Let's Get to Work! Keynote Presentation
“ ALL CHANGE IS DIFFICULT –NO MATTER
HOW LONG YOU PUT IT OFF. “
------ JOE MARRONE
TERRY PRATCHETT
"I'll be more enthusiastic about
encouraging thinking outside the box when
there's evidence of any thinking going on
inside it. “
JOE MARRONE
INSTITUTE FOR COMMUNITY INCLUSION
School Of Global Inclusion And Social Development
MAIN OFFICE: BOSTON, MA
NW OFFICE:
4517 NE CESAR CHAVEZ BLVD
PORTLAND, OR 97211-8124
TEL: 503-331-0687
CELL: 503-490-2072
FAX: 503-961-7714
EMAIL: joseph.marrone@gmail.com
WEB: WWW.COMMUNITYINCLUSION.ORG
Introduction:
IF PEOPLE CAN WORK...
PEOPLE SHOULD WORK
SYSTEMS MUST COMMUNICATE CONVICTION THAT:
1. ALL PEOPLE SHOULD WORK SINCE
2. PEOPLE W. DISABILITIES HAVE THE CAPACITY TO
BECOME EMPLOYED
3. HAVE THE CITIZENSHIP RIGHT TO EQUAL ACCESS TO
EMPLOYMENT
4. WILL BE ASSISTED TO DO SO BECAUSE
EMPLOYMENT IS A WAY FOR PEOPLE TO BECOME
ECONOMICALLY SELF-SUFFICIENT, HEALTHIER, AND
FULFILLED.
WORK IS NOT JUST AN OPPORTUNITY TO BE OFFERED PEOPLE
TO "TAKE OR LEAVE" AS THEY PREFER;
RATHER, IT IS A RESPONSIBILITY OF CITIZENSHIP.
OUTCOMES THAT SHOULD BE SOUGHT IF A HUMAN SERVICE
SYSTEM IS MORE THAN A POSITIVE SLOGAN
 Employment and educational outcomes
 Housing outcomes
 Course of illness/disabling condition
 Community participation/ citizenship (voting,
volunteering, criminal recidivism)
 School completion
 Income support
 Client satisfaction with their own lives
 Client satisfaction with services
OUTCOMES THAT SHOULD BE SOUGHT IN COMMUNITY
SERVICES
 BECOMING A BETTER PERSON AND “SELF
REALIZATION” IS THE CONSUMER’S RESPONSIBILITY.
 HELPING PEOPLE GET EMPLOYED, GET HOUSING,
COMPLETE SCHOOL. STAYING OUT OF HOSPITAL (&
JAIL) AND REDUCE SYMPTOM IMPACT ARE STAFF’S
RESPONSIBLITIES IN PARTNERSHIP WITH THE PERSON.
How to Change a Culture
Image of Pyramid:
Changing what people do leads to changes in Values and
attitudes leading to changes in fulture
NOT…
Changing the corporate culture changes Values and
attitudes changes what people do
SHOOK, J. (2010) HOW TO CHANGE A CULTURE. MIT SLOAN
MGMT REVIEW, 51 (2), 62-68
ROLE/ LIMITS OF TRAINING?
“You can teach a turkey to climb a tree, but
it’s easier to hire a squirrel.”
FROM Spencer M. Lyle Jr., McClelland C. David, Spencer M. Signe
(1994) Competency Assessment Methods. History and state of the
art. Paper first presented at the American Psychological
Association Annual Conference, Boston, MA P. 8
SYSTEMS ISSUES TO TACKLE
 WHOSE PROBLEM IS IT?– MH, DD, VR OR ALL
 DEFINING “WORK” AND “SUCCESS”
 MAKING EMPLOYMENT AN ADMIN NOT JUST CLINICAL
ISSUE
 SHOULD ALL EMPLOYMENT MEET EBP OR BEST
PRACTICE STANDARDS?
SYSTEMS ISSUES TO TACKLE (cont.)
 SHOULD ALL EMPLOYMENT HAVE VR INVOLVEMENT?
 DISPARITY IN DD, MH & VR FUNDING
 TTW POSSIBILITIES- REAL OR NOT?
