Employing Persons with Mental Illness Who are Homeless
I. Welcome and Introductory Remarks
Welcome, everyone, to another PATH national teleconference. My
name is Gary Shaheen and I'm from Advocates for Human Potential
(AHP) in Sudbury, MA, the technical assistance contractor for the
PATH Program. I will be serving as your moderator for today's call.
We are pleased that you have decided to join us in one of our series
of national teleconference calls designed to provide information
and technical assistance to programs serving individuals who are
homeless and have mental illness. Today's call will focus on issues
and practical strategies for employing persons who are homeless
and have mental illness. Before we begin, I would like to review
the format for the call:
Dr. Michael English, Director of the Division of Knowledge Development
and Systems Change at the Center for Mental Health Services, and
Dr. Michael Hutner, PATH Government Project Officer, are joining
us for today's call. Each will provide brief opening remarks that
underscore the tremendous nationwide interest in increasing employment
for persons with psychiatric disabilities who are homeless. I will
then introduce our three panelists: Mollie Lowery of LAMP, Inc.,
Nancy Isaac of Lakefront SRO, and Andrea White of the Center for
Urban Community Services. Each panelist will have 20 minutes to
address the topics that were contained in the announcement you received.
After the presentations, we will use the remaining time to open
the lines for questions and comments from the audience.
A. Comments from Michael English
I must say that it really is exciting to hear that so many people
have joined this teleconference, and I want to thank Mike Hutner
who has stimulated the work that has been done to get this to happen.
I am also very excited about the topic.
We are completing a five-year employment intervention demonstration
here at the Center for Mental Health Services, and while we don't
have all the findings in yet, it is clear to us that we really do
have quite high expectations for employment for persons with serious
mental illness. If you couple the work that we have done around
the supportive intervention for helping people get work, with the
tremendous gains we've made in learning about how to engage persons
who were homeless and get them linked with services, I think we
have very high prospects. Furthermore, I wanted to emphasize that
we are hopefully going to be in a position to provide increasing
amounts of information about supported employment techniques.
One of the things we are learning is that there is no single answer,
that there are at least several models, including individualized
placement services, (IPS), clubhouse model, and other program variations
that demonstrate effectiveness with respect to employment. We are
also working on developing treatment guidelines in the area of supported
employment that will be a useful resource to you as you think about
how your community can increase its expectations for helping persons
with serious mental illness return to work.
I don't want to underestimate the challenges that this involves.
We are learning that, while work is available, it is still, unfortunately,
almost universally available at minimum wage. For a start, that's
great, but I think we can do better in terms of affording persons
with mental illness opportunities that extend beyond minimum wage
work. There is also much work to be done in terms of helping people
explore alternative means of work when they can't work full-time.
Dr. Hutner mentioned to me that you would probably like to hear
more about money, so I will say a bit about funds available for
employment. We have a particular grant program called the Community
Action Grant that allows sponsors of exemplary practices, of which
these employment models would be included, to sponsor the implementation
to those models in target communities around the country. Anyone
on this phone call can be a sponsor. The grant is used to fund development
of an implementation plan for a necessary adaptation of a service
strategy. It can also be used to develop a long-term financing strategy.
The Community Action Grant Program is now on the street. We have
converted it from a guidance for applicants to a program announcement,
which means it will have a rolling application that you can apply
for at any time. We hope to have two or three periods where we collect
applications and make grant awards. The current grant application
closes on May 10th. The next one will be September 10th. I doubt
you will make the May 10th if you haven't already completed your
application, so target September 10th if you want to sponsor work
on supported employment in your community.
As I said, we are very excited about this. The Presidential Task
Force on Employment for Persons with Disabilities is giving us visibility
on this issue. I think that this is one of those topics that communities
are ready for, and I know that you will be an instrumental part
of taking advantage of the learning and opportunities that currently
exist. I'm looking forward to hearing these presentations about
what's being done in the various communities.
B. Comments from Michael Hutner
I want to begin by thanking Gary for assembling this phone call.
You have been in the forefront of activity regarding employment
and raising the visibility and the importance of employment intervention.
So I wanted to thank you personally for your expertise. I want to
also thank Richard Becker, and others at AHP for the fine technical
assistance they have been providing.
We at the Center for Mental Health Services and Homeless Programs
Branch want to help you by providing technical assistance in this
and other areas, and so I would invite you, after this phone call,
to provide feedback directly to Gary. Let him know your views about
this particular phone call- what parts of it you found particularly
interesting-- and we will do what we can to provide you with more
technical assistance.
For example, AHP puts together site visits so that if you want
to implement the employment intervention, but need some expertise
in helping you do this, we would do our best to make experts available
to conduct site visits. Somewhat less intensive on resources, yet
perhaps just as effective, would be the provision of advice through
a teleconference call to your particular state. For instance, if
you want to put together a group of providers in your state or surrounding
regional area, we could make expertise available via telephone for
an hour or two.
You may also want to exchange ideas with others on the phone call,
to tap into the expertise of those who have made better headway
on employment or those who are implementing various types of programs.
We can arrange a conference call to discuss some of these employment
interventions with those who are further along in planning. If you
have a very specific question or set of questions, AHP can also
coordinate conference calls. On this and other topics, we are trying
to be as responsive as we can in providing you with technical assistance
that will make a direct difference in your programs.
Gary: Thank you so much, both of you, for your great words.
And now I would like to begin the presentations by our panelists.
It gives me great pleasure to introduce our speakers for today's
teleconference on employing persons who are homeless and have mental
illness.
II. Panelist Presentations
A. Introductions
Mollie Lowery is the founding executive director of LAMP, Inc.,
a drop-in center and crisis shelter safe haven located in the skid
row area of downtown Los Angeles, for adults diagnosed with serious
mental illness who are homeless. Approximately seventy percent of
those persons served by LAMP are addicted to or abusing drugs and/or
alcohol, and fifteen percent are diagnosed with HIV or AIDS. By
pioneering the Harm-Reduction model with intervention and building
a strong lifelong supportive community, Ms. Lowery has guided the
development of LAMP's forty-eight bed Village Transitional Residence,
four business enterprises, and a fifty-unit apartment building.
