Hello, and welcome. I'm Dr. Amy Cohen, a clinical psychologist and director of SMI Advisor. I am pleased that you're joining us today for the SMI Advisor webinar titled Enhancing Individual Placement and Support, Supported Employment for Transition Age Youth, the Career and Occupational Readiness Experience. Next slide. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Next slide. This webinar has been designated for one AMA PRA Category 1 for credit for physicians, one CE credit for psychologists, and one CE credit for social workers. Credit for participating in today's webinar will be available until December 18th, 2022. Next slide. Slides from the presentation today are available in the handouts area found in the lower portion of your control panel. Select the link to download the PDF. Next slide. Please feel free to submit your questions throughout the presentation by typing them into the questionnaire found in the lower portion of your control panel. We'll reserve 10 to 15 minutes at the end of the presentation for questions and answers. Next slide. And now I have the pleasure to introduce you to the faculty for today's webinar, Dr. Vanessa Borges-Klodnick and Ms. Rebecca Johnson. Dr. Klodnick is nationally recognized for her expertise in community mental health services design for vulnerable and marginalized young people and their families. At Thresholds, Dr. Klodnick partners with youth and young adult services, also called YAYAs, their leaders to implement continuous quality improvement practices to better understand, improve, sustain, and grow innovative multidisciplinary programs for young people with serious mental health needs, complex trauma histories, and current and former system involvement. Dr. Klodnick has trained and consulted with organizations and systems in 12 states to date. Dr. Klodnick is also an adjunct faculty at the Texas Center for Excellence in Mental Health at UT Austin and leads and co-leads several federal, state, and foundation-funded projects to implement and examine adolescent and young adult developmentally attuned mental health care, including peer and vocational support integration. Dr. Klodnick earned her PhD at the University of Chicago Crown Family School of Social Work, University in Practice, her master's at the Steve Hicks School of Social Work at the University of Texas at Austin, and is a licensed clinical social worker in Illinois. To learn more about her work, see YAYAs Research and Innovation. Next I'd like to tell you a little bit about Rebecca Johnson. Rebecca Johnson leads and coordinates multiple YAYAs mixed methods CBPR research, program evaluation, and continuous quality improvement projects that aim to increase our understanding of program feasibility, impact, and value. Rebecca supervises a team of research and innovation specialists, sponsors the YAYAs Young Adult Advisory Board, and oversees research and program evaluation translation of knowledge into useful dashboards, reports, journal manuscripts, conference presentations, manuals, and workforce development tools. Rebecca also oversees intern projects in YAYAs staff advocacy and leadership efforts. Rebecca completed her master's in clinical mental health counseling at Adler University, a master's in women and gender studies at DePaul, and is a licensed professional counselor in Illinois. I'm thrilled that you're both joining us today, and I'll hand it over to you, Dr. Klodnick. Thank you, Amy. Hello, everyone, and welcome. It's always wild to hear all of those accomplishments listed, but we're hoping to bring what Amy just described about our work to life today. We really want to encourage people to ask questions. We fall into the trap of using acronyms sometimes, and so I really want to encourage people, if we're talking about something and you're like, what are they talking about, please put it in the Q&A so we can make sure to address that. Really quickly, I do just want to say we have no disclosures, but I do want to thank NIDILRR for graciously funding this project, which is a development intervention research project, and also I do want to thank Thresholds, which is the largest community mental health provider in Illinois, for both being a leader in developing all the evidence-based practices in community mental health, and also supporting our efforts to adapt them or enhance them for vulnerable adolescents and young adults with serious mental health needs. So today for our learning objective, I'm hoping that in this brief hour, you're going to leave here really deeply acquainted with the unique career development needs of adolescents and young adults with serious mental health diagnoses. You're also going to learn about an innovative add-on to IPS-supported employment called CORE. You're going to learn some of the philosophies and practices that make up CORE, and I do believe that some of these are very transferable right now in real time into your practice. And then finally, we're going to talk a little bit about CORE feasibility and our preliminary outcomes. We're also going to share hot off the press our CORE operations manual that was just posted online today. So don't worry, we have QR codes for you coming. You would have access to that and share that, please, very widely with your network of adolescent and young adult community mental health service providers. Okay. So here's the slide we all love to talk about, all the problems. And these are really complex problems. And so this intervention we're going to get into, it's a complex intervention because it aims to address a complex problem. Serious mental health condition onset, they typically onset in adolescence and young adulthood. And that, of course, coincides with really important time for career development. The transitions from high school to college, the entry-level, part-time work experiences that many young people in high school do. I mean, those are the things that are really disrupted with the onset of a serious mental health condition in adolescence. Also, we know that with serious mental health conditions, there's psychiatric hospitalizations, there's also justice involvement, there is also a serious mental health condition can impact both social skills and cognition that can impact employment and school-based performance. And then in a paper we just published recently, we know that the, at least from many young people who told us about their experiences of a recent onset of psychosis, that it really impacted their self-esteem, self-efficacy, and identity related specifically to work in school. And that that's really important, that these roles are really critical during the transition to adulthood. We also know, there's a lot of research that says that we know that young people who do develop a serious mental health condition in adolescence and young adulthood are at increased risk for unemployment, underemployment, supplemental security, income, benefit, use, and also poverty. And these are big things to tackle in an intervention, and we're going to get into why we think the intervention is theoretically sound that we've developed and how the study is attempting to capture that. We also know that there is incredible, there are incredible evidence-based practice employment services out there across the country. And the IPS supported employment model has, it is the most evidence-based of the evidence-based practices. And we know that many young people benefit from IPS, and then