Career Advancement Resources (CAR): Supported Education as a Career Development Strategy

This article was downloaded by: [York University Libraries]On: 22 November 2014, At: 17:53Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

American Journal ofPsychiatric RehabilitationPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/uapr20

Career Advancement Resources(CAR): Supported Education asa Career Development StrategyAllison C. Russell a & Shari Strauss ba Career Advancement Resources , Boston,Massachusettsb New York University , New York City, New YorkPublished online: 17 Aug 2010.

To cite this article: Allison C. Russell & Shari Strauss (2004) Career AdvancementResources (CAR): Supported Education as a Career Development Strategy, AmericanJournal of Psychiatric Rehabilitation, 7:3, 249-264, DOI: 10.1080/15487760490884540

To link to this article: http://dx.doi.org/10.1080/15487760490884540

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

http://www.tandfonline.com/loi/uapr20

http://www.tandfonline.com/action/showCitFormats?doi=10.1080/15487760490884540

http://dx.doi.org/10.1080/15487760490884540

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

http://www.tandfonline.com/page/terms-and-conditions

Career Advancement Resources (CAR):Supported Education as a CareerDevelopment Strategy

Allison C. Russell

Career Advancement Resources, Boston, Massachusetts

Shari Strauss

New York University, New York City, New York

Since its inception in 1997, under the statewide Supported Education andEmployment (SEE) initiative, Career Advancement Resources (CAR) has pro-vided services to 1077 individuals with psychiatric disabilities seeking toreturn to paid employment. This article describes the CAR program’s parti-cipants, including their demographics and their educational and vocationalgoals, and in so doing, provides an understanding of the "Choose-Get-Keep’’model of Supported Education, which serves as the theoretical frameworkbehind the SEE initiative. The CAR program utilizes full and part time staff,on-campus resources, such as offices of student services and services tostudents with disabilities, as well as a number of peer-tutor=mentors, whoserve as sources of information and inspiration to current participants. CARworks closely with a variety of community resources, including mental healthagencies, career centers, and with on-campus offices, including offices ofWorkforce Development, Student Services, and counseling centers.

OVERVIEW OF THE PROGRAM

CAR is an SEE services program within Center House, Inc. andBaycove Human Services in Boston. Our purpose is to provideSEE services to adults with psychiatric disabilities, who seek toachieve meaningful roles in their communities, through the pursuit

Address correspondence to Allison C. Russell, Center House, Inc., 31 Bowker St, Boston, MA02114. E-mail: [email protected]

249

American Journal of Psychiatric Rehabilitation, 7: 249–264

Taylor & Francis # 2004

ISSN: 1548-7760 print

DOI: 10.1080=15487760490884540

Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

of education and employment goals. These services are guided byconsumers’ individual choices, with the ultimate goal of self-reliance and of assumption of the meaningful social role of paidworker in the community. Education and training are seen asimportant steps toward attaining this goal. A corresponding goalof CAR is to assist participants to achieve a level of independencethat will allow them to cease utilizing community services andreceiving social benefits. CAR is based on the underlying principlethat recovery is possible for people with psychiatric disabilities;staff work alongside participants, instilling hope and assisting withthe acquisition of needed skills and resources.

CAR is a mobile support program. Staff meet with participantsin the community at local colleges, libraries, or coffee shops. CARstaff also visit mental health service provider locations, such as casemanagement agencies, clinical programs, social programs, psycho-social rehabilitation clubhouses, state vocational agencies, hospitals,and residences. Services and supports provided by CAR involve allphases of the Choose-Get-Keep model developed by the Center forPsychiatric Rehabilitation at Boston University. This model issteeped in the notion that meaningful participation in society isbased on the process of choosing a path and setting goals, strivingto attain them, and then continuing to celebrate and build uponthose achievements throughout life. In accordance with the princi-ples of supported education, services are ongoing and provided toparticipants as long as they are needed. Once participants have leftthe program they are able to return whenever support is needed.