 MEDICAID ISSUES
 USE OF HCBS UNDER REHAB OPTION (1915[i])
SPECIFIC EMPLOYMENT PRACTICE ISSUES YOUTH (16-25)
 BETTER LINKAGE WITH TRANSITION TYPE SERVICES
 BETTER INTEGRATION OF YOUTH AND ADULT MH/DD
SERVICES IN TERMS OF PHILSOPHY OF “EMPLOYMENT
FIRST”, RECOVERY AND TRANSITION TO WORK
 PARENTS/ SIGNIFICANT OTHERS SHOULD HOLD MORE
SWAY THAN STAFF EVEN IF THEY ARE “WRONG”
 YOUTH NEED MORE DIRECTION
 PLANNING LESS IMPORTANT THAN ACTION IMMEDIACY
 JOBS THAT WE SHY AWAY FROM FOR ADULTS MORE
AND MORE (FOOD, FILTH, FLOWERS ETC ETC) ARE
MORE ATTRACTIVE & APPROPRIATE FOR YOUTH
 DON’T TRY TO GET YOUTH TO ACT LIKE ADULTS IN
TERMS OF JOB/ EMPLOYMENT STABILITY
VR ISSUES ESPECIALLY FOR YOUTH
 Improving developmentally appropriate strategies for VR
counseling and service delivery
 Modifying traditional approach to IPE development to
incorporate a “work and career development” phase
 Vocational supports unique to youth built on but not
replicating heavily researched adult evidence based
practice of SE/ IPS
 VR service interventions for youth that use greater
variety of employment models, especially those based on
experiential, work- based learning
 Models of youth vocational peer support
Marrone, J & Taylor, S. (2013) Serving Youth with Psychiatric Disabilities in the Vocational
Rehabilitation System. Focal Point, 27 (1), p.37-39.
VR ISSUES ESPECIALLY FOR YOUTH (cont.)
 Developing system interactive pathways focusing on
speed and rapid engagement that swiftly include youth in
concrete experiential services rather than long periods of
assessment or verbal discussions about planning
 Enhancing transition services that support attachment to
adult services where needed or possibly divert youth
from them provided appropriate transition age
interventions enhance adult life success
 Fostering increased use of social media to engage youth
in a variety of work options and in vocational
rehabilitation services.
Marrone, J & Taylor, S. (2013) Serving Youth with Psychiatric Disabilities in the Vocational
Rehabilitation System. Focal Point, 27 (1), p.37-39.
VISION OF LIFE SUCCESS
- JOE MARRONE
IS WORK THE MOST IMPORTANT PART OF LIFE FOR
EVERYONE?
NO. BUT IT IS THE MOST IMPORTANT PART OF LIFE THAT WE
IN HUMAN SERVICES ARE LEAST SUCCESSFUL AT HELPING
OUR CONSTITUENCY ACHIEVE.
IF PEOPLE CAN WORK…
PEOPLE SHOULD WORK…
 REMAINING UNEMPLOYED IS WORSE FOR YOU THAN
BEING EMPLOYED IS GOOD FOR YOU
(MORE DATA LATER).
 AVOIDING LONG TERM UNEMPLOYMENT IS A BETTER
OPTION THAN WAITING FOR AN IDEAL OR PERFECT JOB
MATCH.
“LIFE LIVED WITHIN THE CONFINES OF
THE HUMAN SERVICE & REHABILITATION
LANDSCAPE IS A LIFE IN WHICH THE
FREEDOM TO BECOME & MAKE YOUR
OWN FUTURE IS DIMINISHED”
PATRICIA DEEGAN
20th World Congress Rehab International: Oslo, Norway – JUNE 2004
WORK IS A CITIZENSHIP RESPONSIBILITY NOT JUST AN
“OPPORTUNITY”
SOCIAL POLICY OUTCOMES HAVE TO INCLUDE MORE THAN
CLIENT SELF DEFINED QUALITY OF LIFE INDICATORS
INCLUDING CQL OUTCOMES
EXAMPLE: DROP OUT PREVENTION EFFORTS
MARRONE IN FULL CRANK MODE:
QUESTIONS I PONDER, SOME, NOT ALL, I KNOW THE
ANSWERS TO
LILY TOMLIN
“No matter how cynical you become, it's
never enough to keep up.”
