POLICY AND
ORGANIZATIONAL
CULTURE AFFECTING
EMPLOYMENT:
IF EVERYONE IS ALREADY
DOING IT,
HOW COME IT NEVER GETS
DONE?
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
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.
STAY OUT OF HOSPITAL (& JAIL) AND
REDUCE SYMPTOM IMPACT ARE
STAFF’S RESPONSIBLITIES IN
PARTNERSHIP WITH THE PERSON.
HIGH PERFORMING STATES – ICI SELN
1] Leadership
2] Strategic goals and operating policy
3] Financing and contracting methods
4] Training and technical assistance
5] Interagency collaboration/ partnership
6] Services and service innovation
7] Performance measurement and
data management
SHOOK, J. (2010) HOW TO
CHANGE A CULTURE.
MIT SLOAN MGMT REVIEW,
51 (2), 62-68
WHAT PEOPLE DO
VALUES- ATTITUDES
CULTURE
SHOOK, J. (2010) HOW TO
CHANGE A CULTURE.
MIT SLOAN MGMT REVIEW,
51 (2), 62-68
WHAT PEOPLE DO
VALUES- ATTITUDES
CULTURE
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
•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 THAT 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, workbased 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
 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.
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.
“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
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?
SIMPLE ANSWER: NO
HOW DO YOU ANSWER THIS QUESTION FOR
YOURSELF OR YOUR LOVED ONES?
DO WE WORRY TOO MUCH
ABOUT VALUES - STIGMA VS
BEHAVIOR DISCRIMINATION?
ISN’T A JOB THE OUTCOME WE
WANT RATHER THAN
OFFERING CUSTOMIZED OR
SUPPORTED EMPLOYMENT
(PROCESS) ?
IF EMPLOYMENT IS FIRST
WHAT IS SECOND?
SHOULDN’T WE BEGIN TO
SEE EMPLOYMENT AS
AN OUTCOME NOT A
SERVICE STREAM?
IF YOU THINK
WORK IS BAD FOR
PEOPLE WITH MENTAL ILLNESS,
THEN WHAT ABOUT
POVERTY,
UNEMPLOYMENT,
AND
SOCIAL ISOLATION?
THOMAS EDISON
“ RESULTS!
WHY, I’VE GOTTEN A
LOT OF RESULTS.
I KNOW SEVERAL
THOUSAND THINGS
THAT WON’T WORK. “
US AND MO MH SYSTEMS
/EMPLOYMENT FIGURES 2012
ADULTS WITH ANY EMPLOYMENT
IN FY 2012 = US:16.9%;
MO:10.9%
ADULTS IN LABOR FORCE (I.E.,
EMPLOYED OR LOOKING FOR
WORK) = US:33.7%; MO:11.7%
ACCESS TO EBP SE =
US: 1.7%; MO: 0.9%
US AND MO DD SYSTEMS
/EMPLOYMENT FIGURES 2012
ADULTS IN INTEGRATED
EMPLOYMENT
IN FY 2012 =
US:18%; MO:11%
INTEGRATED EMPLOYMENT
RATE PER 100K GEN POP:
US:35; MO: 9
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
DAVID KAHNEMANN
Psychologist – Economist
“I am not very optimistic
about people’s ability to
change the way they
think, BUT
I am fairly optimistic about
their ability to detect the
mistakes of others.”
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,
NO WHERE TO GO, AND
NO ONE TO TALK TO. “
ED KNIGHT, PH.D.
W. EDWARDS DEMING
“ BEWARE THE
CONTINUOUS
IMPROVEMENT OF
THINGS NOT WORTH
IMPROVING “
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
SO WHAT USUALLY GETS
IN THE WAY OF
IMPROVING
EMPLOYMENT OR
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