some people don't, some young people don't. And so the intervention we've developed is really targeting the young people who are not necessarily responding to IPS like we would like them to. And then finally, I do want to mention this, and this comes from research at Thresholds where we've interviewed young people and scoured clinical records trying to understand engagement. And what we have learned is that so many young people want to work and want to go to school. So consistently in our program evaluation work and in published research, we have found that young people overwhelmingly, 90% of them have in their care plan, I either want to return to work or return to school. So this is a really important area for practice for this age group specifically. So with problems, very complex problems, I'm going to move into needs. So one of the needs, and this is a term I like to use, developmentally attuned vocational services that are embedded, embedded in community mental health care, and that they also support real-world learning. And when I say that, I mean learning through doing, so learning through experience, really important. They also have to be inexpensive and feasible. And as I mentioned a little bit earlier, they need to target the young people that aren't benefiting from services that are already in place. And then finally, there's a real need and opportunity here, it's more of an opportunity for researchers and program evaluators, I'm calling all you program evaluators out across the country, to take a step back and really start to operationalize and evaluate some of the innovative vocational supports that are occurring. There's been a lot of innovation in vocational support through various SAMHSA Healthy Transition Initiative projects, but there often hasn't been resources dedicated to deeply evaluating, operationalizing, refining, and then examining in more rigorous research trials impact of specific vocational services for this age group within community mental health care. That was a lot. Really quickly, if you're not familiar with IPS, I'm throwing out this acronym, I want to point you to this QR code down on the bottom of the screen. And also this link is also, you could Google this and find and learn a little bit about IPS. What I love about IPS is that it has these eight principles, and they are critical to IPS. I'm going to highlight a couple that we think are really important that need to be, I'm going to say, enhanced for youth and young adults. One of them is this notion of job preferences. If any of y'all who are participating today have worked with youth and young adults, you'll know that their preferences change all the time. And so what they might be interested in today is different than tomorrow, and this is something that we need to embrace. We also have to create spaces where young people can learn what their preferences are. And so our intervention does aim to do that. And also this notion of competitive employment, and IPS as a model has transformed the way we think about individuals with, I'm going to use old school language, psychiatric disabilities, and their capacity to engage in competitive employment, meaning being paid at least a minimum wage in a job that anyone can apply for. We fundamentally, Rebecca, I don't want to speak for you, but I'm going to speak for myself and say, I believe that all young people should have access to competitive employment. Some of the young people that we've worked with at Thresholds and have participated in our research have struggled with competitive employment and have struggled with engaging in IPS to get to competitive employment. And so the notion of perhaps doing something that is being paid less than a minimum wage, perhaps a stipend or an internship program, could be really beneficial for certain young people. And I also just want to add one thing on this slide that's important about IPS. It is the most available vocational service within community mental health across the country. It is in very many states. It's in many countries as well. So it's a smart vocational service model, smart evidence-based practice to add onto to meet a certain target population's needs, like transition to adulthood youth. Okay, so let me pass this over to my colleague, Rebecca. Rebecca, tell me how you want me to do this. You can just, yeah, we can start there. So as Vanessa said, Thresholds has a long history of combining research and practice. We wanted to explain a little bit about how our YAHYAS programs are sort of set up. So Thresholds is nationally recognized for rapidly evolving and growing youth and adult services departments. We have five main program areas that make up YAHYAS. Our first that I'm going to talk about is our rapidly growing emerging adult division, which mainly represents two incredible multidisciplinary programs. These programs include MindStone, which encompasses our early intervention for clinical high risk for psychosis youth and those who have experienced a recent onset or first episode of psychosis. Then we also have our Emerge programs, which offer specialized services for emerging adults. So that's that age group that like 16 to 30, 18 to 30 age group with serious mental health needs. Emerge is sort of that ideal bridge between the youth services and the adult services philosophies and practices, practices, practices like the transition to independence process model to really put youth needs first. And we also have our transitional living and residential programs. So we have YAP, our young adult program, which is our oldest and like the first YAHYAS program which I recently like processed and I was like, that's so fun and cool. And this comprises of four residential sites and a therapeutic high school that service youth, young people that are primarily system involved. And we also serve a lot of young people now through school districts and different sort of foundational family grants in order to support young people with serious mental health needs that are a little bit younger. And then we have two transitional living programs, one that services young pregnant parenting young people that are either in state care or experiencing homelessness. And then we have a transitional living program that is very similar that just serves young people that are a little older in child welfare primarily that are about to be out of care. And each of these programs also integrates our supported education and employment specialists that are all trained in this IPS model. So it kind of gives you a little bit of a background of where we're coming from with all of this information. Yeah. Thanks, Rebecca. That's going to set up this really well because we've been doing IPS supported employment within the YAHYAS programs, I think since like 2007 or 2008. So I just wanted to give you all a little history here. I know. So back in 2009, I conducted some focus groups with young people who were doing really well with IPS and getting jobs and young people that were not doing that great with IPS and not getting jobs and then young people that were not engaging with IPS at all. And we use the findings from that study to inform and develop a NIDILRR funded adapted IPS approach, which included the employment piece, supported employment, supported education and vocational peer mentors. And that was tested at thresholds a long time ago. And then from there, we learned that still some young people needed something else. They