Slide 1: Improving Employment Outcomes for Individuals with 
Psychiatric Disabilities - Part 4
Career Exploration, Development and Planning for Consumers with SMI --Part 1
Charles Bernacchio, Ed.D., CRC
Eileen J. Burker, Ph.D., CRC
University of North Carolina at Chapel Hill 
Consultants:  
Bonnie Schell, Consumer Affairs Project
Obie Johnson, BA/QMHP
Laurie Coker, Director of NC CANSO
February 2, 2012
Slide 2: Work & People with SMI
•	4 to 5 million adults have severe and persistent mental illness
•	Only 10 to 30% of these adults are employed
•	When compared to other individuals with disabilities, those with SMI are less likely to achieve successful rehabilitation closure rates in the state VR system.
•	Research also shows that persons with SMI want to work.
Slide 3: Vocational Functioning in Persons with SMI
	“While symptoms and deficits lead to functional impairments, merely knowing a person’s particular symptoms or deficits provides little information about a person’s unique functioning or specific goals.”
(Anthony & Farkas, 2009, p. 15)
Slide 4: Rehabilitation Readiness is…
	….someone’s intent to find employment, not someone’s ability to work
(Roberts & Pratt, 2010)
Slide 5: 5 Assumptions of Rehabilitation  Readiness (Roberts & Pratt, 2010)
•	Readiness describes intent, not ability
?	Readiness is related to a person’s willingness to engage in the rehabilitation process.
•	Readiness is not static
?	It changes over time b/c of illness, personal circumstances.
•	Readiness is related to an environment (living, learning, working)
?	Just because someone is ready to change her living environment doesn’t mean she will be ready to change her work status.
•	The person should be involved in the process of assessing his/her readiness
?	The perspective of the person being assessed must be included
•	Readiness shouldn’t be used to deny services to someone with SMI, it should be used to select services
?	Someone with low readiness should get services designed to help develop readiness towards vocational goals.
Slide 6: Rehabilitation Readiness…
“Rather than being used to screen out individuals from employment services, readiness assessment should be used to identify which services will be most helpful in moving people toward successful employment” 
(Roberts & Pratt, 2010, p. 53.)
Slide 7: Assessing Vocational Functioning in Persons with SMI -1
Accurate vocational assessments of persons with SMI can:
•	help design rehabilitation to match consumers’ strengths and limitations to improve work performance and outcomes 
•	Enhance EBP in vocational rehabilitation to better serve consumers with SMI   
(Peer & Tenhula, 2010).
Slide 8: Assessing Vocational Functioning in Persons with SMI -2
Two methods of assessing vocational functioning:
1.	Work-based performance measures
?	Work samples or standardized tasks designed to assess job skills such as:
?	Circuit Board Assembly
?	Interpersonal interactions with a supervisor
2.	Situational assessments
?	Directly observing a person in a natural or simulated work environment
?	Accuracy of work performance
?	Response to supervisor feedback
						(Peer & Tenhula, 2010).
Slide 9: Assessing Vocational Functioning in Persons with SMI - 3
Work samples and situational assessments were designed to predict:
•	work performance in a specific setting or
•	the potential to benefit from rehabilitation
Information obtained through these assessments can:
•	increase VR counselors’ awareness of cognitive or interpersonal challenges on the job. 
•	improve job placement and job supports, thus improving employment outcomes.
•	provide information about client strengths and weaknesses that can be merged with vocational interests resulting in more employment possibilities. 
•	provide job performance feedback to clients (Peer & Tenhula, 2010).
?	Accurate feedback resulted in improved job performance in persons with SMI  (Bell, Lysaker, & Bryson, 2003).
Slide 10: Measures Developed for Persons with SMI - 1
•	There are 12 situational and performance-based measures of vocational functioning developed for persons with SMI.  
•	They fall into 3 categories.  
?	Multi-Domain Situational Assessments
?	Single-Domain Situational Assessments
?	Performance-Based Measures
•	They all have pros and cons, and there is no gold standard. 
(Peer & Tenhula, 2010).
Slide 11: Measures Developed for Persons with SMI - 2
Multi-Domain Situational Assessments: 
The most practical type 
•	Griffiths Work Report
•	Thresholds Monthly Work Evaluation Form
?	time efficient for routine vocational assessment
•	Work Behavior Inventory
?	provides the strongest situational assessment
?	comprehensive and has high reliability and validity
?	may create a time burden for VR counselors
•	Work Behavior Checklist
•	Generic Work Behavior Questionnaire
?	time efficient for routine vocational assessment
•	Occupational Abilities and Performance Scale  (Peer & Tenhula, 2010).
Slide 12: Measures Developed for Persons with SMI - 3
Single-Domain Situational Assessments:
•	Work Adjustment Skills Scale
•	Interpersonal Skills Scale
?	most comprehensive, assesses 14 items related to work-based social skills
?	has good psychometric properties
•	Vocational Cognitive Rating Scale
?	Most comprehensive assessment of work-related cognitive challenges
?	Has good psychometic properties
			(Peer & Tenhula, 2010).
