NWX-SAMHSA CMHS

Moderator: Maureen Madison
August 14, 2012
2:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a listen-only mode until the question-and-answer session.

Today's conference call is being recorded. If anyone has any objections you may disconnect at this time.

And now I'll turn the call over to Maureen Madison. Thank you and you may begin.

Maureen Madison: Hello and welcome to The Role of Employment in Recovery and Social Inclusion: An Integrated Approach.

Today’s webinar is sponsored by the Substance Abuse and Mental Health Services Administration’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health, also known as the ADS Center.

SAMHSA is the lead Federal agency on mental health and substance abuse and is located in the U.S. Department of Health and Human Services. Please join the ADS Center listserv to learn more about social inclusion, including upcoming webinars, new resources, and events.

This webinar will be recorded. The presentation, audio recording, and a written transcript will be posted to SAMHSA’s ADS Center Web site at http://www.promoteacceptance.samhsa.gov in mid-September.

The views expressed in this training event do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

Our presentation today will take place during the first hour and will be followed by a 30-minute question-and-answer session. During that time, please press star 1 on your telephone to ask a question.

You will enter a queue. And you will be invited to ask your question in the order in which it is received. Upon hearing the conference operator announce your first name, please proceed with your question.

Due to limited time we may not get to all questions. If your question is not answered or you want further information, the presenters’ contact information is provided at the end of this presentation so you can contact them directly.

At a time when the unemployment rate among the general population is about 8 percent, more than 70 percent of people with mental disorders are unemployed despite the fact that most people with mental health and substance use issues want to work and have valuable skills to contribute to the workplace.

We know that unemployment is detrimental to both physical and emotional health. And this is true whether or not an individual has a mental health or substance use disorder.

Increasingly, research has shown that in fact, work is positive and rehabilitative. Employment is one of the single best ways to ensure social inclusion, economic independence, and recovery.

Gainful employment consistent with an individual’s skills and interests plays a central role in promoting financial independence, individual recovery, wellness, and overall social inclusion.

Therefore, it is imperative that the long-standing significant disparity in employment rates among people with mental health and substance use disorders compared to the general population be addressed in order to achieve social inclusion.

We see remarkable employment successes when service providers, public officials, and peers work together to create empowering policies and programs, integrated and creative funding streams, and networks of support.

The SAMHSA ADS Center works to increase awareness and support implementation and replication of socially inclusive practices, programs, and policies.

Our speakers will share information and resources that can be used to support people with mental health and substance use disorders in securing the meaningful work and social supports necessary for continued success in the workplace.

The information will also inform professionals, public officials, and other stakeholders about building successful collaborations, overcoming policy and funding barriers, and implementing programs that are making a difference and contributing to a more inclusive society.

Our first presenter today is Dr. Virginia Selleck, Chief Clinical Officer for Places for People in St. Louis, Missouri. Prior to assuming this position last month, Dr. Selleck spent 5 1/2 years as the Director of the Office of Transformation and Clinical Director for the Comprehensive Psychiatric Services Division of the Missouri Department of Mental Health where she worked with division staff and community stakeholders to create policies, practices, and technical assistance methods that led to enhanced recovery outcomes for people with serious mental illness.

Dr. Selleck has worked in the rehabilitation field for over 30 years and has a wide variety of experience in program development, implementation, mental health grants management, and policy analysis.

Dr. Selleck will be speaking about the adverse effects of unemployment on people with mental health and substance use disorders and the role that employment plays as a recovery strategy, and the tools available to help States successfully address the policy and funding challenges associated with integrating employment and rehabilitation services that serve people with mental health and substance use issues. Thank you so much for joining us Dr. Selleck.

Virginia Selleck: Thanks. I’m happy to be here. And I am looking forward to this day. I’m wanting to dive in here from the Show-Me State. And I’m also, people that are looking at this, having difficulty advancing the slides. So whoever can help me with that at the main level, there we go. Okay great.

Anyway, I’m sorry for the awkward beginning. The key point that I really want to make is that on the whole, unemployment is bad for people. It’s bad for all people. And it’s pretty much well known and agreed to in the general life that people who are unemployed and don’t—and want to be employed suffer from a wide variety of side effects in the general population.

And this slide kind of goes over some of them: increased substance abuse, increased physical problems, increased psychiatric disorders, reduced self-esteem, loss of social contacts, and so forth.

There’s been lots of articles in the popular press in the recent economic downturn about this. And we all know in our own personal lives that if a friend loses their job, we are sad about this. We see this as a bad news type of a thing.

When you look at side effects, and again if you’d please advance the slide, the effects of unemployment for people with mental illnesses are the same as for individuals who do not have mental illnesses.

As it turns out, and our colleague Joe Marrone is a good proponent of this, and I’ve basically borrowed a few of his comments here that—and you’ll find his work in the resources—succinctly it can be said that for people with mental illness, unemployment is worse for your mental health than the stresses of employment, that getting a job quickly is more likely than just planning about it to lead to a career, and that unemployment is a way to meet people and expand social networks. If you think about where you met your own spouse, your friends, where you get tips about your city or your town, employment is a way that embeds all of us into the larger world at large.

The other key thing about this that we don’t ever want to forget is that relying on Supplemental Security Income, Social Security disability, or other public benefits essentially really leaves people in poverty.

It is true that it is a wonderful thing that we have a social safety net that permits people to get some medical benefits and have a stipend to live. But it is not what anyone wants for their lives to be living in that level of poverty. Employment helps raise people from that. Please advance the slide.

Unfortunately, even though it is pretty well understood that unemployment is a harmful thing for people in general, and we are now beginning to really understand that employment, as we’ll talk about later in this presentation, is really a value for people, and helps people with their recovery, there’s been pretty poor performance of the mental health system overall in terms of employment outcomes. This slide here demonstrates the results of status reports that were sent in to the Federal Government around the employment statistics for adults with serious mental illness.

You can see that the overall employment rate when this last data run was done in 2008 was that basically there’s only about 21 percent of individuals with serious and persistent mental illness in the public system reporting who are employed.

And you can see there the ranges of the dates, I mean of the age ranges. It’s a little different depending on what age range you’re in. So hold that thought and please advance the slide.

And now we can see that, think about what we said before about the hard troubles that people have when they’re unemployed, the difficulties that accrue to individuals’ mental health and social connections and basic disillusion with life whenever you are unemployed. Hold that thought.

Now look at this research that has come to us in the last several years looking at the mortality that is associated with mental disorders. This piece of work was done and led by the groups there on the bottom of the screen.

And our Joe Parks here in the State of Missouri has been very formative in doing some of this work and collaborating. And you can see that in the number of States that were examined that people have lost an average of 25 to 30 years of normal life span associated with mental disorders.

And these loss of lives are not due to things specific to the mental illness, but to the consequences of mental illness in terms of poverty and other physical health disorders. Please advance.

You ask yourself, or at least I do, whether or not those facts are connected. We have shockingly high rates of unemployment for people with disabilities. And we are very aware of the bad effects of unemployment. And we also have high mortality rates with people who have these disabilities.

Lots of evidence exists about the deleterious effects of health on unemployment generally. So what in the world do we do about this? Please advance.

The first thing we can do about it is change our mind. We have in many cases, especially those of us who are old—and you heard my biography—you can hear that I’m old as the hills and have been doing this work for many years.

For a long time there was the thought that work was too stressful. That we were hoping to help people with serious mental health problems to stay calm and not become stressed. And that work would provide stress, and there was a belief in the social service field that we were doing people a favor basically by helping them only be calm and only look for maintenance and stabilization.

