Figure 1-1
Challenges to Employment

Client Obstacles

Personal

• Substance use (substances used, history and pattern of use, relapse, associated problems)
• Mental or physical disabilities (psychiatric comorbidity, physical or medical condition, neuropsychiatric disability, cognitive disabilities, HIV/AIDS)
• Deficits in education and skills (education level, learning disability, literacy, language, computer knowledge, obsolete or low-level job skills, little or no work experience)
• At-risk history (developmental, familial employment, employment, criminal, loss of parental rights)
• Unrealistic expectations and attitudes (toward job demands, work habits, authority, capability for self-sufficiency, personal competencies, change, failure, impulse control, delayed gratification)
• Inadequate income (for clothing, food, transportation, housing, child care, job-related equipment)
• Work disincentives (from welfare-based income, illicit activities, relatives)
• Discontinuation of health benefits
• Crisis lifestyle (illnesses, children's illnesses, violent community, numerous family tragedies and deaths, children's school problems)
• Learned helplessness or dependence taught to clients over the years
• "First things first" approach where the client is conflicted about seeking employment and instead encouraged to focus exclusively on sobriety (often this approach is used by 12-Step programs)

Attitudes

• Negative attitudes toward vocational rehabilitation
• Negative attitudes toward disability

Interpersonal

• History of violence or abuse (e.g., domestic, physical, sexual, and psychological abuse; criminal activity)
• Competing family responsibilities (e.g., child or elder care, disabled family members or relatives)
• Inadequate social supports (e.g., spousal, familial, peer group, community, institutional)
• Lack of positive modeling (e.g., peer group, familial/parental, societal)

Substance Abuse Treatment Program-Level Obstacles

Staffing

• No onsite VR counselor
• No staff knowledge about or use of available employment and vocational services
• No staff training in delivery of vocational services
• Lack of understanding about vocational issues

Client--Counselor Interactions

• Poor therapeutic relationship
• Discrepant expectations with respect to vocational goals and needed services
• Agency and counselor attitude about addressing substance abuse disorder before any other issues (e.g., vocational services)

Resources

• Inadequate funding for vocational services for clients, staffing, or staff training
• Inadequate networking with other service providers
• Fiscal disincentives brought about by clients' loss of Medicaid or other public assistance as a source of payment for treatment services

Policies

• Lack of commitment to vocational services
• Vocational services not integrated into substance abuse treatment
• Inflexible treatment schedules (e.g., not open on weekends or after 5 p.m. during the week)
• Lack of commitment to individualized planning and treatment

Structural Barriers

Employers and Businesses

• Biases against hiring persons in substance abuse treatment, with criminal records, on welfare, of particular gender, with disabilities (coexisting), of a certain ethnicity, or with co-occurring mental disorders
• Unfavorable work environment (see biases above)
• Inadequate on-the-job-training
• Inadequate pay scales, promotion policies, or benefit packages
• Lack of supportive services and information
• State-required caregiver background checks and inability to work in various jobs because of background regardless of employer's willingness to hire

Welfare to Work

• Unrealistic expectation regarding client's ability to work now without adequate time to resolve basic problems

Local Labor Market

• Few entry-level jobs at sufficient pay that offer the prospect of advancement and benefits
• Difficulties in matching clients to available jobs
• Lack of, or exclusion from, union membership
• Jobs located too far away for reasonable transportation time

Local Services

• Limited personal or public transportation
• Insufficient safe, affordable housing
• Inadequate regional or local resources (e.g., day care, schools, accessible medical care, libraries)

Local Employment Programs and Vocational Services

• Inadequate or out-of-date programs for current labor market needs
• Unsuitable programs and services (e.g., for clients in substance abuse treatment, women)
• Insufficient funding for long-term training
• No focus on job retention problems
• Premature job placement when client is not ready
• Waiting lists or other delays in obtaining services
• Insufficient attention to short-term training to accommodate welfare reform mandates
• Insufficient coordination between service systems to identify mutual goals, needed collaborative approaches, and means to eliminate structural programmatic behaviors

Funding

• Work is not a goal for managed care or other insurance and therefore is not funded

Sources: French et al., 1992; Platt, 1995; Wolkstein and Spiller, 1998; Woolis, 1998.

Figure 1-2
Strategies for Promoting Employment

Job Placement Strategies

• Job search assistance, either in a group setting or through one-on-one counseling or coaching, sometimes through "job clubs" with workshops, access to phone banks, and peer support.
• Self-directed job search, where individuals search and apply for jobs on their own. Sometimes individuals must submit a log of their job contacts.
• Job development and placement, where program staff members identify or develop job openings for participants. Counselors refer individuals to openings, often using computerized job banks. In more intensive models, staff members develop relationships with specific firms, gaining knowledge of potential job openings or commitments to hire through the program.

Job Training Strategies

• Classroom occupational training, by training or educational institutions such as community colleges or vocational schools, community-based organizations, or nonprofit or for-profit training centers. Training may include formal postsecondary programs leading to certification or licensing in a particular occupation.
• On-the-job training with public or private sector employers, who usually receive a subsidy to cover a portion of the wages paid during the training period. The employer subsidy may be drawn from welfare or food stamp payments that otherwise would have been paid to the individual recipient.
• Use of a mentor, who provides support to the client within the work setting. A mentor could be someone who went through substance abuse treatment and is now working.

Broad Education Strategies

• Remedial education, such as preparation for the general equivalency diploma (GED), basic skills instruction in reading and mathematics, or English-language classes for persons whose primary language is not English, and computer-skills building.
• Postsecondary degree programs (e.g., associate's or bachelor's degree), generally financed by grants, Federal loans, or scholarships.

Mixed Strategies

• Vocational training plus basic skills, either in the workplace or in instructional centers/classes.
• Supported work experience, with pre-employment preparation, assignment to public jobs, and gradually increasing hours and work responsibility combined with ongoing counseling, education, and peer support.