Slide 13: Measures Developed for Persons with SMI - 4
Performance-Based Measures:
•	Work Capacity Evaluation
•	Work Related Social Competence Role Play Task
•	Maryland Assessment of Social Competence Vocational Scenes
(Peer & Tenhula, 2010).
Slide 14: High Outcome Employment Programs (Gowdy, Carlson & Rapp, 2004)
Beliefs & Viewpoints
•	Emphasize possibility and value of work
•	Mitigate societal stigma as major barrier to program performance
•	Expect the consumers want and are motivated to work
•	Potential loss of benefits is seen as need for info, and negotiable but not a major barrier 
Slide 15: Advantage of Networks
•	Roughly, 60-70% of job market is “hidden” so openings are never advertised
•	Search must work through someone’s personal, community and organizational connections
•	Use of networking among CRPs serving consumers resulted in higher wages, greater no# of hours worked and shorter length of time on job search 
(Temelini & Fesco, 1996)
Slide 16: Use of Networks
•	Job seekers with disabilities need to use their own networks, as well as those of CRP staff who work with them
•	Getting a job (or the chance to be considered) is often a matter of having connections
•	Employers often leave using ads as a last resort after “feeling out” leads through networks for people who are known entities (by contacts)
Slide 17: Network Connections
Personal
•	Family, friends, neighbors; volunteering; past employers; and former co-workers 
•	Organizational
•	Board of directors, contractors and suppliers,
•	employer advisors, food service, security, banking, teachers and classmates, and grounds keeping services
•	Other professionals 
Slide 18: Community Network Connections
•	Church, temple or mosque
•	Chambers of Commerce
•	Clubs and associations/affiliations
•	Local services, stores and banks
Slide 19: Benefits of Network Contacts
•	Seeker has credibility thru known relationship
•	Connection draws attention to applicant who would otherwise be overlooked
•	Gleans important info on history of employer, who to approach, business needs and hiring preferences
•	May prevent “screening out” and bring closer to hiring manager for the job
•	Makes easier to request support when hiring and afterwards when a connection is made
Slide 20: Career Development Approaches - 1
Consider potential skill gaps
•	ID interests & abilities
•	ID occupations that relate to interests & abilities
•	Evaluate occupational alternatives based on personal values
•	List more than 1 work alternative
•	Develop a career plan/goal
•	ID symptoms that hinder career activity
Slide 21: Career Development Approaches - 2
Activities occurring within agency
•	Reading about occupations
•	Discussing/clarifying past experiences and current preferences
•	Collecting info from family members and friends
•	Interpreting standard voc. interest and aptitude tests
Slide 22: Career Development Approaches - 3
Moving to community to gather info
•	Research jobs in library or one-stop career centers
•	Shadow or talk w/ workers doing jobs
•	Observe when possible the actual jobs as they’re being performed
•	Help arrange for informational interviews (often used w/ professional level jobs)
Slide 23: Career Development Approaches - 4
Time-consuming, and invaluable to long-term plans
•	Try out targeted jobs (situational assessment), e.g., use of TEP is often exploratory
•	Analyze experience for skill and fit, even in temp job
•	Use info to make subsequent decisions
•	Unpaid or volunteer experiences may be used provided they follow DOL guidelines
Slide 24: Career Development Approaches - 5
Help the consumer to process and make use of all the information and experiences being gathered to make sound decisions about the vocational goal and plan.
Slide 25: Career Development Approaches - 6
Peer experience/expertise for support & information
•	Use support groups focused on career dev. process and goals for consumers
•	Introduce to peers who now work to provide valuable encouragement and feedback to consumers
•	Expose to job clubs and employment dinners which recognize working consumers
Slide 26: What is WIPA?
History
•	Work Incentives Planning and Assistance (WIPA) is the result of the Ticket to Work and Work Incentives Improvement Act of 1999.
•	The Social Security Administration called for states to file applications to provide Work Incentives Planning and Assistance to people who receive either Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or both.
http://www.ssa.gov/work/wipafactsheet.html 
Slide 27: Who is Eligible?
You are eligible if:
•	You receive SSDI and/or SSI cash benefits due to a disability.
•	Are working or planning to work.
•	Are in school or plan to further your education in order to work.
•	Are between the ages of 14 and 64.
Slide 28: Federal Benefit Rate
•	There is a maximum dollar amount set by Congress that individuals or couples can receive in SSI cash benefits each month.
•	The maximum monthly benefit amount received is based on:
?	Unearned income,
?	Earned income,
?	Living arrangements and in-kind support, and 
?	Use of available work incentives such as IRWE, BWE, and PASS.
?	The Federal Benefit Rate for an individual is $698 and $1,048 for couples.
Slide 29: Resource Test
The SSI Program has specific resource limitations set by statute and
include real or personal property (including cash).
•	Limits -- $2000 single/$3000 couple.
•	Limit cannot be exceeded at the beginning of each month.
•	Resources in excess will render individuals ineligible for SSI cash benefits.
•	Ineligibility will continue until resources fall below allowable limits.
•	Eligibility will cease if excess continues for 12 consecutive months.