LAMP has grown into a fully contained continuum of housing, recovery,
and employment services with a commitment to include prior guests
of LAMP as members of their staff.
Nancy Isaac is the employment director for Lakefront SRO Corp.,
a non-profit, community-based housing development agency located
in Chicago. During the past year, Ms. Isaac has developed written
procedures for the employment program and has helped open Lakefront's
second training and employment center serving residential and non-residential
clients on the south side of the city. Currently, Ms. Isaac is arranging
with the City Colleges in Chicago to operate certificate training
programs and an accelerated GED program at the center. In addition,
she is working with other providers to coordinate pre-employment
and employment services, and is developing partnerships with area
employers such as the Public Housing Authority and Employment Training
programs.
Andrea White is an associate director at the Center for Urban Community
Services in New York City where she has worked since 1980. Ms. White
has designed and developed a nationally recognized program serving
homeless and low-income people with mental illness and other special
needs. In 1991, she participated in the design and development of
a supportive services program at the Times Square Hotel, a six hundred
and fifty-two unit permanent residence, serving both low income
and formerly homeless people, including two hundred people with
mental illness, fifty people with HIV/AIDS, and numerous tenants
with addictive disorders. This award-winning program was the subject
of a Sixty Minutes segment highlighting supportive housing as a
solution to homelessness. The Times Square Hotel is recognized for
its extensive employment and vocational services which offer supportive
housing residents throughout New York with a wide range of job opportunities
in a variety of fields. I am pleased to welcome our three panelists
and ask Mollie Lowery to begin.
B. LAMP - Los Angeles, CA
Mollie Lowery: I want to start out by just talking about
who we are and the services we provide. LAMP provides a continuum
of housing, recovery, and support services to people who are homeless
and diagnosed with a serious mental illness, most of whom are also
dealing with drug addictions, and an additional proportionate number
with AIDS or HIV.
In operation since 1985, LAMP grew out of the homeless and housing
movements. We are based in LA's skid row district, a forty-square
block area that, through city policy, has been preserved to provide
for the housing needs of the city's homeless. One of the major results
of that city policy is that we have what has now been called in
national papers, the Open Asylum for persons with mental illness
and the dually diagnosed. Approximately ten thousand people in this
forty-square block area live in the streets, SRO's, or other kinds
of housing. About thirty percent of these individuals are considered
to be seriously mentally ill.
Our goal in creating LAMP was to establish a community, given that
we felt strongly that the folks out there on the streets were seeking
some kind of freedom, respect, and tolerable treatment for their
mental illness. They wanted safety, and they wanted community like
we all do. They wanted a home and friends to love and to invest
in. To address those fundamental needs, we have evolved into what
we call a lifelong non-linear continuum of housing and comprehensive
support recovery services.
We service about fifteen hundred individuals each year and have
a community of staff and guests of nearly five hundred who are participating
in the LAMP programs and housing at any given time. Of our nearly
ninety-five employees, sixty-four are full-time. Of those sixty-four,
fourteen are guests of LAMP, while another seventeen staff are people
who are dually diagnosed.
We conduct a huge volume of street outreach, and since Los Angeles
has the wonderful recognition of having the largest mental institution
in the country-- our county jail-we provide outreach to those persons
as well. We also operate a safe haven drop-in center shelter with
thirty beds, and a transitional residence with forty-eight beds.
In the same building as our transitional residence are our three
businesses that are part of our employment program, which I will
get very specific about in a minute. We also have a fifty-unit apartment
building that serves as our permanent housing component. In addition
to that permanent housing, we have ten units that we are master
leasing from another non-profit housing provider and that will be
expanded to twenty-six units so we have more permanent housing available.
So, clearly, housing is a very important part of what we do. LAMP
also has a forty- acre ranch about five hours away that is used
as a retreat and recovery center. We operate as a fully comprehensive
harm-reduction model, which includes our housing and other services.
No one is excluded from housing, services, or employment because
they are using or are decompensating.
We operate three businesses at LAMP. The largest is a commercial
laundry that we have operated since 1990. We own and service the
inventory of sheets, towels, blankets, etc., and we rent out that
inventory to all the big, non-profit housing providers down here
on skid row, as well as to a number of recovery homes and large
shelters. It's a fairly large operation, which employs about twenty-five
of our guests. There's lots of machinery involved, and a lot of
work to do. We service three thousand housing units, and just this
year, we started covering those costs with the income from the business
itself without subsidy. We are currently establishing a reserve
fund to help replace some of the old machines.
We also operate a coin-op laundry -- the only one in this forty
square block area. It's your standard laundromat, open to the public,
and it is completely staffed by LAMP guests. What we affectionately
call "The Pits" is our public toilets and showers operation, also
staffed by LAMP guests. For our area, this is a very needed service.
We have coin-op showers, and it costs forty cents for a ten- minute
shower, which includes a towel and soap. The showers operate seven
days a week, ten hours a day, as does the laundromat. The toilets,
of course, are free.
Our businesses were able to get started because of a pretty hefty
grant from Robert Wood Johnson Foundation back in 1989/90, which
helped subsidize the first three years. The Community Redevelopment
Agency Continues to subsidize our public showers and toilets.
A unique element of our employment efforts is that we hire people
from our guest population to serve as outreach workers, food service
workers, and case managers. Fourteen full-time staff falls into
that category, some of whom started out by working part-time in
our small businesses. As they developed the trust and confidence
that they could really work and depend on that work for income,
they went on to become what we call regular full-time employees,
versus guest employees who work part-time in our businesses.
Having given you that overview, I want to address some of the questions.
Where we see special needs regarding being homeless and mentally
ill, and trying to work, or have jobs that accommodate them. First,
money is definitely a motivator. It matters to people that they
have paying jobs, that they have a job description or something
they can call themselves, and they can feel proud about going to
work and having a regular schedule.