But as with many other fields of medicine and endeavor in life we know that we have to change when new evidence comes about and we learn. And especially we have learned from those individuals we serve, from their own voices that work, very much, is important to recovery. And that work helps with recovery. And we have now evidence that people can and do work.

If you will please advance the slide, you will see that re—there’s a quote here from Larry Davidson, which I think is very succinct and puts it well. Which is that recovery-oriented practice reverses the conventional wisdom that people become less symptomatic first before trying to return to work.

And that work reduces symptoms while sustained unemployment and activity—inactivity do not. The point here is we don’t want to wait until every single symptom has passed in order to say okay, now it’s time to start thinking about work because for many, many people working helps to remediate those disagreeable symptoms.

Okay, pass that through, or pass the slide. So you might say to yourself okay, if that’s all true, why on earth, you know, haven’t we moved forward and done something faster about helping with getting people to work?

And I think it’s important that everyone should understand that there have been barriers to doing this, and that the barriers are in part rooted in those historical beliefs.

The field has new knowledge now, and we need to look at remediating the barriers. I want to outline here three primary barriers, and I’m sure many of you can think of others.

One of the barriers has to do with the funding of our social services in general, and that overall pretty much there has been a prohibition under the Medicaid Rehabilitation Option, which is one of the primary funders of mental health services, of funding hard employment services.

By hard employment services I mean those things that are not directly connected to illness management but are more about beating the bushes and speaking to employers. And helping with things that are not directly associated with an individual in particular that you can hook to their treatment plan.

That has been a barrier. Another barrier is that assumptions—and this is a big one—assumptions that, erroneous assumptions that the vocational rehabilitation system has the sufficient resources to support the needs. They essentially do not have enough money to serve all the individuals with serious mental illness who could benefit from those kinds of supports.

The third barrier, which is located both within the persons we serve and the persons ourselves attempting to help these individuals, is the Byzantine system of Social Security, Medicaid, and housing subsidies.

These are helpful programs, but they are extremely complex. And those of you who are working in this field or who are receiving these benefits are very keenly aware of this and very difficult to get, and people are very fearful in many cases about losing benefits because they do not want to be pushed back into even more poverty than they’re already in. So people are needing very careful assistance to get past that particular barrier.

If you would please advance. So policy makers, as I have been for many years and worked with many others, can rant and rave all day about how good it is to help people get employed, but if the policies don’t provide providers resources with which to do the work, they’re unable to do it. This quote here is one of my all-time favorites. Upton Sinclair was a muckraking journalist in Chicago in the meat packing industry way back when.

And he said, “It is difficult to get a man to understand something when his salary depends upon his not understanding it.” What this essentially means is that you cannot ask people to do good things if you don’t give them the tools with which to do it.

The next slide depicts a picture of me on one side and anybody else in the system who has been trying to fix this stuff all these years. What this is really meaning to say is that this work is hard, that people in the systems are trying to make these things change, but that you have to have perseverance and you have to have a sense of humor about it, and you got to keep trying.

Okay, the next slide takes us back to some of the barriers I mentioned, in particular, the voc rehab one. This is an example simply of the State of Missouri. I can’t speak for every State or any other State. but here we have done some good data matching looking at the overlap in services between our adults with serious mental illness and those who have been served in a year by the Division of Vocational Rehabilitation.

If you will notice, we have 60,000 adults in a year in the Comprehensive Psychiatric Services. In that same time period, the Voc Rehab people had enough resources to serve 30,000 adults with all type of disabilities.

That included developmental disabilities, orthopedic, alcohol and drug, any other priority group that they were serving. And so you can see that even if you took that yellow circle and shoved it right into the blue circle, you would still have 30,000 adults who wouldn’t have the resources.

It has nothing to do with whether VR wants to be a wonderful partner. It has to do—which they do in our State I will say; we have excellent partnerships with them—but there’s a lack of resources. And I think that’s a fact that people often are not aware of. So if we look at the next slide we can see some possible responses to these barriers.

And we have to, I think, take deep breaths for a moment. And all of us, wherever we are in the system, realize that it was only people that built all of these systems. And we are people. And we can fix them.

But it requires attention to detail, patience and, you know, really understanding where the barriers are. So this business about clear policy guidance from State and mental health agencies that employment is part of the mission is very helpful.

It helps encourage staff to work across these departmental boundaries, whether the departments are mental health and Medicaid and HUD and VR. And figure out each individual State’s own payment matrix for elements of employment supports because it does vary around the State, around the country.

The second thing is also true. That benefits planning tailored for each individual State is important because what the rules are about these public systems are different in Missouri than they are in Minnesota than they are in Illinois. And you can’t just have a one-size-fits-all way of helping people.

One way we’ve tried to address that here in Missouri and you’ll see it in the resource slide is creating sample scenarios to assist individuals who can read it themselves. And see where they might fit and what circumstances matters to them.

Also, important to provide basic benefits training for mental health staff with resources for in-depth needs. People want to help individuals. That’s why they got into this business. And they’re very concerned on many, at many times about doing something that would hurt someone by having them saying yes, you should go out to work.

Well if they lose their benefits, then what? So we have to provide staff with the tools they need. And then one of those tools that we use here in Missouri and again in several other States is this Web tool called the Disability Benefits 101. You can look at that on that slide and find the link to that.

The final thing I want to touch on briefly is the use of evidence-based practices, Individual Placement and Support, IPS Supported Employment.

On the next slide you will see brief descriptions of the elements of this new quote unquote “tool” with decades of research behind it. This is the one method, a method that has demonstrated outcomes, which I’ll show you in a couple seconds here.

And the key elements of this evidence-based method is that the method leads to mainstream jobs in the community paying at least minimum wage, including people in the work setting who are not disabled with an agency providing ongoing support.

And the type of employment support is intended for people with the most severe disabilities. The next two charts really sort of show in summary or quickly the research that supports this evidence-based practice.

And by evidence we mean that they have tried it the old way and they’ve tried it this way randomly. And the research has demonstrated over and over that the rates of competitive employment using this IPS exceed business as usual.

The Johnson & Johnson—Dartmouth Project is a multistate collaborative. And you can see by that lovely chart that, you know, more people who are in this project are employed than they are in the general world, the SAMHSA slide that I showed before about outcomes.

But the other thing we must draw our attention to is still the very small numbers of people who are having access to this particular method. I think there are other States that are doing this work besides the ones in the Dartmouth Project.

However, we do believe that there is, far more numbers of people who could use this type of assistance than are able to access it.

So the final thing here I would like to talk about very briefly is one potential funding strategy which is—that we are attempting to pursue. It has not happened yet in Missouri. So don’t send me letters saying what happened and how did it work. But hopefully you’ll be able to send me those letters in a while down the road.

We are attempting to use a funding strategy that is provided under the Affordable Care Act called the 1915(i) State Plan Option. It is a different type of a Medicaid support than the rehab option that I mentioned before.

And under this particular option you are able to cover more services. More services are under employment that could potentially fund all parts of the evidence-based supported employment in the same kind of way that voc rehab does.

So I would like to just say that this quote from Mark Twain. You have to have a quote from Mark Twain if you’re in Missouri. He said, “Change is the handmaiden Nature requires to do her miracles with.”

And change sometimes doesn’t feel very much like fun when you’re going through it. But it really does provide miracles for people when we can provide the supports that they need. So thank you very much.

Maureen Madison: Thank you, thank you Dr. Selleck for giving us that important information about evidence-based supported employment models, as well as strategies for overcoming barriers to implementing recovery-oriented employment programs, and also integrating that support and resources to foster social inclusion.

