with disabilities. The Medicaid Infrastructure Grant (MIG) NYS committee devoted resources to developing employment opportunities for people with disabilities. 3

4. To create real change toward a recovery based and person centered employment support system you need partners from all sectors: – Recipients – Advocates – Trade Associations – Agency Leadership – Universities – Government 4

5. Transform non-integrated employment to integrated and competitive employment Promote access to evidence-based practices for supported employment Utilize work incentives like the Medicaid Buy-In and Ticket-to-Work Use integrated treatment and rehabilitation services to support employment as a life role goal 5

6. Looking at the issue from 50,000 feet and then implementing a plan at ground level Assessing the key impediments to success and creating a plan to overcome them Believing in what you are doing and what can be accomplished 6

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9. Redirect funding from sheltered workshops to support integrated employment programs Target other non-integrated employment programs (enclaves and mobile work crews) Partnership among many state agencies to create a shared smart system to link job banks to functional resumes Emphasize quality work incentive supports vs. benefits advisement Collect outcome data and make data available to the public 9

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11. Support the evidence-based practice of Individual Placement and Support (IPS) and adapt it to integrated recovery and treatment programs Support programs that get people jobs Promote business models, including entrepreneurship, that employ people with psychiatric disabilities 11

12. NYS OMH, partnering with the Center for Practice Innovations, provides technical assistance to implement the Individual Placement and Support (IPS) model and to adapt that model to recovery oriented services. Intensive IPS training – per the traditional model IPS training using a learning collaborative approach 12

13. The life role of employment has been turned into a distant dream. We have partnered to change that distant dream into real options so people can choose to work. Peers are speaking out through the “We Can Work” campaign to share their hopes and successes in employment. 13

14. NYS Advocacy on Employment History of advocacy related to improved outcomes and relationships with State VR since 1993 Supported advocacy for Ticket to Work legislation in late 90’s; NYS Implementation since 1998 Direct involvement with NY Works Demonstration Call for increased resources for supported employment in 1998 Medicaid Buy-In for WPD in 2003

15. NYS Campaign for Employment State Leadership on Employment Interagency Task Force on Employment Pursue Medicaid Infrastructure Grant (CES) We Can Work Campaign Redirect Resources to integrated employment Develop integrated funding and data system Connect employers with people seeking work

16. A commitment to more employment that is integrated and leads to self sufficiency

17. 2009 NYS OMH Ambulatory Restructuring Report  NYS Ambulatory System serves almost 458,000 people annually  All mental health services that are provided in the community are included outside of clinics  Support – Vocational Supports: Sheltered Workshops, Assisted Competitive Employment, Ongoing Integrated Supported Employment Services, Transitional Employment, and Affirmative Business/Industry and Work Programs 17

18.  NYS receives the Medicaid Infrastructure Grant  Mission:  Through research, policy analysis, training, and technical assistance, the New York Makes Work Pay Initiative provides policy and practice solutions to address New York State's estimated 70% of working-age people with disabilities who are not employed  NYSRA is a strategic partner and is asked to meet the following goals:  Identify and define best practice models for transitioning program priorities and resources to support competitive, integrated employment.  Influence state systems’ transformation by introducing and modeling customized and entrepreneurial approaches to employment. 18

19.  Facilitate a “Stakeholder” workgroup as recommended in final paper of the “21 st century SE Workgroup” that advocate for increased opportunities for integrated employment.  Develop with EDI of Cornell University and Burton Blatt Institute of Syracuse University an organizational assessment tool (CRP Assessment Tool and WORKqual) inclusive of a set of principles and practices that agencies can adopt to support organizational transformation to more integrated employment options.  Options need to include not only individualized job placement but also self-employment, self-employment incubators, cooperatively owned businesses or social enterprises consistent with established practices.  Ongoing consultation with community provider agencies (CRP’s) receiving state deficit financing from NYS OMH supporting their workcenter. Assist the agency to develop Business plans to transform programs and resources toward full competitive, integrated employment  Develop recommendations for policy changes, waivers, modifications to regulations etc. 19

