APRIL 11, 2006
VCU
WEBCAST

Captioning Provided By:  Caption First, Inc.
				
    >> DEBORAH BECKER:  I'm going to divide my talk today into 
three sections.  I'll first talk briefly about the research 
base.  Secondly, I will talk about the practices, supports for 
helping people with serious mental illness obtain and keep 
employment.  And third, I want to talk about the stakeholder 
group that we haven't focused enough attention on, I think, and 
that is the employer. 
    
    First what I'm going to do is go over though what 
traditionally has been provided for people in terms of supports 
for getting to work for people with serious mental illness.  The 
traditional kinds of services, the characteristics you see 
featured here are stepwise approach, and that is when we ask 
people to possibly do prevocational training, work adjustment, 
work activities that help prepare them to go to work.  Another 
characteristic of traditional kinds of programs is having a work 
readiness criteria, in terms of we decide when we think someone 
is ready for work. 
    
    A third characteristic is services are brokered, so the mental 
health piece and vocational piece are separate. 
    
    The fourth characteristic is that the services are short-term.  
They are time limited. 
    
    To make sure we are all on the same page, I want to define 
supported employment. 
    
    It was back in the Rehabilitation Act Amendments of 1986 that 
supported employment was defined, originally for people with 
developmental disabilities, but has since been modified for 
people with serious mental illness.  You see on your screen here 
the elements of supported employment. 
    
    First, these are jobs, regular jobs in the community that 
people are trying to get, either part time or full time.  They 
are jobs that pay at least minimum wage, and have the benefits 
that others doing these jobs have as well. 
    
    They are not for only people with disabilities, but they are 
alongside others that don't necessarily have a disability and 
people provide ongoing support in order to keep the job.  The 
supports are continued at a level and at a length that is right 
for that person, what they want and what they need. 
    Supported employment was developed for people who had 
traditionally been screened out of receiving services, because 
it was, they were seen as not ready to work.  But with this 
approach, people are given the support in an individualized way, 
to be able to work. 
    
    Okay.  So now I'm going to start with what is the research 
base for supported employment for people with psychiatric 
disabilities? 
    
    There are different levels of research, and the most rigorous 
level is the randomized controlled trial.  On this slide, you 
see that I started out by mentioning day treatment studies.  
These studies are when an agency converts their day program 
resources to supported employment and what happens.
     
    That would be a whole program changes.  In these studies, in 
all cases, the employment outcomes of people who are in the day 
programs that converted to supported employment increased their 
work outcomes, compared to the other agencies that stayed the 
same. 
    
    Some people thought there might be negative outcomes by 
changing agencies in this way, that people might drop out, they 
may need to go to the hospital.  And in these studies, none of 
those outcomes were found. 
    
    The one area though that people mentioned consistently in 
these studies is that they missed the socialization 
opportunities of the day program.  So I think in response to 
that, in part, peer support programs have developed, where 
people can participate in those programs and socialize with 
others who have similar experiences that they do. 
    
    The third item on this slide is the correlational studies.  
That is a couple notches down in terms of the type of research.  
In those studies, we have found that having good employment 
outcomes is highly correlated to the implementation process of 
supported employment.  And maintaining a faithful (inaudible) as 
I mentioned, this is the most rigorous test of evidence-based 
practice. 
    
    They are now, there are 13 studies of showing that supported 
employment has better outcomes than more traditional vocational 
approaches, and those approaches have included prevocational 
training, work adjustment, having work crews, transitional 
employment positions, short term jobs.  In all cases, it was 
supported employment that helped people get into jobs and there 
was a three fold difference. 
    
    As you can see, across these studies, 60 percent of the people 
who were in supported employment gained a regular job either 
part time or full time, compared to the traditional approaches, 
where only 20 percent of those people went to work. 
    
    And in all of the supported employment programs, the 
competitive employment programs, competitive employment outcomes 
were higher than the traditional programs regardless of age, 
gender, diagnosis, minority status, whether the programs were 
urban or rural. 
    
    In the studies that I've mentioned, they have been relatively 
short term, that is, from 12 to 24 months.  What happens to 
people over the long term?  What is the pattern of work?
     