Next we’re going to hear from Chacku Mathai, Associate Executive Director for the New York Association of Psychiatric Rehabilitation Services. Chacku has over 25 years of experience in mental health and addiction community-based services in a wide variety of roles including Advocate, Meeting Facilitator, Community Organizer and Educator, Community Residence Manager, Psychiatric Rehabilitation Practitioner, Trainer, and Program Administrator.

Chacku conducts training sessions across the country on these roles, as well as on leadership and exemplary integrated practices for supporting people with mental health and substance use issues.

Chacku is also an implementation partner for the New York State Center for Excellence in Integrated Care, the SAMHSA Recovery to Practice Resource Center for Behavioral Health Professionals, and SAMHSA’s Bringing Recovery Supports to Scale Technical Assistance Center Strategy.

He will be sharing what has been accomplished in New York State through grassroots advocacy and broad-based community and agency collaboration that address employment issues and integrate new approaches in the systems that serve people with mental health and substance use issues. Thank you for joining us Chacku.

Chacku Mathai: Thank you. It’s great to be here. And I’d like to thank you for including us in this webinar. It’s—we’re especially grateful for the opportunity to provide an in-depth focus on employment and economic self-sufficiency as a critical dimension in outcome for recovery and social inclusion.

A lot of times people don’t make the connection between social inclusion, employment, and getting out of poverty. And so doing so so explicitly here is really important to us. It’s been a big part of our work.

And I’m very grateful for the presentation that Virginia offered just now. It provides the perfect foundation for what I’m hoping to offer in this presentation, which is exactly that the collaboration and the types of work that a grassroots advocacy—communities, providers, policy makers, employers, and communities as a whole can accomplish when—in order to make employment and economic self-sufficiency a priority.

So, you know, for those of you who don’t know about NYAPRS, we’re a statewide, peer-run coalition of peers and providers from across New York. And we’re dedicated to improving services and social conditions for those of us with psychiatric disabilities, diagnosis, trauma-related, or co-occurring substance use conditions.

And we, you know, have done a number of things around employment. And I’ll share that with you. And I’m hoping to walk through some of the basic steps that we went through as an advocacy organization and as a community.

So let me first go over a few messages that, you know, both from Virginia’s presentation and then that hopefully you’ll see woven into our advocacy.

One that you heard from Virginia’s presentation is that the message that employment is actually good for us is something that was contrary to what most of us heard. Or many of us heard when we came—found ourselves in the system we were struggling to get back to work or school.

The message was quite the opposite. That employment wasn’t good for us. And that we should be happy about, you know, not trying to kill ourselves anymore or not being depressed anymore, that sort of thing.

But actually as Virginia expressed, we only experience those things anyway. We started to feel worse. The other message is that unemployment itself is bad for us and actually makes things worse.

So that was an important message. And with the research and with the, just to basically change the consciousness that existed within our own community of peers and providers.

We wanted to say that and help people understand that there are benefits, resources and entitlements that really can help and can be an incentive for us to earn income and to reduce our reliance on public resources.

That was often a mixed message. It sounded like there were incentives. But then you’d always hear about the disincentives or people had misinformation that wasn’t clear.

We also wanted to make sure people knew about peer supports, advocacy tips, especially self-advocacy steps that they could take. Resources that we could carry into the social services offices or our providers and services that could actually help us take that next step towards employment regardless of whatever that step might be or where we are in considering it.

Then finally we wanted to express the message that we need to and deserve to be employed at the same rate as everyone else. We didn’t need to stay as a disenfranchised, marginalized community.

So what I’m going to share with you today is how we developed a campaign around that—focused our advocacy towards employment and system implementation strategies that really make employment a priority in New York today.

I want to start by saying we are far from arrived. We have a long way to go in terms of reaching those outcomes that we want to accomplish. But I believe we’ve made some significant steps towards that—in the direction.

So in New York, you know, just to walk you through some initial steps. We have a history of advocacy around employment that goes back to the early ‘90s. You know, really especially with State VR.

And as Virginia said, we need to look at that because there was, you know, a misimpression that we had that advocacy with State VR, Vocational Rehabilitation, would accomplish the goals.

And just as Virginia offered that the numbers just don’t match up. It would only be a small number of people that we’d be able to support even if State VR was able to accomplish all the things that we were asking for.

We certainly advocated for Ticket to Work legislation. And in ‘98 the Ticket to Work and Work Incentives Improvement Act was passed. And the New York State implementation of that process of Ticket to Work since ‘98 was really important to us.

We had a real strong rights-based focus around ticket holders and what it meant for us as well as pursuing things like the Medicaid Buy-In, which I’ll talk about in a minute.

Then there were Social Security Administration projects such as the New York Works demonstration project that really made a difference for us. And we wanted to build on the lessons from those projects and call for more resources for supported employment specifically as evidence-based practices such as Individual Placement and Support.

Now the Medicaid Buy-In is one of those resources that we wanted to focus on. And for those of you who may not know it, it’s something—it’s a provision out of the Ticket to Work and Work Incentives Improvement Act that allows a person with a disability to earn, in New York State anyway, we passed the law in 2003 that allows us to earn up to 53,000 a year and keep our Medicaid, keep $13,000 in assets, keep our home, our retirement, our, you know, those kind of—a car—these kinds of resources that are needed so people aren’t having to choose between health care and work. And it didn’t just happen on its own. We needed to join a cross-disability community and really take on the policy-level issues, both with our legislators, with the Governor’s Office.

As you can see here our Executive Director Harvey Rosenthal is joined by cross-disability advocates across New York by chaining ourselves to the Governor’s Office and really making that case for the Medicaid Buy-In at that level. Doing everything we needed to do to really make it possible.

And so as a result, that June 2003 the negotiations began for the Medicaid Buy-In to be a real possibility for us.

So we also needed to help increase awareness about the Medicaid Buy-In. So just passing the law wasn’t enough. It was one of those things that getting things into policy and then having it hit the ground, hit the street for those of us was a big deal.

And so we created a Medicaid Buy-In toolkit. And this toolkit was something that people could actually walk right into their Department of Social Services office, who at the time, and still to this day, struggled to acknowledge the existence of the Medicaid Buy-In depending on the training of the staff person in that office.

So a person with a disability often had to have more information in hand than the office itself. And this tool also expressed messages of, you know, can-do information that we needed to express.

The opportunity to really bring employment to the forefront in New York State however had still not come. And we’re talking all, you know, in the decade of, you know, after the Medicaid Buy-In gets passed in 2003 we’re seeing a, you know, an increased number of people pursuing employment and going into the Medicaid Buy-In for example and related provisions.

However, we still didn’t have a State policy that called for employment. We needed to gather and connect with all of our grassroots statewide coalitions in New York State and really come together to make the case for this.

So I would call up people like Joe Marrone and Virginia and ask what do we do? What should the messages be? What, you know, what are the priorities? Out of all of these systemic barriers that we have, where do we start?

And so Joe, Virginia, and a number of other people gave me and our New York State advocates some advice about what we should see. And so here they are.

So one was we needed to have strong State leadership on employment, somebody who was going to stand up and carry the torch across State agencies and make that a priority—not just from the bully pulpit, but as implementation leader and a strategy leader.

We needed to have an interagency task force on employment so it didn’t need to be just one State agency like the Office of Mental Health. But we wanted something that was across disability and recognized the full force and capacity of the State to focus on employment, also again, to really recognize and prioritize the need for State policy on employment.

We recognized the need to connect the employment priority with the Most Integrated Settings Coordinating Council, which ended up being where we had our interagency task force.