needed something that was a real life experience with work, with support. And so our wonderful colleague, Ishan Spencer, designed the core model. And we're going to get into what core is. We've been alluding to it a lot. I kind of like this, like we're withholding what's the most exciting part of this. And I was able to collect some data and I also was provided the fantastic opportunity to consult on another iteration of adapting IPS with supported education for high school students with UMass Transitions to Adult Center for Research. And that produced a manual on young adult IPS and also a fidelity scale. Google that. Check it out. And then we took this adapted IPS approach, the supported education, supported employment and peer mentors, brought it down to Texas, tried to implement it at five sites. Lots of lessons learned. And we published that paper if you'd like to check it out. And then we were so excited with the opportunity of NIDILRR funding this particular project that we're going to talk about the design of core and the study of core and highlight a few of our early outcomes and hopefully share and you will share our new manual. Okay, back to Rebecca to say what core is. Yes. So core. So core stands for the career opportunity readiness experience. And it is a 15 week intervention that supports young people in obtaining and maintaining competitive employment by offering supportive and intensive job training and an inner in an interactive classroom setting and then an interactive real life experience paid internship in the community. We consider core and enhancement IPS. This means that we believe that core strengthens a young person's skills and confidence so that they are going to become more successful in those IPS services and in obtaining and maintaining competitive employment. So it's really the purpose of core is to really build up that young person's abilities to be successful in competitive employment. And then core is also as created to support young people who are struggling to secure and maintain competitive employment through IPS. Many have struggle with under having basic entry level job skills, and are also struggling in other areas where they may need a little bit of support. So you'll also see that like a lot of core encompasses focusing on how to manage mental health on the job, and how to like ask for accommodations as well as some other job etiquette and other things that every person is in entering the job force. So core encompasses several key philosophies and practices. The first is in the utilization of near age peer support. Here at Thresholds, we are major advocates for peer support and collaboration with staff with lived and living experience. And we believe that this is a key component in the successful outcomes of our core participants. We have peer support embedded in our team, as well as in the development of the intervention and the fine tuning of the intervention to make sure that it speaks to young people. And we believe that that is what something that makes quarterly special. We also utilize a philosophy called discovery oriented care to support youth and young adults with severe serious mental health needs. Discovery oriented care, care, excuse me, is the combining of the youth service philosophies around resiliency and youth with with with SMI, and the adult services term of recovery. The discovery represents that emerging adults are actively discovering who they are, while also developing real in real time, like these serious mental health challenges, diagnoses, identities, and trying to figure out who they are. We're also noticing that this population of young people, they're not reentering the workforce, but and they're not always coming in with no experience. They have like some reached some education milestones, they're a little bit farther ahead, but they really need sort of this extra layer of support. And we think that this idea of discovering is really important to this population. And then before I pass it to Vanessa, we also follow the Yaya's approach of thinking about positive youth development through putting young adult interests and needs first and meeting young people where they are, while focusing on that young adult self determination piece. Another piece of core that's really critical is cultural and social capital. So cultural capital includes like these soft skills that employees have to learn to successfully navigate work environments. And these skills really do come from exposure to work. And one example of this that's really big for young people, but arguably for all of us, is when can we look at our phone at work? When is it appropriate to engage with your smartphone? When is it not appropriate? Can I have earphones, earbuds on when I'm at work or not? Like different workplaces have different expectations that might be written down or not written down. And so really understanding the culture in regards to technology is one example. And we have to help young people learn to ask questions, to find out like, what are some of the expectations and what is the culture here? And then social capital is this other piece that's really, really critical. All the way back to the focus groups, like 10, 11 years ago, we really learned that young people that were struggling with IPS and also with sustained competitive employment didn't have near age young people that were engaged in employment. And it is just so important, arguably, that you have peers who are working. And I would make the example that would fit for all of us today is sometimes we just need to kind of complain about people at work or the customer that came in and yelled at us. And being able to bond over like, oh, I'm in this with you, we're working, that is really, really critical to be surrounded by people who are engaging in similar types of work. Or at least, I mean, for the entry level, it is tricky and scary. And going through it together is a core piece of core. We joke a lot about core, having lots of cores. Also, the social cognitive career theory also builds on this. But it's this notion that like the social, the social, the context really matters. And we've been talking about how these young people have struggled. And part of the struggles in this why try effect that we discussed earlier was this idea that like, my gosh, if my mental health diagnosis emerged, let's say, freshman, sophomore year of high school, and I really start struggling in school, and I just am failing, and I can't seem to get it right, and I'm just really not doing well, and I can't keep a job, I'm interviewing, like, it just feels awful. So the social context is reinforcing like, oh my gosh, I'm just not good enough to do this, right? So we're seeing low self-esteem, we're seeing self-stigma, low self-efficacy, not seeing hope for the future of a career, or even engaging in work. And so part of core aims is to create an experience that counters this, that counters the negative experiences in work and in school social spaces that many of these young people unfortunately have experienced. Okay, Rebecca. Now we're gonna talk a little bit about this core team. So the core team includes a full-time core coordinator who is supervised by the IPS assistant program director, or I think right now in our case, it's the director. And they also partner really closely with the YAYA's IPS team lead and IPS staff. So these, then they also supervise two part-time young adult peer