THRESHOLDS OPEN DOOR - the UIC Department of Psychiatry

THRESHOLDS OPEN DOOR
A MAGAZINE OF THE NATION'S LEADING PSYCHIATRIC REHABILITATION CENTERS
FALL 2004
www.thresholds.org
Thresholds Breaking New Ground:
The Advancing Customized
Employment Program

Cover
Breaking
New Ground
at Thresholds:
The
Advancing
Customized
Employment
Program
Jonas Coburn struggled to find employment while managing
his mental illness. Frequent doctor visits and group therapy appointments
precluded him from working full-time. Moreover,
his sensitivity to stress—a result of his mental illness—made it
hard for Coburn to commit to more than a few days of work per
week. Beyond a few temporary jobs, Coburn remained largely
unemployed for several years.
Today, however, Coburn is employed as a stock person at a grocery
store, working eight hours a week. He expects the job to be his first
step; if he gets comfortable, his employer agreed to increase his
hours. Coburn found his job through the Advancing Customized
Employment (ACE) program—another pioneering effort to find
jobs for people with severe mental illness.
Employment for people with mental illness is critical. As a vital part of
the recovery process, a job means more than just earning a paycheck.
It is the first step toward a life of dignity and independence. Yet, as
millions of people with mental illness know, finding a job can be a
nearly impossible challenge.
The unemployment rate for people with serious mental illness exceeds
85 percent, which amounts to about three million Americans without
work. The reasons go beyond the natural barriers that psychiatric
symptoms present when looking for a job. Stigma also plays a role.
A recent study by the National Alliance for the Mentally Ill reported
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that one-third of mental health clients had been turned down for a job for which they
were qualified because of a psychiatric label.
The problems do not end there. When people with serious mental illness do find work,
it is often below their skill level. Nearly two-fifths of workers with psychiatric disabilities
have near-minimum wage jobs, compared with only one-fifth of those without disabilities.
Recent figures have also shown that people with mental illness typically earn
a median hourly wage that is far less than their non-disabled counterparts.
The Advancing Customized Employment Program was created in 2004 to meet these
challenges by pioneering aggressive methods of job placement.
Traditional supported employment services have helped many people with mental
illness find jobs. Indeed, while less than five percent of Thresholds members have jobs
when they join the program, more than 50 percent of them who are enrolled in the
agency’s comprehensive program later find work with Thresholds’ help. With more
than 200 area employers hiring Thresholds members and support from the State Division
of Rehabilitation Services, the agency regularly has about 600 people working at
any given time.
What distinguishes the ACE program, however, is its more aggressive strategies. Some
members need the special help that ACE can provide. Traditional job placement involves
placing members who best fit the employers' pre-designated needs. ACE placement
methods require a greater level of job customization to assure the proper fit between
the employer’s needs and the member’s needs. More than 75% of the jobs that come
through the program are individualized.
ACE staff spend a great deal of time taking inventory of a member’s strengths, needs,
and interests. When making a possible placement, those concerns are considered while
evaluating an employer’s job description. Through negotiation with the employer, ACE
staffers customize the job to suit both parties. Customization may include the negotiation
of the essential responsibilities of the job, such as the details in the job description,
or the nonessential expectations of the employer, which can include hours of work,
chosen days of work, workstation location, and productivity requirements. Sometimes,
a job is divided between two people. Other times, simple adjustments to schedules,
supervision, or other job characteristics are necessary.
A customized job may differ from the employer’s standard job description, but it is still
based on the tasks that are necessary within the workplace. The tasks still get done,
but how they get done is negotiated.
"ACE is breaking down
barriers, and that’s what is
exactly needed to help
people with mental illness
reach their potential."
ACE Program Director Carolyn Jones describes
the program by comparing it to
purchasing a suit. “Traditional supported
employment can be like buying a suit off
the rack—you buy it and wear it, as is,” she
says. “But when you alter that suit, that’s
like customized employment—a tailormade
fit.”
A customized job capitalizes on members’
strengths and abilities, hopefully resulting
in greater on-the-job success and longterm
employment. Customizing can be
hard work, but the satisfaction of finding
the perfect fit makes it worthwhile, say
ACE staff.
It was only through much interaction
with member Izzy Nakomis that ACE staff
discovered he once worked as a tailor for
ten years. Specialized in making shirts
and tuxedos, Nakomis also was a skilled
embroiderer. Last month, he began working
full-time with benefits at a local millery,
sewing a variety of uniforms for the business
industry, thanks to the ACE program.
continued on next page
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What is customized employment?
Customized employment is a
relatively new model of job
placement, developed within
the last five years to help people
with disabilities. It is the
offspring of the traditional
supported employment model.
Since 2001, the Department of
Labor has funded almost two
dozen customized employment
programs in the United States.
The Advancing Customized
Employment Program is one
such demonstration project of
this new employment development
model.
“Customized employment
means individualizing the employment
relationship between
employers and employees in
ways that meet the needs of
both. It is based on an individualized
determination of the
strengths, needs, and interests
of the person with a disability,
and is designed to meet the
needs of the employer.”
“Customized employment may
include employment developed
through job carving, self
employment or entrepreneurial
initiatives, or other job
development or restructuring
strategies that result in job responsibilities
being customized
and individually negotiated to
fit the needs of individuals with
a disability.”
“Customized employment assumes
the provision of reasonable
accommodations and
supports necessary for the individual
to perform the functions
of a job that is individually negotiated
and developed.”
