Stories of change

WorkFirst

What:An evidence-based supported employment service, fully integrated with some of Capital & Coast District Health Board\'s (C&CDHB) community mental health teams.

Why:To address the employment and educational needs of people with moderate to serious mental illnesses in secondary mental health services.

How:Actively support service users to fulfil their employment or study goals.

Target:Secondary mental health service users.

Where:Wellington.

"Employment is a health intervention"
WorkFirst career consultant

The profile

WorkFirst is an employment service guided by the principles of the Individual Placement and Support (IPS) model of supported employment. WorkFirst supports service users to actively seek and retain employment in the general public labour market, or enrol in post-secondary study. With the consent of service users, the organisation also provides free specialised assistance to respective employers. WorkFirst is a member of the Association of Supported Employment in New Zealand (ASENZ).

The organisation consists of five employment consultants and one coordinator and is fully integrated with five community mental health teams from C&CDHB. These include the early intervention service for first episode psychosis, child and adolescent services, adult teams and forensic and long-term rehabilitation services. If some service users require further support after discharge from secondary service, a transfer of care to non-government organisations is arranged.

The WorkFirst team consists of specialists with diverse backgrounds, such as social work, occupational therapy, psychology and corrections. The team members meet weekly and keep in contact with each other on a daily basis.

WorkFist has gained national and international recognition with the Silver Achievement award at The Mental Health Services Conference in Auckland, September 2008. In January 2009 Workfirst was granted funding from Work and Income New Zealand for an employment and health project.

The beginnings

The main reason for establishing the service was to meet the employment and educational needs of people receiving treatment for moderate to severe mental illnesses in secondary mental health services. The guiding vision is that with qualifications and employment a service user's recovery is enhanced, enabling the transition from receiving a benefit to living a more fulfilling life.

In 2000 Nikki Porteous, the WorkFirst coordinator and occupational therapist, was working with the early intervention team of C&CDHB. There she identified that the lack of relevant employment and educational opportunities for service users, and particularly youth, could be a key obstacle in their recovery. She became familiar with a supported employment model called Individual Placement and Support (IPS), developed and implemented at that time mainly in the United States. The Early Intervention team of the C&CDHB adopted the model, whereby the employment consultant is fully integrated with the multidisciplinary team, including location, participation in multidisciplinary meetings, and responsibilities within the scope of employment consultancy.

At the same period of time the Ministry of Social Development (MSD) was conducting research regarding supported employment. Their findings confirmed that IPS model appeared to be the most effective model for assisting people with serious mental illness into working and study. Based on these findings, the MSD developed a demonstration project named "employABLE" and WorkFirst was one of the four providers invited to participate in this pilot. The project ran for two years and the results were evaluated. As a result of the evaluation, WorkFirst was offered continued funding from the MSD. The funding is determined by the number of service users who obtained employment or enrolled in study. Currently the team is funded jointly by the MSD and C&CDHB and is working toward meeting employment targets, identified by the MSD. WorkFirst reports back to the MSD bi-monthly, meeting and exceeding the expected contract targets.

Current demands on WorkFirst are greater than the service capacity and reflect the positive shift in the attitude of clinicians towards the importance that employment has on the recovery of service users.

"It's about occupational justice"
WorkFirst career consultant

The process

The clinicians (nurses, doctors, psychologists, social workers) refer clients to WorkFirst. The client or their family can also self-refer. The main criterion for being accepted as a client of WorkFirst is that the service user expresses personal desire to move into work, study, to improve their career prospects, or identifies they need help with returning to work after a period of illness. The employment consultants do not make any judgement about a service users work readiness and actively discourage clinicians from doing that as well.

The first meeting with the service user focuses on establishing rapport and providing initial information about WorkFirst. The second meeting takes place a week later, to provide sufficient time for the service user to decide upon pursuing employment or study opportunity.

Service users who decide to engage with WorkFirst and pursue employment or study are offered the following:

• career planning and development
• CV writing
• job seeking skills
• job interview preparation
• marketing to employers
• course information
• sources of funding
• disclosure counselling
• employment retention if admitted to hospital
• ongoing support.

Service users decide whether or not to inform future employers about their mental health conditions. Often those who disclose their condition to their employer do so later in their employment. By then the service user has already established himself/herself as a valued worker and in most cases employers respond in a positive way to the disclosure.