Career Advancement Resources is accredited by Commissionon Accreditation of Rehabilitation Facilities (CARF). As a CARF-accredited program, CAR must meet rigorous guidelines for serviceand quality and conform to nationally and internationally recog-nized service standards. Its CARF-accredited status also indicatesthat CAR has made a formal commitment to continually enhancethe quality of its services and programs as well as its focus onconsumer satisfaction.

SERVICE PROVISION AND COLLABORATIONS

Career Advancement Resources provides services at multiple sitesaround the Boston area, including Community Career Links, FullerMental Health, and Center House. Community Career Links (CCL)

250 A. C. Russell and S. Strauss

Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

is on-site at the North Charles agency’s Employment Training SEEprogram, located in the Cambridge=Somerville area of greaterBoston. CCL is contracted by North Charles to provide supportededucation services to its participants. To accomplish this, CCLemploys one full-time program coordinator, one full-time edu-cation specialist, and a part-time education specialist. The programcoordinator and the program directors from North Charles andCenter House oversee the running of CCL. This collaboration oftwo agencies in one program is rare, but has proven to be very suc-cessful over the last six years. For example, in fiscal year (FY) 2003,CCL had a total of 65 participants enrolled in supported education,including 50 consumers registered in education and=or job training,taking a total of 115 classes or ‘‘educational placements.’’ An edu-cation placement is a class with a defined curriculum and can takeplace in the community at a local college, adult education center,on-line, or at the program site. A student who successfully finishesall of the course requirements to pass is considered a successfulcompleter. Thirty of the fifty students enrolled in education place-ments in FY 2003 were successful completers.

Fuller Mental Health is an inner city mental health clinic inBoston. The Fuller contract is small, presently serving 12 parti-cipants, with 15 education placements and 75% successful comple-tions. The Fuller contract utilizes the same criteria as CCL fordetermining what constitutes an educational placement. UnlikeCCL, however, Fuller Mental Health measures successful comple-tions by the number of classes completed, rather than the numberof students who complete classes.

In FY 2003, Career Advancement Resources’ main program atCenter House, Inc. was contracted to serve 85 supported educationparticipants, in a total of 110 education placements with a success-ful completion rate—defined as the number of classes studentscomplete—of 75%. These data demonstrate that the program hasbeen quite successful, with actual outcomes across programsexceeding contracted targets.

CAR employs 13 staff in its three programs. Nine part-time andfull-time key staff, two program coordinators, and one programdirector. ‘‘Key staff’’ are direct service workers, providing both sup-ported employment and supported education services to programparticipants. They must have either a bachelor’s degree in rehabili-tation or a related field, or at least two years experience working inrehabilitation with individuals with mental illnesses. Possession of

Career Advancement Resources 251

Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

either or both of these qualifications would indicate sufficientknowledge and understanding of the vocational and educationalneeds of adults with psychiatric disabilities. Key staff must alsohave an acceptable Criminal Offender Record Information (CORI),and the ability to work both independently and as part of a team inan outcomes-based program. Management positions include theProgram Coordinator and the Program Director. In addition tothe requirements listed above, Program Coordinators must alsopossess at least one year of supervisory experience and knowledgeof rehabilitation planning. The Program Director position requiresall of the above and a Master’s degree in either rehabilitation orsocial work, with five years work experience in rehabilitation andtwo years supervisory experience.

BACKGROUND=HISTORY

SEE is currently in the seventh year of a grant, funded by theMassachusetts Department of Mental Health, to provide services toadults with psychiatric disabilities who seek to assume meaningfulroles as paid workers in their communities. Recognizing educationas a critical step in career development and attainment, SEE facili-tates the ultimate goal of career development by providing the edu-cation and training its clients need in order to reach their ownunique career goals.

