1. Employment and Recovery Robert Meyer, IPS Trainer UW-Madison, RPSE Department April 24, 2015 NAMI WI State Conference

2. Overview What is recovery? Evidence based employment programs. Outcomes associated with employment Common factors/take home thoughts

3. What is recovery “A process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.” (SAMHSA) “Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.” (National Consensus Statement,

4. Four dimensions of recovery Health – overcoming or managing disease or symptoms Home* – having a stable and safe place to live Purpose* – meaningful daily activity Community* – having relationships and social networks that provide support, friendship, love, and hope from SAMHSA

5. *recovery factors that relate to employment Home – income necessary to live where and with whom you want Purpose – employment provides many with a purpose to their daily routine Community – employment provides connections to the community: workmates, social interaction, transportation

6. Gap between desires and current situation Although we know that employment leads to good outcomes there is still widespread unemployment for people living with severe and persistent mental illness. ~20% employment rate, 60 – 70% express a desire to work. Current system of providing health coverage/public assistance has a perceived disincentive to work. Use best practices to bridge the gap

7. Evidence based models IPS (Individual Placement and Support) Supported Employment. Developed by Robert Drake and Deborah Becker at Dartmouth College Clubhouse International Founded 1948 – Fountain House NY City

8. IPS Guiding Principles I Zero exclusion Consumer choice Competitive jobs Systematic job development

9. IPS Guiding Principles II Rapid job search Integration of mental health and vocational teams Individualized benefits counseling Time unlimited and individual follow along supports

10. IPS evidence 24 Randomized control trials Typically twice the level of employment compared to standard employment activities. Well researched fidelity of the model program Proven track record in the 17 states in collaborative Rural and urban settings Expanding throughout WI via CCS programs. 20+ sites in 19 counties

11. Clubhouse International Created in 1948 in New York. Based on the principles of sharing work and recovery experiences. 5 locations in Wisconsin (Madison, Milwaukee, Wausau, Manitowoc, Racine)

12. Clubhouse characteristics a work-ordered day in which the talents and abilities of members are recognized and utilized within the Clubhouse; participation in consensus-based decision making regarding all important matters relating to the running of the Clubhouse; opportunities to obtain paid employment in the local labor market through a Clubhouse-created Transitional Employment Program. In addition, members participate in Clubhouse-supported and independent programs;

13. Clubhouse cont’d assistance in accessing community-based educational resources; access to crisis intervention services when needed; evening/weekend social and recreational events; and assistance in securing and sustaining safe, decent and affordable housing.

14. Outcomes related to employment – research (correlation vs causation) Bond & Resnick, 2001 Reduction in psychiatric symptoms Increase in self-esteem Satisfaction with services offered Increased satisfaction with leisure and finances

15. Long-term outcomes ( Saylers, et al. 2004) 10 year follow up study of IPS. 75% had worked beyond the initial study period 33% had worked 5 of the 10 years interim, 32 month average Improvements in reported diverse areas; Self-esteem Hope Relationships Substance abuse control

16. Common themes Take away messages Choice, not availability. Go with strengths. Competitive Rapid search when you are ready. Job development (get to know the people, systems and the place before you ask for a job or accommodation). Three Cups of Tea analogy In person, before on-line

17. Common themes, con’t Team approach – make sure everyone is on board and supportive of work Psychiatrist/therapist Case/care coordinator DVR counselor Family/support network Peer supports Have a clear follow along and crisis plan Triggers/coping mechanisms Boundaries and breaks

18. Resources SAMHSA recovery information http://www.samhsa.gov/recovery http://store.samhsa.gov/product/SAMHSA-s-Working-Definition- of-Recovery/PEP12-RECDEF http://store.samhsa.gov/product/SAMHSA-s-Working-Definition- of-Recovery/PEP12-RECDEF IPS http://www.dartmouthips.org/ https://www.dhs.wisconsin.gov/mh/ips.html Clubhouse http://www.clubhouse-intl.org/ http://www.journeymhc.org/services/community/yahara-house

19. References A Ten-Year Follow-Up of a Supported Employment Program Michelle P. Salyers, Deborah R. Becker, Robert E. Drake, William C. Torrey, and Philip F. Wyzik, Psychiatric Services 2004 55:3, 302-308 A Ten-Year Follow-Up of a Supported Employment Program Does competitive employment improve nonvocational outcomes for people with severe mental illness Bond, Gary R.; Resnick, Sandra G.; Drake, Robert E.; Xie, Haiyi; McHugo, Gregory J.; Bebout, Richard R Journal of Consulting and Clinical Psychology, Vol 69(3), Jun 2001, 489-501. Supported Employment Outcomes of a Randomized Controlled Trial of ACT and Clubhouse Models Cathaleene Macias, Ph.D., Charles F. Rodican, M.S.W., William A. Hargreaves, Ph.D., Danson R. Jones, Ph.D., Paul J. Barreira, M.D., and Qi Wang, Ph.D. Psychiatric Services 2006 57:10, 1406-1415 Supported Employment Outcomes of a Randomized Controlled Trial of ACT and Clubhouse Models

20. Contact information Robert.Meyer@wisconsin.gov