OVERVIEW OF SUPPORTED EDUCATION
AND CAREER DEVELOPMENT
FOR YOUNG ADULTS
with Serious Mental Health Conditions
Presenter:
Marsha Langer Ellison
Associate Professor, Department of Psychiatry
Deputy Director, Transitions Research and Training Center
University of Massachusetts Medical School
Marsha.Ellison@umassmed.edu
Acknowledgements
The Transitions RTC aims to improve the supports for youth and young adults,
ages 14-30, with serious mental health conditions who are trying to successfully
complete their schooling and training and move into rewarding work lives. We are
located at the University of Massachusetts Medical School, Worcester, MA,
Department of Psychiatry, Systems & Psychosocial Advances Research Center.
Visit us at:
http://www.umassmed.edu/transitionsRTC
The contents of this presentation were developed with funding from the US
Department of Education, National Institute on Disability, Independent
Living, and Rehabilitation Research. The content of this presentation
does not necessarily reflect the views of the funding agencies and you
should not assume endorsement by the Federal Government.
Educational Needs of Individuals
with Mental Illness
• More than 50% of students 14 years and older with a mental disorder
drop out of high school1, the highest drop-out rate for students of any
disability group2
• Students with mental health conditions who attend college experience
longer delays in entering college4 and continue to show high dropout
rates5
• Students with psychiatric conditions have a post–high school
employment rate of only 50%3
• Educational attainment is strongly linked with employment and wage
earnings6 and predicts later employment among adults with mental
illness7 - 9.
3
Michelle Mullen, 2015
Department of Psychiatric Rehabilitation & Counseling Professions
4
What is Supported Education?10
• Supported education (SEd) interventions help individuals with serious
mental illness achieve their educational goals.
• SEd services include supports to help individuals with mental illness take
advantage of skill, career, educational and inter-personal development
opportunities within postsecondary educational environments.
• SEd helps individuals with serious mental illness to successfully
(1) set and achieve an educational goal (e.g., training certificate or
degree),
(2) improve educational competencies (literacy, study skills, time
management),
(3) navigate the educational environment (e.g., applications, financial
assistance, accommodations), and
(4) improve educational attainment.
Core Components10
• Specialized staff with time allocated explicitly to SEd services
• Service coordination with professionals outside of the SEd program
• Coordination with postsecondary education institutions to facilitate course access or
within-course assistance
• Specialized career counseling, including vocational planning
• Skill building to facilitate integration into the academic environment, including stress
and time management and academic or study skills training
• Financial assistance
• On-campus information about student rights and resources
• Access to tutoring, library assistance, and other educational support
• Mentoring and support, individual or group support, or peer support
• General support (off-campus support preferred) for the barriers and life stressors that
can lead to educational attrition
What’s the Evidence?
10
• Systematic review in 201014 indicates that effectiveness data are limited due
to the absence of well-controlled studies, the limited number of studies that
examined key outcomes of interest (e.g., degree completion, employment),
and short follow-up periods.
• Difficulties in SEd research include varying outcomes, populations and
settings, absence of a standardized model, and need for long-term follow-up.
• Since 2010 five published SEd programs were tested using an experimental
design. Findings were positive for education enrollment.
• There are ongoing RCT trials, results are pending. 11
Current Approaches:
Integration of SEd and Supported Employment
• Many young adults desire to work and go to school simultaneously,
suggesting the need for integrated supported employment (SE) and SEd
services.
• The integration of SEd and Individual Placement and Support is being
current implemented for young adults with first episode psychotic
disorders.
• This integration is debated in the field with pros and cons for educational
outcomes.
Other Current Approaches to SEd
10
• Supported education as part of campus disability services
• Supported education as a stand-alone service in a CMHC
• Campus-wide wellness and supports for mental health
• Supported education for specific populations, e.g., first
episode, Veterans, high school drop-outs.
From Supported Education to
Career Development 15
• What is a career?
Any course of employment with a.) Sustained periods of employment in
one or a series of related positions; b.) Progressive development of
knowledge, skills, and useful expertise; c.) Increasing remuneration
consistent with growing expertise 15
• How do you get one?