The 22 SEE programs in Massachusetts formed a group known asthe Massachusetts SEE Coalition (MSC). The Coalition ascribes tothe belief that education and employment are the pathways to a per-son’s meaningful identity in society. The mission of the Coalition isto enhance the efforts of each SEE program by combining educationand advocacy to ensure that a comprehensive network of services isprovided across the Commonwealth (Massachusetts SEE CoalitionNewsletter, Winter 2002, Vol. 1, Issue 1). MSC members participatein a variety of activities, which impact all SEE programs. Suchactivities include analysis and dissemination of SEE research, stra-tegies for collaboration, legislative lobbying, best practices, infor-mation sharing, and data collection (Massachusetts SEE CoalitionNewsletter, Winter 2002, Vol. 1, Issue 1).Students of the Program

Participants in Career Advancement Resources are adults withpsychiatric disabilities, living in the greater Boston area, who want


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

to return to paid employment. The following statistics cover the lifeof the program from July 1, 1997 through May, 2003, during whichCAR provided services to a total of 1,077 participants. Demographicinformation is gathered at the time of referral and intake into theprogram. The majority of participants are Caucasian (556; 51.6%)with the next largest group being African American (328; 30.5%),then Hispanic (71; 6.7%), other (72; 6.6%), Asian (33; 3.1%), andNative American (12; 1.1%).1 There were 628 (58.3%) male stu-dents, and 449 (41.7%) females. The majority of participants arebetween the ages of 36 and 49 (555; 51.5%), followed by ages 26–35(222; 20.6%), 50þ (180; 16.7%), and 18–25 (119; 11.0%). The numberof young adults, ages 18–25, is expected to rise over the next fewyears as new statewide initiatives are put into effect to serve clientstransitioning from child to adult services.

Upon entry into the program, the largest group of participantshad graduated high school (288; 26.7%), followed closely by thosewho had some college (213; 19.8%). The next largest group (170;15.8%) had completed grades 9–12 but did not graduate highschool. Eighty-nine (8.3%) students had already completed abachelor’s degree; 64 (5.9%) had a GED; 58 (5.4%) had completedgrades 4–8 only; 20 (1.9%) had an associates degree; nine hadattended trade school, and two had a Ph.D. The remaining stu-dents (143; 13.3%) did not list any education level upon entry tothe program. All participants of the supported education programhave a psychiatric diagnosis. The top five diagnoses reported uponentry were schizoaffective (202, 18.8%), bipolar (188, 17.5%),schizophrenia (146, 13.6%), paranoid schizophrenia (134, 12.4%),and major depression (109, 10.1%). Eight (0.7%) students reportedsubstance abuse, polysubstance or alcohol abuse. Only three(0.3%) reported learning disability as a diagnosis and one reporteda medical issue. There were 116 (10.8%) students who did not listtheir diagnosis upon entry. Students had varying housing statusesupon entry to the program. People who were housed with nohomeless history made up the majority (665; 61.7%). Others weredivided among: housed with a homeless history (210; 19.5%),currently homeless (170; 15.8%), and at risk of homelessness (15;1.4%). Seventeen participants (1.6%) did not list their housingstatus.

1Data regarding race=ethnicity is missing for 185 participants (17.2%).


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

CORE SERVICES OF CAR’S SUPPORTED EDUCATION PROGRAM

Career Advancement Resources provides access to a variety ofactivities for students to choose, get and keep meaningful roles intheir communities. Referrals to the program come from localDepartment of Mental Health case managers and treatment provi-ders, as well as from self-referrals of clients who heard about theprogram from other participants, or had received services in thepast and want to return. All potential participants must be con-sidered eligible for Department of Mental Health services. Parti-cipants can enter the program at any point in their vocationalrehabilitation. The process is guided by the client; thus participants’vocational plans differ, according to their stated goals, needs fortraining and support, and timelines for completion.

The majority of new referrals are people who are in the processof choosing their role in the community. When participants enterthe program at this phase, they undergo an assessment which willassist them in setting their goals—the ‘‘choosing’’ phase of a SEEprogram. For participants who do not have recent work or edu-cation experience, the process of setting goals can take time. Careerexploration can be a helpful tool in the goal setting process. Eachsite offers a career exploration curriculum. The curriculum hasseven core components, although the information is presented dif-ferently at each site. The main components of the career explorationcurriculum are past work, education, community experiences,values, skills, and interests. The curriculum can be taught on aone-on-one basis, or in a classroom setting.