20. LDA Learning Disabilities Association of New York State, Inc. Correctional Educational Consortium CMEP/Coalition of Mainstream Employment Programs 20

21.  The Inclusive Workforce Workgroup began convening in April of 2010 and has worked since that time to identify recommendations to be shared to all partners in New York State to assist in the development of a workforce development system that would be characterized by funding and services that demonstrate flexibility, responsiveness and collaboration.  For such a workforce to exist in our state, individuals with disabilities who are expressing an interest to work must be supported by their families, peers, the provider community, NY’s Businesses, as well as State and Local government.  It must be responsive to both Business and Job seekers’ needs.  The Inclusive Workforce Workgroup identified key factors necessary to establish an effective employment system in New York. 21

22.  The system must provide seamless access to services, timely response to individuals’ needs, and be inclusive to enable any and all individuals the opportunity to seek and gain employment.  New York State must have in place effective partnerships with businesses to meet their hiring needs and the needs of job seekers for the jobs they offer.  It is imperative that the needs of the business owners be met large and small. 22

23.  BOTH Job seekers and businesses are satisfied – we need both business and ALL residents to feel New York wants and needs them in their workforce!  Businesses are educated, engaged, and supported in their quest to hire, train and retain employees that help them meet their bottom line;  Individuals are assisted to find, choose, and maintain employment which matches the person’s career goals, interests, and skills; and  Critical data on the attainment of outcomes in the system is collected so true progress in our State can be objectively measured. 23

24.  Offer an inclusive of a set of principles and practices that agencies can adopt to support organizational transformation to more integrated employment options.  Works to assist the agency to evaluate their Community Partners and resources for transformation. 24

25.  Series of questions to assess an organizational, resource and market environment. These categories develop a profile of your organizational environment, available resources, and market situation.  Key to the use of the tool understanding your organization’s current status and not projecting where you would like to be.  An important baseline is provided that then allows you to conduct an organizational assessment. 25

26.  Find it here http://www.ilr.cornell.edu/edi/allqual/workqual-login.cfm 26

27.  Consultation with 28 agencies began in October of 2009  Host for videoconference on “Business Planning” utilizing the State Small Business Development Centers in April 2010  June 2010 unveiled the CRP Assessment Tool and WorkQual  Affirmative Business White paper - July 2010 http://www.ilr.cornell.edu/edi/nymakesworkpay/docs/Tran sforming_NYS_business_072010.html  September 2010 – Held Employment Institute showcasing ideas for change and business strategies  Ongoing consultation offered by NYSRA, NYS OMH, Cornell University and Burton Blatt Institute of Syracuse University  December 31, 2010 – Deadline for Business Concepts to NYS OMH 27

28.  Three Year Plan – pending NYS Budget  Shifting funds to Personalized Recovery Oriented Services (PROS)  Incubator Businesses  Realignment of Prevailing wage employment opportunities  Corporate Partnerships  Wage Subsidies 28

29.  Revisit and redo regulations  Identify Alternative uses for “workcenter” space  Building an Inclusive Workforce  Student transition Planning  Policies that “include” all 29

30. Center for Practice Innovations brings IPS Supported Employment to PROS Programs in NYS Center for Practice Innovations brings IPS Supported Employment to PROS Programs in NYS Paul Margolies, Ph.D. Center for Practice Innovations at Columbia Psychiatry USPRA Conference June 13, 2011

31. Public-Academic Partnership

33. Individual Placement and Support

34. What is Supported Employment? Supported Employment helps people diagnosed with mental illnesses find and keep meaningful jobs in the community. These jobs exist in the open labor market, pay at least minimum wage, and are in work settings that include people who are not disabled. SAMHSA Supported Employment Tool Kit

35. Individual Placement and Support Principles Competitive employment is the goal Eligibility is based on consumer choice – zero exclusion Consumer preferences are important Supported employment is integrated with treatment Personalized benefits counseling is provided Rapid job search -- starts soon after a consumer expresses interest in working Follow-along supports

36. Individual Placement and Support Practitioner Skills Engagement Assessment: Career / Vocational profile Employment planning Benefits counseling Job development Working with ACCES-VR Follow-along supports

37. CPI’s efforts to bring IPS to consumers in NYS

38. Two approaches to implementation Begin with focus on PROS programs Significant on-site technical assistance Regional learning collaboratives and training sessions

39. Significant on-site consultation, coaching and training Methods Hands-on work with program and agency leadership, supervisor(s), and team members with special emphasis on employment specialists(s)

40. Significant on-site consultation, coaching and training PROS Programs Now Involved HALI Clubhouse of Suffolk FEGS Federation of Organizations Putnam Family and Community Services Occupations, Inc.

