>> In this first demonstration, you'll observe parts of an interview
with the executive director of a fictional agency we are calling Great Lakes Mental
Health Center.
>> We're interested in learning about the executive director's understanding
of supportive employment and the executive director's role in promoting the practice.
>> While observing this interview, we are asking you to identify information that may be used
for scoring specific items in the fidelity scale.
It is also important to make detailed notes that will assist you
in writing a fidelity summary report.
So, let's take a look.
>> Tony, good to see you.
>> Great to have you here.
>> Thank you so much for taking the time to talk to us today.
We've heard that your program has made some changes as far
as implementing supportive employment.
>> Tony: We've been working really hard on it and it's great to have the two of you here.
My staff and I have really been looking forward to this as an opportunity to do some learning
and figure out things we can do to get better at it.
I took the liberty of putting together just some material about the organization
that you can look at at your leisure.
It's just a way of catching up real quickly on a little bit about what's new here.
>> Thanks a lot.
I really appreciate that and thanks again, Tony, for taking some time with us.
I really appreciate it.
>> Sandy: So, we find it really useful to ask you some questions.
Do you mind?
And also, I'd like to be able to take notes.
Is that ok?
Great. So, can you tell us what you've done so far?
At this point I'm real curious to hear about what sorts of measures and steps you've taken
in order to start implementing supportive employment.
>> Well, we've done a lot of things I think to get ready for this.
Some of the big changes are that we're working with vocational rehabilitation
in a really different kind of a way than we used to.
You know, we used to each kind of operate in our own orbits and now we talk
to each other a lot more and we see ourselves as part of the same team working together
in the interest of the clients that we share responsibility for.
That's been a big change for us.
And we're also much more focused on competitive employment.
And so much of the work that we used to do was focused on pre-employment activities,
things you need to do to get ready for that day when you might go out and get a job.
And we've dumped almost all of that and we're really focused on competitive employment
and getting people out into real jobs as quickly as we can.
>> Sandy: Great.
Great. So, what happened as a result of that?
>> Tony: Well, as a result of that, we've had to make a lot of changes in the organization.
And so there's been a lot of buzz around the organization about supportive employment.
Conversation about competitive employment is part of every conversation in the organization.
It's part of our treatment team meetings in a different way than it ever was before.
It's part of our strategic planning process in a way that it never was before.
So, competitive employment is part of every type of conversation
that we do here now in the organization.
We've also made some changes in the size and in the way that our treatment teams run.
They're a little bit smaller and every one of them has an employment specialist on it.
>> Well you know, Tony, you've talked about some of the organizational changes that you've made
and I know there's probably some others that you've made,
but let me ask you specifically about this.
What about supportive employment specialists providing only vocational services
in those community settings that you've talked about?
How is that matching up?
>> Tony: I know that the right answer is they're only doing employment services
and we're really making a lot of progress with that but it's always a little bit of a struggle,
you know, because there are always clinical crises going on.
There's always clinical case management work to do and it's a constant effort
to keep the employment specialists' time from getting pulled into all of those things
that could be doing and to really keep their time focused on what they need to be doing,
which is good jobs in the community and competitive settings.
We're getting better at it.
>> Olright.
Mind just a follow up question to that?
What are the next steps you see in implementing supportive employment?
>> Tony: There are a couple of things I can think of off hand.
One is the fidelity assessment.
And we've got to start using that more regularly I think.
When we first started doing this we were aware of the fidelity assessment
but people were kind of reluctant to use it.
I think they felt like they were being graded.
But we've really come to discover that the fidelity assessment provides us
with really great mile posts for the work
and it gives us good guidance in what we need to do next.
And I think the staff are ready to start doing that routinely
and start really driving service development based
on what we find in the fidelity assessment.
A second thing is this little team that we've done, this little project that we've done
for an in-house janitorial assessment project where we formed a small janitorial crew
that we use to help our clients who haven't really had much work experience just to try
on work a little bit so that they can get a better sense about what it's about
and that our staff can get a better sense of them in a job.
Just as a preliminary assessment kind of a thing.
We may want to expand that a little bit.
>> One more question.
What about outcome data?
