Supported Employment and Social Enterprise Models for

Homeless Youths with Mental Illness

Kristin M. Ferguson, Ph.D. Silberman School of Social Work at Hunter College

National Alliance to End Homelessness

National Conference on Ending Homelessness

Washington, DC July 30, 2014

• High unemployment rates (66-71%) among homeless youths

• Reliance on high-risk survival behaviors to earn income – legal and

illegal

• Low educational levels, limited work histories, housing and food

insecurity, daily survival needs, and mental illness hinder success in

obtaining and maintaining employment

• Unemployment associated with increased substance use and criminal

activity, societal estrangement , and chronic homelessness

Economic and personal well-being interrelated

Employment offers time structure, social contact, social context, and social identity—all of which influence health and mental health

Increased amounts of employment-specific vocational services for

longer durations positively impact employment outcomes, whereas

greater amounts of clinical services for longer durations are

associated with poorer employment outcomes (Cook, 2006)

Supported Employment

(Individual Placement and Support)

Social Enterprises

(Social Enterprise Intervention)

• Supported Employment (SE), or Individual Placement and Support (IPS),

is an evidence-based intervention that assists individuals with severe

mental illness in gaining competitive employment by offering

individualized and long-term support (Becker & Drake, 2003)

• Based upon eight defining principles: zero exclusion, integration of

vocational and mental health treatment services, competitive

employment, benefits counseling, rapid job search, follow-along

supports, preferences, and systematic job development (Drake, Bond, &

Becker, 2012)

• Leads to improvements in relationships, self-esteem, hope, and life

satisfaction, in addition to gains in employability, work functioning, work

hours, and income (Bond et al., 2000; Cook et al., 2005; Cook, 2006;

Drake et al., 1999; Salyers et al., 2004)

• Include nonprofit organizations, socially minded businesses, vocational

cooperatives, affirmative businesses or social firms, microenterprises

and revenue-generating ventures that create positive social impact in the

context of a financial bottom line (Dees, 1998)

• Adopt community economic development approach to neutralize labor-

market conditions of individualism, competition, and profit that create

employment disadvantage for persons with mental illness (Krupa et al.,

2003)

• Clients experiencing homelessness and/or mental illness who participate

in affirmative businesses/social enterprises benefit from teamwork with

peers, and acquire vocational skills and clinical services; agencies and

communities benefit from additional income sources and products

(Krupa et al., 2003; Shaheen & Rio, 2007; Warner & Mandiberg, 2006)

STUDY 1 Social Enterprise Intervention Model (SEI) and Homeless Youths:

Preventing the health, mental health and social deterioration of

homeless and street-living youths in Los Angeles

STUDY 2 Feasibility Study of the Individual Placement and Support (IPS)

Program with Homeless Youths in Los Angeles

Peer engagement

Mentoring

Job training (Photoshop, graphic design)

Small business skills (accounting, budgeting, marketing)

Clinical services and treatment

Harm Reduction

Employment-based, behavioral intervention for street-living youths (16-24) with limited service engagement

(Ferguson, 2007)

Convenience sampling over 1-month recruitment

Youths screened for Time at agency: 2+ times per week in prior month

Verbal commitment to 8-month training

100 youths approached; 20 enrolled; 16 attended

Intervention: 2 parallel SEI groups of 10 and 6 youths

Control: 12 youths receiving usual-care services

Youths matched on age, gender, ethnicity

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SEI = 16 SEI youth

Ctr = 12 control-group youth

(usual-care services)

(Ferguson & Xie, 2008)

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SEI = 16 SEI youth

Ctr = 12 control-group youth

(usual-care services)

(Ferguson & Xie, 2008)

zero exclusion

integration of vocational and mental health treatment services

competitive employment

benefits counseling

rapid job search

follow-along supports

respect for client preferences

systematic job development

Employment intervention integrated with clinical services for homeless youths (16-24) with mental illness, consisting of:

(Ferguson, Xie, & Glynn, 2012)

Convenience sampling over 1-month recruitment

Youths screened for Ages 16-24

Primary clinical diagnosis in the past year using MINI

Intervention: IPS group for 20 youths (agency 1)

