Community Employment Services: What Does the Data Tell

Community Employment Services: What Does the Data Tell

Community Employment Services: What Does the Data Tell Us? Department of Vocational Services Jennifer Kimble, MS, CRC [email protected], (207) 662-2088 June 21, 2016 About the Department of Vocational Services Maine Medical Centers Department of Vocational Services (MMC DVS) has been providing employment services to individuals with disabilities for over thirty years. Its mission is to contribute to the health and wealth of the community by supporting individuals to overcome barriers and achieve meaningful employment. DVS currently provides three statewide services: ASPIRE Vocational Assessment (2013 present) Benefits Counseling / Work Incentives Planning & Assistance (2002 present) Community Employment Service Network (CESN) (2008 present) MMC was one site in the SAMHSA Employment Intervention Demonstration Project (EIDP), which established part of the evidence for the Evidence-Based Practice of Supported Employment (also known as Individualized Placement and Support, 2 or IPS). Historical Context Consent Decree Plan- 2005 2006: External Consultant Recommendation s 2007: Community Employment Services RFP Community Employment Services Contract

Awarded - 2008 2010: DOL BRS Collaboration 2011: Job Placement Target Established 3 Defining Community Employment Services This project provides Supported Employment and Education services to individuals clinically eligible for Section 17 or Section 92 MaineCare services (CI or BHH) throughout the state of Maine. Services provided are the SAMHSA Evidence-Based Practice: Eligibility is based on consumer choice Integrated with comprehensive mental health treatment Competitive employment is the goal Personalized benefits counseling is important Job search starts soon after consumers express interest in working Follow-along supports are continuous Consumer preferences are important FMI: http://store.samhsa.gov/product/Supported-Employment-EvidenceBased-Practices-EBP-KIT/SMA08-4365 4 How does the ES spend their time? June Mon-20 8 9 10 11 12

1 2 3 4 AM :15 :30 :45 AM :15 :30 :45 AM :15 :30 :45 AM :15 :30 :45 PM :15 :30 :45 PM :15 :30 :45 PM :15 :30 :45 PM :15 :30 :45 PM :15 Career Exploration

2016 Tue-21 Wed-22 Thu-23 Fri-24 Professional Development Professional Development Professional Development Professional Development Career Exploration Career Exploration Job Preparation Client-Specific Job Development Client-Specific Job Development Client-Specific Job Development General Job Development Job Preparation Job Preparation Engagement and Intake Engagement and Intake Engagement and Intake Engagement and Intake Engagement and Intake

Engagement and Intake Client-Specific Job Development Engagement and Intake Engagement and Intake Engagement and Intake Engagement and Intake Break Break Break Break Break Post-Employment Support Job Preparation Job Preparation Job Preparation General Job Development Post-Employment Support Client-Specific Job Development Client-Specific Job Development Client-Specific Job Development Client-Specific Job Development Post-Employment Support

Client-Specific Job Development Client-Specific Job Development Client-Specific Job Development Client-Specific Job Development Education and Training Support Education and Training Support Education and Training Support Education and Training Support Resolving Barriers to Employment Resolving Barriers to Employment Resolving Barriers to Employment Resolving Barriers to Employment General Job Development General Job Development General Job Development General Job Development Post-Employment Support General Job Development 5 Where are the Employment Specialists? Seven Employment Specialists (ES) work in a mental health host agency located in each Region of the state, and are supervised by two Project Coordinators: Aroostook Mental Health Center, Caribou

Community Care, Bangor Kennebec Behavioral Health, Augusta Maine Behavioral Healthcare, Belfast/Rockland Common Ties, Lewiston Catholic Charities Support & Recovery Services, Portland Maine Behavioral Healthcare, Biddeford In addition to working with clients of the host agency, each ES maintains a minimum of five spaces on their caseload for non-host agency referrals. 6 Summary: when left up to a mental health practitioner to refer to employment services, only 20% of the individuals expressing a strong or urgent desire to work were referred. PSYCHIATRIC SERVICES ps.psychiatryonline.org October 2006 Vol. 57 No. 10 7 8 Desire to Work: what does the Need for Change Scale data tell us? 9 Most people clinically eligible for Community Integration services want to work.

