Lauren B. Gates

Developing Strategies to Integrate Peer Providers into the Staff of Mental Health Agencies

This study informs new strategies that promote integration of peer providers into the staff of social service agencies. Executive directors, human resource managers, supervisors and co-workers at 27 agencies in New York City were interviewed in-depth. Focus groups with peers were conducted. Consistent with previous research, respondents identified attitudes toward recovery, role conflict and confusion, lack of policies and practices around confidentiality, poorly defined job structure and lack of support as problems that undermined integration. Emerging from the data are strategies related to human resource policies and practices and workgroup relationships and operations that can improve employment of peer staff.

Workplace Accommodation as a Social Process

Successful sustained employment for people with disabilities is a function of a complex array of factors. Key among these factors is appropriate accommodation at the workplace. Current approaches to accommodation, however, are often unsuccessful. Research suggests that this is due, in part, to the limited view of accommodation as technical changes to the job. An approach to accommodation that does not take into account the social context ignores the consequences of the process on work group morale and individual self-esteem and well-being. This has repercussions for individual job performance, job satisfaction and work retention, as well as overall work group productivity. An intervention was designed to take into account the social nature of the accommodation process and pilot tested with 12 workers who were out on a short term disability leave with a psychiatric diagnosis and their work groups. Based on a psychoeducational model, the intervention educates the work group about what it means to work with a disability, provides a safe environment where the worker with disability and coworkers can share concerns about the impact of accommodation on the group, informs about the accommodation process and specifies strategies to help the worker with disability best meet job requirements. Key intervention components include 1) the development of a disclosure plan since workplace intervention cannot occur without disclosure, 2) a systematic method for identifying the work group members, 3) a formal psychoeducation training that includes the supervisor, identified work group members, and the individual in the work organization who has the authority to approve accommodations, and 4) on-going follow up support to the supervisor and worker with disability. Although generalizability of the findings is limited because of the small sample size and its application only to those with mental health conditions, they support the importance of this approach to employment outcomes for people with disabilities. First, findings suggest that the rehabilitation process cannot stop at placement. Providers must be willing and able to enter the workplace with their clients. This requires providers to take on new roles such as educators, interpreters, negotiators and trainers. Disclosure must lose its status as a taboo topic. Providers and workers with disabilities must come to understand the risks and benefits of disclosure, and, when the decision is made to disclose, must have a formal, structured plan for carrying it out. Finally, workplace intervention must take into account the social context and provide the opportunity for communication and interaction in order to insure the success of the accommodations.

Disability management : a complete system to reduce costs, increase productivity, meet employee needs, and ensure legal compliance

An overview of disability management -- Legislation affecting disability management practices -- Components of a disability management program -- Preparing to implement disability management : an organizational perspective -- Laying out the policy on disability management -- Case management as a disability management tool -- Ensuring continuity of disability management -- Profiles of corporate disability management programs -- How do we know disability management will work?.

Building capacity in social service agencies to employ peer providers.

OBJECTIVE While there is evidence that peer providers are valuable to service delivery teams, the agencies where they work face difficulties in fulfilling the potential of including peers on staff effectively. The purpose of this article is to report findings of a pilot test of a workplace strategy that promoted inclusion of peer providers at social service agencies by building organizational capacity to support people with mental health conditions in peer provider roles. The strategy included training, goal setting and ongoing consultation. METHODS Seventy-one peer, non-peer and supervisory staff participated from 6 agencies over a one year period. Goal attainment scaling and data from in-depth interviews about perceptions of differences in the ways in which staff are supported, administered prior to and after the consultation period, were used to assess strategy impact. RESULTS Most frequently staff set goals to respond to role conflict or a lack of support. Staff that met or exceeded their goals utilized the formal structure of consultation to improve communication among themselves, had leadership that sanctioned changes and felt that their participation was of value to the organization and contributed to their individual development. Strategy participation promoted inclusion by initiating changes to policies and practices that devalued the peer provider role, increased skill sets, and formalized lines of communication for sharing information and understanding related to peer providers. CONCLUSIONS Findings demonstrate that a strategy of training, goal setting and consultation can positively affect perceptions of inclusion, and promote implementation of practices associated with inclusive workplaces.

Inclusion of People with Mental Health Disabilities into the Workplace: Accommodation as a Social Process

A review of the literature reporting on the employment status for people with serious mental health conditions typically begins with a litany of statistics demonstrating their continued poor employment outcomes.

Performance-based contracting: turning vocational policy into jobs.

The New York State Office of Mental Health has implemented a 2-year demonstration to determine if performance-based contracting (PBC) improves rates of competitive employment for people with serious persistent mental health conditions, and promotes best practice among providers. This article reports the interim findings from the demonstration. Initial results suggest that PBC is reaching the target population and promoting employment for a significant proportion of participants. It is also stimulating agency re-evaluation of consumer recruitment strategies, job development models, staffing patterns, coordination with support services, methods of post-placement support, and commitment to competitive employment for consumers.

