2.5 employment and community engagement strategies for homeless people with disabilities (post)

Evaluator: Heidi Herinckx, Assistant Director Regional Research Institute for Human Services

Portland State University

CCC Staff: Rachel Post, L.C.S.W., Director of Supportive Housing and Employment

Study Period: July 2007-June 2009

Central City Concern: Supported Employment

Recovery Oriented System of Care

Spans the stages of recovery and provide supports from initiation of recovery through maintenance and on to attendance to total quality of life in long-term recovery.

Addresses the multi-dimensional needs of individuals in culturally accessible manner to include treatment, primary and behavioral health care, housing and acquisition of income.

Peer supports are integral!

HADIN Referrals into 152 ADFC Trans. Units*Data represents all those entering between July 1,2007 and June 30, 2008 AND those exiting

between July 1,2007 and 11/30/2008

20%

92

18%

82

16%

72

13%

60

12%

54

6%

28

4%

18

11%

53

DePaul CCC RecoveryCenter

Hooper CCCEmployment

Access Center

NARA Cascadia Lifeworks Other (Inact,VOA, TPI,HRR, CEP,

RCP, Mentor)

ADFC Transitional Housing Outcomes 07/08

This program served 459 total customers in 152 units of ADFC Transitional Housing

Of those exiting the program, 58% (229 out of 398 people exiting) moved to permanent housing and completed their addiction treatment. Ninety-three percent of these were either employed or receiving federal disability entitlements.*

73% of those who exited to permanent housing remained housed one year later.

Employment Access Center

2 NW 2nd Ave. Supported Employment Programs

Growth Industry Trades Initiative (GITI): •$191,068 PDC Economic Opportunity Initiative for 2 Employment Specialists, .75 Supervisor working with 3 Supportive Housing Case Managers at Harris Bldg. Serves individuals for 3 years.

CCC Homeless Employment Services (CHES): •$300,000 PDC Economic Opportunity Initiative for 3 Employment Specialists, .25 Supervisor serving Mentor Program, JOIN & Harris Bldg. Serves individuals for 3 years.

CCC Employment Recovery Program (ERP): •$184,213 HUD McKinney/Spirit Mountain for 2 Employment Specialists and 2 Supportive Housing Case Managers. Serves individuals for 2 years.

Evidence-Based Supported Employment

(aka Individual Placement and Support)

Principles:

Competitive employment is the goal

Eligibility based on consumer choice

Rapid job search

Service Integration

Long term support

Benefits of Employment

Homelessness and Addiction are “diseases of losses” (friends, family, housing, income, appearance, skills, self-respect and HOPE).

Having a job is critical to ending homelessness.

Employment can reduce relapse and is associated with improved mental and physical health outcomes, particularly anxiety, depression and fatigue (Luchansky, Brown, et al. 2000)

RRI study

Using HMIS data from the city, employment data from programs and addictions treatment data supplied to RRI, this study examined employment outcomes over two year study period July 2007 through June 2009

SE client characteristicsHADIN referred homeless choosing recovery from

addictions, receiving outpatient treatment and

ADFC transitional housing. 319 unduplicated clients enrolled in SE programs 73% male 66% Caucasian, 19% African American, 7% Native American,

4% Hispanic, 4% other 100% homeless at time of entry into CCC programs 70% with felony convictions 28% met chronic homeless category Average age 41

Employment Outcomes

71% successfully placed into employment

53% in full time jobs, 28% 21-31 hrs. per wk

Average wage $9.96 per hour

Placement by Sector

22 (6%)2 (1%)2 (1%)

4 (1%)5 (1%)

6 (2%)12 (3%)

23 (6%)23 (6%)

25 (7%)26 (7%)

28 (8%)39 (11%)

42 (12%)47 (13%)

53 (15%)

0 10 20 30 40 50 60

OtherSanitation

MechanicalEntertainment

Food ProcessingTemp Agency

Health CareTransportation and Warehouse

ManufacturingCustodial

Non-ProfitRestaurant

RetailHospitality and Tourism

Business and Professional ServicesConstruction

n=358 job placements

Job Tenure

77% still employed after their participation in Supported Employment ended with average of 260 days employed.

Of remaining 23% whose jobs ended prior to program end, average tenure of 85 days.

