Transcript Mental Illness: Impact in the workplace

VOCATIONAL PROFILING
I.A.S.E. National Conference 2008
Shane Martin
B.A.,H.D.E.,Dip.Psych,MSc.,Reg.Psychol.,Ps.S.I.
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The Association for Persons in
Supported Employment : "Ethical
Guidelines for Professionals in
Supported Employment"
Basic human principles to follow
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Ethical Guidelines for Professionals
in Supported Employment
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People receive assistance as unique individuals with
varying interests, preferences and aptitudes.
There are sufficient options related to each
individual's interests and desires in life in order for
them to exercise control and autonomy over their
life's direction.
Services are always dignified, age appropriate and
enhancing.
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Ethical Guidelines for Professionals
in Supported Employment
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People have the opportunity to actively participate in
all their chosen pursuits of life.
Individuals are provided opportunities to develop
skills of interest and use in their lives by discovering
their capacities.
People have access to diverse individuals in social
contexts in order to build friendships, working
relationships and networks of individuals to share
places, interests or experiences.
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Ethical Guidelines for Professionals
in Supported Employment
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Services are designed to support persons in natural
settings in ways that minimise artificiality or
restriction.
At all times, the individual receiving supports is the
central driving force in the development of options
and decisions.
Employment should be an option for any person
interested in working, regardless of label, support
need or perceived functioning level.
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Ethical Guidelines for Professionals
in Supported Employment
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Jobs developed reflect personal interests,
preferences, abilities and life goals as well as
employer needs. The decision to take the job is
made by the individual based on reliable
information.
Existing supports natural to the work environment
are maximised for training and ongoing support.
Best training practices and technology appropriate to
the setting and culture are used.
Efforts to provide a holistic and integrated life
service support are made. The individual's family
members and friends are involved.
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Ethical Guidelines for Professionals
in Supported Employment
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Persons have the opportunity and support for career
advancement that may provide additional
responsibilities, compensation and challenge.
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The Vocational Profile process
Callahan and Nesbit 1986 and 1996
McLoughlin (et al) 1987
DiLeo and McDonald 1993
Leach 2001
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The Vocational Profile process
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The process through which information
based on each individual’s interests, skills
and potential skills (as well as
support/resource needs) is gathered with
the sole purpose of helping employment
facilitators find the ideal job for each
individual
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The Vocational Profile process
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Different from many traditional
employment assessments because it
assumes anyone who wants to work is
employable.
An essential time/energy investment to
facilitate someone learning about and
achieving their career objectives.
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Measured application :never to be imposed
on anyone who knows exactly what they
want and need minimal support to get a job
The 3 Fundamentals of vocational profiling
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3 Fundamentals of Vocational Profiling
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The Power of Conversation
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The Power of Observation
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The Power of Partnerships
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Of crucial importance…….
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The relationship between the applicant and
employment specialist
Evolving over time from conversations,
observations, partnerships and time
Empathy, compassion
Strong knowledge base
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Of crucial importance…….
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The profile needs to capture what has been
‘discovered’ and form the basis of planning
Particularly useful for clients with complex
support needs or past difficulties in
achieving successful employment outcomes
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Gathering the Information
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variety of methods
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variety of environments, settings
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investing time
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Linking with family members, friends, staff
etc.
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Gathering the Information
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Accompanying the client to a variety of
work places
The Quiet Observer: the person's reactions
Talking to people who know the client (may
produce additional information)
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Gathering the Information
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Discussions can provide important material
about the person's interests, experiences,
habits and skills, especially if these are
hidden or no longer practised.
Suggested contacts and consent
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Gathering the Information
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Short job trials in a variety of real work
places.
Two weeks maximum or a number of hours
Person's interest in the particular job and
comfort zone (tasks, workplace, colleagues)
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Gathering the Information
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Stamina, speed, degree of focus
On-the-job learning would provide an
insight into typical adaptations, training
development, resources necessary for each
individual
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Gathering the Information
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Listening to and learning with the job
seeker
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Formulate an agreed vision of the needs
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Strengths and potential difficulties
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What needs to be written?
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What are the basic requirements?
