A consumer-initiated job search training program.

The field of psychosocial rehabilitation services emphasizes the fostering and strengthening of consumer-initiated supports. In contrast to other fields of mental health practice, including the community mental health movement and medical approaches to treatment, the service framework of psychosocial rehabilitation stresses the importance of not only involving consumers in the process of service development but also respecting the role of consumers in supporting one another (Chamberlin, Rogers, & Sneed, 1989) and in initiating their own supports. Accountability in this field emphasizes the importance of client satisfaction and the involvement of consumers in active choices both about the environments in which they want to live and in choices about roles they want to fulfill (Farkas, Anthony, & Cohen, 1989).

Involving consumers directly in the process of determining "what they want" and "how they want to obtain" services and supports is becoming a hallmark of psychosocial rehabilitation ideology (Cohen & Anthony, 1988). There is considerable compatibility between psychosocial rehabilitation and that aspect of the consumer movement which emphasizes client self-determination in setting service goals and in identifying the means of achieving these ends (Moxley & Freddolino, 1990). Thus, self help and social support options undertaken by consumers themselves (Chamberlin, 1989) or by consumers working in partnership with rehabilitation professionals are viable aspects of the psychosocial rehabilitation model (Freddolino, Moxley, & Fleishman, 1989). In this manner, the field itself reflects a larger trend in the human services underscoring the critical importance of both self-help and social supports -- that is, the exchange among people of affective, material, and instrumental resources -- in responding to people's needs (Maguire, 1991; Powell, 1987; 1990). The recent National Plan of Research to Improve Services (1991), undertaken by the National Institute of Mental Health, complements psychosocial rehabilitation's value of consumerism by emphasizing the importance of enhancing consumer involvement in decision-making about service delivery.

Consumer-initiated supports are easy to define and recognize. These supports are not controlled or dominated by professionals. They involve any service and support consumers themselves initiate, plan, organize, deliver, and evaluate (Chamberlin, 1989). Or, alternatively, they may involve actual initiation and planning of services and supports while professionals collaborate in the delivery of the program perhaps through the provision of technical assistance. However, this delivery is controlled and evaluated by consumers. At a minimum two qualities are important. First, consumers offer the leadership and inspiration for the program. Second, any subsequent programming is based on the self-identified needs of consumers themselves.

Consumer-initiated supports may be most important in vocational development. Assessments of consumer preferences regarding supports illustrate the high priority consumers place on obtaining training, educational, and vocational development opportunities which result in employment (Freddolino, Moxley, & Fleishman, 1988). Relevant vocational development opportunities, transitional employment, and supported employment have been successfully offered by psychosocial rehabilitation professionals (Danley, Rogers, & Nevas, 1989; Danley, Sciarappa, & MacDonald-Wilson, 1922; Yankowitz, 1990). Yet, given the relatively high unemployment rate among people with serious psychiatric problems, and the interest among consumers in vocational opportunities, it is unlikely that professionals can fulfill all of the expressed need in this area.

In recognition of these limitations, beginning in 1985 the Ohio Department of Mental Health formulated, as part of its state Community Support Program, Consumer Operated Services Demonstration Projects. The purpose of these projects is not only to demonstrate the efficacy of consumer initiated supports but to investigate how consumers can work with one another in supporting their members' vocational development and their members' achievement of subsequent employment outcomes. The purpose of this paper is briefly to review this policy context. We then describe one of these consumer-initiated options--created through a consumer-professional collaboration--which addresses the self-perceived job search needs of consumers themselves.

Policy, Programmatic, and Organizational Context

Policy and Program

During the 1980s, the State of Ohio made significant strides in creating community-based rehabilitation and support options for people with severe psychiatric disabilities. An indicator of the state's achievement in responding to people with serious mental health needs is its substantial movement in the ratings of quality made by the Public Citizen Health Research Group during the period from 1986 to 1990. Ohio moved from a ranking which placed it in the middle range of all states in 1986 to a rating which placed it as one of the leading states in 1990 (Torrey & Wolfe, 1986; Torrey, Erdman, Wolf, & Flynn, 1990). The executive leadership of the Ohio Department of Mental Health took strategic advantage of strong gubernatorial support for mental health care under the Celeste administration. Using this support, the department launched a strategy which combined a strong policy focus emphasizing services to people with severe and persistent psychiatric problems with service system changes consistent with a community support model (Stroul, 1989), the promotion of a strong family movement in the state, and the development of both a statewide consumer organization and the creation of consumer-initiated service opportunities.

All of these initiatives were part of Ohio's overarching community support program which was initiated, in part, through NIMH Community Support funds (Olimpio, 1989). Consumer-initiated services were considered a vital programmatic element of the new state mental health policy framework. The Ohio Department of Mental Health recognized the importance of strengthening natural support systems within local communities as a complement to other community support options. The Consumer-Operated Service program (COS) is a vehicle for promoting self-help efforts among consumers. Two state mental health program goals are sought through this initiative. First, the department wants to strengthen the statewide community support system through the addition of consumer self-help options. Second, the department wants to reduce isolation and loneliness experienced by many consumers through the fostering of on-going personal contacts among consumers themselves (Fleming, 1987).

