Psychiatric Vocational Rehabilitation


The Need

The unemployment rate for individuals with psychiatric disabilities is 85% to 92%, compared to individuals with other types of disabilities whose unemployment rate is around 67% (Anthony, Cohen, Farkas & Gagne, 2002).

For individuals with severe psychiatric disabilities with college degrees, 70% earned less than $10 per hour (The President’s Commission Report, 2003).

People with severe mental illnesses who participate in effective employment services are more likely to be competitively employed and work more hours at higher earnings than those who participate in traditional services (Cook et al., 2005).

Nearly 70% of those with long-term psychiatric experiences in the United States are almost entirely dependent upon Social Security programs for financial and medical support and few ever leave the Social Security rolls to move into competitive employment (U.S. General Accounting Office, 1996).

As indicated by the statistics above and as recognized by the Rehabilitation Services Administration, the rehabilitation professional needs to be knowledgeable about severe mental illness, about rehabilitation principles, and how mental illness and the vocational rehabilitation process interact (RSA, 1995; Dew & Alan, 2005). Vocational service providers often feel “stuck” because they do not know how to effectively help the persons they serve to discover, articulate, evaluate, and move toward their career, work, or educational goals.

In response to this need, the Center for Psychiatric Rehabilitation at Boston University has developed a Certificate Program in Psychiatric Vocational Rehabilitation. The program is designed to help rehabilitation counselors and vocational service providers to improve their skills in building and sustaining partnerships with persons who experience psychiatric disabilities so that they can successfully choose, get, and keep the vocational experiences that they prefer. The program provides a unique learning environment, combining:

  • a recovery-oriented philosophy,
  • a skills-building curriculum, and
  • practical application of competencies,

with new tools and an orientation to new knowledge in the field of vocational rehabilitation. This combination of information, tools, and competencies is designed to help the practitioner assist the person with a serious psychiatric disability through the complicated process of choosing, getting, and keeping a job.


The Certificate Program in Psychiatric Vocational Rehabilitation 

A Unique Combination

The Certificate Program in Psychiatric Vocational Rehabilitation is designed to provide the critical knowledge and technology needed by practitioners to guide individuals through the decisions necessary to move forward. The outcome: recovery-oriented vocational rehabilitation where the individual drives the process and the practitioner has the tools and skills to facilitate it.


The Program

The Certificate Program is a specific adaptation of psychiatric rehabilitation technology developed over the last 25 years at the Boston University Center for Psychiatric Rehabilitation. It is structured to provide a flexible and accessible opportunity for personnel already providing employment support to maintain or enhance their skills, knowledge, and expertise whether or not they have formal education in the area. Participants are eligible for 72 professional development hours for successful completion of the program.

During the one-year program, participants attend two 1-week institutes of intensive learning involving skills training, discussion, readings, and practice exercises. Skill acquisition exercises are performed after each institute at the participant’s home agency or organization with regular contact with trainers via teleconferences, email, and through phone support.

Experiential learning is a critical component in the program. Assignments include person, program, and system components in order for the practitioner to have a chance to practice new skills with the people served by the agency. In addition, specifically tailored assignments have been designed for program administrators without a caseload, and for persons developing new programs.


The Approach

The psychiatric vocational rehabilitation process helps to guide individuals through essential decision making needed to move forward into a job, new career, or an educational environment. A variation of the choose-get-keep approach to employment support (Danley & Anthony 1987; Danley & MacDonald-Wilson, 1996), psychiatric vocational rehabilitation is adapted from the psychiatric rehabilitation process (Anthony et al., 2002).

The Certificate Program responds to concerns of vocational rehabilitation providers who often feel that they are “shooting from the hip” in helping their clients to participate in rehabilitation activities, which often results in strained client-counselor partnerships and the reduced likelihood of positive rehabilitation outcomes. The application of psychiatric vocational rehabilitation concepts, skills, and tools helps practitioners to achieve higher participant satisfaction, stronger vocational outcomes, and lasting results.


The Framework

To address these providers’ concerns, the program provides a framework within which the practitioner operates involving step-by-step activities that facilitate advancement through the vocational rehabilitation process.

Psychiatric vocational rehabilitation competencies are taught in a practical, easy-to-use format, with skill building as the primary focus.

The activities involve assisting the participant to choose the service and service direction, assess readiness for change, develop readiness to utilize services, choose a vocational goal and analyze feasibility of the goal, make decisions related to achieving access to preferred environments, and develop the skills and supports needed to be successful and satisfied in the chosen environment. Engaging the participant in these activities requires effective partnering techniques, which are taught throughout the institutes.


A Focus on Competency

The skills of the psychiatric vocational rehabilitation approach include assessment and development of rehabilitation readiness, psychiatric rehabilitation diagnosis, rehabilitation planning, and skill development interventions (Anthony et al., 2002). Competencies within these skill sets are built through opportunities to practice in the classroom and in one’s own agency. Each practice opportunity is paired with feedback and technical assistance by the trainers for maximum impact.

In addition, tools are disseminated liberally throughout the training. Practical, easy-to-use forms are available for immediate use by the counselors and their agencies. Counselors are taught how to use each of the tools, and are encouraged to work with them throughout the training, with technical assistance and consultation provided by the trainers.