41. Joining a Learning Collaborative A learning collaborative establishes a resource panel who work with providers to improve outcomes through the use of basic quality improvement strategies.

42. Learning Collaborative 69 PROS programs and soon-to-be PROS programs now participating Implementation support for program leaders Training for employment staff

43. Learning Collaborative Methods Regional meetings Regional conference calls Program-specific consultation calls Webinars

44. Learning Collaborative Examples of activities: January regional conference calls with PROS program leadership focused on: Engagement of staff, consumers and others Adaptation of IPS fidelity to PROS Updates on implementation efforts

45. Learning Collaborative Examples of activities: February and April regional two-day training workshops for employment staff focused on 7 core clinical components of IPS, with lots for exercises, role plays and video

46. Learning Collaborative Examples of activities: March statewide webinar for program leadership focusing on the use of an implementation guide – 18 questions that leadership may consider in developing program-specific implementation plans

47. Sample Training Exercise This training exercise is used to teach employment staff about recovery values, engagement, and the “zero exclusion” principle of IPS. It raises issues that are then covered in a debriefing session.

48. Exercise Person #1 is the consumer. You want to work full time. You have had some difficulty with drinking and smoking marijuana. You haven’t worked in 15 years, except for 4 months in a transitional employment position in a copy center two years ago. Person #2 is the practitioner. You are convinced that this consumer should not be working at this point in time, for many reasons. Your task is to explain this to the consumer.

49. Additional Implementation Supports Under Development Guidebook for consumers and staff (NASMHPD/SAMHSA grant) Will focus on key activities for choosing, getting and keeping competitive employment Will be used by consumers working directly with employment staff Each topic will have -Important information -Questions to answer/decisions to make/personalized worksheet -Next steps Should reduce the need for staff training

50. Additional Implementation Supports Under Development Online training module Introduction to IPS Will include video clips. Examples may include: consumer discussing how IPS helped him/her find and keep a meaningful job consumer discussing how fear about losing benefits hurt motivation to work and once he/she learned the facts, his/her motivation increased tremendously consumer who had been actively using substances found the motivation to cut back on this use because he/she was working practitioner discussing how his/her attitude about zero exclusion has changed once working with consumers in IPS program

51. Additional Implementation Supports Under Development Online training module (continued) Content outline What is IPS? Why is it important? 7 key principles 7 core skill competencies

52. Building the Capacity of Psychiatric Rehabilitation Programs to Promote Employment and Economic Self-Sufficiency USPRA 2011Conference Chacku Mathai, CPRP Associate Executive Director Oscar Jimenez, MPH Director of Community and Economic Development New York Association of Psychiatric Rehabilitation Services (NYAPRS)

53. Unemployment among adults in the Mental Health system in NYS 53 Between 50% and 70% of adults in the MH system in NYS indicate that they want to work, but only 12% to 15% are actually employed (OMH, 2009) Less than ½ of those who work have a full-time job 40% of people with a mental disability live in poverty (American Community Survey, 2008)

54. Poverty causes psychiatric disability! Living in poverty makes it more likely to develop serious psychiatric problems Not having enough resources contributes stress, anxiety, and depression Poverty is a barrier to rehabilitation, recovery and wellness Preventing and overcoming poverty MUST be a mission of mental health and rehabilitation programs! 54