They need a lot of flexibility because their lives are still going
up and down, both because of their mental illness and because of
their housing status, which may be changing over time. Most of the
people that we employ are housed in our flexible continuum of housing,
which makes all the difference in the world in their success at
staying employed. You have to have a lot of diversity in skill level
expectations and levels of responsibility so people can be accommodated
according to what they can bring to the job. You also need to have
really clear expectations and policies regarding drug use and the
type of behavior people need to be accountable for when they come
to work.
We have a policy that people are able to quit because of any factor
that they see as a need. They may be too stressed out or too ill
to work, or they may be using drugs too heavily to work, so they
quit, but unless they have done something very badly on the job
itself, they can always return to that job. We do a lot to buoy
up the possibility that they can keep the job by providing support
groups and strong case management to help them through the transitions
they are making. We try to help people really understand what freedom
is really about-that there is an equation there- that freedom and
responsibility have to be matched, and that part of coming in off
the streets and letting go of some of that freedom is taking on
some responsibility for their lives, jobs, income, and everything
else.
I have made a clear distinction that housing is very, very important
regarding our kind of work here. If they are going to keep their
job, they need to be housed and that's why at LAMP we are so strong
in our mission to provide housing in every shape and fashion that
we can. It's a package deal. I think it is absolutely essential.
And as to the benefits of and how work impacts motivation, versus
how SSI benefits motivate or don't motivate their working, we have
to do a lot of work on that. SSI, of course, is something they really
depend on, and to let that go is a big deal. A lot of our folks
choose to work part-time and stay on SSI and not make that huge
leap into permanent full-time employment. They just don't have enough
hope. For the ones that have, it has been exhilarating and wonderful
for them, and each time someone else does it, it is a model for
the rest to try it, and have trust and faith in LAMP being here
for the long haul to provide them with a real sense of worth. We
do a lot of reporting to the Social Security Administration so there
aren't overpayments.
C. Lakefront SRO-- Chicago, IL
Nancy Isaac: Lakefront SRO Corp. is a non-profit, community-based
housing development agency located in Chicago. Our organization
was founded in 1986, and we currently provide permanent, affordable,
supportive housing for approximately nine hundred homeless, low-
income men and women in eight apartment buildings on Chicago's north
side.
This January we opened our new south-end apartments and our job
training and employment center. The training center houses our building
maintenance, construction, and computer training labs, classroom
for our literacy and GED programs, a resource library, and a lecture
hall that holds large training sessions by the City College system.
We offer affordable, safe, and well-maintained apartments along
with a variety of support services for our tenants to assist them
in becoming independent. We have case managers and property managers
working in each of our buildings. Among the other services offered
are tenant councils, recovery support services, and our employment
training program, which is comprised of a literacy program, job
readiness training, in-house training classes, assistance in securing
employment, and ongoing support after program participants are employed.
Last year, fifty-seven percent of all of our residents were employed
during some part of the year, and the range in salaries for our
tenants was from $5.15 an hour up to $22.55 an hour; over seventy
percent of our residents made between $5.15 and $8.00 an hour. Furthermore,
fifty-seven percent of employed Lakefront tenants worked in laborer
positions, while approximately forty percent worked in service positions,
and three percent worked in professional positions.
The City of Chicago's Mayor's Office of Work Force Development
recently asked Lakefront to bring our employment program to residents
in two Chicago Housing Authority developments. We have a two-year
contract, and within that time frame our contract requires us to
serve more than seven hundred CHA residents. The program will move
participants through initial job skills assessment to job placement
assistance and follow up employment counseling services. Tenants
should also benefit from referrals that our staff will be making
to ensure that, if needed, they receive appropriate medical care,
mental health care, and recovery counseling.
The program has been in operation for five months now and our staff
has met with four hundred and twenty CHA residents who have received
career development assessments and counseling. To date, fifty individuals
have entered short-term training programs in areas such as cabling
and fiber optics, graphics, and construction and building maintenance
programs. Fifty-five people have been placed in jobs with the average
wage at right around $7.50 an hour.
At Lakefront, we estimate that about forty percent of our residents
are dealing with mental health issues. So, we are not dealing with
as large a population of folks who are dealing with mental health
issues as LAMP is. We find that residents who have an identified
mental illness tend to be more isolated and have fewer support systems
in place. Lakefront has developed partnerships with a number of
area community mental health centers where individuals participate
in outpatient therapeutic programs, and on occasion, residents are
also admitted to in-patient treatment programs.
We provide the same set of support and employment services to all
our residents, regardless of whether they have a mental illness
or not. Our case management, property management, and employment
staff work closely together and meet regularly to address tenant
issues as they arise before they become major problems. In addition,
Lakefront staff has developed relationships with a number of organizations
that provide vocational services for people with mental illness.
Some of the organizations include the State's Office Rehab Services
and private, not-for-profit organizations that provide training
and supportive employment opportunities for people with mental illness.
We are also looking into the possibility of developing an in-house
business for people who are not able to work in conventional jobs.
At Lakefront, there is a natural tension between the principle
of respecting our residents' privacy and their right to make their
own decisions with a belief that everyone can contribute in some
way to their community. In terms of our best practices model, Lakefront
recently incorporated a new philosophy that supports the concept
of work. We know that a number of our residents are not job ready
or may never be able to hold down a job. However, they can participate
in the community in some way, whether through participating in our
voter registration drive, assisting a neighbor with grocery shopping
on a weekly basis, or going to school to improve their literacy
skills. The key that we found for participation in employment services
is meeting with each individual to identify what his short and long-term
goals are, and assisting the customer in defining the steps needed
to attain those goals. A goal may be to be reunited with a family
member or to move into a larger apartment, but often when people
begin focusing on employment or getting involved with the Lakefront
community, they begin addressing a number of their personal barriers,
including working on conflict resolution, time management, hygiene,
literacy, taking needed medication, and dealing with their mental
health problems.
