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Regulatory and Funding Parameters for Peer Specialists in Supporting Employment – The purpose of this paper is to encourage and strengthen the role that peer specialists can play in supporting the competitive employment goals of the individuals they serve. 

A Call to Change: Employment - A Key to Recovery
March 5, 2008

To move Pennsylvania’s recovery transformation forward, "a person’s recovery journey must include acquiring or returning to social roles in the community – including that of being a worker.” (1)

Pennsylvania’s unemployment statistics for 2006 averaged 4.6% while unemployment for people with a mental illness in Pennsylvania’s Behavioral Health system is estimated at 85%. (2) (3)

The public behavioral health system of care and benefits has institutionalized people’s poverty status and lack of information on the impact of shifting from the system of benefits to an income based on employment contribute to people’s hesitancy to return to the workforce.

Studies have clearly demonstrated the many positive personal and economic effects of working including:

  • Improvement in employment status results in higher levels of self-esteem, morale, self-efficacy, and overall life satisfaction (4) (5)
  • Working consumers contribute to our county’s tax base. In a California study, for each consumer who became employed, $239 was paid each month in federal, state, local and sales taxes.
  • Helping consumers to work reduced the number of people on the SSI/SSDI rolls and saves taxpayer money. In the same study noted above, an average of $200 per month was saved in general assistance, TANF and SSI payments. In addition, an average of $187 was saved in public behavioral health services costs.
  • Employment for consumers can reduce the use of costly behavioral health services. (6, 7).

OVERALL GOAL
To significantly increase the number of persons served by the behavioral health system who are competitively employed.

OBJECTIVES

1. To increase funding and resources for competitive employment.

  • Set aside 5% of reinvestment funds for employment
  • Complete and submit a state Medicaid plan amendment for psychiatric rehabilitation to promote employment (Priority for 08-09)
  • Establish a full time staff position within OMHSAS to focus on promoting employment
  • Establish county lead staff to focus on the promotion of employment
  • Establish county employment workgroups to promote employment
  • Identify joint funding/staffing strategies at the county mental health/district Office of Vocational Rehabilitation (OVR) office level.
  • Deputy Secretary of OMHSAS will meet with the Deputies of Labor and Industry, the Department of Education, The Department of Community and Economic Development and the Department of Transportation to promote a minimum of 1% set aside and/or to negotiate joint agreements to promote employment of persons within the behavioral health system.

2. To Promote system and organizational change in order to increase the evidence based practices of Supported Employment and Supported Education and to address the disincentives to work.

  • Collect information on the number and location of supported employment programs in Pennsylvania in order to establish baseline data and targets.
  • Provide state level incentives to counties and county-level incentives to providers to increase supported employment/supported education services.
    1. Provide technical assistance to counties and providers to increase the number of Supported Employment/supported Education programs. (Priority for 08-09).
    2. Provide technical assistance and training to counties and providers on the implementation of the Supported Employment tool kit.
    3. Establish financially-based performance measures for counties and providers that increase supported employment/education.
    4. Issue a statewide policy promoting the transfer of funds from non-evidence based services to evidence based approaches.
  • Develop a partnership agreement with Open Minds Open Doors, the Maximizing Participation Project (MPP), and Medical Assistance for Workers with Disabilities Program (MAWD), to provide counseling training/technical assistance on the impact of work on federal/state benefits.
  • Engage consumers in the development of strategies to address the disincentives to work.
  • Provide information on the OMHSAS website on employment-related resources including work incentive information.
  • Develop a "Center of Excellence" for employment.
  • Provide annual training opportunities on employment to include training for frontline workers such as case managers, peer specialists, and rehabilitation workers.

3. To collect baseline data on individuals in the behavioral health system who are competitively employed, in order to track and reward system/provider improvements.

  • Require counties and providers to collect information on employment outcomes.
  • Establish a baseline measure for each county and tie performance funding to increases in competitive employment.
  • Track the performance of community based employment programs, sheltered workshops and psychiatric rehabilitation programs.
  • Convene a workgroup to identify the measure(s) that will be used to track employment outcomes. (Priority for 08-09)

FOOTNOTES
(1) “A Call for Change: Toward a Recovery-Oriented Mental Health Service Systems for Adults”, published by the PA Office of Mental Health & Substance Abuse Services, 2005.
(2) U.S. Bureau of Labor Statistics dissemination report on website http://data/bls.gov/cgi-bin/surveymost provides monthly rates for seasonably adjusted unemployment for Pennsylvania.
(3) G. Bond, et al “Implementing Supported Employment as an Evidence-Based Practice.” Psychiatric Services, March 2001, 52,3, 313-322.
(4) Arns, P.G. and Linney, J.A. (1995). Work, Self and Life Satisfaction for Persons with Severe and Persistent Mental Disorders. Psychosocial Rehabilitation Journal, 17 (2), 63-79.
(5) Fabian, E. (1992). Supported Employment and the Quality of Life. Does a job make a difference? Rehabilitation Counseling Bulletin, 36 (2), 84-87.
(6) Rogers, E.S., Sciarappal K. MacDonald-Wilson, I., and Danley, K (1995). A Benefit-Cost Analysis of a Supported Employment Model for Persons with Psychiatric Disability. Evaluation and Program Planning, 18 (2), 105-115.
(7) State of California, (1995). Taxpayer Return Study. California Department of Rehabilitation Mental Health Cooperative Programs.

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