Source: Nightingale and Holcomb, 1997.

Figure 2-1
Vocational Services Provided to a Residential Treatment Facility

The Virginia Department of Rehabilitative Services provides a full-time VR counselor (perceived by residents as a staff member) to support the integration of vocational strategies into residential therapeutic communities. The counselor works closely with the treatment provider, who collaborates in the development of a VR plan. Clients are referred to the counselor for planning and assessment, which include the administration of aptitude tests that often uncover learning disabilities. An array of services, listed below, is then provided based on the client's individual needs.

• Vocational evaluation, including aptitude, skill level, and interest testing
• Research on jobs of interest to clients and help in arranging informational interviews, along with career counseling
• Referral to training and education or apprenticeship programs
• A week-long program in job-seeking skills, including role-playing and videotaped interviews
• An informal job club with ongoing group sessions to support people looking for work; participants keep a log of their accomplishments and discuss the problems related to reentering the workforce
• Employer outreach and marketing to raise awareness of the availability of this pool of prospective employees
• Job placement services that allow for funding of on-the-job training experiences and tax credits for employers
• Assistance in purchasing work clothes or tools required for entry into a job
• After employment, a "reentry support" group that meets at night during a work adjustment period

Figure 2-2
Vocational Information From Initial Screen

Educational History Write a brief description of the client's educational history in order to evaluate current academic functioning and potential to engage in training that could range from remedial to advanced. The history should include the following information:

• Highest school grade completed, and when
• Client attitude toward education and possible future training (verbal report may differ from behavior with some clients)
• Favorite subjects, and why
• Extracurricular activities
• Potential for future education and/or training

Standardized achievement tests of math, reading, and general learning ability are often used to augment interview questions. The client's educational history can also be used to indicate vocation-related interests and values.

Vocational History Write a brief description of the client's work history in order to estimate current and potential vocational functioning. Ask questions addressing the following:

• Types of occupations in which the client has worked
• Chronology of jobs within the last 15 years, including job title, name of employer, length of employment at each job, and primary job duties
• Reasons for leaving each job
• Client-identified work skills and any certifications or licenses held
• Client's perception of relationships with supervisors and coworkers
• Favorite and least favorite jobs, and why
• Work-related ambitions and goals

Figure 2-3
Assessment Tools

Screening Vocational Interests

Measures/Approaches (not all-inclusive)

Categories of interests

• Geist Picture Interest Inventory
• Kuder Occupational Interest Survey
• Reading-Free Vocational Interest Inventory
• The Self-Directed Search
• Strong Interest Inventory
• Vocational Preference Inventory Interest Checklist
• Wide Range Interest Opinion Test

Vocational functioning

• Addiction Severity Index
• Career Attitudes and Strategies Inventoryú
• Career Thoughts Inventoryú
• My Vocational Situation
• Wonderlic Basic Skills Test
• Work Potential Profile

Functioning in particular areas related to employability

• Addiction Severity Index
• Employability evaluation
• Employability plan
• Interview information
• Placement readiness checklist
• Previous work experience
• Readiness planning checklist

Emotional functioning

• Interview information
• Tennessee Self-Concept Scale
• The Psychological Screening Inventory
• Verified work history

Intellectual and aptitude functioning

• Addiction Severity Index
• Adult Basic Learning Examination (ABLE)
• Educational experience and records
• General Aptitude Test Battery (GATB)
• Microcomputer Evaluation, Screening, and Assessment (MESA)
• Minnesota Clerical Test
• Peabody Picture Vocabulary Test
• Revised Beta Examination
• Slosson Intelligence Test
• Wechsler Adult Intelligence Scale (WAIS-R)
• Wide Range Achievement Test (WRAT)

Source: Adapted from Power, 1991.

Figure 2-4
Prevocational Counseling Activities

Psychosocial-spiritual development

• Keep a diary of daily activities.
• Participate in role-playing exercises (e.g., for developing interpersonal communication skills, expressing needs and wants without appearing demanding).
• Complete values clarification, skills assessment, and personal traits exercises.

Career exploration

• Generate an autobiography on vocational and educational experiences.
• Visit community resources, including libraries, stores, businesses.
• Read newspapers for a specific purpose (e.g., employment trends, want ads).
• Watch educational and interactive programs to stimulate discussion and practice new behavior.

Structured activity

• Take a battery of vocational tests.
• Pursue and perform volunteer assignments.
• Take continuing education courses to determine and validate interests.
• Write a résumé.

Source: Adapted from Rehabilitation Research and Training Center on Drugs and Disability, 1996.

Figure 2-5
Job Search Resources: America's Job Bank on the Internet

America's Job Bank (www.ajb.dni.us) is a partnership between the DOL and State-operated employment services. This computerized network links State employment service offices to provide jobseekers with the largest pool of active job opportunities available anywhere, plus nationwide exposure for their résumés. For employers it provides rapid, national exposure for job openings and an easily accessed pool of candidates. The AJB Web site is available on computer systems in public libraries, colleges and universities, high schools, shopping malls, and other public places.

Every day, AJB receives new job listings from the States, and the Internet database is updated each night. On average, more than 5,000 new jobs are received daily from the States. Also, thousands of employers enter their jobs directly into the system in real time. Typically, more than 3,000 new jobs are received directly from employers daily.

In addition to the AJB, there are three other sections to explore on this Web site:

• America's Talent Bank (www.ajb.dni.us). This is a nationwide electronic résumé system. Jobseekers enter résumés into this national network, which is then searched by employers for workers who meet their needs.
• America's Career InfoNet (www.acinet.org). This is a comprehensive source of occupational and economic information. It contains information about general outlook, wages, trends, State profiles, and a resource library.
• America's Learning eXchange (www.alx.org). This is an online source for training and education resources. Jobseekers can find a myriad of training opportunities, including traditional classroom-based training, leading-edge distance learning, Web-based instruction, and multimedia instructional materials (e.g., CD-ROM, video).

