Eventual fate of Supported Employment .

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Future of Supported Employment. Bob Drake Sainsbury Centre March, 2008. The President’s New Freedom Commission Report (2003). “The main goal of the mental health system is to help people to live, learn, work, and participate fully in their communities”
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Eventual fate of Supported Employment Bob Drake Sainsbury Center March, 2008

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The President\'s New Freedom Commission Report (2003) "The primary objective of the emotional well-being framework is to individuals to live, learn, work, and take an interest completely in their groups" Mike Hogan (2006): "Work is the most direct stride to recuperation" "Upheld job is the best system to individuals accomplish their occupation objectives."

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Overview Current Status of SE Limitations of SE Current Research on SE Thresholds-Dartmouth Center

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Current Status of SE model is straightforward and successful Other advantages accumulate with predictable Work results enhance after some time SE is moderately simple to execute

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IPS Supported Employment Competitive job Team approach Client decision in regards to timing Benefits guiding Rapid occupation look Job coordinating in light of customer inclinations On-going backings Becker (IPS Fidelity Scale, 2008)

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CT Supported Employment Study (Mueser, 2004)

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Impact on Other Outcomes Improved self-regard, side effect control, personal satisfaction Related to managed aggressive job No progressions with maintained shielded livelihood (Bond, 2001)

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Long-Term Outcomes 4 studies with 10-year subsequent meet-ups (Test, 1989; Salyers, 2004; Becker, 2006; Bush, in prep) Work results enhance after some time Costs diminish drastically for reliable laborers (Bush, in prep)

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National EBP Project 5 confirm based practices: SE, IMR, FPE, ACT, IDDT 53 destinations in 8 states Programs studied for a long time

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Johnson & Johnson-Dartmouth Project Mental wellbeing professional recovery joint effort actualize confirm based SE Local projects chose by states Dartmouth gives preparing, conference, and assessment First states: CT, DC, KS, MD, OR, SC, VT New states: IL, MN, MO, OH (Drake, 2006)

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J&J-Dartmouth Project

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Limitations of SE Many don\'t express enthusiasm for SE Many in SE don\'t accomplish steady business Consistent specialists in SE don\'t work all day

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1. Absence of Interest in SE Expectations Benefits trap

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8-12 Year Follow-up: Day Treatment to SE 71% working at follow-up 85% in aggressive occupations 71% worked more than half of FU 90% as yet accepting advantages (Becker, 2006)

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Early Intervention First scene psychosis (Neuchterlein, 2005) SSA: change settling process SSA: quickened benefits Health protection

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Early Intervention (Neuchterlein, 2005)

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Motivation People fear losing benefits (NAMI, 2003) Benefits guiding Motivational directing Contingency administration

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Benefits Counseling (Tremblay, 2005)

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Motivational Interviewing Counseling to elucidate objectives, Resolve inner conflict, And improve inspiration (Drebing, 2006)

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Contingency Management Behavioral standards Reinforce wanted practices Attendance, diminished substance mishandle, work discovering errands Initial results constructive (Drebing, 2006)

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Benefits Reform People are associated into inability Changing advantages structure key

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Policy Changes People with handicaps require money, medical coverage, and an occupation They don\'t should be doled out to a lifetime of unemployment and neediness keeping in mind the end goal to get medical coverage Legislative change is basic Carl Suter, CSAVR (2006)

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Current Initiatives National health care coverage Experiments with Social Security Administration controls Temporary help and stretched out advantages with comes back to work

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2. Conflicting Employment Only 33% get to be predictable specialists 33% don\'t turn out to be aggressively utilized 33% don\'t get to be reliable laborers

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Efforts to Improve SE Address indication obstructions Improve work advancement Improve work underpins Improve vocation improvement bolsters

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Social Security Administration Mental Health Treatment Study RCT in 22 urban areas 3,000 SSDI recipients Interventions Insurance bundle IPS upheld business Systematic drug administration EB psychological well-being practices Medical care (Frey, 2008)

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Addressing Cognition Concentration, memory, response speed, and critical thinking Job coordinate Improve intellectual capacity Compensatory procedures (McGurk, 2008)

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Cognitive Training Practicing subjective assignments may make new neuronal associations Tasks straightforwardly applicable to work errands New limit may mean work (McGurk, 2005)

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Medications MATRICS consider Cognitive prescriptions for schizophrenia Will they affect working? (NIMH, 2007)

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Improve the SE Model Job discovering Variability in styles and victories Job underpins Skills preparing while working (Mueser, 2006; Marder, in prep) Individualized occupation bolsters Errorless learning (Kern, in press)

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Career Development Long-term examines Supported instruction Disability arrangements Career directing

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3. Low maintenance Work Disability Reforms Insurance changes

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Thresholds-Dartmouth Center 6,000 customers for every year Recovery focus Multiple convention decisions 90% cooperation objective Electronic choice emotionally supportive networks

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Conclusions SE has made seek after for individuals with psychiatric incapacities, their families, and MH/VR professionals Outcomes can be improved further New research Policy changes

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Hoyt Alverson Marianne Alverson Deborah Becker Gary Bond Phil Bush Robin Clark Bob Drake Laura Flint Paul Gorman David Lynde Greg McHugo Susan McGurk Kim Mueser Doug Noordsy Michelle Salyers Sarah Swanson Will Torrey Rob Whitley Rosemarie Wolfe Haiyi Xie Dartmouth SE Team

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Updates on SE Psychiatric Rehabilitation Journal Spring, 2008, unique issue on SE Supported Employment: A Practical Guide for Practitioners and Supervisors (Swanson, 2008)

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Information: books, recordings, investigate articles Karen Dunn Karen.Dunn@Dartmouth.edu 603-448-0263 http://dms.dartmouth.edu/prc

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