Cathy O'Toole

About Advance Employment Inc.Integrated Employment Project – Evidence Based Practice

Service Delivery Model

Presentation Overview

A Disability Employment Network (DEN) member – 4 STAR Rating

Specialising in Mental Health in the Townsville region (Qld, Australia).

Funded by the Department of Education, Employment and Workplace Relations (DEEWR).

About Advance Employment Inc.

Where is Advance Employment?

“Advance Employment will promote encourage, assist and support job seekers to improve their mental health in order to achieve meaningful, open employment through employment related opportunities”.

Mental health focuses on emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life's inevitable challenges.

Mental Illness focuses on negative symptoms and personal deficits.

Dr William Glasser, 2003 defines mental health or happiness as…“enjoying the life you are choosing to live, getting along well with the people near and dear to you, doing something with your life you believe is worthwhile, and not doing anything to deprive anyone else of the same chance of happiness you have”.

Little distinction between management, staff and job seekers, other than to respect individuality and remember who is the job seeker and who is the service provider.

See past disability/label/diagnosis and focus on the value & strengths of the human being.

Treat job seekers with dignity & respect at all times

Resist making value judgementsNurture job seekers to foster self value and belief Educate regarding rights and responsibilities Provide appropriate & empowering opportunities

to encourage & facilitate educated & informed choices

Communicating to convey information i.e. listening with curiosity & an open mind when it is not your turn to talk… hence…conversing-to-convey. Resist communicating with the emphasis on convincing the other that you are right hence.. the goal is to convince - to be right.

Thom Rutledge 2002

Create partnerships across industry sectors within the local labour market to maximise open and meaningful employment opportunities for Job Seekers.

Create a quality organisation, by maintaining & improving core business, professional development and empowerment opportunities within the organisation.

Create collaboration across mental health services to provide maximum opportunities to assist job seekers to achieve their employment and life goals.

Ensure that the management structure meets the growth requirements of the organisation using a lead management approach.

How competitive/open employment facilitates recovery…Reduces stigma and marginalisationReduces disabilities secondary to the illnessHelps people reclaim a valued place in societyFew other things can be done for 8 or more hours a

dayStrengthens self-efficacy and self esteemValidates recovery progress through real measurable

accomplishmentsIncreases opportunities for positive regard from othersGreater opportunities for social inclusion and

acceptance by the wider communityGeoff Waghorn & Meredith Harris (QCMHR University of Queensland)

Labour force activity by psychiatric disorder (Australian Bureau of Statistics SDAC 2003, n=36,000)

Australians aged 15-64 yrs

Not in the labour force

Looking for work

(%)

Employed part time or full time (%)

Healthy Australians 18.8 4.2 78.0

Anxiety Disorders 48.7 4.6 46.8

Depression (excluding post-natal)

51.9 6.5 41.6

Schizophrenia 73.5 10.7 15.9

Source: Waghorn, Chant & Harris , in review

Psychiatric Disabilities are the most challenging for Disability Employment Services (DEN)

Australian DEEWR unpublished data 2006Of the 12 disability categories assisted by DEN,

psychological/psychiatric had the poorest job retention

25% of workers with psychological/psychiatric disabilities accumulated 26 weeks of employment

35% of all DEN workers attained this milestoneGeoff Waghorn & Meredith Harris QCMHR

What works best for people with mental health conditions...Most effective approach targeting individual career

development is the Drake-Becker Individual Placement and Support approach (SE-IPS)

SE most similar to DEN services in Australia and New ZealandEvidence includes 6 day treatment conversions and 16 Random

Control Trials (RCTs)RCTs are the strongest scientific design for evaluating whether

an intervention works16 qualifying RCTs to date: 12 in USA 1 in Hong Kong 1 in Canada 1 in Europe (6 European Countries) 1 in Australia (in press with BJP)

Geoff Waghorn & Meredith Harris QCMHR

7 Evidence-Based Principles

1.Eligibility is based on consumer choice2.Supported/Open Employment is integrated

with treatment3.Competitive employment is the goal4.Rapid job search (within 4 weeks)5.Job finding is individualised6.Follow-along supports are continuous7.Financial planning is provided


Figure 1. Competitive Employment Rates in 16 Randomized Controlled Trials of Supported Employment

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

96 NH (IPS)

07 Aust (IPS)

94 NY (SE)

07 IL

(IPS)

04 CT

(IPS)

05 HK (IPS)

06 SC

(IPS)

06MA

(ACT)

99 DC (IPS)

07 CA (IPS)

95 IN

(SE)

07EUR(IPS)

06QUE(IPS)

00 NY (SE)

97 CA (SE)

02MD(IPS)

Supported Employment Control Control 2

RCTs of High Fidelity Supported Employment – Individual Placement & Support

11 of 16 RCTs compared high fidelity IPS services to the best available local services (IPS vs controls)Job retention remains the major challenge

Any competitive employment (11 studies)

62% (IPS) vs 25% (controls)

20 or more hours per week (4) 43.6% of all participants (66% of workers) vs 14.2%

Days to first job (6) 144.5 vs 214.0 days

Accumulated employment among workers, following commencement of first job

24.5 vs 25.0 weeks

Weeks worked at longest job Mean 22.0 (IPS) vs 16.3 weeks;Range 10-36.8 vs 10-32.7 weeks