Figure 2-6
Vocational Opportunities of Cherokee, Inc.:
Rehabilitation Facility Providing Primarily Onsite Services

Vocational Opportunities of Cherokee, Inc., offers both supported and sheltered employment for Native Americans with severe disabilities. Clients are referred to the program by social welfare programs; alcohol and drug treatment providers; medical treatment providers; the Women, Infants, and Children Program; and other sources.

Following an assessment, the individual reviews job descriptions and chooses a field of work. Detailed evaluations of the individual's capabilities, if needed, can take up to 18 months. All clients receive a basic training program that includes commonly needed skills, such as conflict resolution and grooming. The client then receives appropriate training in the chosen field and to enhance his functional capabilities. He begins with jobs requiring lower dexterity and skill and moves up to more complex jobs as capabilities increase.

The program includes the following services:

• Evaluation
• Counseling and guidance
• Physical and mental restoration
• Culturally appropriate social activities for the client and her family
• Vocational and other training services
• Transportation
• Services to the family members of the client
• Interpreter and note-taking services for the deaf
• Readers, rehabilitation teachers, and note-taking for the blind
• Telecommunication, sensory, and other technological devices
• Recruitment and training services for public service employment
• Placement and suitable employment
• Postemployment services to enable the client to maintain, regain, or advance in employment
• Occupational licenses, tools, equipment, initial stocks, and supplies
• Rehabilitation engineering services; other goods and services

The program employs three counselors, a job coach, and three trainer/managers. It is funded by the State VR agency and by tribal funds. The industrial training floor is operated through contracts with private employers. Some clients also perform contract work, such as grounds care for Federal buildings.

Figure 2-7
The Michigan Drug Addiction and Alcoholism Referral and Monitoring Agency:
A Case Management Model

The Michigan Drug Addiction and Alcoholism Referral and Monitoring Agency (DAARMA) operated under Michigan Rehabilitation Services of the Michigan Jobs Commission until it was eliminated by changes in Social Security and Medicaid. The program served clients receiving Supplemental Security Income who had substance use disorders in addition to other disabilities. Its purpose was to help these clients return to the workforce by ensuring that they had the tools necessary to achieve full rehabilitation and self-sufficiency. This program description is retained because it has many transferable elements.

The program was a three-way partnership between the alcohol and drug counselor, DAARMA, and the vocational rehabilitation services agency. The partners were cross-trained: the State treatment provider agency gave a 6-week intensive training program on substance use disorders for all staff and in turn received training on Medicare rules and on the counseling rehabilitation model. Written agreements documented the partnership. Collaborating agencies made joint decisions on the appropriate timing for the introduction of vocational rehabilitation services. Services generally were introduced as soon as the clients were "clean" and their condition stabilized. The time required for the referral and monitoring process in the Michigan program ranged from 2 to 5 years. The program operated on several principles:

• Careful, comprehensive recovery plans focusing on full rehabilitation and a return to the workforce are essential if the program is to be successful and cost-effective.
• The effectiveness of a recovery plan is only as good as the quality of partnership between the beneficiary's therapist and the referral and monitoring agency counselor.
• For the treatment plan to be successful, the beneficiary must be an active partner in the accomplishment of his own recovery and must be held accountable for his actions.

The case management program included the following elements:

• A preliminary intake to determine clients' needs. Based on the intake results, some clients were referred to a residential program for detoxification.
• Counseling to ensure that clients understood the program's benefits and the sanctions that could be imposed for noncompliance.
• Periodic progress reports involving the clinician and, for corrections clients, the corrections officer.
• Individualized referral to, and coordination of, all services needed to sustain the client's full recovery and rehabilitation (i.e., substance use, physical and/or mental health treatment, habilitation and rehabilitation services, other supportive social services).
• Tools to monitor compliance, including drug testing.

Compliance issues included the following:

• A distinction between noncompliance and relapse. A client who relapsed might continue to receive benefits while attempting to return to treatment, whereas a client who missed appointments regularly might have her cash benefits temporarily suspended. The ability to suspend benefits gave the program a high success rate.
• Loss of 1 month's benefits the first time a client was noncompliant, 2 months of checks for the second noncompliance, and 3 months of checks for the third noncompliance (which seldom occurred).
• During the first year of the program, 53 percent of the participants were noncompliant; however, 72 percent of them returned within 30 days after losing their first checks.

Social Security funded the case management and monitoring function, Michigan Jobs Commission Rehabilitation Services funded the cost of rehabilitation services, and Medicaid funded treatment services. The DAARMA's case management cost per case was $350 per year. One month's benefit check for one individual without dependents was $457. Thus, successful rehabilitation saved the General Fund a minimum of $5,500 per year, per case, in cash benefits. In cases of noncompliance, 1 month's benefit suspension ($457) saved the cost of case management of a case for an entire year. The average cost of rehabilitation services for substance use disorder clients averaged about $1,200 per case.