No / Not Now Yes or Unsure Unsure : 1229 2685 Yes: 4542 10 Need for Employment Change by Region: 2008 - 2016 Individuals Completing NFC Scale (N=8456) 2500 2000 1250 1500 944 788 1000 331 379 500 77 358 0 Aroostook 262 284 380 91 300

429 74 81 Strong or Urgent Need to Change Bangor Kennebec - Somerset 372 649 110 147 Not sure Midcoast 525 Does not want change, or not now Lewiston Portland 625 York What the data tells us about work history Individuals by Years Unemployed (N=2466) Of the 8456 individuals completing a Need for Change Scale, 2466 also filled in information regarding years unemployed. A significant percentage of respondents (23%) had been unemployed for 11 or more years. Another six percent had never worked. 700 588

461 148 Never Worked Almost a third of individuals had never worked or had been unemployed for 10+ years. 248 less than 2 yrs 2 - 5 years 6 - 10 years 11 - 15 years 321 16+ years 12 Does the amount of time unemployed impact desire to work? 13 Desire to work and years of unemployment: 100% 90% Definitel y do not want 80% 70%

60% Satisfied, not now 50% 40% Not so sure 30% 20% Urgent / Strong Need 10% 0% Never worked Less than 2 yrs 2 - 5 years 6 - 10 years 11 - 15 years 16+ years 14 Can individuals desiring work find jobs? 15 Individuals with SMI obtaining employment in the MMC CESN Project 200

10.0% 180 9.0% 160 8.0% 140 7.0% 120 6.0% 100 5.0% 80 4.0% 60 3.0% 40 2.0% 20 1.0% 0 1 2

3 4 5 Individuals Obtaining Employment by Fiscal Year 6 7 8 0.0% Maine Unemployment Rate *2016: Employment obtained is to date; Unemployment rate is for May 16 What kind of jobs are people finding? 17 Most individuals are working over 20 hours/week Jobs Obtained by Employment Status Part-time; 749; 71.00% Seasonal; 96; 9.10% Full-time; 210; 19.91% Weekly Hours of Jobs Obtained 2 - 10 hours; 8.56% 35+ hours; 21.40% 21 - 34 hours; 31.23% 11 - 20 hours; 38.81% 18 Accounting Assistant Administrative Assistant

Animal Shelter Attendant Assembler Assistant Assistant Cleaner Assistant Coordinator Carpenter/Painter Cart attendant Case Manager Cashier Cashier/Customer Service Desk Cashier/Retail Associate Cashier/stock Data Processing Day Care Provider Deli Deli/Cook Delivery Driver Dietary Aide Dining Room Attendant Front End Cashier Furniture maker Game Operator Garden Dept Team Member Gardener Gas Attendant Granite worker Line Cook Line Worker Lot Attendant Lumber Mill Laborer Lunch Room Monitor Machine Operator Machinist Peer Support Specialist Personal Care Coordinator Personal Care Aide Personal Care Assistant Personal Care Attendant Personal Support Specialist

Phlebotomist Security Self-employed artist Self-employed Carpenter Senior Community Service Employee Server Service Agent Shelter Attendant Associate Catering Direct Support Worker Greenhouse Worker/Educator Maid PhotoCopy Center Sales Associate Shipping / Receiving Associate I Asst. Manager Asst. Cook Attendant Awake Overnight Staff Backroom Associate Baggage Handler Baker Bank Teller Banquet room set up Barber Barn Worker Bartender Beekeeper Behavioral Health Specialist CDL-A Driver Census Taker Certified Nurses Aide Childcare Provider

Cleaner Cleaner/prep cook Cleaning Crew Clerk Coding Specialist Commercial Cleaner Companion Construction Construction Laborer Cook Cook/Dishwatcher Director of Maintenance Dishwasher Dishwasher/Prep Dispatcher Dough Maker Driver Driver/Delivery DSP Dump Truck Driver Dyer Employment Spec I EMT/ Safety English Teacher Entry Worker Environmental Services Grocery Associate Grounds/Custodial Worker Groundskeeper GSA Harvest Worker Head Cook Home Health CNA Home Health Care Homeless Advocate Housekeeper House Staff Housekeeping Aide Housekeeping Attendant In Home Support Independent Rep.

