Statewide Educational Advisory Board Report on Employment, Education and Training

Change Factors Required to Improve Career-Oriented Employment Outcomes for Persons with Serious Mental Illness

November 2002

[see Executive Summary]

SYSTEMIC FACTORS

1. Career-oriented employment for consumers with mental illness must be a system-based outcome priority.
   
   
2. To realize this priority, a demonstrated commitment to producing and maintaining change at all levels is essential.
   
   
3. Empowerment, self-help and recovery must be defining values and should be reflected in policies and practices.
   
   
4. The system includes federal, county, and local level governmental agencies such as the Office of Mental Health (OMH), Department of Labor (DOL), Office of Vocational Rehabilitation (VESID), Department of Health (DOH), Department of Education, Social Security Administration, etc.
   
   
5. Other important system participants include coalition groups (for example New York Association of Psychosocial Rehabilitation Services - NYAPRS) and trade associations (for example Coalition of Mainstream Employment Programs — CMHP, New York State Rehabilitation Association — NYSRA; Coalition of Voluntary Mental Health Associations — CVMHA), state and local unions, EAPs, businesses and employers, consumers and consumer groups, academic institutions, free standing training providers, technical assistance and management consultants. These groups advocate for employment and in some instances deliver workforce training and education.
   
   
6. Funding and contracting authorities (including OMH and county Departments of Mental Health) must articulate and support the priority of career-oriented employment with funds for training and acquisition of new skills, should endorse training organized on evidence-based employment practices, and must stipulate staff education-based outcomes within contractual requirements.
   
   
7. Funding and contracting authorities must offer funding incentives favoring desired outcomes and imposing sanctions when outcomes are not attained. These include mechanisms to tie service activities to the number of consumers attaining and retaining career-oriented employment.
   
   
8. OMH must lead and other system participants collaborate in supporting arrangements for staff to obtain training, including promoting training technologies and technical assistance that can be provided at the job site and are quickly transferable to the practice environment.
   
   
9. Funding and contracting authorities should identify mechanisms to offer training credentials and certification (e.g. certificates, academic credentials, etc.) to enhance staff career development and assure provider accountability in obtaining mandated staff training.
   
   
10. Mental health systems and providers must model good employment practices by demonstrating exemplary hiring of current or former consumers in a variety of positions not just as case aides, peer support specialists, or consumer affairs staff.
    
    
11. Labor market conditions, economic opportunity and career growth must be taken into account in designing employment programs.
    
    

ORGANIZATIONAL FACTORS

1. Clearly stated and consistent organizational vision, mission, values and service outcomes

• Vision, mission, values & service outcomes explicitly incorporate career oriented consumer employment
• Empowerment, self-help and recovery are defining values reflected in policies and practices
• Organizational mission supports employment as a viable, desired, and attainable outcome
• Organization’s mission recognizes that consumers want to work, technology is available, current employment rate is unacceptably low
• Organizational culture is consumer-centered
• Organizational culture supports and promotes cultural competence
• Boards of Directors and Governing Boards support organizational vision, mission, values & service outcomes

2. Leadership recognizes urgency of need for change

• Organizational culture conveys hope, belief in and commitment to change needed to realize career-oriented employment outcomes
• Internal identification of need — e.g. workforce crisis in recruitment and retention of qualified staff
• Recognition of need to reconfigure services and retrain staff to promote consumer recovery, empowerment and career attainment through employment
• Emphasis on specific employment and career development outcomes

3. Organizational process consistent with change

• Ensure consistency in organizational policies -reflecting vision, mission, values and service outcomes: e.g. hiring consumers at all levels in a variety of positions; accommodating workplace; staff job descriptions that include the activities required to achieve organizational service outcomes and consumer goals; hours of operation not conflicting with working consumers’ needs
• Leadership supports and rewards staff creativity and flexibility in conceptualizing and realizing employment goals
• Total Quality Management: set of ‘organizational development strategies’ determined to: a) increase quality and productivity of staff work environment b) link improvement/training effort to data (e.g. evidence-based practices); ensure continuous quality improvement

4. Consumer and family member Involvement

• Consumers and family members are involved in all stages of the change process: e.g. drafting organizational mission, determining goals and outcomes
• Plan developed and implemented delineating mechanisms for consumer involvement
• Employment services staff who are consumers are positioned to enhance peer support and advocacy

5. Organizational staff commitment on multiple levels driven by those individuals or groups who are committed to change

• Leadership investment in change process including board involvement, management, individuals in position of influence; garner support of staff
• Staff investment and involvement: formulation of staff teams of camaraderie and support to transition during change process
• Decision-making coalitions: established for consensus building with strength and persuasion to include upper level individuals and line staff
• Good employment practices modeled by demonstrating exemplary hiring of current or former consumers in various positions (not only as case aides, peer support specialists, consumer affairs staff)

6. Staff integration and cooperation

• Staff in differing roles and services committed to coordinating discrete services and working in collaboration with colleagues to attain individuals’ employment goals

7. Effective communication

• Communication system between and among staff of all levels and consumers regarding organization vision, mission, values, change process
• Honest and open dialogue supporting the exchange of ideas and feeling about process, fears, ambivalence

8. Management skills

• Managers and decision-makers know how to implement a change plan and support human resource development goals
• Managers keep service outcomes at forefront
• Managers must involve and empower staff; let staff know that their commitment and values are important; give staff more control

9. Human resource development goals

• Budget allocation for staff training and perpetuation of skills, knowledge, attitude acquisition
• Consumers are actively involved in the design and delivery of training and education.
• Training identified in staff development plans (employee performance) including dedication of staff role to coordination or planning of training
• Identification of staff competencies required to deliver quality services
• Articulated link between staff training, staff competencies, organizational process, and organizational outcomes
• Overview training offered to all staff on role of career-oriented employment in recovery
• Leadership, managers, direct services staff are together in learning about change (not in separate, stratified groups)
• Interactive staff training responsive to what is viable at a specific organization’s site, and what’s user-friendly
• Leadership training offered to enhance managers’ capabilities
• Training in management and supervision offered to enhance supervisors’ ability to champion employment outcomes
• Supportive supervision prevalent throughout all supervisory levels
• Team structure of "learning culture" to support and reinforce new skills application, job retention, change process
• Organizational culture welcoming to consumer provider employees
• Support for mentoring of new consumer provider staff by experienced practitioners

10. Quantifiable service outcomes linked to philosophical commitment (vision, mission and values) and actions (process)

• Establish measurable goals consistent with service outcomes, e.g. number of individuals attaining desired employment outcomes
• Determination of success in goal attainment and ongoing evaluation of areas for improvement
• Consumers and families involved in evaluating successes and areas for improvement

11. Evaluation of change process

• Establish a system for quantifying the change implementation strategy, e.g. utilize best practice curricula, training and technical assistance efforts; verify the results of educational efforts through formalized assessment tools; draw a relationship between a) who is trained b) which services are delivered c) what outcomes result
• Establish a feedback loop of evaluation results to staff, management, consumers

[see Executive Summary]