Figure 2-8
Combating Alcohol and Drugs Through Rehabilitation and Education (CADRE)

Limited Case Management/Rehabilitation Support for a Public Housing Community

Fourteen CADRE centers provide prevention and intervention services, operating in 12 Chicago Housing Authority (CHA) developments. Each conducts intake assessment and makes referrals for substance abuse treatment for the community and helps residents to move toward self-sufficiency. As part of these services, residents may receive vocational services on a voluntary basis. Participants are self-referred as a result of flyers distributed door to door or are referred by various social service agencies that work with CHA residents. Each center has a director, one case manager (who is a State-certified alcohol and drug counselor), two prevention specialists, and a general clerk. Programs are funded by the U.S. Department of Housing and Urban Development's Public Housing Drug Elimination Program through a grant to CHA's in-house employment and training program

The CADRE centers make available the following vocational services:

• Job readiness programs that teach participants how to write a résumé, how to look for a job, how to dress for a job, and similar skills
• Job fairs where local businesses take applications and résumés
• Recovery support groups (not geared specifically to employment)
• Access to job-hunting resources such as a telephone, fax machine, computers, and the Internet
• Job training provided through outside consultants

Figure 2-9
The Texas Workforce Commission: Project RIO (Re-Integration of Offenders)

Project RIO is administered by the Texas Workforce Commission in collaboration with the Texas Department of Criminal Justice (TDCJ), the Windham School District, and the Texas Youth Commission (TYC). One goal of the project is to link education, training, and employment during incarceration with employment, training, and education after release from prison. Another goal is to reduce the rearrest rate through employment.

Program participants receive services both pre- and postrelease from prison. An individualized treatment plan is developed for each offender to identify a career path and to guide placement decisions. Before release, a comprehensive evaluation is conducted to assess the needs of the offender and to assist in the selection and placement in Windham, college, TDCJ, and TYC programs. The evaluation process is a multistep process that includes information gathering, goal setting, program placement, and offender assessment.

Project RIO staff members encourage participants to take advantage of the education and vocational services and assist offenders in obtaining the documents necessary for employment. Staff also provides placement services to give offenders practical work experience in their areas of training.

After release, program participants receive individualized services, including job preparation and job search assistance. Participants attend job search workshops that focus on basic skills, such as completing a job application, preparing a résumé, and building interview skills through mock job interviews. The most important goal of the Project RIO program is for ex-offenders to secure employment as soon as possible after their release.

Project RIO also involves employers in the community. Program staff ensures that potential employers are aware of the incentives for hiring ex-offenders. The staff certifies prospective employees for the Work Opportunity Tax Credit program, which provides a tax incentive to employers for hiring economically disadvantaged ex-offenders.

Figure 2-10
Basic Materials for a Vocational Reference Library

VR counselors use a variety of resources to help clients find jobs. The following is a list of basic materials that a counselor should have available. Although not all programs can afford an Internet hookup to access online employment-related information, they should identify locations where clients can obtain Internet access, such as schools and public libraries.

DOL Documents

• Guide for Occupational Exploration
• Dictionary of Occupational Titles
• Occupational Outlook Handbook

Local Resources

• Local newspaper classified ads
• Local telephone directories
• Catalog of employer profiles
• Contact information (address, phone number of personnel department) of
• The largest employers in the area
• The employers who hire the largest number of local workers
• The fastest growing local employers
• Employee Assistance Programs
• Mentor lists by employer
• Public transportation routes and schedules
• Course catalogs describing majors and programs in local technical schools, community colleges, and universities

Employment-Related Publications

• College Placement Annual
• National Business Employment Weekly
• The Professional and Trade Association Job Finder
• The National Job Market
• The National and Regional Job Bank
• Career Guide to Professional Associations
• What Color is Your Parachute: A Practical Guide for Job-Hunters & Career-Changers

Other Resources

• Materials from the local Chamber of Commerce
• Materials from the local Job Service
• Access to Web sites such as America's Job Bank (www.ajb.dni.us)
• State economic development Web sites for access to State and national job bank databases

Figure 3-1
Early-Stage Vocational Issues and Approaches

Psychosocial--Spiritual Values

• Explore alternatives to a substance-using lifestyle and personal value system.
• Explore goals, interests, abilities, strengths, weaknesses, and personal values.
• Learn to consider personal and spiritual needs.
• Identify and acknowledge specific talents.
• Develop the concepts of lifestyle change and psychosocial development.
• Have a stable home and intact family; receive regular paychecks.
• Examine the relationship of substance abuse to other life issues.
• Consider ways to achieve positive parenting, good health, and economic independence from welfare and other support systems.
• Revise one's self-concept in relation to independent functioning at home, school, and work.
• Develop a positive outlook.

Activities of Daily Living

• Learn effective socialization skills.
• Interact without the use of drugs, with people who have not used drugs.
• Engage in activities of daily living.
• Begin to incorporate more healthful habits into daily living.
• Learn appropriate dress, hygiene, walk, talk, and eye contact.
• Learn to manage money.
• Open and maintain bank accounts, budget, and save money.
• Change living situation, if necessary.
• Acquire stable housing away from people currently using drugs; reunite with spouse, parents, or children.
• Check for any outstanding arrests on the client's record and follow up on results.
• Clean up legal records.
• Increase independence and responsibility.
• Assume responsibility for managing money and solving problems.
• Improve communication.
• Talk to new people in new ways.
• Learn to structure and be responsible for time.
• Manage time, calendar, appointments.
• Organize documents, e.g., social security card, birth certificate, military discharge papers, driver's license, diploma, training certificates.
• Get credentials in order and ready to present.
• Consider spirituality as a part of daily living.
• Determine sources for spiritual expression.

Education

• Evaluate educational level, skills, and potential.
• Take tests, assess deficits, plan for remediation if required.
• Examine attitude toward school.
• Highlight positive points.
• Consider longer term educational and vocational goals.
• Consider benefits of further education.

Vocational Skills

• Evaluate vocational level.
• Take tests; engage in a situational assessment.
• Evaluate courses that have been taken; differentiate from courses that have been completed.
• Reexamine prior training and what is still current.
• Consider current vocational skills and their potential for employment.
• Perform skills assessment.
• Examine desires for training.
• Consider why further training is necessary; consider in the context of specific goals.