So to make a long story short, the Most Integrated Settings Coordinating Council is the council that was created. It’s part of our Most Integrated Settings Law that was passed in 2002 which is a response to the Olmstead decision.

So Olmstead became a direct connection to employment. And the MISCC, or the Most Integrated Settings Coordinating Council, became another place, an important place, for employment and the opportunity for employment to be attended to.

We asked the State and called for the State to pursue the Medicaid Infrastructure Grant. We had done one part of it when we got the Medicaid Buy-In in order to build that toolkit for example and raise the awareness about the Medicaid Buy-In.

But the comprehensive employment system part of the grant had not yet been pursued. And so the State, after some work with us and grassroots advocates, pursued this and joined Cornell University and Syracuse University and the New York State Office of Mental Health in the leadership around the Medicaid Infrastructure Grant.

I want to mention here that, you know, when it came down to State leadership, Michael Hogan from the Office of Mental Health really supported John Allen, his special assistant in the Office of Mental Health and also the Director of the Bureau of Recipient Affairs.

John became that State leader that I just talked about that not only carried the torch and the priority for employment, but also saw the strategy and also saw the solutions within—that would actually take on all of those implementation barriers that we struggled with.

And so—and he recognized the need to not just focus on State VR, but to have a cross-disability mainstream focus even within Department of Labor. And look at the kinds of solutions which I’ll speak to shortly.

Now one of the things that John did was also pursue SAMHSA’s Olmstead initiative funds. And that really helped us. And it wasn’t, you know, a huge amount of money.

But what we did with it was something that John always wanted—would say to me is, is, you know, we need to have people with disabilities kicking the tires of employment.

In other words, we need people hearing from people who have gone back to work what it was like. And to help people improve that sense of motivation and hope and possibility around work.

So we created what’s called the WE Can Work campaign and WE Can Save campaigns. And I’ll tell you a little bit more about those as we move forward.

But those are really important initiatives as a grassroots community. Michael Hogan also said this to us. He said, “You know, we can pursue employment policy. But if we don’t have a strong grassroots community making that case for employment, it’s not going to—it’s probably not going to happen.”

And this is another policy move and issue I’m going to move to is the redirection of resources to integrated employment. In New York State like many States there was resources directed at employment, but not always at integrated competitive employment.

There was a lot of money being invested in sheltered work or other kinds of employment that may not, although intended to be transitional, people with disabilities found themselves languishing in these services and supports, and not finding themselves moving towards integrated competitive employment.

So we called for that. And are starting to see that happened as a result. I’m happy to say that that policy shift did happen, as well as the need to integrate funding and data across these State agencies and disability groups.

We were oftentimes not aware of our progress. We couldn’t say whether we were making any progress around employment for specific disability groups because we weren’t sure if we were counting them the same way. We weren’t sure if the funding could be integrated or the data systems could be integrated.

And then lastly, we needed to make—get out of the way and make the connection between employers and people with disabilities. It seemed as though the system itself was more in the way. And less supportive of the capacity for people with disabilities and employers to speak directly with each other and actually find each other.

And so this was something that both employers and people with disabilities said was a need. And, you know, our past governors including Eliot Spitzer at the time said that that was an important thing that we would need to do.

So we convened groups such as Mental Health Association of New York State, the Association for Programs in Supported Employment, New York State Rehabilitation Association, Association for Community Living, which is representing a lot of the organizations providing residential services, NAMI, National Alliance for the Mentally Ill, New York Association for Independent Living.

Cross-disability and peer advocacy communities from across the State, we all came together. So this wasn’t just something that NYAPRS did. This was something that, this was a group of advocates that we joined in the NYAPRS community to bring a lot of these significant responses forward.

So speaking of that, I’m going to identify a couple major initiatives for you that we brought forward. One is that WE Can Work and WE Can Save campaigns.

This was a grassroots movement that had some tools that you find closer to our—to the reference list there. And these are provider guides and participants’ guides that actually help people identify what the steps are to move towards employment.

We really wanted to—we created a DVD that would actually allow for people to hear stories of recovery and employment success. All of this is available through our Web site so you can check that out and get to know us a little bit more.

But this was a really important way for people to hear about. And this is the kind of investment that New York State made for us to be able to have a tool for people with psychiatric disabilities to take into their doctor’s offices, clinics, State treatment programs, and supports, including with family supports who may not have believed that recovery and employment was possible.

So New York State also pursued the development of the employment services system. It’s called the New York Employment Services System. Using the Medicaid Infrastructure Grant connected us with the Department of Labor’s One-Stop Operating System.

And now is a way for, just as I said earlier, for people with disabilities to connect with employers directly through the New York State Job Bank, and up to 90,000 job openings. Smart technology allows you to put in a functional resume and really have strong skill matching with the kinds of jobs that you would want to see coming out of this.

There’s access to providers, services, supports, and State agencies that actually support people. So it’s centralized employment services. And it helps identify individual job seeker skills.

It assists with the entitlements and the screenings and the reporting. It actually connects with the tax credit claiming documentation for businesses, employers so that if you hire a person with a disability, a tax credit automatically—that documentation automatically gets generated. So it makes it easier for people to hire people with disabilities, not harder.

And it connects with the Ticket to Work system and Milestone Payment System so that there’s a New York State employment network now that the providers can join and actually become a way for people to have their tickets get paid for, and for providers to generate more income related to employment.

So Robert Williams, he’s SSA Associate Commissioner, calls this the NYESS system that, you know, our first truly comprehensive employment service system of its kind in the country.

And this is the kind of stuff that John Allen and all of the State agency partners in this project put together. And we’re very excited about it.

And then lastly, thing I wanted to mention is that John and advocates around the State and we have all wanted to make the business case for employment. Especially as we move into an incredible era of system reform.

Mathematica studies, which you’ll see references later in the presentation, really make the case that when you go back to work, those of us who were on Medicaid reduced our health expenditures dramatically.

And in New York State, you’re going to see this published soon. They replicated this study with Cornell in New York and have some preliminary data that already shows that 44.3 percent savings in health expenditures for those people with disabilities who went back to work.

And so this kind of case is strong to make with health home implementation, the heads of our health organizations, and managed care organizations that may want to pay for the kinds of services that make a difference.

So I’m going to stop here. I’m probably out of time. And the resources that I have listed here are only the beginning. Please check us out. We’re happy to be involved and very grateful for, again, for the opportunity to be part of this webinar. Thank you.

Maureen Madison: Thank you. Thank you so much Chacku for sharing that information about how integrated whole health approach can be implemented on the State level.

The resources you shared will help increase awareness about the important role that employment success has in recovery. And it offers a model that other States and communities can use to address employment issues in their States. So thank you very much.

Our final speaker is Donita Diamata, Project Coordinator for both Peerlink National Technical Assistance Center in Portland, Oregon and Project OPEN, a project that trains employment peer mentors.

Donita is active in the peer movement where she began her career as a provider and then creator of state-of-the-art peer-delivered services. While she continues to advocate for improved services, empowered clients, and dramatic changes within the system, she’s also pursuing a writing career as she finishes her first novel.

Donita is going to share her firsthand experience of how meaningful employment played an integral role in her recovery and continues to inform the services she provides in her work as a peer advocate. Donita, thank you for joining us.

Donita Diamata: Thank you. First thing I want to note is you’ll be hearing kind of a living example of what was already—has been presented in this webinar as I talk about my story.

I also want to just make an emphasis on, I love hearing the title that I’ve been given, which is great. The role that I have been fortunate to play has now given me identity beyond just being a patient or a client, and how important that is for me.

