Background

Supported Education and Supported Employment for College

Students with Mental Health Challenges

Abraham Rudnick1*, Marnie Wedlake1,2, Wendy Lau3, Bob McEwan4, & Erica Lundberg1,4

1. University of Western Ontario, 2. Canadian Mental Health Association, 3. Leads Employment Services, 4. Fanshawe College. * Email:

[email protected]

Background•Many people with a serious mental illness

(SMI) are commonly unemployed or underemployed (Mueser, Salyers & Mueser, 2001).

•People with SMI experience barriers to employment, such as stigma and cognitive deficits (Mueser et al, 2001)

Background•Approximately 5-12% of the college

student population report psychiatric symptoms (Megivern et al, 2003).

•Persons with mental health challenges have lower educational levels & experience more disruptions in education (eg. Kessler, Foster, Saunders & Stang,1995).

•Hence people with SMI have a low chance of gainful (trained/skilled) employment without special support.

Background• Supported employment is successful in securing

gainful employment for people with mental illnesses (e.g. Cook, Leff, Blyer et al., 2005; Best, Still & Cameron, 2008; Gutman, 2008).

• However, Supported Employment does not usually target skilled work.

• There is a lack of connection between supported education and supported employment, although this combination may enhance gainful/skilled employment for people with SMI.

Background

•Emerging evidence (e.g. Rudnick & Gover, 2009) indicates that combined supported education and supported employment services are beneficial to persons with SMI, by enhancing education and gainful/skilled employment success and personal wellbeing.

Fostering Recovery Project• Collaboration between Fanshawe College, Leads

Employment Services, and the University of Western Ontario

• Goal was to facilitate successful college education and employment of students with mental health issues via combining supported education and supported employment.

• Funded by Ontario’s Ministry of Community & Social Services-Ontario Disability Support Program, Innovation Funds

Fostering Recovery Project

•Fanshawe College •Over 14, 000 students; approximately

1,600 with disabilities •Offers over 100 programs leading to

certificates, diplomas, and degrees.•Provides counselling and a variety of

student supports

Fostering Recovery Project

•Leads Employment Services •Employment assistance for persons with

barriers to employment due to physical health, mental health, developmental or learning disabilities.

•Provide job preparation, job and skills development, transitional employment, job coaching, and job retention supports

Fostering Recovery Project• 37 students were enrolled in the project in 2008-

2009 school year. • Students saw both a college counselor and an

employment specialist (at the college) on a regular or as needed basis. College counselors and employment specialists communicated with each other as needed.

• The 37 students in the project:▫went to 60 interviews▫were placed in 29 positions (paid and non-paid) ▫ those in paid positions earned $8.75-$18.17/hr

(average $10.89/hr)▫19/29 placements were maintained 13+ weeks.

Research Objective & Question

•To explore what is the lived experience of key involved stakeholders in relation to this project – of students, their significant others, and their college counselors and employment specialists.

Method• Funding for evaluation was received by CAREMH.

HSREB and CRIC approvals, as well as written voluntary informed consent, were obtained.

• Participants: ▫6 students

4 females, 2 males; 19-46 years Bipolar disorder (2), Schizoaffective disorder

(2), major depression (2), generalized anxiety disorder (3), panic disorder (4), Obsessive compulsive disorder (3)

enrolled in: culinary, interior decorating, tourism, computer programming, and social service worker

▫5 significant others of these students parents, spouses, children

▫2 College Counselors, 2 Employment Specialists.

Method

•A primarily phenomenological methodology with first person and shadowed data collection, by means of semi-structured interviews.

•Student interviews: ▫ at the outset of the project (diagnostic

assessments and qualitative interviews)▫mid-year ▫end-of-year

•Shadowed data from students’ significant others and project counselors interviews:▫mid-year ▫end-of year

Analysis

•Thematic analysis was conducted on the transcribed and validated interview data.

•Peer debriefing and triangulation across interviewee groups – for trustworthiness.