Office of Disability
Employment Policy
Nakomis says that being a tailor is his dream job. While his more apparent skill in
food industry may have placed him in a food service job, through careful inventory
of Nakomis’ skills, his “hidden” talents and interests were revealed.
This method of employment services was formalized in 2001 when the U.S. Department
of Labor created a specific office to help people with disabilities find employment.
Several years earlier, the Workforce Investment Act mandated the creation of
One-Stop Career Centers, which assist individuals in getting job training. So when
the Department of Labor created its Office of Disability Employment Policy, these
One-Stops were the ideal places to advance the customized employment model
and take advantage of the resource’s capacity.
The ACE program is housed within a One-Stop located on Chicago’s near south side.
It is one of only a handful of similar sites throughout the nation. The One-Stop is a
community resource. Local residents looking for employment take advantage of
its many resources, which include a variety of job assistance services, such as help
with resumes and job interview preparation.
Two days a week, ACE operates out of this One-Stop, identifying and preparing job
seekers for employment. There are five One-Stops like it throughout Chicago. The
ACE program will enter one new One-Stop until it reaches all of them within the
next five years.
Thresholds’ long history of job training and placement makes it the ideal organization
to provide services for the new program. But it also partnered with the Chicago
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Workforce Board and the Center on Mental Health Services Research and Policy at
the University of Illinois Chicago (UIC) to assist in the endeavor.
While Thresholds provides much of the day-to-day job services, the organizational
partners provide valuable support. The Chicago Workforce Board, a coordinating
body of business leaders in Chicago that is charged with advancing Chicago’s work
force, helps the ACE program’s liaison with the One-Stop Center. They assure fiscal
soundness, and coordinate Thresholds’ efforts with the local community’s needs.
The UIC Center is training One-Stop staff about mental illness and how the ACE
program’s principles can be used to better serve all One-Stop clients. The UIC Center
also collects data on the program tracks the ACE program’s success. By doing so,
ACE partners hope to further develop the model, determining what works and
what does not, as the program rolls out to other locations.
The ACE program currently employs seven staff people, including five workers who
provide mobile support. These workers travel from site to site, helping members
on the job. They will work alongside a member as he learns his new responsibilities.
Their purpose is to help members settle into their jobs, while also making
sure employers are pleased with ACE's placement performance. Mobile workers
are valuable liaisons between the workers and employers, sometimes providing
a communication bridge between the parties when adjustments to the job are
necessary.
Good communication is key to the success of the ACE program. Through constant
communication with employers, ACE staff can assure that everyone’s needs are
being met, adjusting expectations and problem-solving whenever necessary.
Working with people with mental illness sometimes requires some accommodation.
ACE staffers can work with an employer when members are uncertain how
to make the request.
While all this work may seem burdensome to the employers, most welcome the
support. Many of the ACE employers have been looking for ways to diversify their
work force, as well as to positively contribute to the community. Moreover, many
employers do not have a clear understanding of working with people with disabilities.
ACE staffers fill that gap. ACE staffers only ask that employers broaden
their notion of job placement. Instead of thinking of filling a certain job, the ACE
program encourages employers to think instead about the tasks within that job
description. ACE promises a solution to the tasks at hand—whether it’s utilizing
the talents of one worker or a group of three.
Many ACE employers also report being pleased with the high level of job support
they receive. Whenever necessary, an ACE staffer is there to help provide solutions.
Additionally, employers receive federal tax benefits by working with ACE members,
providing further incentive to hire people with mental illness.
Just as employers benefit, people helped by the ACE project report good things
about the program. While other employment programs require its clients to participate
in job training or other preparatory work before placement, the ACE program
looks at a member’s current skills, and finds a suitable employment match. Further
educational opportunities and job development are available to ACE members.
They can take advantage of these opportunities while working. By partnering with
Thresholds, if an ACE member does not have access to ancillary support services,
the agency can provide the resources. Thresholds’ college preparatory program,
the Community Scholar Program, is just one example where ACE members can
prepare for post-secondary education.
“The ACE program meets you where you are,” said member Tamila Clark. “I never
thought I could be working right now with everything going on with my illness,
but here I am, employed.”
Thresholds’ ACE program is currently at capacity, helping about 45 people, including
Clark, at any given time. Its success makes replication of the ACE employment
model likely. “There is a need for many more programs like ACE,” says director
Carolyn Jones. “ACE is breaking down barriers, and that’s what is exactly needed
to help people with mental illness reach their potential. It’s about time for a change
like this.”
The estimates of unemployment
for people with serious
mental illness are startling:
about 85% are unemployed.
This unemployment rate is
higher than for any other group
of people with disabilities in
the United States.
Thresholds understands the importance
of work in a person’s
life. Pioneering new, aggressive
strategies has been a top priority
for the agency. In addition
to partnering in the Advancing
Customized Employment
program, The Thresholds Research
department and several
research partners are completing
its comparison study of two
popular employment models.
Which model is more cost-effective?
Which model produces
better work outcomes?
The first, the Diversified Placement
Approach (DPA), has
evolved at Thresholds over 30
years and includes: work readiness
training, group placement,
agency-run businesses, and
individual placement in the
community. The other, Individual
Placement and Support
(IPS), developed by Dartmouth
Psychiatric Research Center
in New Hampshire, supports
rapid job search and direct vocational
placement.
This NIMH and NIDRR funded
vocational project is a collaborative
effort between Thresholds
and Indiana University-Purdue
University Indianapolis. Dr.
Gary Bond of IUPUI is the
Principal Investigator. Results
will be featured in an upcoming
edition of the Thresholds Open
Door magazine.
On the Research Front
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