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