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Registration Information
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Name, age, address and other relevant
personal information
Domestic information: living circumstances,
family and friends in the person's life –
questions re: degree of support and
understanding from these key people
Local environs: employment potential,
services, transport
Current reality: how the client currently fills
their day (from morning to night)
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Educational information
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school experience, certification,
extra-curricular pursuits at school
Post-school training, courses
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Community information
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Involvement in community
Hobbies and leisure
Volunteering activities past/present
Community supports
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Work experience information
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Formal and informal work
performed (at home or for others)
Sheltered employment
Paid work (part time or full time)
The previous job – comprehensive
conversation around this area
important
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Practical information
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Literacy skills
Academic (reading, maths, time, money)
Mobility (walking, sitting, lifting,
carrying)
Sensory (hearing, sight)
Communication
Social interaction
Physical health
Mental health
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Preferences information
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Learning / performance characteristics and
preferences
In what ways/environs does the client learn
best?
Any helpful adaptations, resources?
Agreed degree of instruction
Alone or as part of a team
Line Manager clarification
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Preferences information
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Does the client really want a job? (or is
someone else pushing him/her into it?)
Types of work the person wants to do
What is the client good at doing?
What does the client enjoy doing at home
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Potential partnerships information
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Linking with potential employers
amongst family, friends or
community
Client suggestions re: family or
friend contacts for employer leads
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Employment Setting Preparation
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Flexibility/accommodations that may need
to be negotiated
Any habits or routines, including specific
preferences for hours, location, work
environment, transport, co-workers,
adaptations and assistance
Any physical/health requirements now or
later
Any regular medical appointments
Communication
requirements
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Research indicates that moving
quickly to respond to a clients
desire to ‘return to work’ along with
facilitating his/her preference for
type of work are the key ingredients
influencing a positive employment
outcome
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Vocational profiling does not have to
be a rigid or clinical tool/instrument
Rather a route to highlighting all
areas which may help the person
exploring the pluses to assist them
achieve their goal.
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IMPACT ON WORK
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DEPRESSION
BI-POLAR DISORDER
ANXIETY
PHOBIA
SCHZIOPHRENIA
PANIC DISORDER
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WORK READINESS
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Clarification re: energy levels
Clarification re: sleeplessness
Poor motivation is not a health and
safety issue
Pessimism (downbeat) is part and
parcel of depression
Concentration issues
Medication
side effects?
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WORK READINESS
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Suicidal thoughts?
Not to expect pleasure from work
experience
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More complex mental health needs
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Typical episode description
Hospitalisation
Has the client learned how to recognise
the signs of potential manic phase?
Agreed protocol
Anxiety watching
Honest feedback process
Manic now?
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Anxiety issues
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Current state
Issues re: being noticed by others
Sickness
Last minute withdrawals
Anxiety not about work environs
May check with you for reassurances
Or co-workers
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Phobias
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Should prove no problem
Open and honest discussion wise
Ensure trigger cannot enter work
environment
May be need to share information
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Schizophrenia
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Pre-requisite- medical compliance
Advice from ‘key worker’ re: specific
vulnerabilities
Paranoia – avoid groups/noisy environs
Definite sequence of adsorbing and
focused tasks
Skills and responsibilities match (stress)
Under challenged rather than over
challenged
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Work Readiness
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Frequency of clinics/visits gives clues
Family support
Tiredness – when and how bad?
Change of intervention – be informed
Triggers –computers, security cameras etc
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Best practice
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Regular check-in with client
Regular check-in with colleagues
Potential of ‘buddy’ system
Reassurance for boss
Are ready for work if compliant, staggered
approach, partnership, reviewed and
supported
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Can an employee work safely?
Will the job enhance wellness?
Can the employee cope with high levels of
stress?
Will the employee’s environment help or
hinder progress?