    There are now three studies that have shown that people get 
into a career path, and do continue on as workers.  The three 
studies are from eight years to ten years, and 12 years in which 
people were re-interviewed after being in the original study.
     
    And what we found in these three studies is that people did go 
to work.  Most of the people worked for pay, regular competitive 
jobs.  Most of them were part time.  If most cases, people tried 
several jobs before they then settled into a job for more of the 
long term.  I think the expectation of a person just getting in 
one job is not realistic.  And that I think is fairly true for 
all of us, that we have all had multiple jobs.  So that should 
also be true for others who have disabilities. 
    
    Okay.  Now, what I'm going to do is quickly go over the seven 
principles of evidence-based supported employment.  This is 
supported employment for people who have psychiatric 
impairments. 
    
    The first principle is that eligibility is based on consumer 
choice.  As I mentioned earlier, in the past, our programs were 
set up in a way that the profession an also or the practitioners 
were the ones who determined who could go to work.  But what we 
have found during these studies is that it's actually the 
consumer who is the one who should be choosing whether they want 
to participate in supported employment, because they have the 
goal of going to work.  I would also suggest that that means 
that we need to as practitioners have higher expectations for 
people around work, and that we should be talking about work 
right from the beginning, when people knock on doors for 
receiving services at mental health agencies, right from the 
beginning during intake, asking people about work. 
    
    And that all practitioners within the agency are thinking 
about work for their consumers.  And with their consumers. 
    
    The second principle which is, has recently been added to this 
list is, there is now growing evidence that personalized 
benefits planning is important for people to go back to work.  
The number one reason why people are ambivalent about going to 
work is this fear of losing their benefits.  What we are seeing 
is that with comprehensive individualized benefits planning, 
people make decisions in which they do go back to work more and 
they earn more wages. 
    
    The third principle is that supported employment is integrated 
with mental health treatment.  And I think what that principle 
mainly is about is communication.  That providers need to all be 
on the same page about providing supports for people to go back 
to work. 
    
    So to give an example, if you have a psychiatrist who believes 
that it's important for people to stabilize from their illness, 
and prepare to go to work, and not go to work if they are still 
having any symptoms, that is a different message from an 
employment specialist who will say, I think that there are ways 
that you can go to work and move forward, even though you still 
are having some symptoms. 
    
    We need to be sure that we are all on the same page, and that 
we all know what our roles are and supporting people in being 
able to work. 
    
    Ways that that can happen are, having regular treatment team 
meetings, where everybody sits down together, and has input on 
what is happening for individuals and for timely and 
comprehensive planning. 
    
    In that way, people will be able to be on the same page, and 
inform each other to provide best services possible.  Sharing 
office space, so people are naturally seeing each other in which 
they are able to communicate, and also having a single record.
     
    This, these examples that I just gave you, that is difficult 
to do if there are two different agencies that are supporting 
people in their efforts to work.  In those cases, you are going 
to have to make extra effort, I think, to make that 
communication and to link together, so you are providing the 
same message and the consumer isn't the one who has to do the 
walking to bring all services together. 
    
    The next principle is, competitive employment is the goal.  
There are various discussions about what is a competitive job.  
When we use that phrase here, we are talking about regular jobs 
that anyone can apply for, so they are not set aside 
specifically for people with disabilities.  Part time or full 
time, alongside others who may or may not have disabilities, and 
to help people become more integrated back into their 
communities. 
    
    I sometimes am asked, what about the person who says, I think 
I'd like do that but I want to start with a volunteer job first?  
And in that way, I'll build my confidence, and see if I can do 
that. 
    
    And I think that all these services are really about 
supporting individuals and what they want, and if that is how 
that person wants to get started, we should help them do that.  
And keep them thinking about a regular job.  As everybody is 
getting a volunteer job on someone's caseload, I would say the 
focus is not on competitive employment.  But I think we do want 
to have individualized services.  If a person says, I only want 
to do volunteer work, I don't want to be paid, I'm worried about 
it jeopardizing my benefits or that is how I want it to be for 
me, I think we should save the precious resources of the 
employment specialist for people who are really aiming towards 
competitive employment. 
    
    Next principle is, job start, job search starts soon after a 
consumer expresses interest in working.  So we want to meet with 
a person when they are ready to think about work, and not slow 
them down with our programming by having prevocational training 
or extended work adjustment kinds of activities.
     