Employment

• Develop an understanding of the world of work.
• Read career literature; visit work sites.
• Adopt an identity as a worker.
• Explore opportunities to be productive.
• Examine work experiences for past successes and failures.
• Develop a realistic picture of accomplishments and problems.
• Consider potential for transferability of skills.
• Compare skills to job demands.

Source: Adapted from Rehabilitation Research and Training Center on Drugs and Disability, 1996.

Figure 3-2
Answering Questions Related to Substance Use History-A Sample Scenario

Interviewer: I noticed that none of these jobs lasted more than 18 months, and most were only a few months.

Client: Yes, a couple of years ago I had problems at a couple of jobs. I think it was partly a question of immaturity. I just wasn't ready to take things seriously.

Interviewer: I also noticed that you haven't been working for the past year. What have you been doing?

Client: I decided I had to get my life together. I'd started using drugs and ended up getting arrested. The court gave me a choice and I took the opportunity to go into drug treatment. I learned a lot about myself and also about working. At the treatment program I volunteered to work in the office.

Interviewer: Do you have any convictions?

Client: Yes, one conviction for drug sale and possession while I was using drugs. I did have problems earlier, but at the drug treatment center I found that I really enjoyed working in the office doing data entry, filing, and answering the phones.

Source: Adapted from Englehart, 1993.

Figure 4-1
Steps for Planning an Integrated Program

• Modify mission statement to incorporate vocational goals for clients.
• Encourage all administrative, support, and treatment staff to embrace vocational programming as an essential component for all clients--on an equivalent level of importance with abstinence.
• Perform a needs assessment of current and past clients to identify what vocational services are most needed.
• Use needs assessment results to identify, develop, and deliver vocational services that make the most sense for the agency, clients, and community.
• Hire a vocational specialist or retool/upgrade existing staff to handle vocational counseling responsibilities.
• Develop vocational counseling competencies in all treatment staff.
• Develop and provide necessary vocational support materials (e.g., employment library, computer with Internet access, training materials for job-seeking skills).
• Integrate vocational outcomes into accountability studies when following up with former clients.

Figure 4-2
Job Clubs

A job club can be established in most treatment settings--i.e., high-, medium-, or low-structure programs. However, outpatient programs may find them particularly useful for helping clients obtain jobs with a low investment of staff time. Some job clubs are run by a staff person, but most are organized and operated by clients with a staff person in the role of a consultant.

The job club is a behavioral approach to job finding that is based on research showing that the difficulties faced by most job seekers often involve problems of learning, motivation, and the maintenance of behavior--problems for which the behavioral approach should be most relevant (Azrin and Besalel, 1982). This multistep approach, in which job seeking is regarded as full-time employment, provides a systematic method for conducting a job search. The group context provides important social support to members engaged in the stressful process of finding a job.

To establish a job club, the substance abuse treatment program provides daily newspapers and other current sources of job information and office equipment (e.g., copy machine, typewriter, computer) and supplies. A phone line or lines reserved for job club members and an answering machine help them contact potential employers and allow them to receive messages. The program also can obtain a post office box for members' mail from prospective employers. It is important to remember that some clients may not have a permanent address or phone number and that the person who answers the phone at their home may give a poor impression to the employer or may fail to take messages reliably. Job club members thus use the facility as a home base for conducting their search. Job clubs tend to become part of the treatment milieu and to integrate themselves into programs. There is a natural confluence of substance use disorder and vocational issues in these groups.

The Internet has now become a good resource for job hunting. The cost of a computer and modem may no longer be prohibitive for most programs and may be a good investment if it improves clients' vocational outcomes. In addition, the computer skills that clients gain in their job search may help them on the job.

Figure 4-3
Focus on Client Outcomes:
The Future for Substance Abuse Treatment Providers

CSAT is developing client outcome evaluations that will be disseminated to State and local governments and treatment providers. With these tools, treatment programs can measure their effectiveness and make comparisons on a regional and nationwide basis (http://www.samhsa.gov/csat/topps/default.htm). A substantial initiative by CSAT, the two Treatment Outcome Performance Pilots (TOPPS I and II), which involve 14 and 19 States, respectively, is developing and pilot testing instruments and measures of substance abuse treatment outcomes. These measures will examine changes in several domains including employment, substance use, health status, psychological function, legal status, and family and social relationships. These domains represent consensus among States on the areas where substance abuse treatment is expected to result in changes. Treatment providers will need to address these domains via on- or offsite programming or referrals in order to remain competitive for Federal funding for substance abuse treatment programs.

Figure 5-1
Data-Matching Software

The use of data-matching tools such as unique client identifiers (e.g., the client's first and last name and middle initial and the last four digits of the client's Social Security number) can help agencies determine overlapping client caseloads. The software ArcView (Environmental Systems Research Institute, Inc., 380 New York Street, Redlands, CA 92373-8100) can aid in assessing the effectiveness of collaborative relationships among service providers by providing data on the numbers of clients being served by multiple agencies. Some of the locations in which data matching has been implemented include Chicago, San Diego, Los Angeles, and Alameda County, California. This software compares data from specific client populations with those from other populations. The user can then determine the proportions of clients receiving substance abuse treatment services who are counted in the caseloads of other agencies. This makes it possible to determine, for example, what percentage of clients who are receiving substance abuse treatment have children in remedial education. By identifying areas of overlap such as this, data-matching tools can influence decisions about the makeup of a multidisciplinary team, the coincidental needs of clients, and what types of collaborative relationships with other agencies are most likely to benefit a program's client population.