Mail Room Maintenance Manufacturing Associate Manufacturing Custodian Mason Massage Therapist Materials Management Mechanic MHRT1 Motor Route Driver Mover Musician Nanny Night Cleaner Night Stock Clerk Photographer Pizza Maker Poet Pot Washer Prep Cook Preschool Teacher Production Worker Program Coordinator Property Services Attendant Reader Receptionist Recycling Assistant Resident Attendant Residential Advisor Residential Aide Shoe Sales Siding Technician Snow Removal Sorter Sous Chef Stocker Stocker/Bagger Store Associate Store Clerk Sub Acute Lead RN Subcontractor Paint Sub/Teach-EdTech III

Substitute DSP Substitute Teacher Surgical Tech Bell Ringer Cook/Food Prep Environmental services aide Independent Support Services Worker Nurse Residential Home Care Switchboard Operator BHP Bike Tech Boat Hand Builder Building cleaner Bus Driver Bus Tables/Dishes Cab Driver Call Representative Candle Maker Canvasser Cook/Wait Staff Crew Member Crew/pizza maker Crisis Response Worker Crisis Worker/phone CRMA CRMA/Home Health Rep. Crossing Guard Custodian Customer Representative Customer Service Associate ES I Facilitator

Factory worker Fair Attendant Farm Hand Fisherman Flagger Folder Food Demonstrator Food Prep/Deliveries Food Processor Intermedia Developer Inventory taker ISSW Janitor Jewelry Sales Consultant Job Coach Kitchen Aide Kitchen Crew Kitchen Float Kitchen Helper Laborer Office Asst. Office Cleaner Office Staff Office Support Outreach Coordinator Overnight Receiver Overnight Stocker Owner/Operator Package Handler Packer Painter Residential Support Technician Respiratory Therapist Respite Care Worker Restaurant Hostess Retail Sales Associate Rider Operator Road work/laborer Roofer Sales Sales Associate

Sales Clerk-Kitchen Dept. Taxi Driver Teacher Teachers Assistant Telemarketing Sales Temporary Staff Traffic Flagger Tray Aide Truck Driver CDL-A Utility Person Volunteer Coordinator VRC I Car Agent Customer Service Representative Food Service Sup Landscape laborer Painting/Maintenance Sales Consultant Waiter / Waitress Car Attendant Car Cleaner Car Prep Care Giver Customer Service/Laborer Customer Service/Retail Data Entry Data Entry Operator Food Services Fork Lift Operator Freight Unloader Front Desk Landscaping Services

Laundry Attendant Lead Cleaner Lead lights, sound Pari-Mutuel/Ticket Seller Parking Lot Attendant Parts Picker Part-Time Cleanup Sales/Cashier Sales/Housewares Sandwich Artist Sanitation Worker Warehouse Worker Weaver Welder Yard Worker Carpenter Data Intake Specialist Front Desk Manager Life Skills Coach Peer Counselor Secretary Wellness & Recovery Center Attendant 19 How long do people stay? Ongoing supports were provided to the 734 individuals placed, in line with the IPS model, offering the best opportunity for job retention and future career development. The ES does not close an individuals case before 90 days of employment have been reached. Over 300 individuals have had more than one job. Job loss and/or resignations are expected and Employment Specialists assist individuals with finding the next, perhaps better matched, job.

Average days of job retention by status: Began a job, ended the job while working with the ES 141 Began a job, still employed at end of ES services* 163 Began a job, currently receiving ES support 178 *may have been employed much longer than this timeframe 20 In summary, people want to work, and can work in many different jobs. Does that mean that the majority of individuals who wish to work are working? 21 Employment Rates By State Without Disability With Disability Data Source: American Community Survey, 2013 Stoddard, Susan. (2014). 2014 Disability Statistics Annual Report. Durham, NH: University of New Hampshire. 22 https:// www.nami.org/Press-Media/Press-Releases/2014/Mental-Illness-NAMI-Report-Deplores-80 -Percent-Un http://khn.org/news/report-adults-with-serious-mental-illnesses-face-80-unemployment/ http://www.pressherald.com/2015/09/20/who-will-replace-maines-aging-workforce / In 2010, the nonprofit Maine Development Foundation set out to determine what it would