mentors with lived and living experience who utilize their lived and living experience with both SMI and also like with work, with work experiences. So like sort of like what Vanessa was saying too, like it's been so powerful that like, even sharing your own work stories, I'm sure many of you on this call have like fascinating first job stories and different things like that. It's been a really powerful motivator for these young people. So that's sort of our primary team. And the IPS team also has supported in some of that internship development, which we'll talk about in a minute. Okay, so core has four phases. The first phase and the last phase we have learned are much more driven by the team where the in between phases, so phase one, the learning and individualized internship prep and phase two, the internship are much more driven on the active involvement of your participants. So the first phase is our engagement phase. This is the pre-core phase, if you will. It's when the core coordinator and the peer mentors are trying to recruit participants. They're trying to connect with young people. For us too, it's a lot of connecting with the clinical teams to try to get buy-in and try to have them help support the young people in this process. We've also implemented an application, which the goal of that application is for the young adults themselves to be applying to be a part of core so that we can learn a little bit about them. And they're getting that practice of like applying for a job. So there's a lot of practice that goes into just the basics of participating in the intervention beyond even just the skills that are developed. There's also a screening process and a process of trying of lots of orientations and kickoffs, as well as the core coordinator, all of this throughout the entire process is developing relationships with internship sites and working with the teams and trying to figure out what the young people's needs and interests are to kind of steer the intervention for each individual young person to match those interests. Then we have our phase one, which is our workshop phase. It involves three weeks of like intensive learning in a classroom. It's usually about 68 peers. It's about, I think it's two workshops a week. And then there's a last workshop. So it's seven workshops in total that encompass learning about interview prep, financial literacy, workplace etiquette, navigating the workplace. So like all the things Vanessa was talking about with like, can I use my cell phone? When can I go to the bathroom? As well as like two really wonderful days that are led primarily by the peer mentors around managing mental health on the job and like navigating accommodations on the job. And they're also meeting one-on-one with the peer mentors to learn more about their interests and develop those relationships. So a lot of this phase is about building up that community that they have that extra layer of support as they enter into phase two, which is our community-based 12 week paid internship portion of core. We work really hard to align the internships up with young people's career interests while also paying really close attention to jobs don't always look the way that they seem. So for example, like if a young person really loves reading and wants to intern at a bookstore, there's lots of things that they're gonna do at a bookstore that does not involve reading. So it's also a little bit of managing those expectations in real time. And the core coordinator and vocational peer mentor provide tailored in-community support and coaching. This can look like meeting for coffee before a shift, practicing, traveling to and from the internship, as well as like some of our peer mentors have even like worked for a couple of hours at the internship alongside the intern to support them. And this phase, part of the phase two ends in a big celebration. So we're celebrating the amazing accomplishments of the participants throughout this time, and we're helping them kind of get geared up for what we call phase three, which is our transition phase. So this is the phase again, where we're trying to transition them back into IPS or in whatever direction they're interested in going in. So we've had young people go in different directions outside of IPS as well, but the team works really closely together to make sure that this young person is linked back where they wanna be to keep that kind of momentum going. Can I add one thing to this, Rebecca, that I feel like we don't have on the slide that I feel like is one of the most important pieces and it builds on one of the key IPS principles that is this integration into clinical services. And so the core team works closely with the IAS IPS team, and they have of course, supported employment and education workers within each of the teams. But also what's really interesting about the tailoring of this is during this phase one, the core coordinator is working with the young person and the clinical team and anyone that the young person has identified as important that they want, like involved in this process to create a support plan. And I think we renamed what that is because we're trying to use really empowering youth forward language. But this idea that everyone is together working and thinking about how am I gonna support this young person? What's my role with this? And then when the internship is secured, there is an agreement made between the supervisor at the site, so the employer, real world employers, and they are sitting down with the core coordinator and or vocational peer mentors and the young person and potentially clinical or key people. And they're working together to make sure this young person is gonna be successful. And this varies based on the level of how much a young person wants to disclose to this potential employer. And we have had young people get hired by their internship site supervisor. And so is this, I wanna say that core, one thing we don't have captured here well is that it is very much embedded within the clinical setting. And also there's pieces of this that is about everyone's role. Everyone is caring about core experiences. It isn't just the core team. The clinical team cares, the young person's self-identified family and friends and peers, they care, and that everyone is helping this young person to be successful. Oh, I missed a thing. I'm so sorry. So a little bit about this study, just really quickly. And this is for researchers who are out there. So you must be like, wow, that's a complicated intervention. Yes, yes it is. However, we are interviewing young people at six time points in order to better understand the experience of core as well as the potential impact both on, of course, we wanna know when we're gonna get to a slide, just I think the next one that's gonna say, hey, this is some of our key outcomes that we're looking for. But we're really interested in knowing does core shift self-efficacy? Does it impact self-esteem? So looking at some of those mediating variables, we're interested in those. We wanna know, are those things changing along with the desired outcomes of engaging in IPS and employment and are they not? And for who are they not, right? So this is very much a development project. We're doing lots of exploratory analyses. And the goal is, is that we want to not only understand how and why core works, we also wanna figure out how to sustain it financially. So we are, with our