    Now, that said, these supported employment services go at a 
rate that is consistent for that individual.  There will be some 
people who want to get started right away, have a good idea what 
they want to do.  And maybe, may even get the job within a 
couple weeks.  Someone else may say, I don't want to go that 
fast.  Let's look at different jobs and so the employment 
specialist goes out with that person, and they start learning 
more about the world of work in order for that individual to 
zero in on the kinds of job settings that they might be able to 
get a job, and do well in. 
    
    So, the pace is really determined by the individual, but 
within the first month of being part of supported employment, 
the consumer is helped to start thinking about the world of 
work, and getting out of the office to do that. 
    
    The sixth principle is follow along supports are continuous.  
So there are not time limits in this approach.  If there are 
different agencies that are putting together this service, they 
need to think about how are long term services going to be 
provided and importantly, how are they going to be funded?  I 
think in the past, services have been time limited in part 
because of financing mechanisms.
     
    Supports are individualized, again, and they are also provided 
by the whole team. 
    
    So, this is an approach where it's adding an employment 
specialist who is going to help somebody with their getting to 
work.  It's about a whole team of people thinking about how to 
support that person in getting to work.  That also can include 
family members if the individual wants, significant others, 
other people that they have in their lives. 
    
    The 7th principle is that consumer preferences are important.  
This is all based on who the person is, and what they want to 
do, and how we are going to help them do that. 
    
    So, the employment person is not going to provide an array of 
jobs, you know, I have package of all these jobs available, 
which one makes sense for you?  It's starting with who the 
individual is, what are their skills, what are their past 
experiences?  And what do they want to do now?  How to put that 
all together, and then find that out in the community, in a job 
setting that will fit for that person.
     
    What we have found in many studies is that most people have 
realistic job expectations.  In an all cases, what I would 
recommend is that it's important to ask people, what is it about 
that job preference that you like?  And to continue to broaden 
options for people, rather than limiting them. 
    
    Okay.  Now what I want to do is talk about a few other 
important issues that will lead us into thinking about the 
employer and critical issues related to the employer and the 
work setting. 
    
    The first an area that we need to talk about is, whether a 
person wants to disclose that they have a disability.  And with 
the Americans with Disabilities Act, employers are required, 
most employers are required to provide reasonable accommodations 
for people who have disabilities.  So they will be able to work.
     
    And, what that means though, I think is different for 
different people.  I can remember talking to one consumer who 
thought that meant, well, you are going to hand over my chart to 
the employer.  That is really not what we are talking about 
here.  It's whether an individual will be willing to disclose 
that they have a disability, but conversations about that 
disability may never even come up with the employer.  But it 
allows the employment specialist to have contact with an 
employer, and to advocate for that individual getting the job 
and supporting the job if the individual wants. 
    
    We have found in several studies that about half the consumers 
with mental illness who are part of supported employment 
programs initially don't want to disclose.  So they don't want 
the employment specialist contacting specific employers on their 
behalf, which is fine.  But then the employment specialist needs 
to support that person behind the scenes, and at a level that 
that person wants. 
    
    Other people will say, I think it will be helpful if you are 
there to help advocate for me.  Individuals may have a hard time 
explaining certain periods of their past.  They may have a 
difficult time even thinking about the kinds of accommodations 
that might help them otherwise get the job, and be able to stay 
in the job. 
    
    So, discussions about disclosure I think really need to be 
ongoing.  What do we really mean by that?  What are we going to 
say to people?  Who is going to say, describe information to the 
employer?  Does anything need to be said to coworkers?  It's all 
about need to know information, and in my experience, and being 
familiar with lots of programs, is that it's not necessary to 
get into discussions about diagnoses.  It's more about the 
behavioral needs that people may have.  I'm going to talk in a 
few minutes about accommodations that are related to this.
     
    Supported employment and helping people with psychiatric 
impairments work, it's all about thinking about this 
individualized job search.  So if everybody is working in a fast 
food chain, then I would say this is probably not an 
individualized job search, because most people aren't, that 
isn't their goal.  If I go and visit a program, and ask where 
people are working and talk to consumers who are working and 
they tell me that they are all in different kinds of jobs, 
working different amounts of time during the week, then I have a 
better idea that this really is an individualized job search 
approach. 
    
