Employment Summit Summary
2013 State of the Science Proceedings
Policy and Employment for Individuals with Psychiatric Disabilities
Sep 25 – 26, 2013
The Center for Psychiatric Rehabilitation at Boston University conducted a meeting at Georgetown University on September 25-26 2013, about the role of disability policy in facilitating or hindering the early working careers of people with psychiatric disabilities. The meeting was a key activity of a 5-year project to explore the utility of an Internet-based Employment Learning Community vis a vis employment for individuals with psychiatric disabilities. The project is a component of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and Substance Abuse Mental Health Services Administration, Center for Mental Health Services (SAMHSA, CMHS) jointly funded Rehabilitation Research and Training Center (RRTC) on Improved Employment Outcomes for People with Psychiatric (Co- PI’s: Marianne Farkas and E. Sally Rogers).
Forty-two people participated in the meeting, all leaders in their particular areas of expertise and experience relevant to employment of people with psychiatric disabilities. Included were researchers, individuals with psychiatric disabilities or mental health conditions, service providers, consultants, state and federal government partners, including Federal project officers for the RRTC.
The meeting’s structure was focused on addressing an overarching question: How can/should research inform us about challenges and possible strategies needed, related to disability policy for people with psychiatric disabilities early in their working careers? Three topics were selected that were critical to answering the overarching question:
- The relationship between financial/medical assistance policies and public benefits and employment outcomes/status
- The relationship of policies and the delivery of effective interventions for individuals early in their working careers
- The relationship of policies and career development activities (e.g. identifying careers; education and training for careers; retention and promotion)
Based on their experience and expertise, participants then worked in groups corresponding to one of the three topic areas for much of the remainder of the meeting. A systematic structure was used to focus participant discussion and decision-making so that each group ended its session with three recommended changes relevant to the small group policy topic area.
Policy Issues & Recommendations
- The relationship between policies and public benefits and employment outcomes/status
- A) That the Department of Health and Human Services prioritize Evidence Based Supported Employment (EB SE) in state block grants, and that SAMHSA continue to use its influence to establish employment as a priority, utilizing evaluation and regulatory data to monitor and improve employment.
B) EB SE for psychiatric disabilities be included in state Medicaid plans (e.g., through the 1915i option) and in Medicaid plans offered to the Medicaid expansion population.
C) Social Security Administration proactively offer and encourage the use of employment support services when people first apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), as a means to help some people to obtain employment and, thereby, reduce the need for long-term disability benefit support.
D) The Centers for Medicaid and Medicare Services (CMS) should clarify that mental health parity should apply to all ten essential health benefits specified through the Affordable Care Act so that psychiatric rehabilitation would be covered to the same degree as physical rehabilitation in all health insurance plans sold through the health exchanges and all Medicaid expansion plans.
- The relationship of policies and the delivery of effective interventions for early working careers
- A) States take the lead on developing policies to resolve the funding and service gap issues as a model for federal agencies so that sustained access to EBP SE can be made available to more eligible individuals.
B) Services provide comprehensive early intervention programs for people newly diagnosed with a potentially disabling mental illness and that these services include EB SE as an essential element to be delivered as promptly as possible.
C) Employment services are mandated as part of a comprehensive mental health service.
- The relationship of policies and career development activities (e.g., identifying careers; education and training for careers; retention and promotion.)
- A) Federal funds are realigned to blend funding and data/outcomes so that a prescribed percentage of funding goes to employment and educational services and supports, including long- term supports. Funds could be drawn from Social Security, Criminal Justice, Mental Health, Department of Labor, etc.
B) Pell grant funding is tied to mandating that postsecondary programs recruit/retain students with disabilities from diverse populations and that vocational training agencies, universities, colleges, community colleges, and career colleges be required to recruit/retain/graduate/place people with disabilities.
C) Social Security disability qualification criteria are redesigned to promote employment (including the youth adjudication at 17.9 years), to adopt a “Career First” policy in all states, and expand to mental health with a Board to oversee implementation and enforcement of funding/practices. This Board would include stakeholder groups and advocacy groups at all levels.
A sampling of the major research topics that were thought to be important to pursue include:
- How to move from a narrative of hopelessness to employment possibilities
- Understanding what the message is that people hear about their employment potential, the importance of work, etc.
- National understanding about how mental health money is being spent on day services
- How many people are in fact working? What type of work?
- Effectiveness of comprehensive mental health & employment early intervention (pre-disability – diversion – 1st episode)
- What difference would it make to continued employment if losing disability income was not a factor?
- Impact of supported education in a university setting – outcomes, cost, mode, etc.
- Impact of a targeted wellness intervention
- What is the impact of federal performance standards on employment outcomes for people with psychiatric disabilities compared to others?
- What are the factors, barriers, etc. which impact career success for underserved populations?
- How can we measure the capacity of the mental health workforce to promote employment outcome and can we develop effective interventions to increase this capacity?
- What is the impact of primary interventions for high school students on employment outcome?
- What are the characteristics of people in the VR system who don’t receive SE and re-cycle? (Recidivism)
- What factors impact education and employment for a variety of cultural groups?
- What are the organizational factors within VR and mental health agencies that impact employment focus and outcomes?
- Best employer characteristics for retaining and advancing people with psychiatric disabilities
- Impact of micro-financing on successful entrepreneurship.
- Relationship between economic supports from anti-poverty programs and employment self-sufficiency.
Acknowledgment: The RRTC on Improving Employment Outcomes is supported by joint funding from the National Institute on Disability and Rehabilitation Research, United States Department of Education, and Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services (NIDRR grant H133B090014).
The content of this report does not represent the views or policies of the funding agencies and its publication does not imply or assume endorsement by the Federal Government.