So my story actually doesn’t really begin when I was 21 years old. But this was my first hospitalization and although—although I had struggled over the many years with various mental health issues and certainly depression was a big piece of that, that was my first hospitalization right after my 21st birthday.

I was hospitalized for just 2 weeks. And in those 2 weeks I started hearing these messages. I started hearing you are sick. You are fragile. You should not work.

I was working at the time, full-time, doing pretty well actually. And I was already starting to get the message that maybe I should think about quitting work and going on disability benefits.

I couldn’t believe how quickly that I got to receive those messages. So I entered the mental health system sort of sporadically over the next few years. I was in and out of the mental health system.

I had received outpatient services. And I continued to get the messages, you know, as I saw different service providers, the message kept building up, building up to the direction of, you should not work.

And I finally succumbed to that. So less than 4 years later I did actually quit the job that I had at that time and went to pursue disability benefits. So I was living on General Assistance, which was a form of welfare earning $172 a month and I had food stamps of $160 a month.

So my total income at that time was $332 a month. And my share of the rent was 200, utilities came to 36. You’ll see under the food category, although I had $160 a month in food stamps, I bought myself $50 a month in food. The rest of the food money actually went to buying food for my friends so they could pay me money so I could keep a roof over my head, lights on and the heat and things along those lines.

And then I allowed $20 a month roughly for transportation. So when I ran out of bus fare, I walked to get to those appointments I had. I—and then roughly $26 a month left over for extras. So that was all my toiletries, toilet paper, things along those lines, household cleaners and so on, so—to match that.

And this is how I survived. So I was living in absolute poverty at that time. And I also was living in absolute isolation at that time. I watched my friends going to work. When I did go to get-togethers, which started to get more and more rare for me I had to endure listening to my friends talk about their jobs and all the things they were doing while I was doing virtually nothing.

I would have some weeks where my only social contact was going to a 50-minute appointment with a counselor.

So what my life became then while not working was revolving around going in and out of the hospital, going to the emergency department, and of course going to my appointments as faithfully as I was able to make them.

And in 1 year I was hospitalized six times. Clearly the idea of me being better not working was, I started really questioning that. And that was really the turning point for me, was I was thinking how is it that I’m actually doing so much worse when I’m following the advice of the people in the mental health system who were guiding me than I was before.

And so that was—my biggest turning point for me really was questioning that and acting completely out of boredom and that isolation and that poverty that I was living in. I was really sick of it.

So what I did was I got—I went against medical advice at that point. And I got a job, didn’t tell anybody that I got a job; I just got it. And then I decided I will tell them later. But I didn’t really want to hear the “I told you so” just in case it didn’t work out.

So in 1992 I was hired for an entry-level position at The Mind Empowered. It’s Oregon’s first independent peer-run drop-in program. And it was the antithesis of what the few people in the camp who were working with me who said maybe if you do get a job, at least get just part-time and get something very low stress.

And I’m sure a lot of people might have heard that story for themselves. Now, there is nothing about working in that kind of drop-in center that is not stress—I mean it’s very stressful working in that kind of environment, very rough-and-tumble and difficult environment to work in. And I worked full-time.

So I did all the things apparently wrong. And I thrived, I did—I loved it. So what I ended up doing was continued working for them until 1997 when the organization lost its funding.

And by the time I left I was Program Manager. And what helped me get through the end of that, which was pretty—that was pretty rough to watch a program that I loved so much dissolve.

But I did team up with other—another peer. And we decided hey, let’s get another one going. Let’s start another drop-in program with the same kind of model of being all-inclusive, anyone welcome regardless of their insurance or ability to pay. Regardless of where they’re coming from, what services they’re already engaged in, where they are at with substance abuse or addiction issues.

If they want to avail themselves to the drop-in center we create, let’s do it. So we started a program called Da Vinci Place. We—but before that we actually went from a provider—mental health service provider to mental health service provider all over town farming this idea out.

And we had one taker out of all the providers that said yes, I think we’ll be interested. So we did open our doors. We—Mind Empowered closed in February, the end of February of 1997 and we opened a new place September of 1997. So it was pretty rushed turnaround really to develop a whole new program within an existing traditionally run mental health program, or mental health service provider known as Network Behavioral Healthcare.

So here’s what I was really surprised to find was first we were really treated as second-class citizens. We openly identified as peers. The peer-run program, and the first thing we found out was we were not welcome to eat in the employee lounge.

The other things we found were we were not given an office to do our notes. So we were relying on billing as our source of income. And so we needed to—how we did our notes was we actually used the janitor closet and moved away janitor supplies off the shelves so we could kind of hunch over and do our notes at the end of the day or accumulated notes over a week or something.

We also, although they had janitorial service provided to the building, we were not allowed to access that. And we had to do our own janitorial work.

And then the most significant thing I think for me was the fact that they—no one was comfortable with us actually having a key to the main building. We were housed in the main clinic. And so we—they did not want us, nor did they want—they didn’t want us as employees. And they didn’t want all members of the drop-in center that we’d be serving, they did not want them coming through the lobby like everybody else.

So they outfitted the back door near the dumpsters to—that was our point of entry to work and to offer our drop-in program. So despite that, despite those adverse working conditions, we kind of hit a boom here.

Network Behavioral Healthcare merged with several other traditional mental health providers in the Portland area and became one of the largest mental health service providers in Oregon, became Cascadia Behavioral Healthcare.

And while they grew, we grew as well. So by that time this was running around year 2000, 2001 we averaged 140 people a day coming in to our drop-in program. The name changed to Renaissance because we were asked to go ahead and take over the traditional day treatment program and merge that into one big, open drop- in center, welcome for everyone to use.

So 140 people a day came to participate in our program, and we earned over a million dollars a year, just that program alone which was unheard of for a peer-run program that started out so, with just a trickle of people on deck.

So word of mouth really helped. The people really loved what we were offering. So I was asked to replicate the success of that program with three other struggling day treatment programs and turn them into peer-run drop-in centers with the same kind of model, open to anyone.

So in 2000 I became the Director of Peer Services. And by 2003, Cascadia employed over 30 peers and had five peer-run drop-in programs—or peer-run programs. There were four drop-in programs and then we had the fifth program that was peer-run with an employment program that we developed through a grant.

And the next segment of the story unfortunately goes along in 2003 where Cascadia endured massive layoffs. The whole State of Oregon actually was really struggling and cut a lot of mental health services.

The funding stream that we had relied on actually had been cut significantly, so all of our drop-in programs turned into more traditional treatment models. Many of the peers that I had personally hired had lost their job.

And I slipped into a severe depression. I was still working but I was really struggling. So I was hospitalized for the first time after—in 7 years. And then I was hospitalized again and again and again.

And it was that last hospitalization that kind of was my undoing where I was presented with papers to let me go from my position. I did return just a few months later. But I did lose a great deal of confidence in myself.

And I also was demoted from Director down to a coordinator position again. And I was—lost a significant amount of my money, my income. And then the last thing was on top of all that of course, what comes from hospitalizations when you have private insurance usually is hospital bills.

And so I was presented with something like $90,000 in hospital bills I had no hope of paying. So there I was also struggling with having to deal with bankruptcy on top of that, so all of those things that really took me several years to bounce back from that.

And then finally—but the thing I really want to emphasize what did help me continue on and just keep coming back for more anyway and keep pursuing going to work, wherever that would be. It really was peer support.

I was in a fortunate position to be surrounded by peers who were successful in the positions they were—they held. And they really kept me going. And they also anytime I was given the message, and I really even as a director I was told, “I think you should quit. I think that you should go on disability.”

And here I was in a hospital with them knowing that I’m just there temporarily. And as a director and having worked full-time and I’m being advised to do this all over again. I couldn’t believe it.