MARRONE EASY QUESTION
 IS IT BETTER TO WORK 2-3 HOURS A WEEK AT
SOMETHING A PERSON LIKES THAN 15-20 HOURS WEEK
(OR MORE) JUST TO MAKE A LIVING?
o SIMPLE ANSWER: NO
o HOW DO YOU ANSWER THIS QUESTION FOR
YOURSELF OR YOUR LOVED ONES?
 DO WE WORRY TOO MUCH ABOUT VALUES - STIGMA VS
BEHAVIOR - DISCRIMINATION?
o ISN’T A JOB THE OUTCOME WE WANT RATHER
THAN OFFERING CUSTOMIZED OR SUPPORTED
EMPLOYMENT (PROCESS) ?
 IF EMPLOYMENT IS FIRST WHAT IS SECOND?
o SHOULDN’T WE BEGIN TO SEE EMPLOYMENT AS
AN OUTCOME NOT A SERVICE STREAM?
 Employment Strategy Quadrants
o X Axis - Person's Mental Health Needs from Low to
High
o Y Axis - Person's employment Needs from Low to
High
o (x) Low/(y) Low = Referral with Supports
o (x) High / (y) Low = Community Support Workers
take folks to Resource CEnters
o (x) Low / (y) High = Vocational Rehabilitation
Resource Centers
o (x) High / (y) High = Full Integration
THOMAS EDISON
“ RESULTS! WHY, I’VE GOTTEN A LOT OF
RESULTS.
I KNOW SEVERAL THOUSAND THINGS
THAT WON’T WORK. “
US AND PA MH SYSTEMS /EMPLOYMENT FIGURES 2012
 ADULTS WITH ANY EMPLOYMENT IN FY 2012 =
US:9.4%; PA:16.9%
 ADULTS IN LABOR FORCE (I.E., EMPLOYED OR
LOOKING FOR WORK) = US:33.7%; PA:11.8%
 ACCESS TO EBP SE = US: 1.7%; PA: 0%
US AND PA DD SYSTEMS /EMPLOYMENT FIGURES 2012 (cont.)
ADULTS IN INTEGRATED EMPLOYMENT IN FY 2012 =
US:18%; PA:15%
INTEGRATED EMPLOYMENT RATE PER 100K GEN POP:
US:35; PA: 28
YOU CAN HAVE A JOB WITHOUT A CAREER BUT YOU CAN’T
HAVE A CAREER WITHOUT A JOB!
(YOU CAN’T DISCOVER WHAT ISN’T THERE)
WHY DON’T WE SEEK TO HELP AND ENCOURAGE PEOPLE TO GET
OFF
SSA AND WELFARE?
IF INDIVIDUAL FUNDING AND FISCAL CONTROL OCCURS
SHOULDN’T QUALITY ASSURANCE LOSE RELEVANCE?
WHAT TYPES OF EMPLOYMENT OPTIONS SHOULD WE
ENCOURAGE?
ANY? SOME? ALL?
KEYS ARE REAL ECONOMIC ENGAGEMENT, RESOURCES,
AND CITIZENSHIP NOT JUST SERVICE INTERVENTIONS
JERRY GARCIA
“ SOMEONE HAS TO DO SOMETHING AND
IT’S PRETTY PATHETIC IT’S GOT TO BE
ONE OF US “
HELPING PEOPLE (AND SYSTEMS) CHANGE:
 HOPE,
 HELP,
 AND HASSLING
EDWARD ABBEY
One man alone can be pretty dumb
sometimes, but for real bona fide stupidity,
there ain't nothin' can beat teamwork.