Meeting the Demands of Work and Responsibilities of Caring for a Child With Asthma: Consequences for Caregiver Well-Being

ABSTRACT This study explores work–caregiving conflicts for 98 randomly selected low-income, single parents of children with asthma and how it affects caregiver well-being. Participants, who worked in unionized hospitals in a large urban area and had young children with asthma, were given an in-depth phone survey, which measured quality of life, depressive symptoms, caregivings positive impact, caregiving burden, work–caregiving conflict, and social support. The findings suggested that work tended to conflict with caregiving more than caregiving conflicted with work, as most participants perceived work as inflexible. In addition, parents relied more on family and friends as social support rather than on workplace or union support, as the union fulfills its responsibility to assure employment maintenance despite difficult working conditions. And although caregiving was viewed as a positive experience, it negatively affected quality of life. This population would benefit from education about policies governing the use of personal time, assistance with developing a plan to disclose their work–caregiving conflict and on how to activate workplace supports, and focus on this assistance being provided at the onset of asthma. Future research and recommendations are made.

Peer-led healthy lifestyle program in supportive housing: study protocol for a randomized controlled trial.

BackgroundThe risk for obesity is twice as high in people with serious mental illness (SMI) compared to the general population. Racial and ethnic minority status contribute additional health risks. The aim of this study is to describe the protocol of a Hybrid Trial Type 1 design that will test the effectiveness and examine the implementation of a peer-led healthy lifestyle intervention in supportive housing agencies serving diverse clients with serious mental illness who are overweight or obese.MethodsThe Hybrid Trial Type 1 design will combine a randomized effectiveness trial with a mixed-methods implementation study. The effectiveness trial will test the health impacts of a peer-led healthy lifestyle intervention versus usual care in supportive housing agencies. The healthy lifestyle intervention is derived from the Group Lifestyle Balanced Program, lasts 12 months, and will be delivered by trained peer specialists. Repeated assessments will be conducted at baseline and at 6, 12, and 18 months post randomization. A mixed-methods (e.g., structured interviews, focus groups, surveys) implementation study will be conducted to examine multi-level implementation factors and processes that can inform the use of the healthy lifestyle intervention in routine practice, using data from agency directors, program managers, staff, and peer specialists before, during, and after the implementation of the effectiveness trial.DiscussionThis paper describes the use of a hybrid research design that blends effectiveness trial methodologies and implementation science rarely used when studying the physical health of people with SMI and can serve as a model for integrating implementation science and health disparities research. Rigorously testing effectiveness and exploring the implementation process are both necessary steps to establish the evidence for large-scale delivery of peer-led healthy lifestyle intervention to improve the physical health of racial/ethnic minorities with SMI.Trial registrationwww.clinicaltrials.gov; NCT02175641, registered 24 June 2014

Have I Got a Worker for You: Creating Employment Opportunities for People with Psychiatric Disability

Barriers to employment for people with persons with serious, persistent mental health conditions. psychiatric disabilities are under attack from the combined weight of legislative Contrary to the belief of employers and providers alike, research shows that peomandates, consumer pressure, and changing health care and benefit policies. Deple with serious, persistent mental health conditions can work (Akabas & Gates, spite these forces, the unemployment rate for this group, as for all Americans with 1998; Akabas & Gates, 2000; Weiner, Akabas, & Sommer, 1973; Bond & Meyer, disabilities, remains dismally high. Of the 16.9 million working-age Americans with a 1999). Data suggest that high unemployment rates cannot be explained by a lack disability that limits the amount or kind of work they can do, many of whom have of desire or ability of consumers to work (Louis Harris and Associates, 1994). Nor psychiatric disabilities, more than two thirds (11.9 million) do not participate in does the explanation of high unemployment lie with labor market conditions. the labor force (LaPlante, Kennedy, Kaye, & Wenger, 1997). The purpose of The national unemployment rate is the lowest since the 1960s (reported as 4.1% this paper is to explain how providing vocational rehabilitation services contributes in May 2000 by the U.S. Department of Labor), which suggests that more people to these rates and to describe a cutting edge strategy, the Neighborhood Labor who were often left jobless, such as those with few skills or minimal education, now Market Employment Strategy, which may increase employment opportunities for have jobs (Weinstein, 1999). If consumers are willing and able to work and if jobs are available, then we Lauren B. Gates, Ph.D., and Sheila H. Akabas, must ask why more of them are not emPh.D., are affiliated with the Center for Social ployed successfully. The problem can be Policy and Practice in the Workplace, Columbia explained, at least in part, by a paucity of University School of Social Work. Elana Zwelling, M.S., is affiliated with Towers Perrin. linkages between providers and employAddress for correspondence: Lauren B. ers. Providers of vocational services can Gates, Ph.D., Workplace Center, Columbia Uniplay a determining role in consumer emversity School of Social Work, 622 W. 113th ployment outcomes: They evaluate conStreet, New York, NY 10025. E-mail: lbg13@ sumer readiness for competitive employcolumbia.edu.

Social Work's Response to Poverty: From Benefits Dependence to Economic Self-Sufficiency.

ABSTRACT Welfare reform in the 1990s represented a fundamental policy shift in the United States’ response to poverty from supporting benefits dependency to promoting economic self-sufficiency. Social work’s capacity to integrate this policy shift into practice is central to meeting its mission to alleviate poverty. This study looked at the preparation of future social workers as a way to gauge the extent of the profession’s integration of this shift. Findings showed that about half of social work education programs do not include skills and knowledge related to economic self-sufficiency in their curricula, and there is considerable variability among those that do. Most program administrators are interested in expanding their curricula but are hampered by a lack of resources and faculty and student resistance.