wonderful partners and the amazing core team that is documenting all their services in an electronic healthcare record, we're able to look at and know what is the effort and what is able to be, I'm gonna say, reimbursed within our Illinois Medicaid system and what isn't. And so we're really looking at opportunities to sustain this in Illinois and then of course, across the country. All right, here we go, Rebecca. So some of our findings so far, since July of 2020, we have had five completed cycles of core totaling 112 applicants, 49 participants, 21 participants completing the entirety of the intervention. And as you can see, there's a big mixture of folks who completed each phase. So we have young people that completed phase one and people that completed both phases, young people that matched for an internship and didn't complete their internship. So we definitely have a range of different things that come out of this project so far. But the thing I wanna point out the most is this little purple box, which I'm gonna ask you to click again, which shows our overall outcomes at this time. So these numbers are growing as more young people obtain employment and beyond. And because we follow them for so long, we're able to kind of track where they are for up to a year post participating in the intervention. And we're finding that young people are doing a lot of things beyond securing employment as well. So they're also enrolling in post-secondary education and they're continuing non-competitive vocational activities. Some of them maintained volunteer opportunities at their internship sites and other ways to just be involved in the community, which has been really beneficial for this population of young people. We have also found that many young people that do leave the early, that leave the intervention early, go and get jobs and re-enroll and or re-enroll in post-secondary education. So maybe they didn't actually go through the internship phase because they learned during the workshops what their goals were, or they got a knockout of the workshops to be like, I'm ready, I'm ready to go back to find a job, which has been a really very cool thing to see. And also anecdotally, I've done a lot of the interviews myself with my team. We've learned that there's definitely something to be said about the increase in motivation and self-esteem in these young people. They're really showing through this intervention, a stronger desire to work, more confidence in finding and keeping work, and even just the action of learning to ask for help, which has been really, I don't know, very powerful to see over time. We also, this slide also kind of showcases that we did our first three workshops virtually, which is a very interesting experience. And so this is, we're in the middle of our third cycle in person, and that has been a completely different experience as well. So I'm excited to see how the findings change as the more young people participate in that phase one in person. Yeah, there's really something about the young people being in the room together with each other. And I've talked to several, I'm gonna say mental health interventionists over the years about, you know, you're trying to study this thing that's on a computer, but you've got the youth all in the room together. And it's that social experience that potentially is either messing up your results or it's what's helping these young people. And it's really valuable for them to connect. And I do think that in our operations manual and then forthcoming in a facilitator's guide, you're gonna be able to have access to both virtual activities you can do for these workshops, as well as in-person activities. And I do wanna emphasize the experiential components of this and our earlier iterations of CORE, they were a little bit more, let's say luxury, right? We're gonna teach the way we know how to teach. We're gonna throw stuff on a slide deck, right? And then we've moved into a space where it's all activities all the time. And I've been that way for training anyone, but this idea that it is about young people feeling good in a space that is led by people that have lived and living experience with mental health conditions and treatment, and that they together are learning these skills first in these workshops, right? And it's a little controversial for IPS because this is a job readiness thing. This is, and if we've got some IPS folks out there, this kind of flies in the face of that. Like this does, it intentionally is helping young people connect to other young people who are having similar struggles. So they validate each other and support each other and also learn, learn some just basic, basic stuff about, of jobs. And I do wanna add like the online identity. Like there's just like the, all the things that young people face when they go out into the labor market these days and the need to really be like, what profile pictures do you have that are publicly out there? Like these are the things that CORE tackles, like the real world things that young people need to address so they can get that job and do well in their internship. And one thing that we're interested in, this is gonna, I'm kind of going ahead of my next step slide but is really more deeply understanding that internship experience and the key supports that the peer vocational peer mentors are providing. Like what is coming up during those works, excuse me, during the internship shift and how are the vocational peer mentors and the CORE coordinator helping young people to navigate that? And how are they partnering with the site supervisors? And I just wanna tell you, we've had incredible community partners hosting. I think Rebecca is gonna talk about this a little bit so I don't wanna steal your thunder but I do think that this work, just like IPS is a public health service where by doing this work and helping young people in working directly with really motivated community employees like employers that wanna work with us, it's such a fantastic experience. I just, I have loved meeting supervisors and seeing them on, I'm gonna say one last thing and I'll give it back to you, I swear Rebecca, is we do these celebrations. And I will say if one good thing came out of COVID, it's the opportunity to get a bunch of people together virtually that maybe wouldn't have the time to pop into a 30 minute, let's just celebrate these six CORE graduates. We've had the employers, the supervisors come and give speeches about their experience. And it's been so meaningful for some of our community mental health staff to come to CORE celebrations and be like, oh my God, this is so cool. I'm part of something, I'm really helping this youth grow and learn about themselves and feel good about work and school. And that matters and it's wild. It makes you feel really good about what you're doing. So I think there's a lot of like unintended benefits for both employers and a community mental health setting for CORE that we're not necessarily like, I don't know, digging into super rigorously. So that's for future research. But anyways, I will let you take back over, Rebecca, apologies. Do you want me to do the next slide? No, apologies, me too. Yeah, I'll be really brief anyway. So our key takeaways as we've been talking about is that 90% of our young people that completed the CORE internships, either secured employment or enrolled in post-secondary education, continued competitive vocation or continuing