Once goals have been determined, the participant moves into the‘‘getting’’ phase. The participant, with the guidance of staff, deter-mines the steps to take towards obtaining his or her goals, includ-ing the processes of school selection, application, orientation, andfinancial aid. When participants decide to pursue traditional edu-cation, they research local colleges that offer programs in whichthey are interested. Students often visit schools to get a feel forthe environment and may meet with a program advisor or withcurrent students. If the prospective student feels he=she may bene-fit from reasonable accommodations, it is recommended thathe=she connect with the student services office before the beginningof classes.

CAR has staff who act as liaisons with four local educationalinstitutions: two community colleges, one private two-year college,


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

and the area’s largest state funded university. The role of the liaisonis to be the ‘‘expert’’ regarding the resources that are provided bythe school and how to connect with services available on campus.These liaisons have formed relationships with college staff in theoffice for students with disabilities, as well as in the registrar, bur-sar and academic support offices. Liaisons assist students in con-necting to needed supports on campus, as well as to social eventsand student organizations. They give new students tours of thecampus, if requested, and help with registration. They provideongoing support by meeting with students on campus during theschool year and with the college’s support staff, advisors, or profes-sors as needed and as requested by students. They update the restof the staff on a monthly basis as to changes in the campus admin-istration or campus policies, including issues such as documenta-tion to prove residency, new resources, and services at thecollege(s).

Obtaining the financial aid needed to attend school can be a longand stressful process. The supported education program assistsparticipants in connecting with possible funding sources, such asfederal and state governments, local vocational rehabilitation agen-cies, community organizations, employment opportunities, and theschools’ financial aid programs and offices.

Career Advancement Resources offers some basic skills trainingin computers, study skills, and employment preparedness. Comput-ing to Work is a computer training course offered in collaborationwith Baycove Human Services. Through this collaboration, Baycoveprovides classroom space and computer equipment, while CARprovides staff and training materials. Computing to Work is an inten-sive, 12-week computer-training program that includes vocationalskills training, a one-month internship, and job placement. The pro-gram includes over 150 hours of intensive computer training inMicrosoft Windows, Microsoft Word, Microsoft Excel, and Micro-soft Access. In order to provide students with individual attention,the class size is small, with only six students per session. Tutoring isalso available as needed. The program has two full-time staff whoteach the curriculum. There are seven computer workstations anda computer image projection system to ensure that students canfollow along with the instructor while working at their own compu-ters. In addition to the class, there is a resource center with a widevariety of software and tutorials that students can use, and open labtime to provide students with additional practice or help.


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

Upon completion of the computer training program, each stu-dent is matched with an internship site for one month to utilizethe skills they have learned in a work environment. After successfulcompletion of the internship, job placement services and benefitscounseling are available. The cost of the Computing to Work programis partially subsidized by a Center House, Inc., Skills Training con-tract. Other funding sources include the state vocational agency,Massachusetts Rehabilitation Commission (MRC), local one stopcareer centers, and the students themselves. Computing to Workhas been extremely successful with 94% of participants completingthe program and over 60% using their new skills to successfullyobtain employment.

Study skills are taught in a class format with an average of fourstudents to one instructor. The curriculum integrates study skillsmaterials from various sources, including the ‘Community ScholarSeries’ published by Thresholds PSR Centers (Kerouac, Solomon,Feldman, & Cook, 1993) and Becoming a Master Student (Ellis,2000). To stay consistent with the ‘‘Choose-Get-Keep model,’’ thecurriculum is tailored to meet the individual needs of each student.Topics include time management, test taking, note taking, stressmanagement, critical and creative thinking, diversity and relation-ships, communication, and using the Internet for research. Classesmeet once a week for an hour and a half and last six to seven weeks,depending on the number of topics covered.

As students prepare to transition into the workplace from schoolor a training program, they begin employment preparednessclasses. Career Advancement Resources provides classroom-basedinstruction in job readiness skills. Topics covered include interview-ing skills, networking, resume development, ADA and accommo-dations, and benefits counseling. The interview skills sectionincludes a video-recorded role play that gives students a chanceto ‘‘see’’ how they present in an interview. Networking coversnot only the ‘‘how to,’’ but also includes units on the topics, ‘‘whatis a network,’’ ‘‘who is in your network,’’ and ‘‘creating a network.’’ADA and accommodations covers the law and rights for studentswith disabilities. If a student decides an accommodation is needed,he or she learns when to ask for one, who to ask, what to say, andwhat documentation may be requested by the school or employer.