Results - Project Benefits

Psycho/Social:

• Increased skills: social, organization, stress management

• Increased self-esteem

• Students coping more effectively with their illnesses – expressed & demonstrated desire to better understand & manage their illnesses

• Desire for independence – expressed importance of being independent

Results-Project BenefitsEducational/Vocational:

• Found it helpful to have someone to talk to; comfortable with counselors; liked hands-on Leads coaching & help with job search

• Some students able to gain employment - felt good about finding & keeping work and earning income

• Increased quality of schoolwork, socialization, confidence & sense of pride, self-advocacy

• Overall a good experience for the counselors

Results - Project Challenges• Scheduling issues sometimes made it difficult to see project staff

• Schoolwork + work were overwhelming

• Some students needed to take time off for physical & mental health problems

• Not all students were able to obtain employment

• College and employment environments were, at times, more difficult for older students

• Counselors noted that students with more serious mental illness were more difficult to serve

• Communication was sometimes difficult between collaborators

• Employment specialist not present in the college enough

Results – Student Related BarriersPsycho/Social:

• Effects of students’ illness; Some had poor insight into illness

• Students easily affected by stress

• Low self-confidence

• Student Immaturity

• Difficulty with initiative

• Personality conflicts with other students; Some engagement in socially inappropriate behaviours

• Less than adequate social support network

• Juggling education with family life was problematic at times

Educational/Vocational/Financial:

• Some delay in seeking help; some did not wish to disclose their illness to staff

• History of personal & academic struggles

• Attention problems and problems with organization & time management often interfered with tasks

• Programs chosen by students not always a good fit for their needs, limitations, employment prospects

• Limitations imposed by financial pressures (barriers related to low income)

Results - Student Related Barriers

Results - Student Related Enablers

• Motivated and determined to succeed

• Hopeful, optimistic

• Strong focus on college

• Enjoyed the challenge, enjoyed going to college & work

• Strong career and educational goals

• College involvement may have put students further ahead than typical Leads clients (those with supported employment but without supported education)

Results - Others’ Related Barriers• Students needed more support

• College set-up and schedule a poor fit for students with mental illness

• Older students were rejected by younger peers who were perceived as immature

• Professors’ lack of understanding/knowledge about mental health problems or learning disabilities

• Employer stigma

• Lack of job stability

Results - Others’ Related Enablers

•Good liaisons between project staff & family and/or other services in the community

•Helpful to have support during difficult times

•Support by family, some peers, and some professors

•College accommodations

Results - Suggestions for Improvement

•Address need for increased social support

•Improve coordination with other mental health care services

•Make the college better fit student needs

•Have Leads in the college more often, every week

•Expand the project to other types of disabilities

Limitations of study (evaluation)•Exploratory design, e.g., small sample

size, no control/active comparison

•Short longitudinal evaluation (as compared to time needed to complete college and find and keep suitable work)

Conclusions

•Various themes were found in relation to the lived experience of this project that combines supported post-secondary education with supported employment for people with mental illness.

•Project content, process and context were relevant, some as barriers and some as enablers.

Future Directions

•Further research is required and planned for more rigorous study of combining supported post-secondary education with supported employment for people with mental illness.

•Adding cognitive remediation to this combination may further benefit this population, particularly people with SMI and with learning disabilities.

ReferencesBest, L. J., Still, M. & Cameron, G. (2008). Supported education: Enabling course completion people experiencing mental illness. Australian J of Occupational Therapy, 55, 65-68. Cook, J. A., Leff, S., Blyler, C. R., Gold, P. B., Goldberg, R. W., Mueser, K. T., Toprac, M. G., McFarlane, W. R., Shafer, M. S., Blankertz, L. E., Dudek, K., Razzano, L. A., Grey, D. D., Burke-Miller, J. (2005) Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness, Arch of Gen Psychiatry, 62, 505-512. Gutman, S. A. (2008) Supported education for adults with psychiatric disabilities. Psychiatric Services, 59, 326-327. Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995) Social consequences of psychiatric disorders, I: Educational attainment. Am J of

Psychiatry, 152, 1026-1032.Megivern, D., Pellerito, S. & Mobray, C. (2003). Barriers to higher education for individuals with psychiatric disabilities. Psychiatric Rehabilitiation Journal, 26, 217-231.Mueser, K. T., Salyers, M. P., & Mueser, P. R. (2001). A prospective analysis of

work in schizophrenia. Schizophrenia Bull, 27, 281–296.Rudnick, A. & Gover, M. (2009) Combining Supported Education and Supported Employment in Relation to Skilled (Vocational) Occupations.