by Joe Marrone, M.S.

The Online Technical Assistance (OTAR) model  was developed as a pilot program, with the goal of assisting organizations (e.g. state agencies, providers, for- and non-profit entities) that want to improve  their employment outcomes for people with psychiatric disabilities by improving their policies, funding, and system design.

Two elements of this are:

Program providers perform an assessment of the need for “technical assistance” (TA) services around a specific group of an organization’s [employment focused] goals for the clients or patients it serves. Once the needs of the organization are identified, the consultant develops a site-specific TA plan based on the organization’s response to this assessment. OTAR clarifies a focus on policy and systemic change within participant organizations more than it focuses on training or product development. The model also emphasizes the importance of assigning a subject matter expert (SME) for each organization. Often, it has been advantageous to pursue candidates new to the consulting field with an opportunity to be part of this team and take on this role.

The second step is the construction of an implementation team which includes supervisory and clinical management staff as well as relevant partner organization personnel. The OTAR implementation team conducts regular Zoom calls to review the steps included in the plan.

Typically, sites begin their participation through word-of-mouth and email recruitment.

Once interest is expressed, potential sites are requested to answer the following simple questions:

• What would you like to get out of OTAR this year?
• What problems would you like the TA to solve or issues with which the TA might help?
• What would you hope would be concretely different if the TA were successful?
• If someone came back 1 year after the process was complete, what would that person see in terms of the system your organization uses to assist people with psychiatric disabilities become successfully employed?

Since the project commenced in 10/19, OTAR has worked with several organizations across the country. They have included:

• 3 State Behavioral Health systems
• 1 county Behavioral Health system
• 2 State public VR systems
• 2 statewide non-profit employment service providers’offering services to job seekers with psychiatric disabilities
• 1 county based non-profit employment service provider that aids clients with behavioral health disabilities
• 1 large city housing provider that serves thousands of people with various barriers to employment including behavioral health problems, homelessness, poverty
• 1 mental health oriented social service housing and clinical organization in a farm like environment
• 1 small rural housing provider that serves 20 people who have experienced mental illness
• 4 CMHCs that offer an array of behavioral health services including employment
• 1 large behavioral health managed care entity serving a large portion of a state
• 1 large statewide consumer run organization that provides peer supports, community psychiatric rehabilitation, and housing services.

The specific requests for TA varied by site but most incorporated the importance of employment as a core part of Recovery planning in clinical services instead of as a referral point to an employment unit. These included both micro-level discussions on motivating clinical staff to generate interest in employment with their clients and a broader systems-level focus on creating large scale policy and funding models to increase employment outcomes. A few projects related to how to create a system of financial planning advice early in the process for job seekers with disabilities, albeit one short of the more time-consuming full SSA benefits analysis.

So, what have we learned?

• Remote technical assistance can be useful to a variety of settings interested in enhancing the role of employment within Recovery oriented systems of care.
• It is useful to engage potential recipients in a self-assessment to help define the concrete activities that might attend to the needs identified – the more concrete the recipient organization is on stating needs, the easier it is to respond effectively.
• It is often the case that the first needs organizations identify as those impeding employment are not necessarily the same ones that emerge as the TA continues and other issues are examined.

There are also downsides that have emerged from the online technical assistance model. The initial outreach and engagement with OTAR was presented as a joint priority of each partnering agency with the site’s focus on mental health and employment collaboration. In practice, the commitment to the planned efforts often continued only with some of the participating sites. This most commonly emerges in the context of an employment focused organization getting only intermittent support from the mental health organization (state or local) involved. While the agreement obtained from all sites was to involve at least one of the clinical supervisory and/ or executive level staff, some sites have had only intermittent buy-in from personnel at these levels.

Another downside is that site visits are typically used to expand the pool of informants about the local issues supporting or impeding employment. This activity gets lost with distance-TA-only conditions – those in which the consulting team only has direct involvement with the formal coordinating [on-site] group and captures only a limited view of the local environment. Another downside from the consultant perspective is that it is less satisfying and less fun to be unable to connect with local sites in a more personal relationship and to directly observe the impact of the program. It is conceivable that some form of hybrid model could address these issues in the future.

For more information about  OTAR services contact us at psyrehab@bu.edu.

Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

Tags: consulting, psychiatric rehabilitation, technical assistance