The fear of losing Social Security benefits can be a big barrier toreturning to work for some students. The job readiness programincludes benefits counseling, during which work sheets are


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

completed with each student. Students plug numbers into a for-mula to understand the actual impact work will have on their ben-efits. A representative from the local Social Security office comes tothe program to present information on benefits and returning towork, and is also available by phone to answer questions.

PEER-TUTOR=MENTOR PROGRAM

The most recent addition to services is the Peer-Tutor Mentor pro-gram, which began informally in 2000. The staff tutor position hadbeen continually vacant and the existing staff were having difficultymeeting the tutoring needs of the students. It was in this contextthat peer-tutors were recruited, in order to provide students withthe academic support needed to successfully complete their course-work. Until the fall of 2002, when Career Advancement Resourcesset aside funding to officially launch and support the Peer-Tutor=Mentor program, CAR=s partner program, North CharlesEmployment Training, provided payment for the peer-tutors.Peer-tutors are program participants who have a specialized areaof competency and knowledge, and the ability to assist other part-icipants in their course work. Peer-tutors also act as mentors to stu-dents by sharing their own experiences with recovery. Currently,peer-tutor=mentors must be participants in either the supportedemployment or supported education services within either NorthCharles or Career Advancement Resources.

Participants who are interested in applying for peer-tutor posi-tions send a resume and cover letter to the hiring supervisor forreview. An interview is then conducted with the hiring supervisorand the staff who will be supervising the peer-tutor=mentors. Theposition is listed as a casual position, similar to relief staff, and isfilled on an as-needed basis. Compensation is $11.00 per hourand does not include benefits. All applicants follow the hiring pro-cedures of Baycove Human Services, Career AdvancementResources parent agency. This includes completing an applicationfor employment, signing a release for a CORI check and submittingat least two professional references. Upon a positive interview,acceptable CORI, and two positive references, the participant isoffered the position. Once the participant has accepted the position,the new peer-tutor attends an agency orientation, also called a ‘‘signon,’’ and a program-specific orientation run by the supervising


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

staff. At the sign on, the new staff meets with human resources per-sonnel, shows proof of work eligibility, goes over agency policiesand procedures, and undergoes the standard agency training pro-gram.

The program-specific orientation takes place within the first twoweeks after the agency sign on. The orientation takes about an hourand reviews the job description, time sheet procedure, staff roles,dress code, policies regarding driving with participants, confidenti-ality, including new federal privacy law, lateness and absenteeism,documentation of meetings, handling crises, limits of responsibility,supervision, training opportunities, outreach, and phone calls. Allpeer-tutors are asked to sign off stating that they have receivedand understand the information presented. As of the spring of2003, there were six peer-tutor=mentors on staff. The average timeworked per week varies depending on the needs of the program’sparticipants.

Tutors and students are matched by the student’s area of needand the tutor’s area of expertise, mutual availability, and interper-sonal compatibility. Typically, a student’s principal staff contactwill mention that a client is in need of extra help with a courseand an appropriate tutor will be contacted to determine availability.Then either the student or the tutor will follow up and schedule aninitial appointment to meet. Meetings take place at both programlocations, in the community at local libraries and coffee shops,and on campus. Students can meet with peer-tutor=mentors for aone-time need, or on an on-going basis, as determined by the stu-dent and the tutor.

In accordance with the results of a survey of peer-tutor=mentors,they receive regular supervision in the form of an hour-long groupheld once every six weeks, and facilitated by the supervising staff.Topics discussed include: setting limits and boundaries, dealingwith frustration and stress, listening and communication skills,dealing with feelings that arise when a peer is not doing well,and other training needs. The manual, Peer Support for Students inPostsecondary Education (Unger & Langi, 1998), has been utilizedas a guide in setting program parameters, expectations, andtraining.