Three local service area goals were also prioritized: to strengthen local community support programs; to expand mental health resources at the local level by filling gaps--especially those relating to interpersonal contact, social support, and self-help--created by too strong an emphasis on the delivery of formal mental health services; and to add programs which are responsive to consumers' needs and preferences in a flexible way and according to how consumers themselves define these needs (Fleming, 1987).

Under the auspices of the department's Office of Consumer Services, one-year Consumer Operated Services Grants of $30,000 were made available on the basis of a statewide competition. These start-up funds were secured through the department's NIMH Community Support Program Grant. After initial start-up, three year continuation funding was made possible through block grants awarded to the programs successfully completing the first year of funding.

The Office of Consumer Services defines a consumer-operated service as ". . . a program, project, or service planned, administered, delivered, and evaluated by a consumer group based on needs defined by the consumer group" (Fleming, 1987, p. 9). Operation of the service requires self-governance by consumers themselves, consumer staffing and supervision of this staff, consumer control of program policy, and consumer responsibility for program implementation (Fleming, 1987). Twelve demonstration projects have been developed around the state during the period from 1985 to 1990. These projects include social clubs (Cincinnati and Ashtabula), consumer advocacy (Mansfield), a restaurant (East Liverpool) and coffee house (Cleveland), a women's support network (Columbus), a land-soaping and cleaning business (Cleveland), drop-in center (Newark and Port Clinton), vocational training and employment program (Yellow Springs), peer supported job search and employment alternative (London), and a wellness club promoting general health Cincinnati).

What is distinctive about these projects is their commitment to identifying and responding to local needs as perceived by local consumers, consumer organizations and consumer leaders. These projects are based on ideas of consumers themselves. Although not all of these projects remain in operation the majority of them are currently active in the provision of supports based on models of self-help and incorporating values of self-determination, empowerment, peer support and personal productivity.

Friends Reaching Out to Friends

Initiated in 1989, this consumer-operated program remains in its early stages of development. It was rounded to fill a gap in job search, job development, productive activity, and employment opportunities for people coping with severe and persistent psychiatric disabilities. The program was consistent with the mental health department's guidelines for consumer-operated services. It is run by consumers for consumers and the group has developed its program based on the self-identified concerns of consumers. Serving as a support group focusing on achieving productive activity and employment. Friends Reaching Out to Friends plans and implements vocational development, employment training, job development. and job search opportunities. In particular, the program now sponsors job readiness skill development opportunities, training in interviewing techniques, resume preparation, and on-going support during job search and during subsequent placement in volunteer or competitive employment situations.

Friends Reaching Out to Friends serves a predominantly rural county in Ohio. The economic character of London, Ohio and Madison county is consistent with its rural economic base with the farm economy much larger than the industrial base of the county. Internal public transportation systems are very weak although the local mental health program offers a van service. This consumer-operated alternative fills a critical gap in the county mental health system. Consumers can easily experience isolation, loneliness, and problems with achieving a desirable level of integration into their home community. Friends Reaching Out to Friends is available to reduce this isolation, offer on-going peer supports, and assist the membership in developing basic job search skills to access local volunteer work and job opportunities. Since the program is in its early stages of development, its first major undertaking is the creation and implementation of a job search skills training program. This decision was based on an assessment of the membership's self-defined needs and preferences. However, based on an assessment of its own internal resources, the membership identified the need for external assistance from professionals who offered vocationally-relevant training skills to help them get started. Initiation of a collaboration with professionals who could offer what the membership desired was an outcome of this internal assessment.

A Consumer-Professional Collaboration

To identify the appropriate organization or professional with whom to work, Friends Reaching Out to Friends implemented a request for proposals for job search skills training. The group committed approximately $14,000 to this initiative through funds obtained from the NIMH's Service System Improvement Program. Criteria guiding selection of the successful respondent involved: experience in addressing the employment needs of people coping with psychiatric problems: tailoring employment and vocational development experiences to the needs and preferences of people coping with psychiatric disabilities; and expertise in formulating and implementing a curriculum with content addressing interviewing techniques, application completion, resume writing, grooming and attire issues, job search process, appropriate job behaviors, and the influence of participants' disabilities on the job search process and subsequent employment.

From the seven respondents to the request for proposals, the membership selected the Center of Vocational Alternatives (COVA), located in Columbus, Ohio, to design and implement the consumer-initiated training. In addition to meeting the above criteria, the consumer group was impressed with this organization's commitment of several trainers who brought differing experiences to the training, the flexibility of the training program, the inclusion of a follow-up one month after closure, and membership accessibility to trainers by telephone for on-going individualized technical assistance.

COVA offered substantial experience in addressing the employment needs of people coping with psychiatric disabilities by tailoring vocational development, transitional employment, temporary employment, and supported employment opportunities to an individual's needs through a variety of community-based alternatives. Funded through self-generated revenue, fee for service from the Ohio Rehabilitation Services Commission, and a performance contract with the local mental health board, COVA involves over 200 people annually in some form of community-based work experience, work adjustment, competitive employment, or supported job search activities.