Figure 5-2
Steps for Establishing an Authentically Connected Network

The Consensus Panel developed the concept of authentically connected networks, which include the following steps to their establishment:

1. Determine the services that are available in the local area by developing an updated inventory and by resource mapping.
2. Hold discussions with agencies identified as potential collaborators. Discussions can include topics such as the following:
• Emphasis on the benefits of collaboration
• Cross-training of staff
• How the other agency conducts business (e.g., "turf" issues)
3. Develop working agreements or memorandums of understanding between collaborators to organize information sharing and communicate respective roles.
4. Determine the agency's criteria for accepting clients (e.g., what types of clients and levels of severity do they accept?).
5. If warranted, establish a partnership with the agency, as well as agreements regarding the flow of information and feedback between the agencies to ensure provider accountability.

Figure 5-3
Characteristics of Authentically Connected Referral Networks

• Multiple agencies work as equal partners with each other and with the client; referring agencies make the initial contact to the referral source and keep abreast of client progress.
• Clients and agencies have mutual responsibility and trust; interagency accountability and data sharing exists.
• Communication mechanisms for timely information dissemination are accessible to all agencies and stakeholders.
• The full range of stakeholders is identified, including local community services, and feedback is elicited from all of them.
• Relationships among providers are collaborative and flexible in the assumption of multiple job tasks related to client needs.
• The network is client-, vision-, and mission-driven.
• Change and growth of the referring organization are demonstrated as a result of the referral process; dynamic network.
• The network is open to new paradigms, approaches, use of technology on behalf of clients (e.g., electronic portfolios), and individualization of client treatment plans and services.
• There is ongoing provider training and involvement in continuing education and staff development.
• Shared assessment of network effectiveness is ongoing.
• Cross-training of staff among collaborating agencies is ongoing.
• Accountability is results- and progress-based, with interagency negotiation of shared outcomes.
• The referral process is concurrent.

Figure 6-1
Agency Self-Assessment Categories

Client

Agency Mission

"Agency Fit"

Endpoints

• Demographics
• Culture
• Family
• Trends
• Focus groups
• Client feedback
• Inclusion of clients in planning
• Disability issues

• Capacity
• Staffing
• Cultural competence
• Readiness for collaboration
• Accountability
• Resources
• Technological capability
• Desired outcome
• Client centeredness
• Service needs

• Analyze agency's service delivery profile versus what clients need
• Choose to provide services in-house or by referral
• Identify community resources and partners
• Build relationships
• Changes in organizational structure
• Specialization and market segmentation

• Sustainable employment
• Better client outcomes
• Improved community conditions
• Multiple access points

Figure 7-1
Americans With Disabilities Act and Rehabilitation Act Protections

Alcohol

Illegal drugs

Current abuse

Recovering

Current abuse*

Recovering

Educational or Training Program

Individuals qualified for services are protected

Protected

Protection limited to health and rehabilitation services

Individuals qualified for services are protected

--Exceptions

Individuals are not protected if

• Their alcohol abuse is so severe that they no longer meet the eligibility requirements.
• They pose a significant risk to health or safety of others that cannot be eliminated by service modification or auxiliary aids/services.

No Exceptions

Substance abuse treatment programs may expel clients who continue to use illegal drugs while attending the program.

Individuals are not protected if they pose a direct threat to the health or safety of others. Service providers may administer drug tests to ensure that an individual with a history of illegal drug use is no longer using illegal drugs.

Employment

Individuals qualified for the job are protected if they can perform job duties without posing a threat to health, safety, or property.

Protected

No Protection

Individuals qualified for the job are protected if they

• Participate in a supervised rehabilitation program and are no longer using illegal drugs
• Have successfully completed treatment and are no longer using illegal drugs

--Exceptions

See box above.

No Exceptions

Not Applicable

Employer may administer drug testing to ensure that an individual with a history of illegal drug use is no longer using.

*Current abuse is defined as the illegal use of drugs that occurred recently enough to conclude that it is still a problem.

Figure 7-2
Services Provided Under the Workforce Investment Act of 1996

Core Services include

• Assessment of individuals' skill levels, aptitudes, abilities, and supportive service needs
• Job search and placement assistance and, where appropriate, career counseling
• Information about current job vacancies, the skills those jobs call for, and the kinds of jobs that are generally available in the community, including pay levels and skill requirements
• Information about training available through the one-stop delivery system
• Information about and referral to supportive services, including child care and transportation
• Assistance with establishing eligibility for welfare-to-work activities and financial aid programs for training and education not funded by the Act
• Followup services (including counseling about the workplace) for those placed in unsubsidized employment (?134(d)(2) of P.L. 105-220)

Intensive Services include

• Comprehensive and specialized assessments of the skill levels and service needs of individuals, including diagnostic testing and in-depth interviewing and evaluation to identify employment barriers and appropriate employment goals
• Development of individualized employment plans identifying employment goals, appropriate achievement objectives, and appropriate combinations of services required to achieve
  employment goals
• Counseling, including group, individual, and career
• Case management for those seeking training services
• Short-term prevocational services to prepare individuals for unsubsidized employment or training (including development of learning, communication, interviewing, and personal maintenance skills and instruction about punctuality and professional conduct) (?134(d)(3) of P.L. 105-220)

Training Services include

• Occupational skills training, including training for nontraditional employment
• On-the-job training
• Programs that combine workplace training with related instruction
• Training programs operated by the private sector
• Skill upgrading and retraining
• Entrepreneurial training
• Job readiness training
• Adult education and literacy activities
• Customized training conducted by an employer or group of employers committed to employing individuals upon successful completion of the training (?134(d)(4) of P.L. 105-220)

Figure 7-3
Sample Consent Form

Consent for the Release of Confidential Information

I, ___________________________, authorize XYZ Clinic to receive
(name of client or participant)

from/disclose to ________________________________________
(name of person and organization)

for the purpose of _______________________________________
(need for disclosure)

the following information__________________________________
(nature of the disclosure)

I understand that my records are protected under the Federal and State Confidentiality Regulations and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also understand that I may revoke this consent at any time except to the extent that action has been taken in reliance on it and that in any event this consent expires automatically on ____________________ unless otherwise specified below.
(date, condition, or event)

Other expiration specifications:

_________________________
Date executed

_________________________
Signature of client

________________________
Signature of parent or guardian, where required

Figure 7-4
Making a Referral to a Vocational or Training Program

When a substance abuse treatment program refers a client to an outside agency providing vocational services, it has three choices:

1. A counselor can give the client the agency's name, address, and telephone number and urge her to make an appointment.
2. A counselor can call the agency for the client and set up an appointment.
3. The program can invite the agency to interview clients and/or provide services on its premises.

