1 Workforce Retention in Supported Employment: Promising Practices Amy Gelb, MS, CAGS, CRC, CPRP- Rick Kugler, M.S., CPRP- The Institute for Community Inclusion-UMass Boston

2 Questions… Why talk about mental illness and work? What are the current vocational outcomes for this group? What are the issues involved in maintaining (or finding) employment? What are some possible strategies to increase workforce tenure?

3 Work and Mental Illness The majority of people with mental illness report the desire to work The employment rate is low Unemployment is costly for everyone – Living on $600 - $900 a month? –SSA distributes over $75 billion a year on disability benefits: 25% - 30% are beneficiaries with SMI

4 Three Myths and a Fact Generally, stress from employment make it more likely for someone to be hospitalized People who are unemployed have more time to invest to control their symptoms People with SMI and a substance abuse problem are likely to benefit from SE services Clinical benefits for people with SMI who work are rare

5 Research and SE People with SMI may require more support and have difficulty with retention than people with chronic disease/disabilities (non- cognitive)* Most of the current research is comparative in nature – one program vs. another Over a decade of research demonstrates that 40% - 60% can obtain employment through SE interventions** Hoekstra et al., 2004 & Lerner et al., 2004, ** Bond, 2004

6 What Are the Reasons People Go to Work?

7 What Are The Reasons People Stay At Work?

8 Principles for Effective SE: Evidence - Based Principles Consumer Choice Integration of vocational and clinical Competitive employment is the goal Rapid Job search Individualized job finding Follow-up supports are continuous Work Incentives Counseling Principles based on work done by Becker, Bond, and Drake

9 Employment Outcomes SE studies (mainly IPS) lasting 18 to 24 months: People work weeks -job tenure weeks SE participants followed up after 10 years* 1/3 of worked five or more years Average job tenure at <3 years Retention Rates - Clubhouse – Working members averaged 300 days over 3 years** 10-year span - average tenure of working member <3 years(?)*** * Salyers, Becker, Drake, Torrey & Wyzik, 2004 ** Mckay, Johnsen & Stein, 2005 *** Dorio, 2004

10 Turnover for Other Populations Convenience store workers - 130% Leisure/Hospitality - 45% * National Average - 40% ** Low Wage Earners – 4 in 10 jobs turnover quarterly *** *Employment Policy Foundation, 2005 **Tumulty - Gannett New Service, 2002 ***Lane-HHS, 1999

11 What Interferes With Work: Problems Reasons for turnover are not prevalent in the literature Resignations and terminations are more common than career advancement & layoffs The relationship of substance abuse and work yields inconsistent results* * Drake, Becker & Bond, 2003

12 What Interferes With Work: Problems Studies also identify struggles with: psychiatric symptoms & hospitalizations physical illness involving interpersonal issues unattractive, low paying jobs the same problems that people without mental illness confront

13 Know the Job Seeker What skills does the job seeker bring? What abilities do they have? What are their strengths? What can they do for an employer? What kind of work culture works best for them?

14 Know the Employer What do they do / make? What jobs do the typically hire for? What hiring needs do they have? What tasks are not getting done? What areas of business do they want to expand? Are tasks getting done by high paid employees that someone else could do?

15 Now... Look for a match between the businesses needs and the skills and strengths of the job seeker and… Identify how the employer will profit from hiring the job seeker.

16 Potential Factors That Help Perpetuate Employment Provision of ongoing support services (needs more study) One FACT study yielded better consistency than IPS* People who hold on to their job report intrinsic rewards Job satisfaction through better matches Attachment to better paying, benefited jobs and or ones with potential Teach skills, soft skills, retention strategies, etc.** * McFarlane et al., 2000 ** Wallace & Tauber, 2004

17 Recommendations Start: Use EBP principles Include: Good job matches, if the pay cant be great, the job should at least be looking up a stairway SSA Considerations- Make sure people know what they will earn Include: Integrative and Collaborative services-vocational, clinical and social

18 Recommendations Include: Provide community based-services, assertive outreach Help develop natural supports Explore: Employment support staff need to encourage consumer participation in ongoing skills development

19 Resources Articles on Dartmouth NH – Psych Research Center (click publications; vocational) …or …visit for information from research and training centerswww.naric.com/research/ Find out more about Work SAMHSA Workbook on SE s/employment/16.SE_workbook.pdf s/employment/16.SE_workbook.pdf

20 Acronyms FACT= Family-aided assertive community treatment IPS= Individual Placement & Support Model SE= Supported Employment SMI= Serious mental illness SSI= Supplemental Security Income SSDI= Social Security Disability Insurance SSA= Social Security Administration