55. The Systemic Barriers to Employment and Economic Inclusion Institute for Community Inclusion- NYAPRS- Burton Blatt Institute policy research project (2009-2010): Illness-orientation still predominating in mental health, vocational and workforce systems: limited capacity to facilitate full recovery in all areas of life, including employment and economic self- sufficiency. Availability, accessibility and utilization of employment services seriously compromised by fragmentation: –“ Silo” funding structures, –Services not well-coordinated –duplication of services and inefficiency in the use of available resources, –complex eligibility criteria, –lack of prompt access to services –and limited program capacity to provide integrated care that addresses mental health, vocational, and wraparound support needs. Misinformation, isolation and lack of hope

56. Key Recommendations: Build upon ongoing transformation initiatives in order to improve the systemic capacity for providing recovery-oriented employment services in ways that: – maximize the utilization of funding available, –integrate recovery-oriented mental health, vocational and wraparound services –increase accessibility to services, and –improve economic self-sufficiency outcomes Want more information or a copy of the report? “Policy and Programmatic Recommendations to Address the Systemic Barriers to Employment of People with Psychiatric Disabilities in New York State: A Report to the NYS MIG” (Marrone, J., Jimenez, O, Mathai, C., et al, 2010) at: http://www.ilr.cornell.edu/edi/nymakesworkpay/docs/MIG _policy_recommend_report_012010.pdf

57. Growing PROS license in NYS: Key Opportunity

58. The Ticket–to-Work Program: Opportunities for braided funding The Ticket-to-Work (TTW) program: long-term and sustainable opportunity for PROS programs to increase scope and intensity of services to meet the complex employment support needs of individuals with psychiatric disabilities in NYS: –A focus on promoting long-term employment and greater levels of economic self-sufficiency that provides ongoing funding for an extended period of time; –A flexible funding source for program areas not funded through Medicaid, such as general job development, job coaching, peer support, career advancement, and asset development strategies; and –A stable funding stream authorized through a federally-funded program and Ticket-to-Work legislation.

59. Challenges and Opportunities for Implementing the Ticket-to-Work Program Misconceptions about, and negative attitudes towards, the TTW Little or no information about the (2008) TTW regulation changes A training needs survey revealed that PROS administrators identified several perceived barriers to becoming an Employment Network, with half to two-thirds indicating that: – The payment scheme was unrealistic for the earning potential of their program participants, and too complex; – They felt not to have the necessary staff – The upfront costs to implement the program were too high. Multiple supports were available to NYS providers for establishing and operating Employment Networks (e.g., CESSI, MAXIMUS), but providers were often confused about the many online resources, technical assistance organizations, events, and contact persons.

60. Providers’ perceptions about the economic self-sufficiency potential of participants What proportion of your participants do you believe could…? Control their own finances Earn enough to depend less on benefits Earn enough to save and build assets Earn enough to get off of benefits Less than 20% 19% 24% 39%48% 21% to 40% 23% 33% 24% 41% to 60% 17% 15%17%10% More than 60% 37% 26%20%16% Provider survey with administrators and middle-management (n=70) in Jan 2010

61. Providers’ knowledge about economic self- sufficiency supports in the community Providers indicated to have significant knowledge about: Financial education supports : 81% Earned Income Tax Credit and tax preparation assistance: 67% First-time home-buyer programs: 60% Individual Development Accounts: 27% entrepreneurship opportunities: 27% Asset development coalitions in my community: 27% 61

62. Providers’ perceptions about the importance of and their potential to promoting self-sufficiency Providers agreed or strongly agreed to the following: It is important for our program and similar programs to provide information about economic self- sufficiency supports : 92% Currently, our program provides individuals with economic self-sufficiency supports : 46% With our current level of staff, training and capacity our program can provide economic self-sufficiency supports: 19% With training and technical assistance, our program can provide economic self-sufficiency supports: 69% 62

63. Level of Desire to Seek Work and Economic Self-sufficiency among PROS Participants * * Survey with participants of PROS programs (n=71) in December 2010-January 2011