Looking Ahead

The Certificate Program was initially funded by the Department of Education, Rehabilitation Services Administration (Grant #H129H980005) in 1998. Since then over 130 people have participated in this year-long program. Participants represent a variety of types of programs, including public VR, clubhouses, inpatient hospitals, employment programs, mental health agencies, community rehabilitation providers, educational support, VA work programs, day programs, and private rehabilitation companies.

Originally offered to people in New England, the program now reaches professionals from throughout the United States, including Hawaii and Alaska, as well as other countries such as Canada and Belgium . Currently, plans are underway to take the Certificate Program “on the road” to Asia and Europe in 2005 and 2006.

Agencies interested in bringing the Certificate Program to their area are now offered a non-certificate training option as an introduction to the philosophy and content, and to provide an evaluation of the feasibility and interest in offering the Certificate Program in their area. With an interested constituency of 12 to 25 participants, the program may now be brought in its entirety to an agency or region interested in the skills and tools this program has to offer.

On the horizon : The Certificate Program is developing online training seminars to provide increased access to the psychiatric vocational rehabilitation process to practitioners around the globe.


References

Abbot, J. (1993). Rehabilitation Act Amendments of 1992: Implications for people with psychiatric disabilities. Community Support Network News, 9 (3).

Anthony, W. E., Cohen, M. R., Farkas, M. D., & Gagne, C. (2002). Psychiatric Rehabilitation, 2nd ed. Boston : Center for Psychiatric Rehabilitation.

Cook, J. A. Leff, H. S., Blyler, C. R., Gold, P. B., Goldberg, R. W., Mueser, K. T., Toprac, M. G., McFarlane, W. R., Shafer, M. S., Blnkertz, L. E., Dudek, K., Razzano, L. A., Grey, D. D., Burke- Miller, J. (2005). Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness. Archives of General Psychiatry, 62, 505-512.

Danley, K. S. and W. A. Anthony (1987). The choose-get-keep model: Serving severely psychiatrically disabled people. American Rehabilitation, 13 (4), 6-9, 27-29.

Danley, K. S. and K. Macdonald-Wilson (1996). The choose-get-keep approach to employment support: Operational guidelines. Boston , Center for Psychiatric Rehabilitation, Boston University .

Dew, D. W. & Alan, G. M. (Eds.). (2005). Innovative methods for providing vocational rehabilitation services to individuals with psychiatric disabilities. Institute on Rehabilitation Issues Monograph No. 30 . Washington , DC : The George Washington University , Center for Rehabilitation Counseling Research and Education.

President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America . Final report. Pub. No. SMA-03-3832. Rockville , MD: Department of Health and Human Services.

Rehabilitation Services Administration (1995). The provision of vocational rehabilitation services to individuals who have severe mental illnesses: Program administrative review (Final report). Washington , D.C. , Office of Special Education and Rehabilitative Services, U.S. Department of Education.

U.S. General Accounting Office. (1996, April). SSA disability: Program redesign necessary to encourage return to work. Report to the Chairman, Special Committee on Aging and the U.S. Senate. GAO/HEHS 96-62. Washington , DC : U.S. General Accounting Office.


Program Impact: Survey Responses from Former Program Participants and Their Supervisors

In a survey conducted in 2004 of former program participants and their supervisors, respondents were asked to describe the extent to which the training had an impact on themselves, consumers, and their agencies. Answer included: don’t know, much worse, worse, no change, better, and much better.


Responses from Program Participants:

97% The way you provide services is better or much better.

94% Vocational outcomes for people using your services is better or much better.

91% Consumer satisfaction is better or much better.

88% Your job satisfaction better or much better.


Responses from Supervisors:

93% The way services are provided by the person who participated in the training is better or much better.

80% Vocational outcomes for people using your services is better or much better.

93% Your perception of the employee’s skill in providing services to people with psychiatric disability is better or much better.


Comments from Program Participants

“The partnering skills and the reflective skills are the heart of the program. I find myself using the reflective skills in all aspects of my job and in my personal life.”

“This program has expanded and improved my expertise both professionally and successfully.”

“I find the skills learned are valuable in a variety of settings both in rehab and outside. They are particularly useful in management areas. Excellent training.”

“I use this method everyday and find that it provides positive work outcomes.”


Quote

“Your training has made a big difference! I’m regularly praising Christine for the effective listening and responding skills she is demonstrating. She’s been very enthused over all she has learned and eager to incorporate new ideas into our process. We’ve gained a well-trained staff member who is effectively using her newly learned skills to engage individuals. Also, she has become a great role model to other staff.”

-Bill Gravel, Program Director, Alternatives, Unlimited, Inc., speaking about staff member Christine Olley, a graduate of the Certificate Program in Psychiatric Vocational Rehabilitation


Photo captions

Proud graduate Dawn Yager, MS, CRC, Vocational Rehabilitation Counselor at the Massachusetts Rehabilitation Commission; Holyoke , MA .

Former Rehabilitation Administration Commissioner Joanne Wilson, Graduation Speaker, accepting an award from Dr. Art Dell Orto, Director of the Rehabilitation Counseling Program, on behalf of Sargent College of Health and Rehabilitation Sciences.


Side bar

In 2002, the Certificate Program won the prestigious Commissioner’s Award for Excellence in Training and Education from the Rehabilitation Services Administration.