Response to the peer-tutor=mentor program has been positive.Program staff asked both peer-tutors=mentors and students whoreceived support to comment on their experience. Specifically, theywere asked what they thought about the program and what impact


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

it has had. One tutor=mentor stated, ‘‘it is a good idea to have peer-tutors. . .the participants and tutors can relate to each other havingexperienced similar struggles with their disabilities.’’ Students havefound the service helpful to their success. One student commented,‘‘I was really struggling before I started seeing the tutor. Theyhelped me get back on track and build my self confidence.’’ Thesuccesses have been many, but there have been challenges as well.Most commonly, peers struggle with how to communicate witheach other. Tutors are sometimes so eager to be helpful that they failto set limits at the beginning, which can be difficult and even pain-ful to correct later on. Learning what one’s limits are and how tosay no when necessary are essential qualities in preserving therelationship and can keep peer-tutors from burning out. Students,on the other hand, often have difficulty asking for more time withthe tutor, or asking to try a different teaching technique for learningthe material. Part of the peer-tutor=mentor supervisor’s role hasbeen to help each party clarify their needs and learn how to com-municate better.

BARRIERS AND SOLUTIONS

Barriers to employment and education occur throughout therehabilitation and recovery process. Barriers may be seen as inter-nal—within the participant—or external—within the participant’senvironment. In 1998, the Friends of the Psychiatrically Disabled,a group of professionals, consumers and families which promotesbest practices in the field of psychiatric rehabilitation, held a round-table meeting and surveyed key leaders and constituents in thefield to determine what barriers were perceived as the most chal-lenging. They identified four categories of internal and external bar-riers: (1) perceptions and expectations of others, (2) consumers’fears and lack of confidence, (3) structure and complexity of theSocial Security Disability system, and (4) other external barriersin the local community (Friends of the Psychiatrically Disabled,1998). We have seen all of these barriers at one time or another overthe last six years.

The stigma associated with having a mental illness, and the waythat mental illness is portrayed in the media, often as dangerousand criminal, is a powerful and pervasive barrier. Often consumersare given the message that they are too sick to work, or that work


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

would cause them too much stress and could cause them to relapseand face hospitalization. These external messages feed in to stu-dents’ own fears of returning to school and=or work after what,for many, can be years and even decades in the mental healthsystem.

These fears can manifest themselves in several different beha-viors. Often we see participants take two steps forward and onestep back in their vocational pursuits. It may seem as if a participantis intentionally sabotaging his=her progress by not followingthrough with a stated goal of taking a class or looking for work,when in reality it is the fear of returning to school or work—thefears of success, failure, socializing, stigma, and the unknown—thatkeep him=her from moving on. McCrory et al. (1980) described thisphenomenon as the rehabilitation crisis: ‘‘The experience of the dis-abled person who has accepted the challenge to grow, has achievedsignificant movement toward his goals, and is now feeling over-whelmed by his changing=changed state. The client has advancedfar enough in the process to begin to experience a transition inhis activities, his relationships, his sense of himself. He is proudof his progress, yet sad for what he must give up and frightenedof the uncertainties he must face.’’ (p. 136)

To address the fears associated with losing Social Security bene-fits, CAR provides benefits counseling to help consumers to have arealistic idea of how their Social Security benefits will be affected byreturning to work. The loss of benefits, however, is just one of manyexternal barriers to our students’ successful participation in theirlocal communities. Other barriers include the bureaucratic mazeof the school environment, lack of accommodations by specificemployers, costs associated with college and training programs,and access to transportation—specifically disability-related publictransportation.

CAR staff attempts to address these potential barriers from thebeginning—during orientation and before the consumer signs onto the program—and continues to discuss the reality and role offear in the process of recovery and rehabilitation while the partici-pant is engaged in services. Through these discussions, we helpeach consumer to identify what his=her fears are and possible solu-tions to working on them so as not to let the fears become over-whelming.

We advise students to ‘‘think small.’’ Many participants respondwell to the idea of breaking down their goals into small steps.