take to make up an anticipated shortfall of 65,000 workers in the state by 2020. Along with the Maine State Chamber of Commerce, it asked more than 1,000 business leaders for their input. The general consensus was that bridging the gap would require a significant boost in workforce participation among those already living in Maine, as well as redoubling efforts to recruit workers from outside of Maine. According to the foundation, roughly 20,000 young adults living out of state would need to be lured to Maine, along with about 12,000 foreign citizens. In addition, 10,000 Mainers with disabilities, 12,000 older residents, 5,000 veterans and 6,000 disengaged youths would need to be coaxed into the workforce. People want to work, can find employment, and in fact the Maine economy needs them. What gets in the way? 25 Misperceptions about People with Psychiatric Disabilities and Work For decades, people with psychiatric disabilities were either believed to be unable to work, or it was believed that, for their own good, they should not work. This notion was based on the assumption that people with psychiatric disabilities were unable to handle the stress of work an assumption that studies have consistently found to be baseless (Luciano, Bond, & Drake, 2014). These misperceptions created substantial attitudinal barriers that unfortunately remain prevalent. Henry, A. D., Barkoff, A., Mathis, J., Lilly, B., & Fishman, J. (2016). Policy opportunities for promoting employment for people with psychiatric disabilities. University of Massachusetts Medical School and the Bazelon Center for Mental Health Law. Misperceptions about People with Psychiatric Disabilities and Work Studies show that many providers do not believe that people with psychiatric disabilities can work (Braitman, et al., 1995; West, et al., 2005). One study found that people with psychiatric disabilities who wanted to work were frequently not referred to services, even if they asked (Casper & Carloni, 2007). These ingrained beliefs must change if real progress is to be made; people with psychiatric disabilities, providers, and state policy makers must be educated that work is not

harmful, but in fact is a critical part of mental health recovery. Henry, A. D., Barkoff, A., Mathis, J., Lilly, B., & Fishman, J. (2016). Policy opportunities for promoting employment for people with psychiatric disabilities. University of Massachusetts What impacts the ability of a person to achieve successful employment? - Felony record? Receipt of disability benefits? Age? Marital Status? Regional economy? 29 Solution Empirically compare those that achieved stable employment (n=153) to those that did not (n=203) Analytic Methods Independent T-Tests between groups on continuous variables Chi-square tests between groups on categorical/ nominal variables 30 Summary of Comparability Those stably employed are largely comparable to those not (same in terms of gender, criminal history, marital status, education, most motivation) No differences observed in stable employment by program site Differences: -Slightly younger -Slightly less monthly CM use prior to intake -About 1 yr less average time since last job* -More likely to not have SSI or SSDI (and conversely, less likely to have both) % of population that is working

age SSA disability State Eligible SSA recipients % of working-age disability recipients total population population Ranking State Total State Population CY2014 161 SSA TICKET TRACKER DATA - JUN 2015 Working-Age SSA disability recipients % of total working-age population Ranking US CENSUS DATA - 2014 EST West Virginia 1,850,326 62.1% 1,149,052

149,122 8.06% 1 12.98% 1 Kentucky 4,413,457 62.5% 2,758,411 323,446 7.33% 2 11.73% 2 62.1% 3,011,463 345,224 7.12% 3 11.46% 3 Alabama

4,849,377 Mississippi 2,994,079 61.4% 1,838,365 204,228 6.82% 4 11.11% 5 Arkansas 2,966,369 60.6% 1,797,620 201,456 6.79% 5 11.21% 4 Maine 1,330,089 62.6%

832,636 84,457 6.35% 6 10.14% 6 Louisiana 4,649,676 62.6% 2,910,697 269,341 5.79% 7 9.25% 7 Tennessee 6,549,352 62.3% 4,080,246 371,473 5.67% 8

9.10% 8 Rhode Island 1,055,173 64.1% 676,366 58,020 5.50% 9 8.58% 10 Michigan 9,909,877 62.3% 6,173,853 539,971 5.45% 10 8.75% 9 South Carolina 4,832,482

62.2% 3,005,804 255,132 5.28% 11 8.49% 11 Vermont 626,562 64.0% 401,000 32,916 5.25% 12 8.21% 13 Missouri 6,063,589 61.9% 3,753,362 317,927 5.24%

13 8.47% 12 12,787,209 62.3% 7,966,431 641,249 5.01% 14 8.05% 15 3,878,051 61.1% 2,369,489 192,461 4.96% 15 8.12% 14 Pennsylvania Oklahoma 31 Social Security Disability

Insurance in Maine by Disability Type (N=66,896) 25000 20000 15000 22702 10000 19985 5000 8914 5980 5971 1823 0 yc Ps t hia ric t le ke s lo cu s u al se Di *

es as em st M y Data Source: www.disabilitycompendium.org S ID /D m tis u A D/ r Ne st sy s u vo .. n. e /S em he Ot n ow n k Un r/