Short term and long term educational paths
Training certificate
Internships and work experience
Career/vocational counseling
HELPING YOUTH ON THE PATH
12
TO EMPLOYMENT
Survey of Innovative Career
13
Development Practices
11
Kohler Taxonomy Adapted to Programs
Serving Young Adults
-Focus
-Models and Approaches
-Engagement and
Retention
-Meeting Them Where
They’re At
-Doing Whatever It Takes
Family
Involvement
-Psycho-education
Young Adult
Focused
planning
-Planning
-Participation
-Communication
-Support Services
-Empowerment
-Training
Program
Structure
*listed separately
-Life Skills
-Employment Skills
-Education and Training
-Psycho-Education
-Social Aspects
Young Adult
Skill
Development
* Listed separately
Interagency
Collaboration
-Collective
Framework
-Collaborative
Service Delivery
Education and Training
• Education Skills
Accessing Available Resources
Applying for School
Transition to College Stress
• Financial Aid Planning and Application
• Secondary Special Education & Transition Planning
• Vocational Schools and Vocational Training
APPROACHES TO DELIVERING
CAREER DEVELOPMENT SERVICES
Practices that are unique to young adults
Youth oriented engagement and retention
Meeting them where they’re at
Specific Practices that are
“Unique to the Population”
Age Specific Programming
Tolerance for Missed Appointments and Gaps in Services
Protecting Non-Patient Role
Adapting Practices to Fit Developmental Changes
Continuous Support
Focus on Both Work and School
Youth-Oriented Engagement Practices
Survey of Innovative practices. Helping Youth on the Path to Employment Development Meeting.
New Brunswick, NJ., Rutgers University, 2015
Youth Oriented Engagement and Retention
• Build relationships (trusting, genuine, and understanding)
• Goal focus
• Assertive outreach – in the community; gentle but proactive
• Non-treatment environment
• Avoiding Diagnosing/Labeling Due to Stigma
• Younger staff, connection with youth culture, willingness to engage with social
media, ability to text
Meeting Them Where They’re At
• Literally, service provision in the community, mall, home, school
“Meet them where they’re at, on their terms, as often as you need to.”
• Figuratively, responding to their felt needs and goals at that time
• Varying intensity of services according to need
“We’ve had people who were literally unwilling to come out of their
room, in fact we had one fellow who was literally in his closet, and we
did a series of home visits and we have communicated with people
using sticky notes…we’re about as flexible as we can be”
Specific Practices for
“Meeting Them Where They’re At”
Varying Intensity of Services
Service Provided According to Need
Meeting Anywhere in the Community
Goal Setting is Not Dependent on Assessments
Using Stages of Behavioral Change Model
Matching Interests to Jobs
Varied Education Outcomes are Supported
Facilitating Communication Between Systems when the
Individual Can’t
Conclusions
• The need for education supports for young adults with
SMHC is urgent
• SEd may be a promising practice but is not yet evidence-
based – more research is needed
• “Supported Education” is a service design in flux
• Standardization and manualization is needed, but there
are clear common practices and core components
References
1. Armstrong, K. H., Dedrick, R. F., & Greenbaum, P. E. (2003). Factors associated with community adjustment of young adults with serious emotional
disturbance: a longitudinal analysis. Journal of Emotional and Behavioral Disorders, 11(2)
2. U.S. Department of Education. (2004). Twenty-sixth annual report to congress on the implementation of the Individuals with Disabilities Education Act.
Washington, DC: U.S. Department of Education.
3. Wagner, M., & Newman, L. (2012). Longitudinal transition outcomes of youth with emotional disturbances. Psychiatric Rehabilitation Journal, 35(3), 199208.
4. Newman, L., Wagner, M., Knokey, A. M., Marder, C., Nagle, K., Shaver, D., & Wei, X. (2011). The Post-High School Outcomes of Young Adults with
Disabilities up to 8 Years after High School: A Report from the National Longitudinal Transition Study-2 (NLTS2). Menlo Park, CA: SRI International.
5. Salzer, M. S., Wick, L. C., & Rogers, J. A. (2008). Familiarity with and use of accommodations and supports among postsecondary students with mental
illnesses. Psychiatric Services, 59(4), 370-375.
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from http://www.bls.gov/emp/ep_chart_001.htm
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K., Stewart, M., Blankertz, L., Dudek, K., Taylor, A. L., & Carey, M. A. (2006). Demographic characteristics and employment among people with severe
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10. Feasibility Study for Demonstration of Supported Education to Promote Educational Attainment and Employment among Individuals with Serious Mental
Illness. Ringeisen, H. Ryder-Burge, A., Ellison. M., Biebel, K., & Alikhan, S. RTI International.
11. Nuechterlein, K., Subotnik, K., Turner, L. R., Ventura, J., Becker, D. R., & Drake, R. E. (2008a). Individual placement and support for individuals with
recent-onset schizophrenia: integrating supported education and supported employment. Psychiatric Rehabilitation Journal, 31(4), )
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Youth and Service Providers. Presented at the Recovery Workforce Summit: 2015 Annual Conference of the Psychiatric
Rehabilitation Association. Philadelphia, PA, June, 2015A
14. Rogers, E. S., Kash-Macdonald, M. B. D., & Maru, M. (2010). Systematic Review of Supported Education Literature,
1989-2009. (Report). Boston, MA: Boston University, Sargent College, Center for Psychiatric Rehabilitation.
15. “Transition to Employment for Youth and Young Adults with SMHC” CFDA# 84.133B Grant application submitted by
the University of Massachusetts Medical School. Maryann Davis, PI.