non-competitive vocational activity, which is really amazing. So the young people that are going through the entirety of the intervention are getting really awesome benefits out of it. And then, like I said before, we wanted to show that there was nine young people that completed the workshops that went directly into competitive employment, showing that this workshop alone can be very helpful for some young people in developing their skills and confidence to succeed in continued competitive employment. And we had 26 internships hosted at 17 sites, which are all mostly small businesses in the city of Chicago limits, which has been really amazing. And many of them have come back and taken many interns, like Treehouse Humane Society. I can't even tell you how many interns. They were like at a site 10 years ago as well, which is also very cool to kind of see this community continue to thrive and really enjoy working with these young adults. Okay. So next steps, and we will share this with you shortly, don't worry. We have just published our core operations manual, which has an incredible, the gold in that manual is the appendices. Always the appendices are sort of the gold in any kind of, I'm gonna argue, operations manuals for interventions. There's just a lot of the forms that are in there and guided protocols and processes are really helpful in doing good work with engaging young people around their vocational goals and working with clinical and also with community-based employers. That's what we'll share that with you in just a moment. We also are in the process of analyzing a lot of data, having data across six time points that is both qualitative and quantitative is a lot of work. And so we're finally at the point where we are spending a lot of time making sense of this data. We have one year left in this project. And so we are gonna collect data all the way up until the end of the project because we wanna maximize our opportunity to understand young people's experience of this and also those mediators and then the mediators factors impact on the key performance outcomes we're interested in. Also, we want to, of course, summarize these findings for a variety of audiences. And this is where we work with many youth and young adults with lived and live experience. We work with many providers, state administrators, a lot of our projects that we have currently really help us to inform our knowledge translation efforts for this project. So you're gonna see this as the start of a series of infographics and tool sharing. And so please definitely come visit us. I'm gonna share a QR code in just a moment. We're gonna be posting things probably systematically over the next year. We have so many tools we've developed for this project. But I do wanna give a huge shout out to anyone who's on this meeting who does intervention research or has built programs from the ground up. It takes an incredible effort across departmental collaboration. And when we went virtual back in March, 2020, we had to figure out how to get wifi to young people. Did they have devices? We secured foundation money to get devices for young people so they could engage in the workshops. Everyone had equal equitable access to the workshops. So we definitely have learned a lot through this and it does take a village and cross departmental collaboration to build programs like this, that I'm gonna say cross clinical and employment departments within a large agency. Also, we are hoping to leverage a lot of our relationships so that we can bring CORE elsewhere. We want people to use CORE. We're putting everything out publicly. Thank you NIDILRR for doing this. We want you guys to feel empowered to reach out to us and also to use our materials. It is very, very critical. I listed out that terrible problem slide, terrible. Like we need to be working on this. And I think some of the pieces within CORE can be easily applied to your work right now with young people if you're in a clinical or employment services setting. And finally, of course, I'm a researcher. We're gonna secure some more money. We need to study this. We need to replicate it and test it in a more rigorous way. All right, so here we go. Rebecca, would you like to talk about these? So during the last three years, we've created three products so far to contribute to the knowledge in the field. Our first was our virtual best practice guide for youth and young adult community mental health care providers. So this was actually developed like through COVID and having to go virtual. And CORE was a big part of us learning a lot about virtual best practices because we had to pivot the CORE model to be delivered in a virtual way, which was very interesting. So this is a guide for best practices for agencies and practitioners around utilizing virtual services to enhance community mental health care. It's also publicly available on our website. And then we also created an email best practice guide to support our CORE participants in learning how to interact effectively through email. We also love this little tool. It's been really helpful with our interns and even like staff and workforce development over time, which has been very cool. And then finally, oh, go ahead, Vanessa. No, it's no one teaches you how to email. It's just this like false assumption that people know. And I have gotten the most interesting emails from various people over the years. And we just realized we just have to incorporate this into CORE. And we realized very quickly for our youth and young adult services advisory board representatives, that just reviewing just email etiquette, just small things like proofread, but we're often moving so fast. And also young people have a different culture and approach around communication. And so we have to also recognize that we actually gotten tons of debates about who defines etiquette, which we don't need to get into right now. But I do think that this tool, it's a back-to-back tool. And if you scan that QR code, you can get it and please use it, share it with people you know. And finally, our CORE operations manual. So this operation guide focuses on what you need to start a CORE program. And it's the first part of many CORE tools to come. So as Vanessa said, we're actively working on a facilitation guide right now. And we have lots of more appendices coming your way that will be really helpful in implementing CORE anywhere that is interested in doing so. And so I think, to wrap us up, we really would love to answer your questions. If you wanna learn more, please reach out to us. We love young people. We love vocational and peer work. We love to talk about innovative ideas. You can also visit us on our website where you can see some of our other partners and other projects. And please do, like, let's take a look at this operations manual. Definitely look at those appendices. There's some gold in there, practice gold that would be really helpful for your vocational staff, your peer staff, your clinical staff, and maybe even you in your life and other young people you know. I mean, this is what's wild about this is I can't tell you the number of times that I'm like, oh yeah, dear cousin, check this thing out that we built at Thresholds and that we're studying. Like, this really does translate far beyond the community mental health space, but definitely we believe and we hope with publications and with the analysis of some of those data that we'll