1521 e nc a C r sm la p eo /n 32 There are financial safety nets for: Medicaid and Medicare People with disabilities currently receiving Medicaid (MaineCare) who go to work normally do NOT lose their MaineCare coverage by increasing earned income. In fact, there is a specific way that people with disabilities who are NOT receiving MaineCare can become eligible by working. Medicare coverage is not impacted by increased earnings. Assistance in paying for Medicare premiums may be

impacted. Social Security Benefits Whether receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), there are special rules called work incentives that allow in fact, encourage benefit recipients to work. Most people have more money when they work. These rules differ based on type of benefit, and became more generous in 1999. There are individuals specially trained to advise people receiving these benefits on how work will (or will not) impact their specific benefits. Services are free to the consumer and available statewide. 33 How Benefits Counseling Services Can Help A Community Work Incentives Coordinator (CWIC) can provide various levels of benefits counseling depending on where the person is in the employment process: If the beneficiary is We recommend Thinking About Work A basic overview of how working impacts benefits by phone with our Program Coordinator, who is an experienced CWIC. Person gets written Fact Sheets explaining work incentives. Working, Actively Seeking Work, Starting a

Business, or has a Job Offer Pending An in-person CWIC meeting to discuss impact of anticipated earnings on benefits, applicable work incentives, and how to report income changes. Person gets a written Benefits Summary & Analysis based on anticipated earnings. Experiencing a Change in Employment (gets a raise, hours increase/decrease, stops working, is considering whether to accept employer benefits such as health insurance or retirement benefits) Reconnect with the CWIC. The CWIC can explain how the change will or will not impact benefits, along with any rule changes since the last CWIC contact. Many of these questions can be answered quickly by phone, or in-person if the benefits situation is more complex. Having benefits issues because of working (i.e. Social Security check, MaineCare, etc.) Call the CWIC right away. The CWIC can explain why the issue is happening and how to fix it, if the issue can be resolved. If there is difficulty resolving the issue, the CWIC can sometimes contact the benefit agency directly. 34 BCS Referral Process 1) Call 1-888-208-8700 or visit: www.benefitsandworkinme.org for a referral packet. 2) Return in the provided business reply envelope or by fax to 662-6789: 3)

Beneficiary's contact and employment/job search status 2 SSA Release of Information forms 1 BRS Release of Information form 1 DHHS Release of Information form Optional: Your agency release form if beneficiary authorizes you to discuss benefits and work incentives questions with the CWIC before/after appointments Program Coordinator or Project Specialist will call to review work incentives by phone or schedule appointment. 35 How can YOU help? Employed, home-owning, graduated from SSDI consumer quote for Maine Can Work: I have had to be persevering and courageous to succeed and to find people that could help me when I ran into challenges. Where I am today is through using many programs and supports. It is the only way I got to be where I am. I want to tell you something else in answering this question. You have to find motivation deep inside yourself. It is hard to break the confines of the role, of the system, of the external expectations of whats possible for you. You have to believe you ARE capable of doing more than this. Walk away from those stupid conversations where youre competing to be the sickest. Want to be something more because you ARE more than that. There are other ways to connect. You are worth something. Find the motivation so when hard moments come, and they do, you are still determined to stay the course. Get some supports around you to help, find them, dont give up. Reconnect with people. Think about what 36

you want to do, what are you passionate about? Employment: An Allowable Service NOTE: The information in these slides was provided by the Maine Department of Health and Human Services Office of MaineCare Services and has been shared with APS. All MaineCare services must be medically necessary and linked to a goal in the members plan of care. While services may not be primarily vocational in nature, there are functions that the provider can do that are able to support a members work related goals. It is expected that the development and revision of support plans/ treatment plans includes discussions about the full range of domains, including employment. 37 Employment: An Allowable Service MaineCare expects that providers will assist members with exploration of interests, abilities and vocational goals, to include helping the member in accessing career exploration, job hunting resources in the community and access information regarding what training or education is required for certain jobs and how to access the training. This may include helping the member arrange informational interviews with people that work in jobs that the member is interested in exploring further, instruction in dress and grooming, or helping the member pack their lunch for work. Additionally this may include assistance to identify and access resources to overcome barriers that have hindered or been obstacles to becoming employed. It is also expected that providers will assist members in accessing information and resources about the potential impact of work on their benefits. All services must be properly documented and related to a goal. 38

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