Implications for Australian service developmentAustralian DEN services characterised by...Segregation from mental health treatment and

careDifficulty with zero exclusionDifficulty with rapid job searchDifficulty with financial counsellingDemand often exceeds places availableOtherwise a highly suitable type of service for

people with severe mental health conditionsGeoff Waghorn & Meredith Harris QCMHR

Qld Health Multi-Site 2 year Outcome Evaluation

HSD EC’s Ethics EC Start Date

Data Collection

Research Design

Cairns & Hinterland

1 Near approval

Dec 07 Not yet RCT 2

Townsville 2 Approved May 07Sept 08

Not yet RCT 2

PCH –Chermside 1 Approved Jan 08 Commenced Parrallel Control

PCH – Pine Rivers

1 Approved May 08 Commenced Parrallel Control

Inner North Brisbane RBWH

1 Approved April 08 Not yet Descriptive

PAH Mt Gravatt 1 Approved Jan 08 Commenced RCT 2

West Moreton & South Burnett

2 Approved Feb 07April 07

Commenced RCT 2

Gold Coast 2 Near approval

May 08June 08?

Not yet RCT 2


Advance Employment – Kirwan

Total Clients

Diagnosis Total Job Seekers

% Employed

4 Week Outcom

e

13 Week Outcom

e

26 Week Outcom

e

Total % Employed

21 Schizophrenia 13 38.46% 100% 60% 40% 61.9%

Bi Polar 4 100% 100% 75% 75%Depression

Anxiety2 100% 100% 50% 50%

PTSD 1 0% - - -

Choice Theory Reality TherapyLead ManagementService delivery that is focussed on encouraging

and teaching job seekers the skills required to interact effectively & meaningfully within

relationships.

Current World Current World How do you see your life at this point

in time? What is your current situation?

Quality WorldQuality WorldWho are the people that are important

in your life?What are things, activities or events

that are important in your life? What is a belief that you hold?

What do you want?What do you want?How would you like your life to be? (work

or personal)What would this mean to you? What difference would this make for you?How do you see me/Advance Employment

helping you to move forward?

What are you Doing?What are you Doing?What does a day look like for you? Who is someone that you can get to

support you?Where do you go for fun & enjoyment?

Is what you are doing getting you what you want, or taking you in the direction that you want to go?

Yes NoIf Yes – how?If No – What would you need to do things

differently?

Are you willing to do something else? Yes NoWhat would that be?What is your first step?Where will this take you?What is your Plan?

Choice theory states that… All we do is behave, That almost all behaviour is chosen, and That we are driven by our genes to satisfy 5 basic needs…1.Survival2.Love and Belonging3.Power4.Freedom5.FunThe most important need is love and belonging, as this is a requisite

for satisfying all of the needs.Dr William Glasser – The William Glasser Institute

The greatest power that a person possesses is the power to choose! J. Martin

Survival Somewhere to live, something to eat, money & personal safety

Love & Belonging Connectedness with work colleagues, friends & family and being a part of something meaningful

Power Recognition, appreciation & purpose

Fun Continued growth, learning & enjoying life

Freedom Choice of job/home, decision making skills & independence

Dr William Glasser – The William Glasser Institute

7 Caring/Connecting Habits

1.Supporting2.Encouraging3.Listening4.Accepting5.Trusting6.Respecting7.Negotiating

differencesDr William Glasser – The William Glasser Institute

7 Deadly/Disconnectin

g Habits1.Criticizing2.Blaming3.Complaining4.Nagging5.Threatening6.Punishing7.Bribing, rewarding to

control

The only person whose behavior we can control is our own.

All we can give another person is information. All long-lasting psychological problems are relationship

problems. The problem relationship is always part of our present life. What happened in the past has everything to do with what

we are today, but we can only satisfy our basic needs right now and plan to continue satisfying them in the future.


We can only satisfy our needs by satisfying the pictures in our Quality World.

All we do is behave. All behaviour is Total Behavior i.e. Acting, Thinking,

Feeling and Physiology. All Total Behavior is chosen – we have direct control

over acting and thinking. Feeling and physiology is controlled indirectly through chosen actions and thoughts.

All Total Behavior is designated by verbs e.g. not “he made me unhappy” but “I am choosing unhappiness”


Reality Therapy is…A method of counselling/interviewing based on Choice

Theory and is aimed at helping individuals gain more effective control over their lives.

The process of developing effective counselling and management skills.

Based on the belief that we all choose what we do with our lives and that we are responsible for these choices.

Responsibility is defined as learning to choose behaviours that satisfy one’s needs and, at the same time do not deprive others of a chance to do the same.

Reality Therapy is used to work with Job Seeker’s to...Focus on the present - avoid discussing symptoms and

complaintsFocus on what the job seeker can do directly - act and think.Avoid criticizing, blaming and/or complainingRemain non-judgmental and non-coerciveTeach the job seeker that legitimate or not, excuses stand

directly in the way of their making needed connectionsFocus on specificsHelp the job seeker to make specific, workable plans to

reconnect with the people they need, and then help self evaluation of progress

Be patient and supportive but keep focusing on the source of the problem - the disconnectedness

1. Encourages honest discussion regarding both quality and the cost needed for the organisation to be successful.

2. Models expected outcomes from the top down and the bottom up.

3. Understands that the individual knows best what high quality work is and how to produce it at the lowest possible cost.

4. Teaches that the essence of quality is continual improvement.

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Cathy O'Toole