We find that there is definitely a link between longer housing
retention and customers who work. Approximately fourteen percent
of Lakefront's residents receive Section 8 housing subsidies and
pay no rent. We estimate that thirty-three percent pay the rent
using SSI or SSDI, and the rest need income to pay their rent. So,
with this in mind, housing and employment are intricately connected
for many of our residents here at Lakefront. We have found that
many people receiving SSI and SSDI have issues related to work as
well. Whenever possible, we assist those individuals in finding
part-time jobs; we have also invited representatives from the local
advocacy organizations to talk to our staff and residents about
how they can work and still receive benefits. But it remains an
uphill battle for us.
In terms of positive partnerships, we have recently developed a
partnership with the City Colleges to provide short-term certificate
training classes on-site at Lakefront's job training center. The
classes are available for residents, as well as community members.
The City Colleges work to identify industries with work force shortages,
and work with companies to tailor the training programs to meet
their specific needs.
The training programs are relatively short-term, and run usually
somewhere between twelve and eighteen weeks. Companies participating
in the program employ most of the graduates. Currently, the City
Colleges are running cabling and fiber optics programs at Lakefront,
and will be starting a bank teller program in the beginning of May.
We are also looking at some additional programs, including a medical
office assistant program, a consumer services representative program,
and a word processing certificate program that would be run on-site.
What we really like about this collaboration is that, because the
City Colleges have developed relationships with industries that
have significant work force shortages, the industries have a real
stake in the classes. In fact, members of the various industries
participate in teaching the classes, and there are real jobs once
folks successfully graduate from the program.
What Lakefront brings to the table is recruitment, not only from
our buildings, but from Chicago Housing Authority buildings and
a number of supportive housing organizations in the city who have
untapped labor resources. Through our literacy program, we provide
one-on-one tutoring, study groups, job readiness training, and ongoing
support for folks once they have moved into their new jobs. The
beginning pay for many of these jobs-- in fact all of these jobs--
is beyond minimum wage. Salaries range from $7.50 to $12.00 an hour
for graduates of the City College programs. We also promote a number
of local training programs, including a twelve-week professional
culinary training program for jobs in the hotel industry, available
for welfare-to-work and non-custodial parents. A machinists training
program and a woodworking training program are available to these
individuals as well.
Lakefront is committed to developing partnerships with other organizations
that provide vocational services and supportive employment opportunities
to people with mental illness and people with developmental disabilities,
and we are currently working on other ways to collaborate with organizations
that serve people who are homeless. Right now, we are working with
a local organization that provides job readiness training and employment
support to people in shelters and transitional housing. They are
providing a four-week intensive job readiness training class for
our residents, and, based on the outcome of the class, we may be
developing a long-term relationship with this organization, which
will enable us to really focus on what we feel we do best.
Our tenants are also taking advantage of some training programs
that other supportive housing organizations are providing, such
as the Chicago Industrial League, which has a building maintenance/janitorial
program, and also a landscaping program. We continue to develop
relationships with area employers to secure jobs for our customers.
Through our relationships with fifty employers, we pre-screen individuals
to provide them with pre-employment training. It might be job readiness
training, or it may be some support in math or reading skills to
get people up to a minimum level where they would quality for a
job with an employer. We then provide ongoing support for individuals
once they are employed.
We contact our customers fifteen, thirty, ninety, and a hundred-twenty
days after they are employed to check in with them, to make sure
things are moving along as hoped, and, in the event that problems
arise, to intervene before they become real issues. With those organizations
or companies that we have relationships, we will also contact them
on regular intervals to check in and make sure they are satisfied
with their Lakefront employees.
We have a partnership with the City of Chicago's Mayor's Office
of Work Force Development (MOWD) to provide funding for our employment
program and our in-house construction and building maintenance programs.
I mentioned earlier that they have asked us to provide services
to residents of two Chicago Housing Authority developments, and
that's a two-year contract. The Illinois Department of Human Services
provides funding to Lakefront to pay for training of non-custodial
parents for jobs in the hotel industry. We anticipate receiving
a grant from the Illinois Secretary of State to help fund our literacy
program, which will be expanding to include an accelerated GED class,
not only for our residents but for people in the community, as well.
We will also be providing one-on-one tutoring to residents of several
shelters in the Chicago area.
We have applied for a grant with the City of Chicago's Department
of Planning for employment services, and should be hearing in a
couple of months whether we will be receiving the funds. We also
receive about $43,000 in funding for employment programs through
various foundations.
D. Center for Urban Community Services - New York, NY
Andrea White: The Center for Urban Community Services operates
a variety of programs, ranging from street outreach to two transitional
programs called Therapeutic Living Communities for people who are
mentally ill-one designed for those who may be long term shelter
users or those living on the streets-and one for women who have
been in a shelter for a long time.
The 350 Lafayette Program operates on a six-month time frame, and
our Harlem Transitional Program operates on about a twelve-month
time frame for people in the streets or long-term shelter users.
In addition, we provide the social services in six SROs, five in
the uptown SROs in partnership with a group called Broadway Housing
that does development and manages the buildings, and the Time Square
and the Prince George. Prince George is our new four hundred and
eighteen-unit building on 28th Street in Manhattan. We have a hundred
people who have mental illness, forty-five with HIV, seventy from
the general shelter system, about thirty from the streets, and the
remainder are low-income people who make between fifteen- and thirty
thousand dollars a year.
As mentioned, we also operate an extensive vocational program for
people in supportive housing, and people in Tier Two Shelters, which
are transitional shelters for homeless families, and particularly
in our own program. In addition, we run a technical assistance training
unit with contracts from HUD and HOPWA (Housing Opportunities for
Persons with AIDS) that provides training and designing of supportive
housing throughout the country.
One of the things that I wanted to talk about is the adaptations
that are necessary for people with mental illness who are homeless
to really participate fully in vocational or employment programs,
or to get a job, and I think it is really, as Mollie said, sort
of a context for our services. I think you have to be aware of how
homelessness affects people's lives.