But luckily I had my peers, my friends who supported me through that and kept saying no, no, no. This is not the path you need to go. And keep going back.

So I ended up where I’m at now. So I actually ultimately did quit on my own terms in the end and decided to pursue family. And so now I am a mother of a beautiful 4-year-old daughter. I’m the Project Coordinator for Peerlink National Technical Assistance Center and Project OPEN.

And I’m as—an aspiring writer. So I’m just finishing up the second draft of my very first novel, fiction. And that’s my story in a nutshell. Thank you.

Maureen Madison: Thank you so much Donita. Your story is—it’s really inspiring. And it provides a powerful example of how important the role of employment is in the recovery of people who experience mental health and substance use issues.

And the tremendous contributions that people in recovery can and do make in the workplace, not to mention the strength that you get from peer support.

Thank you to all our presenters. Now before we open up the lines we want to ask each of our speakers to share their vision for what social inclusion and employment would look like. We’re going to start with Dr. Selleck.

Virginia Selleck: My vision is really simple. I see people with mental illnesses employed at the same rates as the rest of the population, leading to better health and longer lives.

Maureen Madison: Thank you Dr. Selleck. Chacku what is your vision?

Chacku Mathai: Well my vision is very similar to Virginia’s. So I’m going to say it a little bit differently. Not only are we employed at the same rate of the general population, but in order to do that, we are taking our place in the workforce. That we see ourselves contributing to the diverse and social fabric of our communities in order to do so.

Maureen Madison: Thank you. Thank you. Donita?

Donita Diamata: My vision is that no recipient of mental health care receives the message that he or she cannot or should not work. And the right kinds of support would be readily available for those struggling to return to work or for those who struggle to keep their jobs.

Maureen Madison: Thank you. Thank you to everyone for those inspiring words. Those are visions that we can all aspire to. Thank you so much.

Our speakers provided some great resources at the end of their presentations. And on Slide 55 to 60, there are some additional resources for you to learn more about the topics that have been discussed today.

Slide 60 was added yesterday and is not yet included in the presentation on the SAMHSA ADS Center Web site. The presentation site will be updated when the archived teleconference files are posted in mid-September.

We apologize for any confusion, but wanted to include these important resources that were recently received from the Bazelon Center for Mental Health Law.

We will now take questions from callers. To ask a question, please dial star 1 on your telephone to be placed in the queue. Be sure to tell the operator your name. If you do not wish your full name to be announced, then please only state your first name. Because time is limited, please ask only one question.

After the conference operator announces your name, you may ask your question. Once you’ve asked your question, your line will be muted so the presenters could respond. Operator, can we have the first question please?

Coordinator: Thank you, one moment as they queue. Our first question comes from Hanes. Your line is open.

Hanes: Hi, I actually wanted to expand upon Donita’s vision and ask a question. It seems like there’s a lot of stigma around people with mental illness and substance use disorders in getting work that actually come from the field itself.

So I wanted to know what examples or what kinds of things any one of the presenters would recommend that we do in the field to get rid of some of that stigma?

Maureen Madison: Donita do you want to start that?

Donita Diamata: Sure. Just, I just want to say, I am absolutely still shocked that people are feeling left out in working in this field. I’m shocked. I really thought back in 1992 I had a vision that at least 75 percent of the people providing services in mental health as mental health providers would identify as peers openly.

So I don’t really have an answer to your question unfortunately other than I think providers need to really be aware of the great role that peers can play and should play in the system.

And that they are actually equal partners. When you hire someone as an employee, they are an employee first. Thank you.

Maureen Madison: Thank you. Chacku would you like to weigh in on that?

Chacku Mathai: Yes, I’d love to. It’s a great question. And I think that there’s a few things that happened in New York. One was that we tried to break down the message pretty clearly.

Have—recognize that a lot of times providers didn’t have the information that they needed. So sharing the data on unemployment and how harmful it can be on mortality and the impact of health concerns.

You know, and trying to raise that priority even in clinical work. Just helping them see that unemployment, what needed to be just as much of a red flag as drug use, self-inflicted violence, suicidal histories and the like, domestic violence and so forth. It needed to be—the bar of priority needed to be raised at that level.

And then to share how helpful employment has been for people and get those stories out there of hope by people who have disclosed about their backgrounds and are willing to go back to work and share about that.

So that was a piece of the WE Can Work campaign. That is what we did is really get those messages and stories of hope out there to the system.

The other thing that the system itself did, the Office of Mental Health created a Work is Everybody’s Business campaign. And really internally started emphasizing that language of, you know, work is not only the business of people who are employment providers, but at every level of the service what do I do to support somebody in getting a job?

So am I aware of the jobs around me? Am I talking about it? So there’s a lot of conversations that can get started that way too.

Maureen Madison: Thank you. Dr. Selleck?

Virginia Selleck: Oh yes, I have to emphasize what Chacku said there at the end, the business about work being everyone’s business I think is absolutely critical.

And the other part is just I think research in general shows that when people see and get to know individuals as individuals, and see them working and know that they are productive and so forth. Basically, familiarity really helps reduce some of those unnecessary fears and confusions.

And in Missouri and I know in other States as our certified peer specialist programs grow, and as it is more—much more obvious that we have peers working side by side in their scope of practice, which—they bring a special thing that just your basic social worker who hasn’t had lived experience may not offer.

They become such an important part of the treatment team. And that’s on the mental health side. On the other side, just plain working like everybody does out in the world, whether it’s in banking or computers or whatever, I think if people are willing to disclose it really helps reduce some of those barriers.

Maureen Madison: Thank you. Operator, could we have the next question?

Coordinator: Our next question comes from Patty Russell. Your line is open.

Dottie Russell: Hello, it’s Dottie Russell. And the question is how does one feel secure to get a job without being afraid to lose their disability specifically because they’re afraid their medication wouldn’t be paid for? And then they wouldn’t be able to afford to get their medication anymore.

Virginia Selleck: This is Virginia. I just want to jump in there. Dottie I don’t know what State you’re in. It is very, very scary. And I don’t want to downplay that for one moment about how scary it is to think about losing your benefits.

But I think that knowledge is power. And there are many ways to find out about what you actually can do in terms of how much income you can make. Whether you are on—whether you are in a State that has a 1619(b) provision.

I know that sounds like mumbo jumbo. But in many States there’s an opportunity where you can make, you know, a pretty good amount of money and still retain Medicaid eligibility.

So I think the first start—you know, the first way to do that is to get with whatever State you’re in and get to the—get the real information from the real source about what really, instead of the fears, what’s the fact.

Maureen Madison: Chacku or Donita do you want to weigh in on that?

Chacku Mathai: Yes I’ll just say briefly I wholeheartedly agree with Virginia’s point. And I really appreciate the question because we really do want to be able to address people’s real stakes and fears and concerns.

And I think part of it is having, and again in New York we have a strong—Cornell University provides a great benefits management certification training program. It’s, you know, EDI online. You can actually check it out on their Web site.

And it provides accurate—it’s certified benefits advisement training. So that way we’re more confident about the information that’s being shared. But it’s also not from a benefits retention standpoint. It’s helping people really look at the possibilities for themselves from the perspective of what resources do I have. And how can I move forward in getting out of poverty and going back to work.

So I think that’s a really important lens of the benefits management. We found that to be extremely important for anyone going back to work is to have somebody be able to walk that process forward with them as opposed to feeling like you’re doing that alone.

And all that includes all the resources Virginia talked about, whether it’s 1619(b), the Medicaid Buy-In, impairment-related work expenses, PASS plans which are plans for achieving self-support or self-sufficiency resources. Thanks.

