Ways to Work Demonstration

Programs

New York Work ExchangeCoalition of Voluntary Mental Health Agencies

December, 2002

Colleen Gillespie, PhDNYU Wagner

Center for Health and Public Service Research

Evaluator

Background

The New York Work Exchange, a project of the Coalition of Voluntary Mental Health Agencies, funded five Ways to Work Demonstration Programs beginning in January, 2002.

The Ways to Work initiative was launched to promote the creation of effective new service delivery methods targeted at increasing the integration and coordination of employment and clinical services.

The overarching goal of Ways to Work is to increase the number of people with psychiatric disabilities who get and retain competitive employment.

Principles of the Ways to Work Demonstration Project include: Consumers of mental health services can work. Work and the role of work are important parts of the recovery process. Integrating employment and clinical services improves consumers’ employment

outcomes. Those agencies that were selected for funding each proposed innovative and effective means

of enhancing services by integrating employment services into their array of existing Continuing Day Treatment and/or Clinic programs.

The following five agencies were selected through the RFP process to develop and implement Ways to Work programs:

Brooklyn Bureau of Community Services Jewish Board of Family and Children’s Services Riverdale Mental Health Association Postgraduate Center for Mental Health Transitional Services for New York, Inc.

The two major goals of the evaluation are: to document the effectiveness of integrating employment services with clinical

services among these pilot projects and to use these agencies’ experiences to show mental health service providers

throughout the country how they can most effectively promote competitive employment within clinical settings.

These objectives stem from the nature of these projects as demonstration projects – the emphasis is on qualitative description and documentation of process, rather than on the quantitative impact of the programs, given that the effectiveness of employment services has been well established.  

Evaluation activities will focus on three major components of the projects: How do agencies design the programs and introduce a focus on competitive

employment to their continuing day treatment programs and clinics? How do agencies implement these new programs, overcome any barriers

that may arise, and sustain the programs over time? What is the impact of the programs on consumers, clinicians, and

agencies? What changes are associated with the Ways to Work programs? The following represents some preliminary information on the Ways to Work

programs, who they serve, how many consumers have participated to date, reasons why consumers signed up, and how satisfied consumers are when they first start out in their Ways to Work programs.

Evaluation of the Ways to Work Demonstration Projects

Agencies with Ways to Work Programs

Agency Name Location Description Size

Transitional Services for New York, Inc. (TSI)

Queens Provides a continuum of rehabilitative services to enrich the lives of the mentally ill and facilitate their transition to increased levels of independence.

2,000

Served/Yr

Riverdale Mental Health Association (RMHA)

Bronx Offers child, adolescent, and adult services, continuing day treatment for post-hospitalized and seriously mentally ill persons, a substance abuse treatment program, supported employment and welfare-to-work programs, mental health consultation and educational programs, a 15-bed supervised community residence, and a supported apartment program.

1,600

Served/Yr

Jewish Board of Family and Children’s Services (JBFCS)

Central Offices:

Manhattan

Services:

All of NYC

Operates a diverse network of more than 160 community-based programs serving the adult mentally ill, emotionally disturbed children and adolescents, victims of domestic violence, the homeless, children at risk of abuse and neglect, people with AIDS, substance abusers, Soviet émigrés, the developmentally disabled, and people suffering from trauma and bereavement.

55,000

Served/Yr

Postgraduate Center for Mental Health

(PCMH)

Manhattan Offers individuals with mental illness a full continuum of care, including outpatient clinic programs, continuing day treatment, intensive psychiatric rehabilitation, a full complement of employment services, a large residential services division, and a division for services to persons living with or affected by AIDS.

4,000

Served/Yr

Brooklyn Bureau of Community Services (BBC)

Brooklyn Serves Brooklyn residents with the greatest needs, including adults and adolescents with serious mental illness, adults with physical and developmental disabilities, parents at risk of losing their children to foster care, and children in need of academic support.

15,000

Served/Yr

The agencies vary significantly in terms of size, mission, target populations served, experience with employment services and location.

CDTPs Associated with Ways to Work Programs

Agency

CDT

Program

# Participants

Age Ethnicity

/Race

Gender

TSI Jamaica Consultation

Center 100+ groups

TSI has strong vocational focus

98 90% < 55 yrs 52% African American

24% Latino/a

20% White

4 % Asian

32% Women

68% Men

RMHA Continuing Day Treatment Program

40% in RMHA housing

51 18 – 55 yrs 22% African American

16% Latino/a

55% White

8% Other

71% Women

29% Men

JBFCS Coney Island CSS

(4 CDTPs and clinics)

adult home residents

want to develop vocational expertise

400 26% 21 - 39 yrs

26% 40 - 49 yrs

37% 50 – 65 yrs

11% 65+ yrs

20% African American

15% Latino/a

50% White

15% Asian/Other

56% Women

44% Men

PCMH Westside CDTP

Westside Outpatient Mental

Health Clinic many homeless

CDT: 177

Clinic: 262

31% 18 – 39 yrs

42% 40 – 49 yrs

27% 50+ yrs

30% African American

18% Latino/a

50% White

2 % Asian

37% Women

63% Men

BBCS Project Moving On many young adults

95 95% < 55 yrs 76% African American

16% Latino/a

7% White

44% Women

56% Men

The Ways to Work programs are situated in Continuing Day Treatment Programs and Clinics that serve different populations.