“IT IS NEARLY IMPOSSIBLE TO MAKE
YOUR OWN
FUTURE WHEN YOU
ARE NOT PART OF THE
ECONOMIC FABRIC OF THE CULTURE YOU
LIVE IN”
PATRICIA DEEGAN
20th World Congress Rehab International: Oslo, Norway – JUNE
2004
PRIMARILY EPIDEMIOLOGICAL SUPPORTING DATA
ON SEPARATE PPT
“ WHAT DRIVES ME UP THE WALL IS THE
INTENTIONAL TEACHING OF FEAR OF
HAVING ANY KIND OF MEANINGFUL LIFE
BECAUSE ‘YOU WILL DECOMPENSATE’ OR
‘YOU ARE STRESS SENSITIVE’. THE MOST
STRESSFUL THING IN THE WORLD IS
BEING A COUCH POTATO WITH NOTHING
TO DO, NOWHERE TO GO, AND NO ONE TO
TALK TO. “
ED KNIGHT, PH.D.
“ BEWARE THE CONTINUOUS
IMPROVEMENT OF THINGS NOT WORTH
IMPROVING “
- W. Edwards Deming
HELPING PEOPLE (AND SYSTEMS) CHANGE:
 HOPE,
 HELP,
 AND HASSLING
KEN MILLER
“The length of a minute is relative,
depending on which side of the bathroom
door you are on.”
From WE DON’T MAKE WIDGETS
5 SIGNS TO RECOGNIZE SYSTEM CHANGE:
Grieff, D., Proscio, T., & Wilkins, C. (2003). Laying a new foundation: Changing the systems that
create and sustain supportive housing. Oakland, CA: Corporation for Supportive Housing
 CHANGE IN POWER:




o Designated positions—people with formal
authority—responsible for the new activity (not just
individuals who care about it).
CHANGE IN MONEY:
o Routine funding is earmarked for the new activity in
a new way
[new money, shift in existing
funding, or new priorities & criteria for accessing
money].
CHANGE IN HABITS:
o Participants in a system interact with each other to
carry out the new activity as part of their normal
routine not just respond to special initiatives,
demonstrations, or projects.
CHANGE IN TECHNOLOGY OR SKILLS:
o Growing cadre of skilled practitioners at most levels
in the delivery chain, practicing methods not
previously common or considered desirable.
Practitioners are now expert in skills that new
system demands & have set a standard for effective
delivery of results.
CHANGE IN IDEAS OR VALUES:
o New definition of performance or success, & often a
new understanding of the people to be served & the
problem to be solved [i.e., new goals]. The new
definition & understanding are commonly held
among most actors in the system, & are no longer in
great dispute
“ YOU NEED A LITTLE LOVE IN YOUR LIFE
& FOOD IN YOUR STOMACH BEFORE YOU
CAN HOLD STILL FOR SOME DAMN FOOL’S
LECTURE ABOUT HOW TO BEHAVE.”
BILLIE HOLIDAY
SO WHAT USUALLY GETS IN THE WAY OF CHANGE AT ANY
LEVEL?
ANY DEAD HORSES IN YOUR ORGANIZATION?
(TAKEN FROM MATERIAL FROM ARTHUR EVANS, PH.D., FORMER DEPUTY COMMR, CT
DMHAS), NOW MH DIRECTOR, PHILA MH
Dakota tribal wisdom says that when you discover you are
riding a dead horse, the best strategy is to dismount. However,
in human services, we often try other strategies with dead
horses, including the following:
* Saying things like “This is the way we
have always ridden this horse.”
or from a Native American
Tribal Saying:
"If we don't turn around now, we just may
get where we're going."
 Appointing a committee to study the horse.
 Harnessing several dead horses together for greater
performance
 Providing additional funding to increase the horse’s
performance
 Arranging to visit other sites to see how they ride dead
horses
 Increasing the standards to ride dead horses
 Creating a training session to increase our riding ability
 Changing the requirements; declaring “this horse is not
dead.”
 Declaring the horse is “better, faster and cheaper” dead
 Promoting the dead horse to a supervisory position
Finding a consultant knowledgeable about dead horses.
" There is nothing you can say in answer to
a compliment. I have been complimented
myself a great many times, and they
always embarrass me -- I always feel they
have not
said enough. "
Mark Twain