    Okay.  It's very important for the employment specialist who 
is going to be contacting employers to think about, what do I 
need to do in terms of engaging employers?  And what do I want 
to come out of my contact with employers?  And again, for the 
employment specialist who is advocating for a specific person, 
it needs to be someone who says and agreed that they are willing 
to disclose that they have a disability, and it may be merely 
because the employment specialist needs to say what organization 
they work for, which would then naturally, reveal that they may 
be working for, on behalf of people who have a serious mental 
illness, for example, if they work for an agency where in the 
title it says, community mental health center, then some level 
of disclosure is occurring when they say where they work.
     
    For those people that they are not advocating for, employment 
specialists still may have direct contact with employers, 
because one of their main roles is to become familiar with the 
employer community, and to be able to know what employers want, 
who they want to hire, what skills they are looking for, what 
needs to be done in their business, to be successful.  And so 
what is their work force that they are looking for? 
    
    I have gone out with lots and lots of employment specialists, 
and it really can vary, how that happens.  But in all cases, the 
employment specialists who develop working relationships with 
employers, they have done their homework, and they present 
professionally.  They know what they want to say to the 
employer.  They are confident in the way they do it. 
    
    They know that they are really there to help solve an employer 
problem.  And they want to recommend qualified applicants.  So 
it behooves them to really find out what is the employer looking 
for?  Are there certain jobs that they tend to have turnover?  
Why is that?  Or maybe there is a specific job that the employer 
needs filled right now.  I think sometimes what happens is, 
people who are new to being employment specialists, the tendency 
is to go in and ask, do you have any job openings?  The employer 
oftentimes will say no.  The employment specialist will say, 
thank you very much, and then leave.
     
    And I think what we want employment specialists to do is 
really to be able to open up conversations with employers and 
can get them talking, and simple questions that will give a yes 
or no answer tend to shut down the conversation. 
    
    Respect the employer's time.  So let's say you have someone 
who is interested in working in a restaurant, has skills of 
being a cook in the past, lives nearby a restaurant, that they 
think they might like to work.  You and the individual are job 
searching together.  You want to think, what is the best time to 
go meet that employer?  It wouldn't be in the middle of when 
they are serving meals.  If it's a dinner restaurant, obviously 
you are not going to want to go at 5:00 or 6:00.  But at a time 
that is more convenient for that employer.
     
    In all your contacts with the employer, you want to keep in 
mind, what is the next step?  What do I want to have be the 
outcome of this contact?  Sometimes it's just merely to make 
yourself familiar with that individual.  It may be because you 
want that person to meet a candidate for that position.  It may 
be that you want to say, well, I understand that you may not 
have anything right now, but I'm going to check back with you in 
a month.  So, I really see that employment specialists who 
continue to go back and meet employers and groom those 
relationships, that they are the people who are ending up giving 
employer recommendations to their clients who are looking for 
jobs, or actually helping clients get the jobs more directly 
with employers.
     
    You will see on this slide, the last item that says, be 
dependable.  Do what you say you are going to do.  And I can't 
emphasize how important that is.  It's really clear as I see 
employment specialists working with employers that when I go 
back and talk to employers, they will say, I can always count on 
that employment specialist.  She says what she is going to do.  
She is always there for me.  And that clearly is an important 
quality.
     
    I'm sometimes asked, where is the consumer in this?  And I 
want to remind people to think about, that we encourage people 
to do as much as possible of this as they can on their own.  And 
the employment specialists are there to support people in an 
individualized way, that is going to help them.  And so it may 
be that the employment specialist is not going to be contacting 
the employer.  It may be that they are going to be contacting 
and working with the employer in the beginning, to help set up 
the employment opportunity.  Make recommendations for 
accommodations.  And it may be that they will just back off, and 
ask to touch base every few weeks.  It's all going to vary.  But 
they need to have a plan for connecting with employers and 
typically back off over time, because the person is able to do 
the job.
     