Enrollee Treatment Outcomes

155 of enrollees served by CCCRC

72% completed treatment

40% with known co-occurring mental

health disorders

Primary substance abuse diagnosis was 40% alcohol, 22% heroin and 16% amphetamine

Associated Costs for 160 study clients FY 08/09 ADFC Transitional Housing= $432,000

($450 rent/operations per month x 6 months x 160 clients)

Employment Program = $312,160($1,951 per person x 160 clients)*

Supportive Housing Peer Case Management= $101,960($637 per client x 160 clients)

Outpatient A&D treatment = $144,000($300 per month x 5 months x 96)

TOTAL COST= $990,120

AVRG. PER PERSON= $6,188* Clients receive ongoing Supported Employment assistance for 2-3 years)

Program Funding Sources for 160 clients

PDC EOI Employment Program= $280,610 Multnomah County Outpatient Treatment = $144,000 Multnomah County DCJ (10 units) $110,000 Fees (client fees based on 30% of income) $20,000 Supportive Housing (includes rent & supportive services):

HUD-McKinney Estate Units (56 clients) = $95,000 HUD-McKinney 20 Harris Units (21 clients)= $60,000PHB City General Fund/ESG 75 Harris Units (79 clients) = $137,500

Gap (Central City Concern)= $143,010

TOTAL REVENUE= $990,120 AVERAGE COST = $6,188 Average cost to PDC= $1,754 Average leveraged= $4,434* Additional services not included in this leverage include Primary Care at Old Town Clinic

Factors associated with competitive employment

Results of this study demonstrate no statistically significant differences in competitive employment rates for demographics including gender, race, diagnosis, completion of drug treatment, age, indicating that these SE programs were equally successfully employed men and women, ethnic minorities and whites, older clients and younger clients.

The variable that was significantly associated with employment was completion of CCC’s ADFC transitional housing program: 85% of those who successfully transferred to permanent housing were employed compared to 61% of those who exited the housing due to relapse or other program violations.

How these results compare to other studies Competitive employment outcomes reported in studies of SE

for adults with mental illness or co-occurring disorder average 61% (Bond, Drake, Becker, 2008).

In a study of indigent and chemically addicted adults, who received publicly funded treatment in Washington State, those who completed employment services AND drug treatment were more likely to be employed over the 54 month follow-up period and earned an average of $130 more per month than those who dropped out of treatment or employment services. 77% of clients were employed upon exit and 54% remained employed 3 years later (Luchansky, et al, 2000).

2008 CCC Mentor/ADFC Study

A prior study of the CCC Mentor and ADFC program demonstrated that approximately half of graduates (49%) were employed.

Average monthly income from wages was $347.

With the addition of CCC’s supported employment programming- the % of those employed have increased substantially to 71%.

Oregon Center for Excellence Supported Employment

OSECE Number Served and Number WorkedJan 1, 2008 - Dec 31, 2009

537

646 660 678673735757748

274261288297306283

255211

11.511.112.212.1

9

6.45.55.7

0

100

200

300

400

500

600

700

800

Q-1 2008(39%)

Q-2 2008(39%)

Q-3 2008(38%)

Q-4 2008(40%)

Q-1 2009(40%)

Q-2 2009(43%)

Q-3 2009(40%)

Q-4 2009(40%)

0

2

4

6

8

10

12

14

Un

emp

loym

ent

rate

Number served

Number worked

Unemployment rate

Limitations The only data available for analysis was from administrative

records which did not include qualitative measures or client report of the impact of employment on quality of life, standard of living, empowerment, or self sufficiency.

Little was known about clients’ prior work history, which has been found in other studies to be the major predictor of employment.

Because data used in these analyses came from three different data sources, some key variables such as level of education, co-occurring mental illness, and recent arrest history was known only for a subset of SE participants.

Future Research Findings from this study indicate that supported employment is a

critical ingredient in a recovery oriented system of care if employment and economic self sufficiency are to be attained.

CCC is unique in that it offers a complete array of services, housing, addictions treatment and supported employment.

Future research should include a comparison or control group. While randomization is often not possible, it may be possible to identify reasonable comparison groups that only receive some aspects of the complete treatment model.

It would also be beneficial to track clients over an extended period to determine long term employment outcomes.