Control: Usual-care services for 16 youths (agency 2)

*p<0.05

Instrument: Mini International Neuropsychiatric Interview (MINI)

IPS youth monthly work rate = 45-70%

(Adult IPS monthly work rate = 35-45%)

1. Client benefits: Learn vocational and business skills, access social enterprises and competitive

employment, and receive continuous mentoring

Receive ongoing mental health services tailored to individual conditions

2. Agency benefits: • Generate alternate funding streams (social enterprises)

• Build professional relationships with employers (supported employment)

• Eligible for intervention funding (e.g., NIH) to develop/test models & hire staff

• Staff advance professional development in designing, implementing, and evaluating interventions and administering standardized assessment tools

3. Society benefits: • Job opportunities for local residents and needed products and services

• Increased media coverage of successful employment interventions

• Reductions in homeless youths and survival behaviors in public spaces

1. Evidence-based interventions require start-up funding

In-kind assistance from faculty/students at business schools or from community

Donations of materials/equipment from companies and community groups

Public/private agencies funding pilot studies

2. Employment interventions with homeless youths in their infancy

• Lack of standard treatment manuals for developing and replicating evidence-based employment models with homeless youths

• Limited feasibility and effectiveness data to inform agency staff in program design

3. Discrepancies between federal funding requirements and agency ethos

• Federal (NIMH) funding requires mental health diagnosis as inclusion criteria

Train agency clinicians to administer diagnostic assessment tools

• Practitioner objections to screening clients for mental illness Train agency staff to offer the intervention to clients who do not qualify

Becker, D.R., & Drake, R.E. (2003). A working life for people with severe mental illness. New York: Oxford University Press.

Bond, G.R., Becker, D.R., Drake, R.E., et al. (2000). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52, 313-322.

Cook, J. A. (2006). Employment barriers for persons with psychiatric disabilities: Update of a report for the President's Commission. Psychiatric Services, 57(10), 1391-1405.

Cook, J. A., Leff, S., Blyler, C.R., et al. (2005). Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness. Archives of General Psychiatry, 62, 505-512.

Dees, J. G. (1998). Enterprising nonprofits. Harvard Business Review, Jan.-Feb, 55-67.

Drake, R. E., Bond, G. R., & Becker, D. R. (2012). Individual Placement and Support. An evidence-based approach to supported employment. Cary, NC: Oxford University Press.

Drake, R. E., McHugo, G. J., Bebout, R.R., et al. (1999). A randomized clinical trial of supported employment for inner-city patients with severe mental disorders. Archives of General Psychiatry, 56(7), 627-633.

Ferguson, K. (2007). Implementing a social enterprise intervention with homeless, street-living youth in Los Angeles. Social Work, 52(2), 103-112.

Ferguson, K., & Xie, B. (2008). Feasibility study of the Social Enterprise Intervention with homeless youth. Research on Social Work Practice, 18(1), 5-19.

Ferguson, K., Xie, B., & Glynn, S. (2012). Adapting the Individual Placement and Support model with homeless young adults. Child & Youth Care Forum, 41(3), 277-294.

Krupa, T., LaGarde, M., & Carmichael, K. (2003). Transforming sheltered workshops into affirmative businesses: An outcome evaluation. Psychiatric Rehabilitation Journal, 26(4), 359-367.

Salyers, M. P., Becker, D. R., Drake, R. E., et al. (2004). A ten-year follow-up of a supported employment program. Psychiatric Services, 55(3), 302-308.

Shaheen, G., & Rio, J. (2007). Recognizing work as a priority in preventing or ending homelessness. Journal of Primary Prevention, 28, 341-358.

Warner, R., & Mandiberg, J. (2006). An update on affirmative businesses or social firms for people with mental illness. Psychiatric Services, 57(10), 1488-1492.

Kristin M. Ferguson, Ph.D.

Associate Professor

Silberman School of Social Work at Hunter College

Email: kferg@hunter.cuny.edu

Phone: (212) 396-7553

Dartmouth IPS Supported Employment Center:

http://sites.dartmouth.edu/ips/

University of Kansas Center for Mental Health Research and Innovation:

http://mentalhealth.socwel.ku.edu/