Transitional Employment Program

Introduction

Fountain House is a Psychiatric Rehabilitation facility that utilizes an intentionally created community as its treatment modality. (See Fountain House: Creating Community in Mental Health Practice, published by Columbia University Press) The Fountain House model of treatment, is a recent winner of the Hilton Humanitarian Prize and has been replicated in most of the United States and in many countries around the world. Transitional Employment is a pre vocational program utilized by Fountain House that offers clients, called members, the opportunity to work on a real paid job in the community, as a first step to full time independent employment.

Supported employment refers to those programs that help and guide disabled individuals who are independently employed. In 2009 Ralph Bilby, a Fountain House employee, in a well meaning article wrote, that TE is the most supported form of all the supported employment types”, thereby creating the erroneous impression that TE is a comparable type of supported employment. Although it is true that the amount of money members make on a TE and the six months of continuous work built in to a TE, compares favorably with clients in other supported employment programs, the comparison unfortunately misleads and undermines the unique therapeutic nature of a TE program. Therefore l House offers, it should not to be confused with the unique contribution that TE makes to the viability of its intentionally created community and the goals of its individual members.

What is TE?

TE is not a job training program, but rather an opportunity for members to learn the generic qualities necessary to successfully function on any job. The jobs used in the TE program are given to Fountain House by community employers to be used over and over by different members. The employer agrees to allow Fountain House to select employees and to pay them the established rate or in the case of a new position, at least the minimum wage. This wage agreement is important to the treatment process because it guarantees that the standards for success, set by the employer, will be applied to Fountain House members.

The length of time a member can be on a placement is limited to 6 months. The Fountain House community guarantees to the employer that the job will be competently done on an ongoing basis. This promise places a purposeful and specific obligation on the Fountain House community. The promise to the employer is satisfied by splitting one full time into two part time jobs. Assigning a staff worker to learn the details of the job, by actually doing it. Then assigning that staff worker the responsibility for training all new members on the job, choosing the members who wish to try the job and being available to cover the job in the event of a members failure to attend.

TE exists in the context of and is an integral part of the treatment at Fountain House. It is a continuation of the side by side work done by members and staff working together in the Fountain House community moved to real job in the general community. Regardless of where side by side work is done at Fountain House or on a job in the community, its goal is for members to experience success, feel needed and motivated. The real as opposed to simulated work at Fountain House and on a TE, motivates positive action by helping members reduce their defeatist attitudes by experiencing authentic success in necessary work. Progressive successes in side by side work increases the members belief in their ability to do things (self efficacy), which positively affects cognition, motivation, affective states and the biology that underlies them. Increases in self efficacy also builds motivation by changing the person’s expectation of failure and helps correct self evaluations based on self stigma and lack of personal power. It also heightens mood and lowers stress. If a person has a strong mastery experience that increases their belief in their ability to change, that experience can have a positive generalizing effect on other risk taking activities. When a person experiences a number of mastery experiences a basic change in attitude can occur which redefines fearful activity into challenging activity. In addition to increasing self efficacy the Side by Side practice is designed to facilitate relationships and create in the members the feeling that they are needed. Members feel needed for the work of the community because the staff are asked to do more then can be accomplished by themselves alone and are therefore forced to ask for help from the membership. Although this organizational design, which leads to staff needing members and which puts their focus on the members personal strengths, is built into every aspect of Fountain House community activity, it is most readily observable in TE.

Training for a TE and Group Placements

After a TE has been established the training of a new prospective member employee or the temporary coverage of that placement in the event of absence, can be done by the trained staff worker or a member who has previously completed the placement. In the latter case, the training or coverage can serve as a reinforcement of the original mastery experience. When a staff do the coverage, they have the opportunity to expose fearful or unsure members to the idea of community employment. Although a new member on a TE can be interviewed by the employer as a courtesy and to complete the necessary paperwork, choosing who will work on the job placement is the sole responsibility of the Fountain House community. TE’s are either single jobs broken down into two part time jobs usually from 9-1 and 1-5 or group TE’s. Group TE Placements happen when the Fountain House community is asked to produce work at a place of business that requires at least five members at a time. Although all of the salary requirements for members remain the same on a group placement as on an individual placement, the support offered by a group can make a first paid employment an easier transition to the world of work. For example on a group placement, the employer evaluates the production of the whole group not any single individual, thereby offering each member more of a chance to try to meet employment standards. Usually, a group placement requires that a staff worker assume a supervisory role. Although this is an extra staff burden and an expensive obligation for an intentional community, different staff can rotate on different days and the unique and supportive opportunity afforded to a less motivated segment of the community usually makes a group placement a worthwhile endeavor.