    I think many people who have, are living with symptoms of 
mental illness find that it can be stigmatizing to have a 
professional meet them on the job.  It may be that really, the 
support is going to be provided off the setting where the work 
is being done.  Other tips that I can recommend, and this is 
partly having been an employment specialist though it was a long 
time ago, but now I learned from people, probably many of you 
who are doing this work, is that it's important to use the sort 
of language.  And be confident when you are talking to 
employers.  Avoid words such as, as you see there, could, or 
might.  Or maybe.  It's very important for the employment 
specialist, if you are advocating on behalf of individuals, that 
you recognize what that, what those skills are of that person.  
And what their special talents are.  So you can talk with 
employers about that.  If you don't believe that your person can 
work and you don't believe that this is possible.  I guarantee 
that will be conveyed in one way or another.  To the employer.  
So they are going to wonder, you know.  Is this somebody I 
really want to hire.  That said, I think it's also true that we 
can't make guarantees, and but what your job is and the job of 
the team is to know who your individual is, that you are working 
with.  And help them identify what their strengths are.  And 
help them, teach them how to advocate for themselves.  So they 
can show what they can offer to an employer.  It may be that 
through work, the individual will learn about having morning 
hours aren't going to work for them.  We want to learn from each 
of our job experiences, and then move forward to maybe a 
situation that might be better for us.  But at the same time, we 
want to work with employers.  And advocate for what we believe 
in about the person, and be there for the employer, if it 
doesn't work out.  And that is what the individual wants us to 
do. 
    
    Make a follow-up contact, I sometimes talk to employers and 
they will say, this employment specialist was there, and I 
thought this was great, and I like the person they were 
advocating for when we got the job but then they never showed up 
again.  Then there were problems and I wasn't sure what I should 
do or handle. 
    
    So, I encourage employment specialists if you are having 
contacts with employers, ask them what would be helpful, and 
work together with the employer, the employee, and the 
employment specialist. 
    
    Also, you can recommend other employers who have hired people 
with disabilities, or have worked with other employment 
specialists.  So they can hear from their peers that this is 
really an untapped work force, and this can be positive.  As you 
are contacting employers, there may be questions that the 
employer has, and so be prepared for these questions. 
    
    For example, if you are advocating for an individual, and that 
person is not with you, the employer may simply say, well, why 
is that person not with you?  I have actually been with 
employment specialists who have gone with an applicant, and 
talked to an employer, but it was the employment specialist who 
did all the talking.  The employer said, can this person not 
talk?  Can they not, you know, tell me what they want?  And so, 
it's important to think about those things. 
    
    The employer may ask, what is your role, and what do you do?  
Are there fees for this service?  They may have the, the 
employee applicant may have a resume, but a common question is, 
are there gaps, or what are these gaps in the resume, in the 
work history?  And it's important that the individual have an 
answer for that, and what do they want to say, what are the 
reasons for that? 
    
    Ultimately, this is all about, can the person do the job.  So, 
stay focused on what is in this for the employer.  It's to get 
the job done.  Also, encourage you not to use mental health 
jargon, that really use business language, that employers aren't 
terribly interested about issues that people have, and goals 
and, they are interested in hiring people who will get the job 
done. 
    
    So, as an employment specialist, you can offer certain 
services to the employer that will benefit them, such as, you 
offer actually a prescreening service, because you have become 
familiar with this individual.  And you know a little bit about 
them.  This is more than most employers have, when they meet 
applicants for a position.
     
    You have also been able to collect some information about the 
person's skills, and their strengths, and been able to develop a 
vocational profile, and be able to convey that information to 
the employer. 
    
    You can provide simple education and guidance about 
accommodations for the employer. 
    
    Also, for some people, may be short-term job coaching is what 
will be helpful to get that person started on the job.  But the 
job coach or the employment specialist wants to, from the start, 
with the employee thinking about how that person will fade away.  
It makes me think about an example of one employment program 
where the employment specialist started with an employee on a 
job cleaning, doing maintenance work.  And stayed with that 
person, and this went on for actually months, and what it 
became, what became clear was that actually, the employment 
specialist really was the one who was doing the job, and it 
wasn't a job that the individual wanted, or could do actually, 
in some of it, is because of the speed that was required. 
    
    So, step back.  Whose job is it?  Make sure this is something 
that you are constantly talking about, you know, how to get the 
job done, and can the person do it.  And it may be that that was 
not, I think, in that example, it was not a good job match for 
that person.  But they did go on, and take what, took what they 
learned from that job, and then went forward with another job. 
    