You know evidence based practice employment as you know is pretty outcome driven, Tony.
And I'm wondering how you're handling that situation.
What steps are you taking around that?
>> Tony: Well, that's new for us and I think we've got pretty good tools in place
with our information systems and quality systems, but it's only been very recently
that we've put together a specific set of data elements and outcomes
that we want to track around employment.
So I don't have anything I can show you in terms of a report because we're
at the beginning stages of that but I do recognize that beginning
to collect specific outcome data is going to be important for us.
>> Sandy: Great.
It sounds like you've really committed
to helping people re-enter the workforce and that's terrific.
I'm just wondering if you've had any opportunities in the last year to talk
about the supportive employment program, to bring it up to the management team, newsletters,
anything else that may have occurred.
>> Tony: You know, as you mention, I think that most of the work
on that has been pretty informal.
We talk about it a lot in the organization and I suspect that every one of my managers is going
to tell you they know that supportive employment is important here.
But, we may have missed some opportunities around newsletter, web page,
those sorts of things for bragging about what we do.
And to show what we've done over the last year and where we're going with it,
that we still need to take care of.
>> Sandy: OK.
OK. Let's think about some of the ways that you've talked
about how you started implementing supportive employment that will help me out here.
So, if I can just kind of re-cap that you've increased your partnership
with VR, vocational rehabilitation.
You're building that relationship together, and you've integrated the team meetings
so that now employment specialists join the teams.
It sounds like employment specialists are more focused on jobs only, but that still is struggle
because there are so many other things that are going on.
So, you're focusing more on that.
Is there a way that you have of talking to the supportive employment supervisor
in case there are any issues or problems that come up within the program itself?
>> I think it will come up mostly clinical management structure,
and I certainly see the head of our employment services around the hallways.
But, you know, that person reports to their supervisor who reports
up through the chief clinical officer.
And I see the chief clinical officer all the time.
So, it's pretty informal and then through the management structure.
>> Sandy: OK.
>> Well, I don't want to leave before asking Tony if he has any questions for us.
>> Tony: I don't think so.
I'm really looking forward to hearing what you find out there.
And for all your feedback and consultation I know
that like I said earlier, we've come along way with this.
But I know that there are things that we can do better with.
And your visit and consultation is going to be an important part of helping us get there.
>> Sandy: Great, great.
Yalend and I will be writing up the report and hopefully we'll get that to you
in around two weeks, and then we'd like to schedule a time to talk to you
so we can review it and hear if there are any issues and concerns.
>> Tony: Good, looking forward to it.
>> Sandy: Great.
>> Tony, really appreciate your time.
It was great to have you here.
>> Tony: Thank you.
>> Thanks a lot.
>> Sandy: Now that you've seen this interview and made notes, we want to share some
of the information that we gathered from this interview.
>> I'll start.
I heard some information about the actions of the executive director, and the management team
to facilitate the integration of Mental Health Treatment Services
and Supportive Employment Services.
That information will be helpful as part
of scoring the fidelity item executive team support for supportive employment.
>> I was impressed with how much the executive director knew about supportive employment.
He has a real passion for this.
That being said, it may be very helpful for him to find ways
to communicate how employment fits with the mission of the agency.
>> I also heard information about the fidelity scale item vocational service's staff.
The agency is working to protect the role of employment specialists
for doing just employment services.
As we know, agencies sometimes assign case management duties to employment specialists,
which prevents them from assisting people to get jobs.
When we review the client records, we should remember to find documentation
about how employment specialists spend their time.
Sandy, we heard how the agency has begun tracking employment outcomes,
which is useful for the fidelity item agency focus on competitive employment.
>> Sandy: Well, when I looked at this fidelity item on the scale,
it said that the agency not only collects the outcomes data,
but the agency then shares the outcomes with the agency leadership and staff.
It appears that Great Lakes Mental Health Center does not currently share outcomes.
>> I agree.
What else did you notice?
>> The executive director mentioned something about a janitorial
at the agency, which could be an issue.
We'll need to gather more information about that in-house work program
and other items during our visit.
>> And we will.
Let's move on to the next interview.
See you in the next section.