Our consumers have been in a prolonged period of crisis. Their
priorities and coping strategies may be dramatically different than
the skills that are needed to either maintain housing or participate
in work. They have a sense of being cut out. They have limited options,
and I want to pick up again on what Mollie said about hope. People
are really missing hope. They believe that there are limited resources
available to them and that they probably won't have access what
is available. I also think that mental illness affects people's
lives in different ways, and that you have to look at how the mental
illness affects their lives-for example, if people are stabilized,
if they are not stabilized, how they deal with mental illness, and
what sort of help they have gotten in the past. Those all have to
be factored into the kind of services that we provide.
Our housing and transition programs are designed around people
reaching their life's goals, including those related to starting
a career. We identify the skills to help them achieve those goals
and help them begin to think about what it takes to work, including
literacy skills. Those are all part of what people need to maintain
housing, and are really part of what a case manager would be doing
with somebody-identifying goals and barriers, and helping people
reach those goals.
So what we've done is broken down the types of jobs that we want
integrated into our services as full service case managers. We also
provide something a little different. It is called Cognitive Remediation,
and theory is that people with mental illness, have cognitive deficits.
Because they were engaged in other things at the time when they
might have developed those cognitive skills--notably late adolescence/early
adulthood--they may be missing some of those focus skills. They
may have difficulty in transferring their thoughts and ideas to
another person, in setting priorities, in organizing, and in thinking
things through.
Cognitive Remediation is a program developed specifically for people
with a history of schizophrenia and/or substance abuse. We were
beginning to see where people, particularly those with mental illness,
weren't getting through the vocational process. The problem was
mostly around those skills like focusing and taking direction, being
able to apply one thing to the other. This program addresses those
cognitive needs by using a computer and games on the computer that
teach people those skills. Another component involves one-on-one
identification of which skills they are working on and how those
skills can be transferred.
I also think there needs to be a consistency across programs. People
who are homeless or were formerly homeless, need to know they can
depend on the program. They need to know they are there for the
long term, and there needs to be very good communication between
the case management and vocational programs. And, of course, there
needs to be housing. People need to have a safe place to be. It's
very difficult to concentrate on other tasks when you are wondering
where you are going to sleep at night, and how you going to get
money, and housing really goes arm-in-arm with employment. So literacy
training is also important in the intervention. People need the
skills to access jobs, and if they are going to engage in a career
plan, as opposed to a one step thing. They need those skills to
address that.
The outcomes of this are very important, too. You can't do a training
program, or you can't work with people towards employment unless
they know their outcome, and they really have to be able to control
some of the outcomes. Towards that end, we started with in-house
businesses. We have a partnership shop with Ben & Jerry's; the
shop was donated, and is run by tenants in our building. We also
have a thrift shop, again run by tenants in our building. Remember,
these are also retail jobs that are somewhat difficult for people,
particularly people who don't have great social skills. So one of
the things we did was develop something called Beadworks, a tenant-owned
jewelry design cooperative. People are paid by how much they work,
and we actually sell to high-end designers. These are tasks that
people can do in their rooms or in a group. It is very flexible,
and that has worked quite well. We are developing a decorative arts
program towards the same end. There are many people with very good
artistic talents. So the lobby of one of our buildings has been
registered as a gallery where we sell art. We have openings every
month, and that has been very effective.
Because businesses that are on-site and are run by the agency are
very intensive in terms of staff time, we have rented out commercial
space with a proviso that they hire twenty-five percent of their
employees from supportive housing, and we made that deal with Starbucks
and other businesses, and we are opening a restaurant that will
have the same deal. We also have contracts with the Business Improvement
District, which has been incredibly supportive to us.
We operate a business called Time Square Delivers, subsidized by
the BID, which picks up donations from people in the district and
delivers them to not-for-profits. Because this involves so much
driving, we have made a link to our commercial driving program and
people can graduate into that. We also run a laundry. We have some
agency specific training with a number of industries: Marriott Hotels
provide training and placement; Phoenix Recycling provides cleaning
of offices, training, and placement; and Home Depot offers placement.
Since they have a large number of stores or, in terms of Phoenix
Recycling, contracts, there are opportunities for very flexible
employment. There's a lot that people can do within that flexible
structure, and if they do well in these training programs, they
can move up the career ladder. These training programs are all run
in partnership with Common Ground, our employment program collaborator.
The other barrier to employment that I wanted to talk about involves
not just outcomes, but money. We have an entitlement specialist
as part of the jobs program and also as part of all our case management
programs so that we really keep on top of this to make sure that
people have all the information in order to make informed decisions.
An issue that has been of concern for us is medical insurance and
when people want to come off entitlements. We have been lucky enough
to get a grant from HUD that pays for medical insurance for a limited
amount of time as individuals come off entitlement. As we all know,
psychiatric medications are very expensive. It is unacceptable to
deny access to those medications when someone is starting employment.
As I mentioned earlier, the most important partnership in the jobs
program is the one with Common Ground. They do a lot of the development,
while we do a lot of the vocational services. We do the business
development together, and the most important thing is that we get
ideas from each other and can identify our differing perspectives
and where the barriers are. We also work with HUD and they provide
us with funding. The Division of Mental Health and the State Office
of Mental Health (OMH) have made a real commitment to fund employment.
Interestingly enough, OMH has put together a State VR (Vocational
Rehabilitation) /OMH Collaboration where, after the first six-month
period of job counseling and support funded by VR, OMH will pick
it up for persons with mental illness. People need help to get to
the next step; they need to know somebody is absolutely there for
them. We have also worked with the Corporation for Supportive Housing
(CHS), as part of Next Step Jobs initiative, to get some money,
but also to participate in a group that talks about employment opportunities,
much like what we are doing today, and that's has been incredibly
helpful.
Gary: Thank you so much. In listening to all three of you,
there are two things I see. The first is that there is no one cookie
cutter approach-- that the menu needs to be broad, wide and flexible-and
the second is a challenge to the traditional concept of readiness:
particularly presenting the option of work at the earliest opportunity.