Maureen Madison: Thank you. Donita, do you have anything to add about your personal experience with this?

Donita Diamata: Well for me I actually never did make it to that end of things of getting on disability. I’m really glad I didn’t because I think that is, I think she emphasized a real important point that once you kind of get in there, it is really difficult to get yourself out of there because you get sort of trapped in that need to continue on with having good mental health services, and mental health benefits available to you.

And it shows you how much Medicaid and Medicare and Social Security Administration really needs to build up their services and their information. And get that out there for people of what is available. Because it is, I know that it is not true that you will lose everything necessarily.

So there are things that people can do. And it’s just a matter of having—everybody should be informed. Everybody who’s working in the health systems should be informed and be knowledgeable of how it works. That’s all I have to say. Thank you.

Maureen Madison: Thank you. I’m going to paraphrase a question that we got through the chat line. And perhaps Donita you can take this first.

Is there data or can speakers address the kind of work that peers are getting? Are they entry level, management, executive level, entrepreneurial, a little bit of both? You know all those things or etcetera. Can you address what kind of jobs you’re seeing people get?

Donita Diamata: Yes, well with the work that we are doing here with Project OPEN, the reports that I’m getting from people are the whole gamut, from entry level to people, ah—you know, the interesting thing is there’s a lot of people out there who are on disability who have higher levels of education. Who have before prior to them actually getting involved in the mental health system they have some, you know, some high-level experience.

So we have people who are entering right into high-level positions as well as entry-level positions. So it really runs the gamut. And it’s all—it’s wherever people want to go.

People are doing—whatever somebody else out there is doing, there’s a peer doing it too.

Maureen Madison: Thank you. Chacku what have you seen?

Chacku Mathai: Very similar outcomes across the board. We, you know, we, you know, there’s a saying we used to always see food, fill, filing, furniture and sometimes flowers kind of jobs for us.

And I was no different. That was my first job out of a vocational kind of process was a dishwasher job. And I thought I was signing up for something more—I guess I would say more complex in terms of a task that I would, you know, got into a suit and tie and all this kind of stuff to practice, and I was looking for other jobs. And so we needed to extend the career development process and have people really be aware of those possibilities as far as—and also that’s why it was good to connect with Department of Labor so that we knew what jobs were most in demand, and could make that case. And could help people prepare accordingly.

Maureen Madison: Thank you.

Virginia Selleck: I would just comment that one of the barriers for people sometimes to get more advanced jobs is that their illness may have interfered with their continuing education.

People may not have been able to complete college or get specialized training. And so supported education is another thing that we need to keep thinking about as an important thing to do, particularly for our young people who are in their early years who become ill, that we really can’t let those folks get doomed to this life of disability and unemployment.

We really need to be thinking about continuing education as well as employment.

Maureen Madison: Thank you. Thank for saying that Dr. Selleck. Actually our last webinar was on education and social inclusion. So I urge everyone to check out the Web site for that archived webinar. And you’ll learn a lot more about that issue. Operator, could we have the next question?

Coordinator: Our next question comes from Crystal. Your line is open.

Crystal Blyler: Hi. This is Crystal Blyler from Mathematica Policy Research. And I think you talked a little bit about this from one of the prior questions.

But the concern I have is about what benefits planning is kind of becoming in the context of supported employment, well maybe that’s not fair. I don’t know if it’s supported employment.

But the way it’s discussed is often as helping people figure out how to keep their benefits. And in the short term there might be some value to that. But in the long term it leads to, you know, people need to understand that if you stay on benefits, you’re likely to be subject to a lifetime of poverty.

So I think that Donita’s example is of—is an example of what people most fear. That if I’m not on benefits, then eventually I’m going to have a relapse and I’m not going to have the insurance to cover it. And I’m going to end up $90,000 in debt and in fear of bankruptcy.

And Donita has already said that she doesn’t regret that decision. But I think that’s interesting. And so I also think this idea of trying to keep your benefits can be a barrier to getting those higher level jobs because if you get a higher level job that makes too much money, eventually you will lose your benefits.

So I wonder if people could comment on this balance of trying to protect your benefits and yet not subject yourself to a lifetime of poverty.

Virginia Selleck: The benefit—this is Virginia. I’ll jump in here. I’m sure that Chacku and Donita have comments as well. Benefits is a giant bucket. And I think we sort of have to separate out what we mean by benefits.

There is medical insurance, i.e., Medicaid, which is different than cash benefits like Social Security or HUD rent subsidies. And that’s the reason it’s so doggone complicated because they all interfere or, you know, intersect with each other.

I think that the Affordable Care Act, certainly if it is fully implemented, as I certainly hope it will be fervently, will provide some greater opportunities for people through insurance exchanges and other—and also if, you know, Medicaid is advanced for people at 133 percent of poverty, there’ll be opportunities for the medical benefits. I think that for most of the people that I know, those medical benefits are the ones that they’re most concerned about.

And you can, as Chacku mentioned a whole string of things between PASS plans and work incentive, you know deductions and so forth. You can begin—you can climb out of the hole by getting to a certain level of employment. And then hopefully get hooked to an employer that does provide an array of medical benefits where you make the leap off.

But your point is well taken that we don’t want to create a system where we’re basically artificially suppressing people by making them stick to the system. I don’t know if that’s where you were going. But that’s my thought.

Maureen Madison: Thank you Dr. Selleck. We have a few more questions in the queue. So Donita and Chacku do you have anything to weigh in on what Dr. Blyler said?

Chacku Mathai: Well just really quickly I want to affirm it because that’s exactly my point earlier was that we needed to recognize that the benefits planning model, if there was one ever, it was always defaulting to a benefits retention approach or how you can stay on cash benefits or this and that.

And we needed to go and switch that lens. So I think it’s an explicit thing to look at and something you have to actually set up systems for.

And I was really pleased to see Office of Mental Health, for example, in our State really emphasize that. Provide even in our PROS services, Personalized Recovery Oriented Services license, provide a category for—of services called benefits management and financial management.

So people could explore that and also get paid for it from a provider’s perspective. Thanks.

Maureen Madison: Thank you, Donita?

Donita Diamata: Yeah, I just wanted to make sure that it was understood that when I was referring to people being able to possibly retain their benefits, I really was referring to the medical insurance end of things.

I don’t see the—a great outcome for people that try to cling to that poverty level by just working minimal hours and things along those lines as far as a long-term kind of approach. So I think, but that’s my style. I just—I dive into things. So I don’t know.

Maureen Madison: Thank you. Operator, could we have the next question?

Coordinator: And our next question comes from Larry White. Your line is open.

Larry White: Good afternoon, my name is Larry White. I’m an employment specialist with the Bay Pines VA here in St. Petersburg, Florida.

I wanted to know more about when you go to—have a veteran or anyone that’s on Social Security contact the benefit analysis person at the Social Security office. About how long does that process take?

Maureen Madison: Okay thank you. Maybe Chacku, can you weigh in on this first?

Chacku Mathai: Let me quite make sure I understand the question. I think it’s how long does the process take for somebody to go to get a Social Security administrative claim?

Maureen Madison: Operator could you unmute the—well—

((Crosstalk))

Coordinator: One moment, I can get him back, just a moment.

Maureen Madison: Okay thank you.

Chacku Mathai: And in the meantime it really varies from State to State. And even from region to region I would say. So it’s hard to say depending on that person’s claim what that looks like. Virginia may have more information than I on that.