The first option requires no communication between the program and the vocational or training agency; thus, no consent is required. However, the first option does require the client to take the initiative, something she may have difficulty doing. The second option requires the client to sign a consent form permitting the counselor to call the agency and set up an appointment. The third option provides the path of least resistance for the client--she need only present herself to the outside agency on the day it schedules services at the program. By appearing to request services from the outside agency, the client is making a disclosure about her participation in treatment and no consent form is required. However, if the program sets up appointments for clients beforehand, it will need a consent form signed by the client before it can present the list of applicants for services to the vocational or training program. And, as noted above, the substance abuse treatment program must have a proper, signed consent form if it and the vocational or training agency are to communicate in the future about any client they both serve.

Figure 8-1
A Program That Addresses Women's Issues

California has been a pioneering State in allowing women inmates with children under the age of 6 to live in community-based facilities. The California Department of Corrections Community Prisoner Mother Program (CPMP) is an innovative program that allows women inmates to strengthen bonds with their children and to reintegrate back into the community as productive and self-reliant individuals. As part of the community re-entry programming, women receive vocational training, job preparedness training, job placement services, referrals, and aftercare services.

Figure 8-2
Summary of Program Examples

Safer Foundation (Chicago)

Center for Employment Opportunities (CEO)(New York)

Project RIO (Texas)

Corrections Clearinghouse (CCH) (Washington State)

Original Objectives

To provide vocational training to inmates and to assist them in entering into unions and private industry after release

To develop work crews that could offer day labor employment in neighborhoods where offenders were living

To provide specialized employment services to ex-offenders to reduce recidivism

To coordinate job search activities for adult offenders being released from prison

Program Components

(1) 200-bed work release centers where residents attend nine 90-minute minicourses and basic reading and math skills courses using a small-group, peer-learning approach.

(2) The PACE (Programmed Activities for Correctional Education) Institute, a private school that provides basic education and life skills courses

(3) A coordinator closely supervises 200 trained volunteers who provide literacy tutoring and 65 who facilitate groups.

(1) CEO assigns ex-offenders to day labor work crews.

(2) Orientation includes four all-day job readiness classes and a 90-minute orientation to the work crews.

(1) Funds for a prison school district for life skills courses, job readiness counseling, and help assembling needed documents (e.g., birth certificates, social security cards, school transcripts)

(2) A 30-minute orientation to the RIO hotline number and the program that inmates attend on their release day

(3) Assessment, placement, and followup services

(4) Arrangements for employers to spend a day in prison talking to inmates about job opportunities

(1) Several prerelease job-related courses as well as vocational assessment

(2) At the Corrections Center for Women, CCH offers two transition-to-trades initiatives for women

(3) CCH contracts with six community agencies and one employment service center to provide job search assistance to adult and juvenile ex-offenders, including ongoing postplacement services ("Ex-O" Program)

(4) A college program for ex-offenders in recovery for substance abuse problems

Data/Results

(1) Improved GED scores by an average of 12.5 percent

(2) Ninety-one percent of inmates improved basic skills test scores

(3) Fifty-nine percent of those who found jobs remained on the job for at least 30 days

(1) Average placement rate of 70 percent

(2) Half of those who remained on the job for 1 month were still on the same job at 6 months

(3) In 1996, the average hourly wage of placed participants was nearly 50 percent higher than minimum wage

(1) In 1995, almost 74 percent of clients were employed at an average of 21 percent above minimum wage.

(2) At 1 year after release, 69 percent were employed, compared with 36 percent of non-RIO parolees.

(3) Of minority clients, 66 percent found employment compared with 30 percent of African Americans and 36 percent of Hispanos/Latinos who were not enrolled.

(4) Forty-eight percent of RIO clients were rearrested during the year after release, compared with 57 percent of non-RIO parolees.

(1) In 1997 and 1998, 3,082 inmates completed a CCH program.

(2) Ex-O contractors enrolled 1,312 ex-offenders, 59 percent of whom found work and 68 percent of whom were still employed after 45 days.

(3) Recidivism rate for the Ex-O clients after 1 year was 3 percent, compared with 10 percent for all releasees; after 5 years, recidivism rate was 15 percent for Ex-O clients, compared with 30 percent for all releasees.

Figure F-1
Federal Funding Sources

Services Provided

Federal Agency

Enabling Rule

Target Populations

Eligibility Requirements for Target Populations

Grantee

Contacts

Alcohol abuse prevention and treatment

Substance abuse prevention and treatment

Primary prevention activities

Administrative costs

DHHS

SAPT Block Grant formula (42 U.S.C. §300)

People with alcohol and substance abuse disorders

Special populations (e.g., women)

Substance abuse disorders

Pregnant/postpartum women

SSA

SSA

Funding for substance abuse treatment of Medicaid-eligible individuals. This is an optional benefit at the State's discretion.