III. Questions and Answer Session
Q:I am most interested in the cognitive remediation. How
would I find out more about it? Can Andrea talk more about that
right now?
A: Sure. The person's name is Alice Medalia and she's from
Nathan Kline (contact info for Dr. Alice Medalia: 718-920-7311,
e-mail: amedalia@aol.com).
She developed cognitive remediation from some of the cognitive work
that people have done with traumatic brain injuries, but found that,
especially with people who are schizophrenic and who people who
use substances, that the cognitive deficits were developmental as
opposed to all in one time, and they may not have had real strong
functioning before they developed the cognitive deficit. This program
is built around specific cognitive deficits that you develop around
late adolescence/early adulthood, addresses them, and helps people,
as I said, with focusing skills, transferring skills from one thing
to another, mediation skills, how to express themselves, and how
to negotiate. It has been very successful. The other thing I want
to mention is the tenants here absolutely love it and, because it
is all computer-based, they also develop a mastery on the computer,
and really feel good about that and what they are learning. It's
hard to get them out of the room at the end of the session, and
people really look forward to the next one. They are very proud,
which, to me would have been enough on its own. I mean, people's
faces light up when they go in there.
Q: We are a middle hospital and run a work therapy program.
We have just recently started doing what we call critical job skills--
a pre-employment class- and it is pretty successful. We also have
a definite need for literacy and have been looking for some adult-based
computer tutorials. Did you have a resource?
A: (Andrea) The computer-based stuff we are doing
is mainly around cognitive remediation and, again, I would be glad
to get you that information. We are also under contract with Laguardia
Community College's School of Continuing Education, which is developing
an employment contextualized literacy program designed to raise
people's literacy skills about two grade levels. It's a twenty-five
week course, nine hours a week, and that's really how we are addressing
it. We have got some computer stuff, but we are hoping that this
course-- because it is employment contextualized, and that's really
hard to find-- might be helpful to us. Once that's developed this
fall, we would be happy to share some of that information with people.
(Nancy) We found that computer programs don't work for our
customers. Most of those who have literacy issues are not comfortable
with computers. We do have a computer program and a literacy program,
but we've found that one-on-one tutoring and the classes that folks
take both in-house in community-based literacy programs, is what
really works for our residents. Also, I forgot to mention earlier
that one of the things we started in several of our buildings is
consumer-run book clubs, specifically Oprah Book Clubs. As many
of you probably know, Oprah Winfrey is in Chicago, so we are hoping
that once we get these Oprah Book Clubs up and running, that we
can go to Oprah and ask for some funding for our literacy program.
But people really like the book clubs, as well, and folks choose
what books they want to read and discuss.
Q: Although I am a consumer, I have my Masters and was asked
to teach a job club. On my first day, being all excited, I found
that all my clients were SSI people and had never worked. All my
lesson plans went down the drain.
A:(Andrea) I think that people on SSI will talk about
wanting a job, but especially if they have never worked, they may
not know how to develop a career plan. Sometimes you have to start
with that; and, if you can develop lesson plans around what the
career plans are, and help people develop their skills for the kind
of jobs that they want, even if that is far into the future, you
can begin to talk about interim jobs. You can begin to talk about
how they can apply those skills to other things. I think it is difficult
when people are first considering employment to do it as a structured
class unless that has really been identified as a skill that they
need to reach their goal. So it's sometimes helpful to talk with
them about what they want.
(Mollie) On that issue, I think most people who are on SSI
and have been all their lives, haven't had the experience of working,
or don't have a sense that that possibility is there for them. It's
not just on their side of the situation, but also on the side of
the employers. It isn't just a matter of the person being ready
to work; it's also a matter of the employers having the accommodations
for them to work, which allow some flexibility for when they are
not well, allowing for the insurance that they need, and all of
that. But this whole panel is about homeless folks who are mentally
ill. Since SSI is the only thing that has kept them above water
for so long, they need not just a class on careers, but the opportunity
to actually do hands-on work, which might be part-time for a long
period of time until they really gather the hope and courage to
go beyond that.
(Nancy) At Lakefront, we define employment broadly. Our
mission is to get people engaged, and we know that not everybody
who lives at Lakefront will hold down a conventional job. We want
people to have as much control over their lives as possible, and
so we don't define their goals for them. What we're working to do
is to get people engaged somehow, to get them involved. It is our
job to work with each tenant to identify short- and long-term goals,
and those goals may or may not include employment. So, for a number
of our residents, employment is not the goal today, but it may be
a foreseeable goal in the future.
Q: Is anyone doing direct placement of consumers when they
ask to go to work rather than put them on any other kind of training
path? Also, it sounds as if most providers are placing the mental
health consumers in agency-based positions as opposed to competitive
jobs, and we wanted some feedback about that.
A:(Mollie) At LAMP, most of our employment is agency-based,
and I have to say it seems a very realistic approach for us right
now. We are in a part of town, as I said, Skid Row, which is isolated
in itself and is sort of the bottom of the barrel. Most of the folks
that come into this area have been homeless most of their adult
lives. For the folks that are mentally ill, it's all compounded
with drug use, mental illness, and being homeless for all these
years. It's not like a whole bunch of folks are running down here
to ask for good employees, and so we are just trying to build a
foundation for folks to move along on, to reconstruct their lives,
both housing-wise and employment-wise so that they can, if they
can get to that place, move from here. A few have, but not many.
As I say, we work with a very severely mentally ill population,
and the doors aren't extremely open for them from our experience.
We are definitely working on that, but they can't account for all
these years of not being employed. Even our most talented skilled
people can't seem to get through those barriers so far.
(Nancy) We serve a very diverse group of folks here at Lakefront.