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

For example, instead of thinking of the goal of returning to schoolas getting a degree, they start with taking one class. Students maystart with an elective, a class that the student would really enjoy,but not necessarily one of the core requirements like English, math,or science. Taking a class at an adult education center can relievesome of the pressure of performing for a grade. Many participantslike to start with a class at the program site. This can feel supportiveand safe, and is a good way to evaluate one’s academic skills, whileallowing time to find the right program. Sometimes a smallerschool can provide more individual support than a large universitywhere a student might be one of hundreds in a class.

Developing a plan of support is also an important part of assuag-ing participants’ fears. This involves identifying with the studentthe supports he=she needs in order to be successful. Will the stu-dent need an accommodation, like a note taker or untimed tests?Does he=she need a tutor? Or help navigating through the bureau-cratic red tape of the administration? Does the student have neededsupplies like notebooks, pens, and highlighters? Will financial aidcover books? Does he=she want to take a dry run before schoolbegins, to find the classroom and other resources on campus likethe library, cafeteria, and student support center? We haveoccasionally been able to connect supported education studentswith other students attending the same college. These relationshipscan be helpful in easing new students into the campus community.Each fall we have a student kickoff before the semester beginswhich gives the participants an opportunity to meet with oneanother and share their fears, hopes and expectations about return-ing to college.

Students who had the onset of their illness during college oftenhave difficulty knowing how the symptoms of the illness mayimpact their ability to be successful in school. Sometimes parti-cipants can have difficulty accepting where they are in terms ofwhat they can do currently versus what they were able to do beforetheir illness. Sometimes students may not have considered thatthere may be a difference in their level of functioning and how itcould impact their ability to do well in school.

The recovery process can be very painful. It often brings up feel-ings of loss, anger and discouragement. This is when it is importantfor staff members to ‘‘hold the hope’’ for the participant. They dis-cuss what is different, and what new supports are needed. Theymay also need to discuss the fact that it may take longer to achieve


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

goals than initially anticipated. Here, too, it may help to reevaluategoals, or to break them down into smaller steps, while at the sametime, helping students to believe that in time, they will be able toreach them. Students may need continued encouragement andreminders that rehabilitation works and that recovery is possible.A strong support system, through friends and family and a socialnetwork, can be very important to a participant’s success.

Open lines of communication between program staff, parti-cipants, and their support network is crucial. Students deserve tohave a treatment team that is on board, and supportive of their aca-demic goals. A team that sends mixed messages, or messages thatgoing back to school or work may be too stressful, can be extremelydiscouraging. Therefore, the team needs to understand rehabili-tation and recovery, and the specific supports that a particular stu-dent finds helpful. Sometimes this means that CAR staff musteducate other professionals in the theory of psychosocial rehabili-tation and the process of recovery. Having someone outside of theirtreatment team, such as an academic advisor, can also be a usefultool to help guide students through their degree programs.

IN THEIR OWN WORDS: SOME THOUGHTS ABOUT CAREERADVANCEMENT RESOURCES FROM PROGRAM PARTICIPANTS

Some of the participants from Community Career Links were askedto share their thoughts and experiences with the program:

‘‘Before I became involved with CAR, I really felt as if my lifewas in suspended animation, with intermittent moments of func-tioning and lucidity. I felt as if I had a heart, but no soul. I wasnot a complete person. I have both a psychological and a physicaldisability and that was my frame of reference as an existence. Allmy potential as a human being was arrested by a diagnosis I trulydid not understand and did not want to know about. My counselor[at CAR] helped me learn to accept the concepts of ‘one day at atime,’ supported education and employment, and importantly,self-expectations which will help with having a certain amount ofself-acceptance which can be both liberating and life-affirming.