DHHS/HCFAMedicaid

Title XIX of the Social Security Act (42 U.S.C. §§1396-1396v)

Medicaid-eligible individuals

Medicaid

Income

Age

Participation in other Federal programs

Pregnancy status

State departments of health and social services

DOL

State HHS

Some substance abuse treatment services if State sets funds aside

Job training

Transportation

Child care

DHHS

Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193)

TANF recipients

TANF receipt

Three-quarters of formula funds go to States; one-quarter of formula funds go to local communities

DHHS and welfare contracting

Support services for "hardest to employ" TANF recipients

Transportation assistance

DOL

Welfare-to-Work grant provisions of Title IV, Part A of the Social Security Act (P.S. 105-33)

Hardest to employ TANF recipients

TANF receipt

State driven

DOL

State HHS

Basic and remedial education

Job skills assessment

On-the-job training

Job search assistance

Work experience programs

Internships

School-to-work transition programs

Transportation and relocation assistance

DOL

JTP (29 U.S.C. §201-206) (Note: JTPA is superseded by the Workforce Investment Act of 1998 and will be repealed on 7/1/00.)

Unemployed adults

Youth

Disabled persons

Dislocated workers

Native Americans

Migrant and seasonal farm workers

Veterans

Disadvantaged and disabled individuals

Funds are channeled to States, which oversee the planning and operation of local programs

State DOL

States receive block grants for adult employment, training for disadvantaged youths and families, and literacy

Grant establishes a system of "one-stop" centers for job seekers

DOL

Workforce Investment Act of 1998(P.L. 105-220) consolidates more than 60 Federal programs into 3 block grants to States for employment, training, and literacy

Disadvantaged adults and youth

Disadvantaged adults and youth

85% of funds go to local areas; the remainder for Statewide activities

DOL Employment and Training Division

Substance abuse prevention, intervention, referral, and treatment

Job training (to assist prevention efforts)

Security improvements in public housing complexes

HUD

Drug elimination, "back to work" efforts

Public Housing Drug Elimination Program (42 U.S.C. §11901)

Public housing residents

Public housing residence

Local public housing authorities, which contract with service providers

HUD regional office

State and local public housing authorities

Substance abuse disorder assessment and treatment

Prescription medications

Equipment and accommodation for disabled

Transportation

Training and secondary education

Vocational testing and evaluation

DOE

Vocational Rehabilitation Act (29 U.S.C. §720-728a, 730, 731)

Workforce Investment Act of 1998 (P.L. 105-220, §106)

People with disabilities

People receiving Supplemental Security Income

People with disabilities; Supplemental Security Income

VR agency designated by State

Varies by State

Foster care

Services to prevent child abuse and neglect

Substance abuse treatment (often court-ordered)

Child care

DHHS

Title IV of the SSA (42 U.S.C. §1862)

Parents in child welfare system (often TANF)

TANF-eligible and those in the child welfare system

State or county child welfare services

Child welfare agency or contractors

State determines benefits package; in some States, adolescents and teen mothers are included

DHHS

Title XXI of the Social Security Act (P.L. 105-33 §4901a)

CHIP

Uninsured children (as defined by State)

Uninsured children; sometimes more narrowly defined

Varies by State

State HHS

Child care

Transportation

Detoxification

Substance abuse treatment services<

Social services

DHHS

Title XX of the Social Security Act (42 U.S.C. §§1397-1397f)

State determined

State determined

State HHS or subcontractor

State HHS

Substance abuse treatment services

Tear down housing

Move drugs out, services in

DOJ

"Weed and Seed"

Residents in designated neighborhoods

Law enforcement agencies with local community coalitions

Law enforcement agencies working as part of a community coalition

Executive Office for Weed and Seed of the DOJ

Substance abuse treatment at every point of entry in the criminal justice system

Substance abuse treatment services for adjudicated and non adjudicated individuals

DOJ, Office of Justice Programs, Drug Courts Program Office

Violent Crime Control and Law Enforcement Act of 1994 (28 CFR §93)

Adjudicated and non adjudicated individuals

Adjudicated and non adjudicated individuals

Local criminal justice system

DOJ Office of Justice Programs

Counseling

Medical and psychological services

Job training

DOE, Office of Special Education and Rehabilita-tive Services, Rehabilitation Services Admini-stration

Rehabilitation Act of 1973 (29 U.S.C. §701ff)

Individuals with physical or mental disabilities (priority given to severely disabled)

Individuals with physical or mental disabilities (priority given to severely disabled)

State VR agency

State VR agency

Help States and local communities develop flexible transportation services that connect welfare recipients and other low-income persons to jobs and other employment-related services

DOT

Transportation Equity Act of 1998 (49 U.S.C. §5309)

Welfare recipients, low-income persons

Welfare recipients, low-income persons

States, local communities

DOT

Federal Transit Administration

Loans and grants to create jobs, expand business opportunities

Support activities for job hunting, such as job training, child care, transportation

HUD, USDA

Empowerment Zone and Enterprise Community Initiative (26 U.S.C. §1391)

Designated EZs or ECs

Within area with local discretion

EZ/EC local coalitions

HUD

Aid in the elimination of slums and blight

Meet other urgent community development needs

Neighborhood revitalization

Economic development

Improvement of community facilities and public services

HUD

Housing and Community Development Act of 1974 (42 U.S.C. §5301)

Low- and moderate-income people

Low- and moderate-income people

Entitled communities (metropolitan cities and urban counties)

HUD

Figure F-2
Federal Sources of Discretionary, Time-Limited Project Grants

Note: This list is not intended to be comprehensive.

Department of Education

National Institute on Disability and Rehabilitation Research

Office of Special Education and Rehabilitative Services, Rehabilitation Services Administration

Department of Health and Human Services

Administration for Children and Families

Health Care Financing Administration

Health Resources and Services Administration

National Institutes of Health

National Institute on Alcohol Abuse and Alcoholism

National Institute on Drug Abuse

National Institute of Mental Health

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Prevention

Center for Substance Abuse Treatment

Center for Mental Health Services

Department of Housing and Urban Development

Department of Justice

Executive Office for Weed and Seed

National Institute of Justice Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention

Department of Labor Department of Transportation

Federal Transit Administration