64. Level of Self-Efficacy to Seek Work and Economic Self-sufficiency among PROS Participants * Do you believe you could? Have a paid job in community Control how you spend on a daily basis Earn enough to save and build assets Earn enough to depend less on benefits Earn enough to get off of benefits Agree 63.3%87.2%61.7%53.2% 29.2% I’m not sure22.4%8.5%17.0% 31.3% Disagree14.3%4.3%21.3%29.8%39.6% Total100.0% * Survey with participants of PROS programs (n=71) in December 2010-January 2011

65. PROS WORKS! Project Strategies and Activities Implementation-oriented training and TA: Tools for Ticket assignment, provision of services, tracking of outcomes and billing Web-based seminars: –Ticket 101: Introductory webinar –Ticket 201: Application walk-thru webinar –Ticket 301: Training on Operating an Employment Network –Ticket 302: Tools for Ticket Assignment and Tracking Milestones/Outcomes Individualized Technical Assistance (face-to-face, electronic, phone)

66. Composition of Programs Engaged in Project Activities by PROS Status

67. Composition of Ticket Training Series Attendance by PROS Status

68. Improvements in implementation-related knowledge On a scale of 1-10, the average self-perceived knowledge increased from 3.66 (Pre Ticket 301) to 6.45 (Post ticket 301) Over 80% of Ticket 301 participants indicated that they received information about key aspects of Employment Network operation, including: –Developing a business model; –Braiding TTW funding with Medicaid, State aid and other sources; –Recruiting and assessing individuals for the TTW program; –Developing Individual Work Plan (IWPs); –Tracking and billing for Ticket milestones and outcomes; & –Accessing work incentives, financial education and asset development.

69. Comparison of EN Status among PROS-Licensed Programs at Baseline (June-July 2010) vs. End-of-Intervention (December 2010)

70. Employment Network Status by PROS Status (December 2010)

71. Increase in Employment Network Activity in 2010: Number of Assigned Tickets and Revenue among Agencies with PROS-ENs January 2010June 2010November 2010 Number of Tickets 495887 Revenue$66,164$77,553$127,817 Cumulative data provided by MAXIMUS (January, 2011) in regards to 17 agencies with PROS licenses by the end of November 2010.

72. Conclusions and recommendations The outcomes of and data generated by this project suggest that a training and TA intervention to improve the number and capacity of mental health programs providing Employment Network services is feasible, and may indeed increase significantly the knowledge and implementation capacity of providers in regards to the Ticket-to-Work program.

73. Conclusions and recommendations The overall level of readiness of PROS participants to pursue employment and increasing levels of self-sufficiency indicate a significant potential for the expansion of the Ticket to Work program in New York State. More than two-thirds of PROS participants indicate a desire to achieve greater levels of self-sufficiency. However: – Less than half believe they can rely less on benefits – Less than one-third believe they can end their dependency on benefits. – About sixty-percent had never heard about the Medicaid Buy-In for Working People with Disabilities or Ticket-to-Work programs – Less than 10% had heard about the Earned Income Tax Credit, PASS and other economic supports. Individuals receiving services ought be engaged in activities and support to improve their sense of hope and self-efficacy.

74. Conclusions and recommendations A majority of providers find crucial to offer economic self- sufficiency supports. However: – Most providers feel that only a minority of program participants can achieve Ticket-to-Work earning levels and higher levels of self-sufficiency. – A comparison between the consumer and provider surveys suggest a twenty to forty percent gap in the perceived efficacy of program participants to achieve greater levels of self- sufficiency, with a much less optimistic view among providers. Providers ought to receive information about the high level of desire among program participants to pursue work and economic self-sufficiency.

76. Goal: Build hope and share information to improve employment and economic self-sufficiency Key Strategies and Outcomes: Established grassroots advisory committee (2008) Developed and distributed recovery-oriented tools : –WE Can Work: The Employment Tool: over 7,500 copies (2008-2011) –WE Can Work DVD: Our Stories of Recovery and Employment Success: over 500 copies (2009-2011) Training of regional Peer Facilitators: 55 (2010-2011) Reaching directly over 2,000 people in recovery and providers through workshops at statewide conferences, regional forums, and program-based events and several thousand more indirectly (2008-2011)