What Motivates Employers To Participate In TE

The Fountain House community, through its TE program enlists the business community as partners in the rehabilitation process and will through employer recognition dinners and by offering mental health consultation, show its appreciation for that partnership. In so doing the employers that join the TE program can become resources and connections for other intentional community needs such as fund raising and help in developing supported and regular full time employment opportunities for the membership.. The appeal to an employer is on two levels. First, they and their employees are helping in the rehabilitation of a fellow human being. Second, it is a prudent way for the employer to avoid the problem of unforeseen absences and sudden turnover on unskilled jobs that plague many businesses.
Therapeutic Aspects of TE

Therapeutic Aspect 1: The Fountain House community and its staff, self interestedly, need members to succeed on a TE placement.

Fountain House needs its members to fulfill the promise made to the employer, that the job given will be competently performed regularly. This obligation encourages staff to find members who are willing to try a TE. This need staff have for member participation in TE motivates members, particularly when that need is expressed in the context of a significant staff- member relationships or in a members desire to help Fountain House satisfy its obligation to employers.

Therapeutic Aspect 2: A member can try a placement, with no obligation, for a day, a week, alone or with on site staff support

Therapeutic Aspect 3: TE offers staff a range of flexible and beneficial treatment options and the opportunity to offer the member meaningful support. accurate feedback and effective future planning

Since staff are the first to learn the work and the employers requirements they can not only teach but also support a member on the placement. A support that includes, correcting fearful thoughts, clarifying the goals of the work and offering honest feedback . Staff can also utilize members who have previously mastered a particular TE as fill-ins in case of absence, or to train a new a member for the placement. Members who take on these mentoring responsibilities with other members often experience increases in their self esteem. Finally by generalizing a members success on a particular TE to other potential work, educational or personal situations, staff can more accurately assist in planning a members next steps.

Therapeutic Aspect 4: TE offers a member the opportunity to learn the generic qualities of work applicable to all paid employment and to master specific job requirements that vary from one placement to the other.

Although each TE job has generic similarities to all work environments in terms of punctuality, dealing with an employer and other employees, appropriateness of appearance and symptoms control, each TE also represents a unique work situation. Some TE’s require a comfort in relative isolation, while others require an ability to interact with many different people. Some of the placements emphasis, memory, problem solving or other cognitive skills while others focus on organizational skills or the efficient use of public transportation.

Therapeutic Aspect 5: A members desire to try a TE always trumps staffs evaluation of their readiness. It also offers staff the opportunity to offer pragmatic supports which include on the job assistance, wake up calls, occasional staff coverage and planned meetings with other members on TE.

Finally a practice value in the intentionally created community of Fountain House, is that a members desire to try a TE always trumps staffs evaluation of their readiness. Staffs role after a TE has been chosen is to provide the supports necessary to help a member experience success. Pragmatic supports include, on the job assistance, wake up calls, occasional staff coverage and planned TE meetings with other members on TE. As with all side by side activities at Fountain House the goal of developing a ” can do” attitude inevitably requires a series of progressive successes. Success on a TE can motivate a member to try a more challenging TE, go to school or get a independent job.