I have always been self-sufficient to a fault, so this informationwas radical to me and my way of thinking. I have learned to try toquestion distorted thinking. My guilt and shame and feelings ofbeing stigmatized are being addressed in the light of understanding,


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

compassion and education right here at CAR in the context of edu-cation and employment. I am motivated to try to use all my skills,capabilities and gifts to be engaged in my life. I hope to be able towiden my circle and help others as well. That’s important to me.I have a heart, but because of CAR, I know I have a soul as wellbecause I want to live a life in spite of my challenges. I am respon-sive, as opposed to being numb. I have learned I will have difficultdays. That is a reality, but more importantly, I understand thosedays will pass. Career Advancement Resources’ work is so far-reaching in healing, restoring and maintaining the lives of themen and women they support.’’

Another student said: ‘‘[my counselor] is patient and alwaysready and available to help me with academic questions or pro-blems.’’ And another, ‘‘I don’t feel pushed or pressured to findwork. [They] work with clients’ own pace. Education opportunitiesare great. Staff really listen.’’ ‘‘Staff anticipates my needs before Ican articulate them.’’

THE FUTURE

July 1, 2004, begins the eighth year of supported education andemployment services provided by Career Advancement Resources.In the last seven years, we have helped more than 600 participantsobtain paid, competitive employment, and 900 participants haveattended postsecondary education and=or training. The Massachu-setts Department of Mental Health instituted a new measure for fis-cal year 2004: job training. Job training is identified as any programspecifically geared towards a particular employment type, such astraining to work as an auto mechanic or Certified Nursing Assist-ant. Career Advancement Resources has moved forward in thisarea and has established relationships with community-basedcareer centers, training programs, and job force development officesat local colleges and universities.

In the next year, we will continue to work collaboratively withparticipants, service providers, employers, educators, and legisla-tors to make sure that services of the highest quality are availablefor adults with psychiatric disabilities, and that these servicesrespond to the needs of our participants. This includes involvingconsumers through consumer satisfaction surveys, and continuingto gather their feedback through key staff. As a contract renewal


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

with the state of Massachusetts is coming up this year, one of themain goals of the SEE coalition is to lobby at the state level to con-tinue funding services for CAR consumers.

Furthermore, there is a recent statewide initiative in progress towork with young adults through their transition from childhood toadult services. Accordingly, the SEE coalition will include in ourservices, programming that is specifically relevant to studentswho are 18–26 years old. We are gathering feedback, through sur-veys and other assessment measures, from students in this agerange to determine their specific needs and to identify ways inwhich the coalition can best accommodate these students. We aretraining staff in providing services to young adults. Dependingon student and tutor demand, we would also like to expand thepeer-tutor=mentor program. Based on tutor feedback, we haveplanned additional in-house training for peer-tutor=mentors. Newtraining topics include issues such as working with students withlearning disabilities. While these trainings will be open to the entireSEE staff, they are being provided based on a need identified by thepeer-tutor=mentors and with a focus on their role in the supportededucation program.

Our strong network and solid collaboration throughout theregion has contributed greatly to our improvement of services. Aswe learn more about the needs of the students in our community,and as supported education programming develops across thecountry, we continue to reevaluate and update our program.

REFERENCES

Ellis, D. (2000). Becoming a master student (9th ed.). Boston, MA: Houghton Mifflin Co.Friends of the Psychiatrically Disabled (July 1998). Barriers to employment andeducation for adults with psychiatric disabilities.

Kerouac, J., Solomon, M.L., Feldman, R., & Cook, J.A. (1993). Preparing students withpsychiatric disabilities for postsecondary education: Improving study skills. Chicago:Thresholds National Research and Training Center on Rehabilitation and MentalIllness.

Massachusetts SEE Coalition Newsletter. (Winter 2002) 1(1).McCrory, D., Connoly, P., Hanson-Mayer, T., Sheridan-Landolfi, J., Barone, F., Blood,A., & Gilson, A. (1980). The rehabilitation crisis: The impact of growth. Journal ofApplied Rehabilitation Counseling, 11(3), 136–139.

Unger, K. & Langi, S. (1998). Peer support for students in postsecondary education.Chicago: UIC National Research and Training Center on Psychiatric Disability.


Dow

nloa

ded

by [

Yor

k U

nive

rsity

Lib

rari

es]

at 1

7:53

22

Nov

embe

r 20

14

Documents

Career Advancement Resources (CAR): Supported Education as a Career Development Strategy