77. A Provider’s Guide to Promoting Economic Self-sufficiency: A recovery-oriented approach A Workbook for People in Recovery Seeking Economic Self-sufficiency Oscar Jimenez, MPH Kelly Stengel, MPH Leslie Kuhn, MPH 7 th NYAPRS Executive Seminar (April 27-28, 2011) New York Association of Psychiatric Rehabilitation Services

79. Provider Guide: Contents Lesson 1: Why Is Economic Self-sufficiency Important to Recovery? Lesson 2: What Can Providers Do to Support Economic Self- Sufficiency? A recovery-oriented approach to financial wellness What providers can do to support economic self-sufficiency: An overview  Engaging individuals through conversations about life dreams  Assessing readiness to pursue economic self-sufficiency  Developing readiness to pursue economic self-sufficiency  Creating a plan towards self-sufficiency  Empowering through financial skills and asset-building  Linking and referring individuals to economic self-sufficiency services Lesson 3: Strategies and Tools to Engage, Assess and Develop Readiness towards Economic Self-Sufficiency

80. Lesson 4: Strategies and Tools to Create a Plan towards Self-sufficiency Lesson 5: Strategies and Tools to Empower through Financial Skills and Asset- building –Module 1: Budgeting –Module 2: Accessing work incentives to increase earned income –Module 3: Filing taxes –Module 4: Saving –Module 5: Clearing and building credit –Module 6: Dealing with predatory lending –Module 7: Getting help with addictions and financial stressors –Module 8: Increasing social capital –Module 9: Essential skills to achieve self-sufficiency: a review –Module 10: Accessing services and supports to pursue self-sufficiency Lesson 6: Developing programs to promote self-sufficiency Provider Guide: Contents

81. Contact information Chacku Mathai, CPRP Associate Executive Director chackum@nyaprs.org 518-527-3651 Oscar Jimenez, MPH Director of Community and Economic Development oscarj@nyaprs.org 518-436-0008 New York Association of Psychiatric Rehabilitation Services (NYAPRS)

82. Provider Guide: Contents Lesson 1: Why Is Economic Self-sufficiency Important to Recovery? Lesson 2: What Can Providers Do to Support Economic Self- Sufficiency? A recovery-oriented approach to financial wellness What providers can do to support economic self-sufficiency: An overview  Engaging individuals through conversations about life dreams  Assessing readiness to pursue economic self-sufficiency  Developing readiness to pursue economic self-sufficiency  Creating a plan towards self-sufficiency  Empowering through financial skills and asset-building  Linking and referring individuals to economic self-sufficiency services Lesson 3: Strategies and Tools to Engage, Assess and Develop Readiness towards Economic Self-Sufficiency

83. Lesson 4: Strategies and Tools to Create a Plan towards Self-sufficiency Lesson 5: Strategies and Tools to Empower through Financial Skills and Asset- building –Module 1: Budgeting –Module 2: Accessing work incentives to increase earned income –Module 3: Filing taxes –Module 4: Saving –Module 5: Clearing and building credit –Module 6: Dealing with predatory lending –Module 7: Getting help with addictions and financial stressors –Module 8: Increasing social capital –Module 9: Essential skills to achieve self-sufficiency: a review –Module 10: Accessing services and supports to pursue self-sufficiency Lesson 6: Developing programs to promote self-sufficiency Provider Guide: Contents

84. Contact information Chacku Mathai, CPRP Associate Executive Director chackum@nyaprs.org 518-527-3651 Oscar Jimenez, MPH Director of Community and Economic Development oscarj@nyaprs.org 518-436-0008 New York Association of Psychiatric Rehabilitation Services (NYAPRS)

85. Working Together The Key to Improving Employment Services & Outcomes Aaron Vieira, LMSW Associate Director Center for Rehabilitation and Recovery The Coalition of Behavioral Health Agencies 90 Broad Street, 8 th Floor New York, NY 10004 212.742.1600 x238 avieira@coalitionny.org www.coalitionny.org Center for Rehabilitation and Recovery USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA85

86. Center for Rehabilitation and Recovery Presentation Objectives Describe CCRR’s contribution to NYS OMH’s employment initiative; Explain CCRR’s approach to collective transformation; Discuss tools used to engage stakeholders in authentic conversation and action. USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA86