We have people who come to us with very little education, people
with graduate degrees, people with no work history, and people with
a great deal of work history. Our employment services are voluntary,
so, at a minimum, what we would do is to offer a career development
assessment, which provides us with some information on the individual's
work history, educational history, their skill sets, and potential
barriers to employment. We then give the individual an opportunity
to start identifying short and long-term goals. We would expect
all individuals who participate in our program to at least complete
that assessment, and then it's really up to the individual in terms
of the kinds of services they want. We do have a job bank and so,
if all that somebody wants is a job, and they are asking for assistance
in finding that job, we will assist them. Regarding agency-based
versus competitive positions, we don't make a clear distinction.
We don't have separate paths for our customers who have mental illness
and our customers who do not have mental illness. So there are folks
who we place in outside employment who do have mental illness.
(Andrea) We also don't really differentiate and will do
direct placement if that's what people want. If they have the skill
level for it, we will do a full assessment with the tenants themselves.
I don't think we do a lot of direct placement. Though I don't know
the numbers for people who are mentally ill, I know we do a lot
of competitive employment. It really depends, though, on exactly
what people want, and what their skill level is. We also do a lot
of work around ADA, get the adaptations that people need, and do
a lot of education around that, and I think that is really important.
Q:One of things we are trying to do in Iowa is to work out
some employment situations for mentally ill people. Your programs
sound great, but how did you get started? We are in the beginning
stages.
A:(Andrea) When we first got started, we didn't apply
for grants. Most of the grants I saw-- and this was about ten years
ago-- had a lot of time limitations, and I didn't want to make a
commitment to a time limitation that would box in either the tenants
or ourselves to meet a goal we weren't sure was appropriate. So
we got started out of our case management money, and that was very
helpful because it gave us all a chance to figure out the direction
we were going in. We had a lot of sessions with consumers in our
buildings and in our programs and continually asked them what they
wanted. I had mentioned before that we have a grant from HUD to
pay for medical insurance. That idea didn't come from us, but from
the people in our programs. So, basically, we bought ourselves some
time in the beginning. We just really diverted some of the funding
towards employment and really listened to people, and that's how
we built our programs. Eventually, we got other funding to build
from there. We also got together with groups of other providers
and talked to them about what they were doing.
(Mollie) We started with employment, once again, because
the consumer population was saying they wanted it. They wanted access
to jobs, and so we started creating them within our own agency because
that was a no-brainer. We could do that. There were street outreach
and advocacy jobs that we could offer folks, and then, of course,
we wanted to diversify, and that's when we started thinking about
starting our own businesses. And, yes, we did need some capital,
some money to start these businesses, particularly the commercial
laundry which involved a lot of equipment and expertise. We did
find a foundation that was willing to put up some of the first few
years of money to help us get started, but we sure had to show them
we knew what we were doing, and have a market plan on how we were
going to make it.
(Nancy) Our employment program was created much the same
way. We spent a lot of time talking with our residents to find out
what it is that they need from the organization, and employment
kept surfacing. We were finding that many of the issues that the
residents needed to be addressing-things like hygiene and developing
relationships with people-those kinds of things were getting addressed
through working on employment. I think Andrea mentioned she spends
a lot of time talking to other organizations. We do the same, and
we try not to duplicate services. We are working more and more in
a collaborative effort with other supportive housing organizations
so that we can concentrate on what it is that we do best, and let
other organizations provide services to our residents in the areas
where they are strong. So my suggestion would be to talk to other
organizations in your locale and see what's out there, and where
you might be able to develop some collaborations. In terms of funding,
we have depended pretty heavily on foundations when it comes to
covering the cost of our employment programs. We also have a grant
from the city.
Q:How did you handle employment support, and what steps
were taken to work with people once they were placed? Did you use
job coaching, job shadowing, or on-the-job assistance?
A:(Andrea) We have job coaches, and that's a difficult
position. Sometimes people don't want a job coach, and sometimes
they do. So we have a real flexible model of that. We also conduct
informal support groups, but I think the most important thing is
we really involve the case management staff in any program that
we are working on so that they can provide individualized support
to people. The question of whether to go on the job or not can be
very tricky. It is always important to have that available, but
sometimes that creates a really uncomfortable situation for people.
We also offer on-the-job training for supervisors, which has been
very helpful to us.
(Nancy) We don't do job shadowing, but we have job coaches
who work very closely, not only with our employee tenants, but also
with our case managers and property managers who are on-site in
the buildings. We have developed a number of relationships with
area employers, so we will be in regular contact with the tenant
and employer, when appropriate, to touch base, but we do not normally
go on the site.
Q:Do you know the maximum amount of what SSI recipients
are allowed to keep of their benefits once they earn wages?
A:(Andrea) Well, there are all sorts of changes in
Social Security with the Work Incentives Act. We would be happy
to send you something on that, if that would be helpful. (See
www.ssa.gov, 'Legislative Bulletin 106-11, 11/9/99 - Ticket
to Work').
Q:We were wondering, for all the agency-based placements,
how do the different parts of the agency manage the relationships
with consumers in staff roles? When they are in an employment role,
are they receiving case management services, and what policies,
or any other practices, have you developed to manage that role change
and support services effectively?
A:(Mollie) We have definitely structured some policies.
Like I said in my presentation, for the folks who are working part-time
and are still receiving SSI, we deliberately have a category called
Guest Employee for them, and there is a different statement of ethics
and confidentiality that they sign. The personnel policies, however,
for the agency apply to the Guest Employees in the same way as regular
employees. Many of our Guest Employees live in our facilities and
do receive case management and all the other services that we provide.
The distinction we make is that where they work is always a separate
site than where they live so that we can keep some of those roles
separate, but it's something you have to really work very hard at
and clarify. The weekly support group for Guest Employees really
helps with that because, when things get confusing, they get to
air that and have it straightened quickly. It's a constant education
process, and it's a challenge, but it's a good challenge.
Q:Is that time limited, those Guest Employee jobs?
A:(Mollie) No. One can be a Guest Employee for years.
We have got some who have been Guest Employees for nine years because
they choose to stay in part-time employment and subsidize their
SSI rather than take the plunge into full-time employment.