    The work opportunities, tax credit, this is an incentive that 
I understand that some employers are interested in, and will 
make a difference on whether they hire someone or not.  And for 
other employers, it really isn't as much of an incentive.  But 
that is where the employee is encouraged to hire certain groups 
of people, and they will then have a reduced federal tax 
liability for certain qualified employees up to $2400. 
    
    Another benefit to employers is that, the employment 
specialist can provide support, and they can be in touch with 
the employer to make sure everything is going okay.  Obviously, 
with, if it's part of what the consumer wants to do. 
    
    Now I'd like to describe some of the reasonable accommodations 
that have been used to help people with severe mental illness 
maintain jobs and keep jobs. 
    
    As you will see as we go through the list, most of the 
accommodations are not expensive.  They don't cost a lot of 
money.  And they are relatively easy to put in place.
     
    The first one that you see is, temporary job coach.  That may 
be to help someone get started on the job that they have not 
worked in a long time.  They are nervous about getting work, 
getting to work again.  And that having a job coach there to 
help smooth away is important. 
    
    For an individual who may have trouble with memory, it may be 
a simple job accommodation by having written instructions on job 
tasks that they are supposed to complete.  That is helpful.  It 
may be just a piece of paper, outlining what that person is 
going to do.  It may be helpful to have somebody to work 
alongside with.  For example, an accommodation for someone who 
has fearful thoughts, one person may feel safer if their work 
station is a little more separate from the mainstream of where 
lots of people are working in an office.  For someone else, it 
may be most helpful to feel safe and be able to control these 
thoughts, by having a coworker buddy to be able to check out and 
make sure that everything is okay.
     
    Sometimes having a change in the supervisor can make a big 
difference for people in terms of who they have to relate to.  
That is a simple change that can be made.  Then also, by simply 
having positive reinforcement that someone is doing a good job, 
I can remember when I used to do this work, working with an 
individual who was, had no trouble at all finding jobs, but what 
happened when she started working is that she tended to think 
that her supervisor was thinking that she wasn't doing a good 
job. 
    
    And they would become tearful and end up leaving the job.  
This happened a series of times.  So we decided that maybe if we 
could ask the supervisor to point out each day to her something 
positive that she did, that she would be reinforced on how she 
was doing, and this simple accommodation made all the difference 
for her, was able to keep the job for a long time. 
    
    Other examples of accommodations are around scheduling, people 
who want part time hours.  They want to have, it's more helpful 
to have a self-paced work load.  For some people, having more 
frequent breaks helps them to keep working. 
    
    For others, it may be that it's unavoidable that they need to 
have clinic appointments during their work hours.  So trying to 
make a change for those appointments, and for some people who 
may need a hospitalization, having paid or unpaid leave for 
that. 
    
    Other accommodations may have to deal specifically with the 
work setting.  People who take medications, may have side 
effects of dry mouth and so it's important for them to feel 
comfortable with having liquids regularly.  So having access to 
water. 
    
    For the individual who may need to have a place for them to 
relax, after having a difficult time, that may be an easy 
situation to set up.  For example, I remember visiting a 
furniture store, where an employee, a consumer had been hired.  
And what his job was, was to unload a lot of the furniture that 
would come in on big trucks and help get it set up in the 
showroom.
    
    But at times, and he had auditory hallucinations.  He would 
become overwhelmed by the voices, and start feeling agitated and 
uncomfortable.  What was helpful for him was for his supervisor 
to suggest that he go in a separate room in the back, and take 
some time to himself, and when he felt better, come back out 
again.  So these breaks that would be no more than five minutes, 
were helpful to him.  That was what made a difference in him 
being able to keep the job.
     
    Other examples is making changes in the work station that 
might work better for an individual, removing or reducing 
distractions, that people may have, that makes it difficult for 
them to work.  Sometimes people use headsets, for people who 
have auditory hallucinations or even white noise. 
    
    There are also reasonable accommodations that could be put in 
place for the actual work tasks, providing opportunities for 
additional training, or for a gradual increase in job duties.  
It may be dividing the job up in, so there is job-sharing, and 
restructuring jobs, were the essential job features. 
    