WorkFirst offers also free assistance to employers, such as:

• presentation of perspective applicants with relevant job skills
• support for service users job retention
• assistance when service users return to work after a period of illness
• identifying access to wage subsidies or other funding
• ongoing support.

The WorkFirst service ends when the service users are discharged from the secondary community mental health team. If ongoing support is required the service user is referred to an NGO supported employment provider.

" Our whole service model is around doing as much or as little as the person you're working with wants and feels they need."
Work First career consultant

The unique approach

• The service originated from the work done at the Early Intervention Service, specialist community mental health team treating people with the experience of first episode psychosis.
• WorkFirst employment consultants hold solely vocational roles with no clinical responsibility irrespective of any clinical background.
• Employment consultants participate in the multidisciplinary team meetings.
• WorkFirst practices supported education alongside supported employment to ease the transition of young people from school to tertiary education, and for adults whose education has often been disrupted by their mental illness.
• More recently they have been providing their services to the adult acute psychiatric in-patient ward as an acute intervention approach for job retention.
• They have also established WorkFirst in the forensic and long-term rehabilitation services.

"The best way to meet people's functional needs is by providing employment services."
Nikki Porteous's impressions of the new clinical approach, International Early Intervention Psychoses Conference, Melbourne, October 2008

The results

WorkFirst evaluates its work by providing formal reports on meeting their contract targets to the MSD, and by collecting qualitative feedback from service users and clinicians.

After six years of service delivery WorkFirst has met and exceeded contract targets. Of 430 clients, the overall outcomes have averaged 49 per cent into work and 65 per cent into work and study.

Qualitative feedback by service users and clinicians is used to evaluate the level of independency service users have achieved.

• Service users state that they appreciate the help and also acknowledge their own strengths and abilities with comments such as "You helped but I did it on my own" or "Your [service] is way better than others. It's easier and way quicker [to achieve]".
• Clinicians expressed strong views about the relevance and need of such a service, for example "This sort of work is essential in any effective contemporary community mental health service. Without employment or vocational study, many people loose a sense of meaning and role, which in turn impacts adversely on mental health, and may even be a prime determinant of wellbeing."

Additional achievements

• WorkFirst took part in the development of the reference booklet ‘Taking the First Step'. The resource has been developed by a Like Minds Employment Advocacy Group (LEAP) and is used by people with the experience of mental health issues in the Wellington region, clinical teams and also with Work and Income offices to assist their organisation to better assist beneficiaries with mental illness into work.
• Workfirst has taken the informal role of facilitating better relationships between NGOs and clinical mental health services by the virtue of their unique position of independency and incorporation in secondary mental health care.

The lessons learnt

• Sustainability of staff plays a major role in the provision of the service.
• Community outreach is really important and is very beneficial particularly for youth service users.
• Structure of the mental health services (smaller teams in various locations) provides more flexibility in the service provision, leading to better engagement of service users.
• A strengths based approach to meeting the needs of service users enhances their self-confidence and self-esteem and leads to improved employment and study outcomes.
• Joint funding provides security in the provision of the service and reflects a positive working partnership between health and social welfare.
• There is a need to develop New Zealand's own service implementation fidelity scale which reflects the national culture, labour market, consumer participation in service delivery, the educational needs of service users, and the increased use of information technologies.
• The service model of integration and co-location can be adopted in other settings.
• The positive effects of supported employment and education inspire not only the service users but also their families/whanau and friends, as well as mental health professionals.

More information

Contact

• Nikki Porteous at nikki.porteous@ccdhb.org.nz or phone (04) 494 9161, mobile 0274 710904

Download this story in PDF format

The information on this page is also available for download in PDF format.

WorkFirst an integrated vocational and educational support for service users (PDF)

Documents/links

• WorkFirst leaflet (PDF)
• Implementing evidence-based employment services in New Zealand for young adults with psychosis: progress during the first five years. (PDF) A paper written by N. Porteous and G. Waghorn (2007). British Journal of Occupational Therapy, 70(12), 521-526.
• WorkFirst poster (PDF). Presented at Early Psychoses conference, Melbourne, October 2008.

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Page last updated: 7 November 2008