Virginia Selleck: I’m not sure. I thought he was asking about a benefits analysis to try to figure out how long that would take. And your answer is the same either way. I mean, it depends on who you call and how long.

And, but I would just also comment that a Social Security analysis is—needs to be complemented by working with the State Medicaid rules. Which is why if you look on the resource page you can see what Missouri did with looking at how those two things intersect because they most, you know, they intersect each other. So you can’t look at each one in isolation.

Coordinator: And we do have Larry again.

Maureen Madison: Okay. Would you like to follow up?

Larry White: Yes. I think you pretty much answered my question. And would like—referring veterans over there, should I as an employment specialist job coach also assist them and be present during those times when they have a scheduled appointment with the benefit analysis person or should I just leave that person on their own?

Chacku Mathai: That’s a great question. I’ll just jump right in and say absolutely, we should help. And the ways that we found to be most helpful is to, you know, anticipate the benefits calculation. Be as prepared to do that with somebody and have them walk in with a set of numbers that can be analyzed by Social Security.

So having that person be prepared as much as possible from that perspective. And then if you’re available to or have services that can support somebody by going with them that’s even better.

Maureen Madison: Okay great. Thank you. Operator, could we have the next question?

Coordinator: And our next question comes from Karen Dears. Your line is open.

Karen Dears: Okay, I missed the first part of the webinar. Can you hear me? Hello?

Maureen Madison: Yes.

Karen Dears: Okay. So I hope that you didn’t already cover this. But one thing that I was struck by in hearing a lot of the presentations was that I was just thinking how like women were—there was a campaign to exclude women after World War II and men coming back from the war from the workforce.

And how that might have—some kind of social engineering might have happened with people who have been labeled as having mental health problems.

And I’m wondering if there’s any movement to look at larger economic and employment trends, especially in light of the economy right now is just so bad. And I’m calling from Humboldt County, California which is extremely, we had a high poverty rate and not a lot of jobs.

So that’s kind of a broad question but anyone want to take that on?

Chacku Mathai: Yes. This is Chacku. Do you mind if I jump in?

Maureen Madison: Please do.

Chacku Mathai: All right so very quickly I’ll say that first of all it’s a great point. I really appreciate that—the recognition that poverty isn’t specific to any particular group. But it has been discovered as a problem and a reality for many people now, especially now.

And actually I think that’s something to work on and build on is that there are shared needs. So one of the things we did was recognize that people oftentimes, people with disabilities aren’t aware of the resources that are available for people who are poor.

And so a lot of the Federal initiatives, whether they’re Individual Development Accounts, the work, the kinds of things like the Earned Income Tax Credit. Having people become aware of those resources and joining with broader cross coalitions like the CASH coalitions and others that really try to raise awareness about those incentives that exist for people.

So that’s one strategy. The other is our broader advocacy strategy that I think we still have a long way to go with. And I just want to appreciate. I think that’s something we’re going to look at is recognizing whether it’s communities of color, you know, women, LGBTQ advocacy communities.

Recognizing that certain unemployment rates are unacceptable across the board and is really a civil rights, human rights issue.

Maureen Madison: Thank you. I have a question online from Will. And his question is what’s in place, if anything, to help families understand that employment is possible? That they do not stop or diminish a person’s dream to go back to work, especially in relation to the fact that Social Security income is often what they rely on to ensure that the family has income.

Has anybody encountered issues with the families of people who are trying to go back to work?

Virginia Selleck: This is Virginia. And yes certainly I think families who want the best for their relatives may be concerned about, as mental health professionals have been in the past, about stress and about whether or not it was, you know, okay for somebody to try to go back to work and would it make things worse and the economic situation is—also can be relevant.

I think the education part is very important. Helping families understand that we know that work is helpful and help giving, not the reverse is the first step. And again, back to that subject of benefits analysis, to really understand the pros and cons of the decisionmaking.

Maureen Madison: Thank you. I think we have time for one more question, operator.

Coordinator: And our last question will come from Veronica. Your line is open.

Veronica: Yes good afternoon. My question is that after being unemployed for about 15 years, I tried to go back to work on a part-time basis from December 2009 to December 2010.

And I, when I got the job it was on a part-time basis of course. But I came from a research program that was done by the Social Security Administration for people with disabilities.

But I felt stigmatized. I felt the gossiping. And there were barriers. And I never felt like an equal, you know, employee. And it was very difficult. But also the part was that, you know, part of it was that my rent went up because I live in a subsidy housing, Section 8 housing, my rent went up.

My food stamps were cut down. And because the way the supervisor worded the letter, the—my rent went up. And my job did not cover the amount that was adjusted. And I’m still to this day trying to fight for the credit that I had overpaid.

And I haven’t been able to reach them. And that has, you know, stopped me from trying to get to go to work because I—you can’t live on this check to check.

Maureen Madison: Donita do you have anything to help her with that?

Donita Diamata: Well yes. The comment I have really is just that resonates so much with me. The living in poverty piece, the fighting to get out of the poverty and then that whole, the story you have to say about feeling stigmatized just at the work site.

I don’t, you know, the only advice I have really is just to keep going with what you’re—in the direction you’re going. As far as keep looking for work that you find does—where you do feel like you fit in, that you feel that you are going to be an equal player there.

And there is work to be had. I hear stories all the time of people feeling that they’ve really kind of found their home as far as that goes.

And I do understand the whole—that losing some of those benefits, the subsidized housing piece and as far as that going up, and sort of have a feeling like there’s consequences to going back to work.

But I do absolutely, 100 percent believe that it’s all worth it. Because the value you get overall and just feeling that value of self-worth, feeling like you have something structured to do, something important to do. Feeling an overall member of general society, that’s the kind of stuff that we’ve been, as peers have been left out of for too long. So that’s it.

Maureen Madison: Thank you. Thank you, that’s a great positive note to end on. And I want to thank everyone for the thoughtful questions and answers. I know we didn’t get to everyone either online or on the phone. But I urge you to contact one of the speakers directly or any or all of them, or the ADS Center.

You can reach out to the ADS Center at promoteacceptance@esi-dc.com. And contact information for each speaker is now available on new Slide 62.

You can also read more about the biographies of each speaker on Slide 63, 64, and 65 in the updated version of the presentation.

In addition to that, we value your feedback. Within the next 24 hours you will receive an e-mail request to participate in a short anonymous online survey about today’s training.

It will take about 5 minutes to complete. Please take the survey and share your feedback with us. Survey information will be used to help determine what resources and topic areas need to be addressed by future training events.

This conference has been recorded. And the audio recording and transcript will be available in mid-September on the SAMHSA ADS Center’s Web site.

If you enjoyed this training teleconference, we encourage you to join the ADS Center listserv to receive further information on recovery and social inclusion activities and resources including information about future teleconferences.

In addition, you will learn more about SAMHSA’s Wellness effort if you go to http://www.samhsa.gov/wellness.

We’ve come to the end of our time today. Again if you have more questions or would like follow up please contact the SAMHSA ADS Center by phone, fax, or e-mail. The Web site is http://www.promoteacceptance.samhsa.gov.

For future reference, ADS Center contact information is on Slide 69 in the updated presentation.

On behalf of all of us at the ADS Center, I want to extend our sincere appreciation to Dr. Virginia Selleck, Chacku Mathai, and Donita Diamata who have taught us about the essential role of employment in recovery and social inclusion and how existing barriers can be addressed and overcome to implement recovery-oriented employment programs in communities throughout the Nation.

And also thanks very much to you, all of our listeners, for taking time out of your afternoon to join us. And thank you in advance for completing our survey. Goodbye.

Coordinator: Thank you for participating in the conference today. You may now disconnect.

 

END