    When jobs end, sometimes it's for good reasons, and sometimes 
it's for not so good reasons. 
    
    When people move on to better jobs, and they are developing 
their careers, that is a good thing.  When sometimes people 
leave jobs, they may leave them or they may even be fired, for 
reasons because it didn't work out for them.  Oftentimes, that's 
difficult.  It's not pleasant to leave jobs that, when it hasn't 
worked out. 
    
    So it's the role of the practitioners and employment 
specialists to help that person review what was learned from 
that job, and what will we do differently to move forward? 
    
    I'm often asked about the kinds of jobs people get into.  As 
I've been saying throughout this presentation, this really is an 
individualized job approach.  And so if you are seeing people 
get different kinds of jobs, then you know that that is what you 
are doing, I made a list of jobs from one of the programs that I 
am familiar with, and you can see that the jobs are in diverse 
settings and different types of jobs.  That is really what we 
want to aim for, helping people with serious mental illness get 
it back into the work force. 
    
    What are the roles of different people, the role of the 
employment specialist is to help engage people around work.  
Listen to them and who they are and what they want, to be able 
to help them move forward.  Help develop a vocational profile 
that includes work experiences that they have had, what their 
talents and skills are, who they know now, try to network to 
find a situation that is going to be good for them.  Other 
roles, obviously, putting together a good job match, helping 
people to manage their symptoms that they may be experiencing, 
because of their illness. 
    
    Even though someone is having symptoms, that doesn't mean that 
they necessarily have to stop the job.  There are ways to 
overcome that, and working with that individual to do that are 
helpful. 
    
    Educating employers, helping people to manage interpersonal 
issues that they may have on the job is very, what to say to 
coworkers during times of breaks may be different, different for 
them, particularly for people who have spent much of their 
recent time in day programs.  Providing individualized follow-
along support.  What are the roles of consumers?  What is your 
work plan?  Consumers, please, request information about 
benefits and what it's going to mean if you go to work.  Be 
involved in identifying jobs that you want.  Be involved in the 
jobs search.  This is all about you.  And connect with your 
peers, who have gone through this particularly if you are unsure 
if you want to do this, because lots of people have gone to 
work, and have moved forward in their lives through work.  What 
is your particular support plan?  What will be helpful to you, 
may be different than what it is for somebody else.  The role of 
the supervisor for the employment specialist at the mental 
health agency or the rehab agency is also key. 
    
    They need to be overseeing what kinds of jobs matches are 
being made.  It's most helpful if they also go out with 
employment specialists to connect with employers.  I think this 
is a relatively new idea, and some employment supervisors are a 
little bit nervous about doing it, but those that do go out and 
do it, we have seen end up having programs where more and more 
people are going to work.
     
    I think it's, a lot of that has to do with their role in 
supporting their staff in supporting employment, consumers 
getting jobs. 
    
    Focus on outcomes.  Are people getting jobs?  And help your 
staff focus on that as well.  And are they following the 
critical components of supported employment that will help them 
get jobs? 
    
    Employers clearly have a role in this.  They are looking for 
qualified applicants.  It's helpful for them to be open to ways 
to support all their employees.  Having a diverse work force I 
think is a good thing, in that employers need to think about how 
to do that.  And employment specialists are there and can help 
them with that. 
    
    I also encourage employers to talk to other employers to talk 
about this untapped work force of people who have disabilities, 
who are and can be good workers. 
    
    Finally, I want to say that employers do have positive things 
to say.  Johnson & Johnson company, believes in this, and is 
supporting evidence-based supported employment in 11 states 
right now, indirectly by providing a gift for this to happen in 
the states.
     
    Then there are smaller employers, like D's Magnolia in 
Roseburg, Oregon, who says that having an employment specialist 
has been very helpful, and that hiring people who have a 
disability like mental illness has not been a problem, and I 
find that that worker has been just as good as other workers 
that I have in my restaurant.  And also like people to think 
about that while there are probably lots of people in most 
employment settings, who have disabilities of one sort or 
another, and they may just not disclose it, and so we need to be 
more inclusive in our work force. 
    
    I've just listed here a few resources for you.  And welcome 
the next section of this as a discussion about questions or 
thoughts you might have about these comments.  Thank you very 
much. 
    
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