Transitional Employment Programs
Transitional Employment Programs
he availability of alternatives for having meaningful roles in the community (e.g., housing, employment, education) is a critical part of engaging individuals in their own process of recovery. Transitional Employment Programs (TEPs) are a vital part of the clubhouse model, providing the primary link between the work-ordered day of the clubhouse and work in the community. Four of the ive clubhouses studied are at the initial phase of developing this critical component. Because of the time and resources required, the development of viable TEPs stand as the most diicult barrier to achieving ICCD certiication.
Recommendations: A plan for providing technical support and other resources to clubhouses for TEP development should be considered to ensure their success.
Conclusions
he administrative service data analyzed in this study demonstrate a signiicant shift of service activity to the new Psychosocial Rehabilitation Services described in the 2004 AHCA Handbook. he focus groups and interviews describe a period of transition for both consumers and staf in implementing these services. Per descriptions in the AHCA handbook, programs were focusing less on the amelioration of symptoms and more upon restoring functional capabilities, as evidenced by skill development activities in each of the programs. However, both consumers and staf express struggles with the emphasis on greater consumer self- direction that is central to the implementation of recovery-oriented programs.
In contrast, clubhouse services had no statewide billing activity for the period of this study. Each of the ive programs had explored Medicaid as a funding option, but only one was preparing to bill for services. Key issues include a lack of billing infrastructure, concern about the level of compensation, and documentation requirements that are not compatible with the clubhouse model. However, each of the programs followed International Center for Clubhouse Development (ICCD) standards, and are part of a growing statewide coalition. Staf and consumer members were almost universal in their passionate support for the clubhouse model. Despite issues related to compatibility with traditional inance structures, clubhouses in other states have successfully created a process for billing Medicaid. he Florida Clubhouse Coalition, AHCA, and other interested stakeholders should explore strategies for overcoming current barriers and may beneit from approaches employed in other states.
Funding mechanisms to support rehabilitative, recovery-oriented services such as those introduced by AHCA provides critical inancial incentive to service providers. However, service descriptions such as those provided in the AHCA handbook can only provide general parameters for guiding service delivery. Program standards are needed to provide a detailed roadmap for efective program implementation and a foundation for program evaluation. Standards to support rehabilitative, recovery-oriented services are emerging in the ield (Onken et al., 2004). Program standards should be considered as an important next step in supporting efective service delivery.
Policy changes taking place at both state and national levels provide an important context for service delivery. Florida, like many states across the nation, has taken the lead from President Bush’s New Freedom Commission and identiied recovery as the goal for transforming our mental health system. Partnerships of consumers, family members, policy makers, service providers, and representatives from a broad range of government agencies who serve individuals with mental illnesses have formed at the state and community level. Strategies for developing inance structures to support rehabilitative, recovery-oriented services should be integrated with these policy initiatives.
he shift in some AHCA areas from fee-for-service inancing to capitated systems, represented by Prepaid Mental Health Plans (PMHP’s) and Health Maintenance Organizations (HMOs), also has important implications for the he shift in some AHCA areas from fee-for-service inancing to capitated systems, represented by Prepaid Mental Health Plans (PMHP’s) and Health Maintenance Organizations (HMOs), also has important implications for the
1 data demonstrated a shift from day treatment services to drop-in centers after the implementation of the PMHP. hese consumer driven programs could not have been implemented under the fee-for-service system. PMHPs and HMOs should be considered critical partners in the state’s transformation planning. Consumer input into the development and implementation of PMHP and HMO contracts will also be critical to supporting recovery-oriented service delivery.
Cultural and community resource issues also signiicantly impact the implementation of rehabilitative, recovery-oriented services. he prevalence of stigma connected to mental illness continues not only among the general population, but also within the mental health system. Limited inancial resources strain the workforce and contribute to high levels of staf turnover, representing a major area of concern for the consumers who participated in this study. he lack of afordable housing and employment opportunities creates a signiicant barrier to achieving full community integration. Services and inance structures are critical to helping people with serious mental illnesses on the road to recovery, but they should be planned and implemented as part of a community-wide response.
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