Slide 30: SSI Work Incentives
SSI:  Supplemental Security Income
•	PASS (Plan To Achieve Self Support)
•	IRWE (Impairment Related Work Expense)
•	1619B
•	Student Earned Income Exclusion (SEIE)
•	Blind Work Expense (BWE)
•	Expedited Reinstatement of Benefits
http://www.socialsecurity.gov/disabilityresearch/wi/generalinfo.htm#work
Slide 31: Social Security Disability Insurance (SSDI)
Social Security Disability Insurance (Title II)
Entitlements are based an inability to perform Substantial Gainful Activity (SGA) due to being medically disabled  (In 2012- $1,010: non-blind; $1690: blind)
?	Benefit amount is based on credits earned in Social Security from working
?	Not based on economic need
?	Benefit amounts vary from person to person
?	Must have insured status
?	Need 20 credits in the 10 years prior to onset of disability
?	Those disabled prior to 31 need less to qualify
?	Possible to earn up to four credits per year
?	Entitled to Medicare coverage 
Slide 32: SGA Rule
Annual increase from previous year’s amount based on national wage index.
	Effective January, 2012:
•	$1,010.00 
•	$1,690.00 Blind
Slide 33: SSDI Work Incentives
SSDI:  Social Security Disability Insurance 
•	Trial Work Period
•	Extended Period of Eligibility
•	IRWE (Impairment Related Work Expense)
•	Subsidy
•	Extended Medicare
•	Expedited Reinstatement of Benefits
http://www.socialsecurity.gov/disabilityresearch/wi/generalinfo.htm#work 
Slide 34: References - 1
Bell, M.,Lysaker, P.,  & Bryson, G. (2003).  A behavioral intervention to improve work performance in schizophrenia: Work behavior inventory feedback, Journal of Vocational Rehabilitation, 18, 43-50. 
Gowdy, E., Carlson, L. & Rapp, C. (2004). Organizational factors differentiating high performing from low performing supported employment programs. Psychiatric Rehabilitation Journal, 28 (2), 150-156.
Hoff, D., Gandolfo, C., Gold, M. & Jordan, M. (2000). Demystifying job development: Field-based approaches to job development, St. Augustine, FL: Training Resource Network.
Slide 35: References - 2
Howton-Ford, L. (1995). Providing employment support for people with long-term mental illness, Baltimore, MD: Paul H. Brookes Publishing Co.
Marrone, J., Gandolfo, C, Gold, M. & Hoff, D. (1998). Just doing it: Helping people with mental illness get good jobs. Journal of Applied Rehabilitation Counseling, 29, (1) 37-48.
Peer, J.E., & Tenhula, W. (2010). Assessment of Vocational functioning in serious mental illness:  A review of situational assessment and performance based measures. Journal of of Vocational Rehabilitation, 32, 175-189. 
Slide 36: References - 3
Temelini, D. & Fesko, S. (1996). Shared responsibility: Job search practices from the consumer and staff perspective, Research to Practice, ICI, Boston.
www.ssa.gov/work
www.socialsecurity.gov/disabilityresearch/wi/generalinfo.htm#work
www.socialsecurity.gov/pressoffice/factsheets/colafacts2012.htm
www.passplan.org
www.vcu-ntc.org/index.cfm
www.disaboomjobs.com/career-resources
Slide 37: Comments & Questions
Slide 38: Contact Information
Charlie Bernacchio
Assistant Professor, Coordinator Rehabilitation Counseling - University of Southern Maine
Email: charlieb@usm.maine.edu? 
Eileen Burker
Associate Professor/Director, Rehabilitation Counseling & Psychology- University of North Carolina at Chapel Hill
Email: eileen_burker@med.unc.edu
Slide 39: Upcoming Webinars
Improving Employment Outcomes for Individuals with Mental Health Disabilities 
•	March 9– Career Exploration, Development and Planning for Consumers w/ SMI – Part 2
•	March 30 – Job Development, Placement & Support Strategies for Consumers w/ SMI
•	April 17 – Job Development, Placement & Support Strategies for Consumers w/ SMI – Part 2
Slide 40: Education Credits
CRCC Credit - (1.0)
Approved by Commission on Rehabilitation Counselor Certification (CRCC) 
•	By February 10th, participants must score 80% or better on a online Post Test and  submit an online CRCC Request Form via the MyTACE Portal.
My TACE Portal: TACEsoutheast.org/myportal
Slide 41: THANK YOU!
Slide 42: Southeast TACE (Region IV)
Toll-free: (866) 518-7750 [voice/tty]
Fax: (404) 541-9002 
Web: TACEsoutheast.org
My TACE Portal: TACEsoutheast.org/myportal
Email: tacesoutheast@law.syr.edu
Slide 43: Disclaimer
This presentation was developed by the 
TACE Center: Region IV ©2011 with funds from the U.S. Department of Education, Rehabilitation Services Administration (RSA) under the priority of Technical Assistance and Continuing Education Projects (TACE) – Grant #H264A080021. However, the contents of this presentation do not necessarily represent the policy of the RSA and you should not assume endorsement by the Federal Government [34 CFR 75.620 (b)].