What motivates member participation in TE

Aside from the salary and the opportunity to get a reference from an employer, there is a certain status that a member achieves in the Fountain House community. As discussed above, there is the fact that the members participation in TE is really needed by the community. Also the temporary nature of the job and its separation from long term vocational goals lowers the stress level for most members. A final motivating factor, provides the opportunity for a member to cover a TE to protect the opportunity for the community and other future members

The History of TE

From 1950 to 1951 John Beard, the first and most influential executive director of Fountain House, worked in ward N-206 of the Wayne County General Hospital. The hospital was known locally as Eloise, as it was located in the Detroit suburb of the same name. The ward Beard was assigned to was populated by about 250 male patients suffering from severe and chronic schizophrenia. It was there that as part of Activity Group Therapy (AGT) a program developed by Beards supervisor that John took a group of patients to a local food market to give them the experience of working on a real job. His role in this project was to find employment nearby and to offer the support that his patients needed to succeed, such as on-the-job training and coverage when they were sick. After coming to Fountain House Beard, borrowing from his earlier practice at Eloise, reached out again and tapped into the vast potential of local establishments in New York City to support the vocational aspirations of the membership. The resulting program, started in 1958, was initially called the Employment Placement Project. A brochure prepared by Fountain House introduced this program as:

“Having made a good vocational adjustment within the Fountain House environment, the patient now looks to employment within the community. This is what he has been building up to. Only one more step is necessary. To assume regular full-time employment, a ‘transitional experience’ is required. The employment placement project of Fountain House is designed to provide this type of experience.” (As quoted in Anderson, 1998, p. 29)

The signature title for the initiative, “Transitional Employment” (TE), came one or two years later. When I came to FH in 1964 TE was an established part of the FH community. In the years that followed, I as program director and then assistant director of Fountain House witnessed the substantial increase of employers who gave one or more of their established jobs as an essential part of our rehabilitation effort. Later, as the number programs replicating the Fountain House model grew a series of standards were written to guide them in those efforts. TE was included in those standards as a mandatory pre vocational program by which all legitimate replications would need to develop.
For example, in 1973, The Club, a replication of the Fountain House model, I created at the University of Medicine and Dentistry in New Jersey, prominently featured TE as its signature program. The program garnered much of the respect we enjoyed and our employers not only helped members to find independent employment they were crucial in the funding that facilitated our state wide housing program.

Case Example

The job placement opening at Siebert & Nicholas, was for a messenger to carry packages of printed material to clients all around NYC. Robert was a 24 year old member of Fountain House who helped out in Fountain House thrift shop. He had a masters degree in English literature and the dream of eventually getting his Phd and teaching at a university. Although Fountain House, did not at the time, have a formal tutoring program Robert was our unofficial English professor and would help members learn to read or improve their reading skills. Robert had a history of three different psychiatric hospitalizations and although he enjoyed academic success, had never completed a paid job. He presented with a quirky, absent minded and disheveled appearance and I knew from him and his brother who visited him at Fountain House that his apartment was a mess. Robert was well aware that TE had a number of white-collar job placements and as a person with a masters degree he felt ready to pursue one. I shared with him my concern that those placements to which he aspired, required organizational skills that he at that time did not possess. I further insisted that even though as a member, it was his right to try any available TE, I wanted his first real job experience to be a success and felt that the messenger job at Siebert made sense. With some trepidation he agreed. Frank, the member coming off the Siebert placement was scheduled to begin a new job which meant I would be training Robert on the job. For the next two weeks Robert and I in the blistering heat of that August summer, delivered packages for the Siebert & Nicolas printing company. After those two weeks I called Robert every morning for the next two weeks because it had become apparent he needed help getting up in the morning and I continued to meet with him after work daily, to offer support and review his experiences on the job. Robert completed the placement and then went on to a placement with Benton and Bowles, where with feedback concerning his appearance, dress and grooming and with some organizational help from his supervisor at Benton and Bowes, successfully completed the placement. Approximately two years after completing the Siebert placement Robert became a full time Phd candidate at New York university. On one of his occasional visits to Fountain House he shared with me his belief that his first paid work experience at Siebert Nicholas helped focus him on the realty of what a job is and his success there was a powerful experience which created in him the belief that, as he put it, “maybe, I can really make it”.

Conclusion

TE, which is a uniquely essential therapeutic tool in the social practice of any intentionally created working community, should never be confused with other employment programs. TE has a therapeutic dynamic that extends from the Fountain House community to the world of work. The employers in TE, use their work to further the rehabilitative goals of the Fountain House community and as such each can be thought of, as are Fountain House staff, members and board, being essential intentional community participants.