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Impact of various psychological disorders
on vocational functioning is a crucial area of
training
Badly needed
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Proper assessment is key
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Impact of specific psychological disorders in
workplace
Methods for helping people find and keep
satisfactory competitive-level work
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Essential factors
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Cognition
Pace
Persistence
Reliability
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Essential factors
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Conscientiousness
Motivation
Interpersonal skills
Stress tolerance
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Honesty
Trustworthiness
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When an employee’s disorder
significantly affects these
psychological dimensions, it can
have major implications for all
involved in the workplace,
supervisors, co-workers and the
troubled employee
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Cognition
Effects on Job Performance
Intelligence, memory, concentration,
academic skills
Diagnostic Factors
Intellectual disability
Brain injury
Schizophrenia
Depression
Anxiety
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Pace
Effects on Job Performance
Ability to perform tasks at a
reasonable speed
Diagnostic Factors
Depression, OCD, Passive Aggressive
Personality Disorder
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Persistence
Effects on Job Performance
Ability to stay at task until complete
Diagnostic Factors
Bipolar disorder manic phase, ADHD,
Psychosis, PD
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Reliability
Effects on Job Performance
Coming to work everyday in spite of
personal or emotional problems
Diagnostic Factors
Agoraphobia, Major Depression,
Bipolar disorder manic phase,
psychosis, PD
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Conscientiousness and motivation
Effects on Job Performance
Wanting and trying to do a good job;
persisting until it is accomplished
Diagnostic Factors
Major depression, Psychosis, PD
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Interpersonal functioning
Effects on Job Performance
Ability to accept supervision, to get
along with co-workers or public
Diagnostic Factors
Bipolar manic phase, Post Traumatic
Stress Disorder, Narcissistic PD,
Paranoid Schizophrenia
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Honesty, trustworthiness
Effects on Job Performance
Ability to be truthful, direct, and
straightforward, to refrain from
such things as lying and theft at
work
Diagnostic Factors
PD, Addiction
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Stress tolerance
Effects on Job Performance
Ability to withstand job pressures
such as deadlines or working with
difficult people
Diagnostic Factors
Schizophrenia, Post Traumatic Stress
Disorder, Major depression
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The following areas are linked to satisfactory
employment outcomes according to best
research
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Interpersonal functioning
Severity and type of disorder
Job satisfaction
Work history
Cognitive functioning
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The following areas are linked to satisfactory
employment outcomes according to best
research
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Family support
Substance abuse
Level of motivation
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Mental health disorders less easily
understood
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Criteria for diagnosis is subjective
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Suggests that clinician knows best
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Clinician knows best?
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Exclusively rely on clinician as
primary source
Self-reporting difficulties
Rogers: empathy, warmth,
congruence and unconditional
positive ‘regard’
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Key Information for Employment
Facilitators
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Work history: length, job
description, disciplinary history,
absenteeism etc.
Prior medical and/or mental health
data as is relevant
Data may yield critical clues i.e.
prior episodes of illness, treatment
recommendations, prognosis etc.
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Key Information for Employment
Facilitators
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Comprehensive interview via best
instruments (training)
Employee’s description of work
problems
Employee’s social history
Employee’s work history
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Employee’s social history
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Education
Family
Legal
Psychiatric
Substance use
Aggression
Medical
Activities of daily living
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Employee’s work history
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Prior to problems
Training placement(s)
Work trials
References
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Current symptoms
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Current mental health status
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Behavioural observations
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Employee’s perception of ability to work
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Views of employee
Examples of worries, concerns
Suggestions around modifications
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Five Star Extra
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Psychological Assessment aimed at
vocational potential
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Other countries
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Not in Ireland
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Five Star Extra
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Cognitive: measures of intelligence,
concentration and memory
Personality: measures personality and
emotional characteristics
Effort and Motivation: measures extent
employee is putting forth appropriate
effort and is motivated to present in
accurate manner i.e. whether employees
are minimising or maximising their
symptoms
Organisational behaviour: job matching
with appropriate validated tests
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Assessment not complete
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Unless specific recommendations
have been agreed and documented
Unless fully implemented and
reviewed
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Workplace modifications
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For vast majority of mental health
problems, these are simple and
inexpensive
Major issue is confidence of
employee
Appropriate handling of disclosure
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Recommendations for major
depression (Fischler & Booth, 1999)
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Giving employee simple,
straightforward tasks to aid memory
and concentration and help him
develop mastery over the job
Promoting as much predictability as
possible in employee’s daily tasks
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Recommendations for major
depression (Fischler & Booth, 1999)
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Providing clear guidelines and
instructions, possibly in writing
Allowing for flexibility with regard to
pace of work and timing of breaks
Working as part of a team to
decrease sense of loneliness or
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Crucial sustainers
Regular three-way feedback
Review meetings
Maintain partnerships (assuming they
have been established)
Promise of on-going support link
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RED FLAGS
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Continued problems with symptoms
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Increased anxiety (protocol?)
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Lack of family support
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Treatment non-compliance
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RED FLAGS
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Addiction but no intervention
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Denial
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New behaviour / symptoms
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Hyperactivity / Over-confidence
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