Diagnoses of CDT Program Participants at Ways to Work Agencies

Most of the consumers participating in the Continuing Day Treatment Programs and Clinics at Ways to Work agencies have a psychiatric diagnosis of schizophrenia.

The proportions of diagnoses represented are very similar across the five Ways to Work agencies.

65% Schizophrenia

21% Schizoaffective

10% Bi-Polar

4% Major Depression

21% Schizoaffective

How the Ways to Work Programs Work

CDTP Participants

Determine Who Wants To Work

Consumer Choice(e.g., sign-up list)

Ways to Work Program

AssessmentJob Profile

Career Interests/Goals

Rapid Job SearchJob Development (Client Specific)

Individualized Job Placement

Job Support (Follow Along Supports)

Job CoachingPeer Support

Family Support

Integration with CDTP and Mental Health Treatment Services

Work Incorporated

Into All TX Goals/Plans

Integration of Work & Clinical Goals• Team Meetings/Case Conferences• Regular Communication

On-the-Job Assessment• Regular Communication• Management of

MedicationsSymptoms

Other SupportsPsychosocial ClubsFamily Education

HousingBenefits

Counseling

What is Competitive Employment*

The goal is to assist consumers in obtaining competitive and satisfying jobs in community

The work pays at least minimum wage

People are employed in a work setting that includes non-disabled co-workers

Service agency provides ongoing support

Intended for consumers with a desire to work

Includes people with the most severe disabilities

Eligibility for Supported Employment services is based on consumer choice

Consumer preferences are important

Supported employment is integrated with mental health treatment

Competitive employment is the goal

Job search process starts soon after a consumer expresses interest in working

Follow-along supports are continuous for employed consumers

*Evidence-Based Practices Project(SAMHSA, CMHS, Robert Wood Johnson Foundation, West Family Foundation

Johnson & Johnson Corporate Contributions & Community Relations)

Distinguishing Features of Each Ways to Work Program

Approach/

Philosophy

Staffing

($: What Does Ways to Work Finance?)

Employment

Innovations

TSI/

JCC

Ways to Work tracks added on after CDTPInvolvement of both CDTP & Vocational staff

Job Developer and Supported Employment SpecialistSupervised by Dir of Voc’l Services and Clinical Dir$:Half-time each Job Developer + Employment Specialist

Seasonal positions

RMHA Job and Career Clubs incorporated into CDTPImportance of integrationOn-site and off-site job development

Employment Specialist performs all Ways to Work activities, with assistance from Job CoachReports to CDT Program Director and Director of Employment Services$: Full-Time Employment Specialist

Work try-outsDisclosure encouraged

JBFCS

CI CSS

Importance of belief in ability to workImportance of self-management in relation to work

Role of Peer Counselors in providing support, role modeling, and especially motivationFocus on educating clinicians about employment$: Job Developer and Peer Counselors/Job Coaches

Need to develop work experience (to help identify work interests and goals)

PCMH Directed job search with individualized supportProgram physically located in CDTP/Clinic

Employment Specialist performs all Ways to Work activities, with assistance from Job CoachReports to Employment Services Director$: Full-Time Employment Specialist

Role for affirmative businessesDisclosure discouraged

BBCS/

PMO

Importance of assessment (Workplace Center, Columbia Univ. School of Social Work)Employment programming co-located on-site with CDTP

Ways to Work Coordinator performs all activities while working closely with clinical staffReports to Director of CDTP and Director of Psychiatric Rehabilitation Services$: Coordinator with some Job Developer/Coach time

Community-based opportunitiesImportance of training/certification

Each agency’s approach to promoting employment within their clinical settings is based on agency philosophy, staffing and employment options.

# Ways to Work Participants Enrolled Monthly (Jan 2002 – Sept 2002)

7 7

10

23

15

9 10 11 10

0

5

10

15

20

25

Jan Feb Mar Apr May Jun Jul Aug Sep

102 Ways to Work Participants Enrolled in First 9 Months

…

Reasons Why Ways to Work Participants Signed Up

0%

10%

20%

30%

40%

50%

Not surprisingly, most consumer sign up for the Ways to Work program because they want to work – however, others cite

both more practical concerns ($) and more recovery-focused concerns (to get a better life, improve self-esteem).

Sociodemographic Characteristics of Ways to Work Participants

43%

57%

46%

39%

11%3%

36%

31%

29%

5%Gender Race/Ethnicity

Education

Male

Female

African American

White

Latino/a

Asian

HS Grad

Less Than HS

Some College

or Post HS

College Graduate

Initial Satisfaction with Ways to Work Employment Services

2.452.38

1.00

1.50

2.00

2.50

3.00

Help in Finding Job Help in Preparing for Job

Very Satisfied

Somewhat Satisfied

Not At All Satisfied

Overall, consumers are pretty satisfied with the services they receive early on as part of the Ways to Work program.