(Andrea) We also try not to hire people at the same site
they are living at and also try to keep the differentiation. I mean,
case management is case management, and employment should be employment.
It's always tricky, the supervision role, particularly in social
services, to keep it absolutely to employment. Frankly, I think
it's really the same issue. It can be intensified when you hire
people who are in your own programs or housing, but you really need
to keep those roles separate. We also do some training on confidentiality
and have tried hiring people in the same building, but that's very
difficult for the other tenants in the building. So, we're finding
we really need to separate those issues in order to do a good job.
(Nancy) Currently, thirty percent of Lakefront staff are
tenants or past tenants, and I feel very strongly about that. It's
very important for us to have hired residents, especially in employment.
Folks who are tenants or past tenants become mentors for other residents
and can reach tenants in a way that those who are non-residents
just can't. The issue of confidentiality has come up, and we do
not actually have a strict policy right now regarding tenants not
working in the building where they live, but it is something that
we are reviewing. I think the benefits far outweigh the problems.
We also do training on confidentiality, and I agree with everyone
that it can be tricky, but our residents who aren't employees are
such an asset to the organization that I really can't see it running
any other way.
Q:This is a quick question for Mollie. What does LAMP stand
for?
A:(Mollie) LAMP, when it was first established, was
the Los Angeles Men's Place, but in 1987, two years into operating,
we changed it to LAMP because we were serving women as well as men.
So it has been LAMP ever since.
Q:Is there a standardized assessment tool that you use to
determine someone's employability? I know we get a real subjective
view from our clients, but we often find that what they tell us
isn't necessarily in agreement with what their abilities are.
A:(Andrea) We have an assessment tool that's standardized
for our program. It's not standardized for anything else, but we
would be happy to make that available to you.
Q:We come from a small mental health center, and we hire
our own consumers from case management to janitorial positions.
We have been in touch with the Village in Long Beach and I just
wondered if the folks that you have there, do you have time limitations
on some of the jobs and then look more to community outcomes, or
is that part of your curriculum now?
A:(Andrea) We do have limitations. As Nancy had said,
it's important to have flexibility, so we have all sorts of jobs.
We have some that are not time limited, and we have some that are.
One of the things we're moving towards, even in our case management
services is-- in our new housing, for instance-that we don't have
any groups. Groups tend to go on forever. What we have instead are
classes where the curriculum is available up front and people know
exactly what they are going to get out of it. We are definitely
moving towards more outcome-based services where the people who
participate are able to choose the outcome they want, and can see
the steps towards it. I also think it is important to have some
non-time limited slots where people can really stay there for a
long period of time if they need to do that, and that's something
that, for instance, OMH and VESID (our State VR) have really worked
together to provide us with. So I think you need both. That's my
personal opinion.
(Mollie) I feel real strongly that, for people who have
been homeless for a very long time, their lives, even when they
are in treatment, are transient. They are moving from program to
program and place to place, and providing them with a job that isn't
time limited really matters to them. They really sink their teeth
into it and get a lot of pride out of being there. I have been doing
this job for five years. It is really important to me that I can
say that. They get lots of rewards for doing that, and it's about
just building this foundation under them that they can really move
from if and when they are ready.
(Nancy) I think, from Lakefront, none of the jobs that
we make available are time limited. People can, once they are employed,
stay in a position as long as they feel comfortable, as long as
they meet the minimum qualifications and perform in their positions.
Q:We heard LAMP talk about harm-reduction and not having
any prerequisites around sobriety. We would be interested in hearing
what Lakefront and CUCS do with that in terms of employing people.
A:(Nancy) At Lakefront, if we know that somebody
is actively using, and if the individual wants a job, we will assist
them in getting a temporary job, but we will not assist them in
getting a permanent position until they are actively addressing
recovery issues. We do that for a number of reasons. One is that
we are regularly developing relationships with employers and we
value those relationships. We work very hard to find the right fit
for individuals, and we want people who are moving into permanent
positions to have some sense of security that they will not burn
bridges and that they will be reliable. So, I guess that's mainly
the reason why we would steer somebody who we know is actively using
to a temporary position.
Q:Could each of you talk just briefly about your relationship
in partnering with your state offices of vocational rehabilitation?
What have been some of the challenges and some of the successes
in getting vocational rehabilitation support for the consumers you
are serving?
A:(Mollie) We haven't had much success. A few of
our folks have gone through their program and gained some ground
in terms of getting training, but not actually job placement. In
terms of getting involved with voc rehab for our businesses and
getting some kind of subsidized help, we didn't find that they had
the flexibility that we needed in order to employ this population
effectively. You had to be on a continuum that was exact. The intent
had to be career and most of our folks are not on that career path.
(Nancy) We haven't had much success, either. There are a
limited number of folks who go through a janitorial training program,
which is run through the state's Department of Rehabilitation Services.
We, too, have found that the program is rather inflexible for our
residents, and our residents are, for the most part, I think, somewhat
distrustful of large, bureaucratic organizations.
(Andrea) I think you have to look at the intake criteria
and what people are able to provide, and the time frames, as we
said, when you are looking at funding. We have had a lot of luck
with our state VR (VESID), and one of the things that really improved
our ability to use VESID is the partnership that they formed with
OMH to provide ongoing support to people over a period of time.
I think those kind of partnerships are very important, and the fact
that OMH is really pushing employment has been a big help to us.
IV. Closing Remarks
Our thanks to Mollie, Nancy, and Andrea for a job well done, and
also to Mike English and Mike Hutner for your remarks and comments.
Please note that AHP, as a PATH technical assistance contractor,
has the ability to provide a limited number of teleconference-based
assistance sessions to PATH providers in your state, as Dr. Hutner
indicated earlier. If you'd like to schedule a technical assistance
teleconference on employment as a follow up to this call, please
contact me, Gary Shaheen at (518) 453-2255, extension 243. Our thanks
to everyone in the PATH network across the United States for joining
us today.
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