87. Center for Rehabilitation and Recovery CCRR’s Work on Employment Support NYC agencies in implementing PROS programs. Deliver training on “IPS Supported Employment” and “Benefits Management” to direct service providers. Organize and participate in conferences on Economic Self-Sufficiency. Developed and maintain The WORKbook, an online guide to NYC’s mental health employment programs. Developed and maintain a “Peer Job Board” to facilitate the hiring of peers in community rehabilitation programs like PROS. Conducted strategic outreach to increase awareness and enrollment in MBI-WPD, as part of NY MIG grant. Coordinate efforts with NYS OMH, NYC DOHMH, CPI, NYAPRS, and NYRSA. USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA87

88. Center for Rehabilitation and Recovery The Challenge of Transformation How do we improve employment services in systems and organizations? – WRONG QUESTION! We know what works, but we’re not doing it. USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA88 We cannot solve our problems with the same thinking we used when we created them. Albert Einstein

89. Center for Rehabilitation and Recovery The Challenge of Transformation How do we engage people in ways that inspire commitment and accountability for change? – RIGHT QUESTION! Developing answers to this question requires a shift in awareness, a new mental model. USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA89 If we change the system, but don’t change ourselves, nothing will really change. Mark Ragins, MD

90. Center for Rehabilitation and Recovery The Key to Successful Transformation ENGAGEMENT is key – The way we gather together to create and problem solve is what matters most. – Shifts in intangibles — relationships, motivation, commitment and accountability — are what make transformation succeed.* *Adapted from work of Peter Block. USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA90

91. Center for Rehabilitation and Recovery CCRR’s Approach to Transformation Values Driven Approach – Center staff make a conscious effort to apply recovery values in our internal operations & external activities We emphasize hope, strengths, shared decision-making, responsibility and positive outcomes when interacting with each other and stakeholders. Methodology: Focus on Relationship & Process – Convene meetings in ways that promote inclusion, collaboration, and commitment to improve access to and quality of employment services. USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA91

92. Center for Rehabilitation and Recovery CCRR’s Approach to Transformation Values into Action – Supporting NYC agencies in implementing PROS Convene 4 “NYC PROS Learning Collaborative” mtgs per yr – Clarifying the intent – The invitation – Setting the context – Structuring the experience – Maximizing participation – Authentic conversation – Creating – Commitment to action USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA92 Approach informed by work of Craig and Patricia Neal

93. Center for Rehabilitation and Recovery Tools to Engage Stakeholders Assessing Readiness to Change – Engaging questions: Do you feel our program needs to convert to PROS? Why or why not? If we did convert, what would motivate you to take part in the conversion process? How will PROS improve services, such as employment? What risks do you see in converting our program to PROS? What could leadership be doing to demonstrate that PROS would be a different, more improved program? What would interfere with your desire/ability to take part in the PROS conversion process? USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA93

94. Center for Rehabilitation and Recovery Tools to Engage Stakeholders Inspiring a Shared Vision – Meaningful process USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA94 Reflect on the Past Attend to the Present Envision the Future

95. Center for Rehabilitation and Recovery Tools to Engage Stakeholders Inspiring a Shared Vision Reflect on the Past What did we like and not like about our old program? What elements of our old program can we preserve in PROS? What elements of our old program must we let go of? Attend to the Present What changes do we see taking place among the people that we serve? What are the most influential trends in our field? What resources will we have available to create a PROS program? Envision the Future What do we want to create together? What will our PROS program look like? USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA95

96. Center for Rehabilitation and Recovery Benefits of Authentic Engagement Authentic Engagement leads to…. USPRA 36 th Annual Conference / June 13-16, 2011 / Boston, MA96 These process improvements are critical to achieving better outcomes. Why? Because quality improvement is always local, customized, unfolding and emergent. So we need to work together more closely to improve our system, organizations and ourselves!  Greater Energy  Better Relationships  More Creativity  Innovative Solutions  Stronger Commitment  Increased Accountability