have a pretty strong foundation for showing it does have some efficacy. We know from pilot data it does, so we're hoping to really dig deeper. So thank you all for the opportunity and the space today to share this. I wonder if there are questions or comments. Thank you all for the presentation. You know, I think everybody on this call and we'll roll through a few of your bibliography here, but people can download the slides and see your three pages of bibliography, which are really helpful. But, you know, it's just a really exciting look on how we can really help our young people. So we're gonna get to questions in one minute. Let me just, before we shift into Q&A, let me take a moment and let our audience know that SMI Advisor is accessible from your mobile device. Use the SMI Advisor app to access resources, education, upcoming events, complete mental health rating scales, which score and you can share them with your mental health, with your medical record, or with the individual who took it or their loved ones. So you can track over time how someone's doing. You can submit questions to SMI Advisor directly. You can download the app at smiadvisor.org forward slash app. We need to get a QR code like you guys. So let me move into a few questions here. And I know some are gonna come in, but I, since I'm the moderator, get to ask some of my own first as we're waiting. So one thing I'm a little confused about is, so if you have an IPS team, how are they related to the core team? I mean, you kind of went into it, but I'm like, is core like a pre-IPS? Like, would they eventually move into IPS? Or like, what's the relationship between those two groups? Because we know from IPS that they can only carry so many people on their caseload. So what do you, what's the relationship between those two? You can take it, Rebecca. That's an awesome question. So it's kind of interesting because it can actually go either direction. So some young people go into IPS first, and the IPS team is like, they're not responding well. Or like, we have a lot of young people that are amazing at getting jobs, but cannot maintain them. So that's a big area of concern. And so, and then sometimes it's the other way. So because we have a therapeutic high school on site as well, we get a lot of referrals from that team that is like, these young people are not quite ready for IPS, we want to do this first. So it's actually a little bit of both. And I don't think that's the perfect direction that we have found yet. Anecdotally, I think that young people come from either direction and be successful, and then also vice versa. Well, it sounds like you're kind of saying the beauty of it is we have the ability to handle any place that they're at. If they're ready to go into IPS, we put them there. If IPS says they need a little bit more rudimentary training, you put them back in CORE. Or maybe they are accelerated through CORE. It sounds like you, I mean, the beauty of thresholds, and we don't all have this where we live, is kind of the myriad of programs that you have there. But it's good to know that you don't see them as mutually exclusive, that you could move back and forth between them, which is great. Can you talk for a minute about, I know you mentioned some of the internships, but is there, in IPS, there's a coach who spends half their time in the field drumming up where these people are gonna get jobs, right? Is there a coach as part of CORE who's drumming up internships? And if so, tell us a little bit about how they do that. Do you wanna do it, Rebecca? You can start us off, and then you can jump in, so I'm sure you'll have people in the panel. So the CORE coordinator's role is mostly building those internships, and they actually have partnered with the IPS staff, because sometimes the IPS staff are out in the field, and they come across a place, and they're like, we're not really hiring, but then we're like, hey, wait, we have this internship program, and some employers are like, oh, what's that? That's cool, so there's a lot of partnership there. The peer mentors do not do the internship development. Their focus is more of the coaching the young people at the job placement, where the CORE coordinator does the sort of behind-the-scenes, setting up the internships, maintaining those relationships. Yeah, and so we are, I just wanna call out thresholds for being this very resource-rich, so you have 10 IPS teams across a giant geographic area. They have developed longstanding employer relationships that you can lean into for internships. So leveraging that, while at the same time thinking about, all right, where in the communities does this young person live? What is their travel capacity? Travel is one of our number one barriers to young people engaging in IPS and in CORE. Reliable public transit, depending on where young people have chosen to live, if they are getting SSI, and they wanna live independently, we have a whole line of research that shows young people will live independently where they can afford it, and typically it's very far away from accessible public transportation, which then cuts them off from employment. And so, and also potentially services, unless the services can get out to them. And so it is this interesting, how do I say this, like developing the internship is, it's work, but as Rebecca said, because it's been such a positive experience for many, they wanna have another intern. And we get asked a lot when we've presented on this in the past, like, how do you match? How do you really do career matching and based on a young person's preferences? And I would argue, we go back to, well, we've developed all these relationships. So we've got this 17 sites and these 26 different types of interns. We kind of explore, the team explores, are any of these a good fit for the young person? And if not, during that phase one, when the workshops are happening, that CORE coordinator is out there talking to people, emailing people, talking to us, talking to their own social network, being like, hey, a youth is interested in comics. A youth is interested in animals. A youth is interested in retail, looking for, and we also suggest small family-owned businesses have typically been stronger partners for this type of work. But yeah, you lean into the big network of the IPS teams that already have, and then you also end up having to build based on, I'd say, geography and then also preference. Yeah. I mean, one thing that you emphasized here, and I love the fact that you said a couple of times, listen, these apply to all of us when we were first getting jobs or when we have jobs now. And I mean, even when I got my most recent job and I'm not youth, I think that's obvious. There is a lot of implicit messaging that you gotta pick up on. What do you wear? What time do you come? Eat lunch at your desk? Do you, like, again, phones, what if your phones are, like, do you have a crazy phone ring? Do you like the lights off when you come into the office and keep them dim? There's, like, all kinds of stuff. And so when we hear about IPS data, it often shows that the problem is not getting the job but retaining the job. Of course. And I feel like there's so many parts of core that could be used as part of IPS to help people retain a job. What do you do when you're sick? Who do you call? What time do you come? Do you call them at 5 a.m. when you wake up and you're vomiting? You know, or do you call them at eight, when a normal time, you know? And so I think there's a lot there that could be transferred. Okay, let me get to a couple of questions by the people I've been hogging all the time. One thing is that a couple of people have asked in that they weren't fast enough to get the QR code and that the links aren't like a visible link. You would have to be able to punch it. But isn't it true that you can go to thresholds.org? Tell me how I would navigate when I get to thresholds.org to get to your stuff. Great question, Amy. It's in two places. You would go to our IPS supported employment services. They're under our services tab. And you could also look on our youth and young adult services tab as well. So both will take you to places where you can find this. Right now we're all the core, the new operation manual lives is definitely on the IPS supported employment website within thresholds.org. All right, one person, many people wrote in. Thank you so much for this presentation. This particular person said, what have you found are barriers to these individuals enrolling in post-secondary education programs? So it's a little bit right of what you presented on, but what are the barriers to getting them back to education? Oh, a lot. Rebecca, do you want, I mean, I have my own. Do you want to go first? Do you want to name just a couple of them that you found that would be helpful? For some of the young people who have long-term system involvement. So if you're in residential care settings, off and on as a, you know, childhood and adolescence, these are young people who've had significantly disrupted vocational development and just really, really struggle with college. Every young person says just, I want to go to college. I want to go to college. That's very normative. I want to go to university. I want to go to college. And when we, our wonderful supported employment education specialists do a great job enrolling, supporting enrolling, I can say this from actually our research, many young people will enroll in four or five classes at once. These are young people who have struggled and had IEPs. And so they're almost setting themselves up for failure. And in particular, the youth who are system involved, but suddenly you're in debt because you have signed up for all these classes and you missed the ad drop date. And suddenly you're not, now you've failed all these classes and you still have to pay and you don't have the money to pay. So that's one very complicated, complex barrier is young people often having, I don't know what the right terminology. I feel like there's probably people in the room that would be like, oh, this is what this is. But this kind of idealistic view of both themselves and what they can take on in college and the notion of what is college. I mean, basic study skills, study habits, using your phone for reminders of when to study. There's so many barriers of young people not knowing, again, that's like some soft skill navigation of post-secondary ed type of skills. I'll stop there. Let me ask one other question before I have to move on because a couple people wrote in about this. So I think it's, people are wondering, which is, is your program working with like state or federal voc rehab services? So are you somehow working with the state voc rehab or even federal department of labor, anybody else to make sure that this is kind of aligned or is leveraging whatever expertise or levers that they can push? I would like to answer that. That yes, yes, we are very lucky at Threshold to have a robust relationship with our department of voc rehab. And we have a large contract with them in order to help, I don't love this term, place people into jobs successfully. So the goal is when someone finishes core, finishes the internship, they transition very quickly. And that transition starts a few weeks prior to the internship end. They transition into the IPS team. The IPS team connects that young person to competitive employment, and then is working with a DOORS rehabilitation counselor in order to register them. And so the young person can get all the benefits that the state has to offer for that job placement. So it helps fund the services in some part at Threshold. It also helps get fantastic benefits for young people. It includes like stipends for clothing, which is really, I mean, there's little things like this are real barriers. Like they just really, really are. And so yeah, we absolutely do work with our state department of voc rehab. Wonderful. Well, I'm gonna move on, but let me just remind everybody while Vanessa and Rebecca's screens are still up and they have their full names on there, each of their emails is firstname.lastnameatthresholds.org. So if you have any questions about any, if I didn't get to one of your questions and you wanna ask them, they have very graciously said they would love to talk to audience members who wanna stand this up, who are struggling, who are thinking about these same issues. They really value that kind of interaction. So again, firstname.lastnameatthresholds.org. All right. If there are any topics that we covered in this webinar or anything else you'd like to discuss with your colleagues in the mental health field, post a question or comment on our SMI advisors webinar round table topics discussion board. This is an easy way to network and share ideas with other clinicians who participate in this webinar. We also have another way for you to talk about these topics. If you have questions about this webinar or any topic related to evidence-based care for SMI, you can get an answer within one business day from our national experts on SMI by submitting a consult. This service is available to all mental health clinicians, peer support specialists, administrators, anyone else in the mental health field who works with those with SMI. It's completely free, confidential service. We'd love to hear from you. All right. SMI advisor is just one of many SAMHSA initiatives that are designed to help clinicians implement evidence-based care. We would encourage you at SMI advisor to also explore the resources available at the mental health addiction and prevention TTCs, as well as the National Center of Excellence for Eating Disorders and the Suicide Prevention Resource Center. These initiatives cover a broad range of topics from school-based mental health through the opioid epidemic. And again, all these services are free because they're supported by SAMHSA. To claim credit for participating in today's webinar, you'll need to have met the requisite attendance threshold for your profession. Verification of attendance takes about five minutes after we end this program. You'll then be able to select next and advance to complete the program evaluation and then claim your credit. So please join us next week on October 22nd as Dr. Wesley Sowers presents Managing Value, The Level of Care Utilization System, LOCUS, Family of Tools. Again, this webinar is on October 27th at three o'clock Eastern time on Thursday. Thank you both for joining us today. What a lovely afternoon it's been to speak with you about this exciting work that you're doing. Take care everyone in our audience and we'll see you next time. Bye-bye.

Dr. Amy Cohen

SMI Advisor

webinar

Enhancing Individual Placement and Support

Supported Employment

Transition-Age Youth

Career and Occupational Readiness Experience

clinical psychologist

serious mental illness

continuing education credits