Job Search Skills Training: Structure, Process and Content

Aims of the Training

Three major aims of the job search program were established by Friends Reaching Out to Friends. The aim with the highest priority was basic to the process of psychosocial rehabilitation: increasing participants' awareness of their own strengths as potential volunteer workers or employees as well as clarifying their own work preferences. The second aim involved the altitudinal and emotional preparation of participants for a self-directed job search. A third aim involved the preparation of participants for undertaking their own job search process so that the outcome of the actual training was enhanced skills in tangible areas such as interviewing, use of the hidden job market, completion of applications, sustaining a job search, dressing for an interview, and addressing issues pertaining to one's disability. All participants wanted to end the program with tools for supporting their own self-directed search which in some cases meant securing volunteer work or targeting their own psychosocial rehabilitation goals pertaining to vocational development while in other cases it meant securing actual employment.

Participants wanted to end the training having completed a tangible job search resource. Thus, with the technical assistance of COVA trainers, all participants prepared their own personalized resource packet including a typed model application form containing most of the essential information required of any application, a resume prepared in class and critiqued by participants, a completed listing of personal and business references, letters of recommendation especially from former employers, discharge papers from the service if relevant, and any training certificates. These materials were organized in a folder which also contained a pen and a pad. Participants ended the training with a resource they could carry with them to any job search situation.

Structure and Process of the Job Search Program

The sixteen session format of the training addressed all of the major themes identified by Friends Reaching Out to Friends. These sessions were organized into a manual entitled Developing Job Search Skills (COVA, 1991) which can be used by subsequent members of Friends Reaching Out to Friends who are interested in organizing their own self-directed job search skills training. Each session, lasting approximately three hours, was organized as a module which specifies learning outcomes, instructional content, specific examples of issues and their resolution, and appropriate forms and handouts.

Although the program is highly structured the professionals offering technical assistance and training do not dominate the delivery of the content nor do they require participants to complete all the training scheduled for each session. The training proceeds at the pace established by the members and emphasizes the content prioritized by the members during each particular session. Members desired an experience emphasizing group process, tangible assistance with consumer-defined issues, and member involvement. Since the members themselves contracted for the service, COVA personnel respected the values and desires of consumer's during the delivery of the training. Using adult learning principles, which underscore the legitimacy of learners' own experiences, and demand the incorporation of these into the actual training context, the training follows a specific structure: Self evaluation (one session), understanding employment expectations (one session), completion of applications (two sessions), resume preparation (two sessions), issues relating to grooming (one session), interviewing (three sessions), the job search process (two sessions), addressing job behaviors including ones relating to disability (two sessions), a session devoted to integration of learning around the theme of self directed job search, and a follow-up session. All of this content is consistent with state-of-the-art job search models (Jacobs, Collier, & Wissusik, 1992).

Content of the Job Search Modules

There are eight modules composing the Friends Reaching Out to Friends Self-Directed Job Search Program. The content of each of these incorporates information provision, discussion, overheads and handouts, and completion of forms and checklists. Briefly, for each module the following is addressed:

1. Initial Self-Evaluation. This module focuses on the question of whether "you are ready to look for work." The module reviews personal and social issues created by unemployment and the needs fulfilled through work. External (e.g., job availability) and internal (e.g., personal preferences) factors and their influence on job search are discussed. Self-assessment of experiences, personality characteristics, values, basic academic skills, and personal assessment of issues created by psychiatric disability are examined through discussion and the completion of handouts.

2. Employer's Expectations. Responding to the participants' concerns about what employers may expect of them, this module focused on issues relating to both personal and work related expectations including dress, punctuality, use of time, treatment of customers, reliability, safety, and skill competencies involved in a specific job. Participants are able to evaluate themselves in key areas using the dimensions of employers' expectations an they are assisted by facilitators in completing a dress rehearsal plan.

3. Completion of Applications. Aside from explaining the purpose of the employment application, this module explores application completion in depth. Each participant completes a standard application that can be used later as a model for the completion of specific applications. Specific steps relevant to the completion of applications are covered in this module.

4. Resume Preparation. All participants left the training with prepared resumes, an outcome of this module which focused on both the preparation and use of resumes to obtain employment. The various models of resumes are reviewed and participants obtain training in the preparation of both functional and chronological types. Handouts summarizing specific steps required to produce resumes are reviewed. Dissemination of resumes to family members, friends, and to personal and former business references is emphasized as well as the use of a resume as a business card.

5. Grooming. This module makes use of checklists designed to help participants to self-evaluate their grooming and to plan their grooming for a specific interview situation. Once the importance of grooming is reviewed, especially as it relates to making a first impression, participants review grooming tips relevant to body care, face, hands, and hair. Attention is then given to evaluating clothing and the appropriateness of dress for various interview situations. Participants bring into the group the actual clothes they will wear to an interview. These are reviewed by group members and participants are given tips about their actual clothing. Also, for those consumers who are interested, videotapes of participants in their actual interview clothes are produced and viewed by the group as a whole.

6. Interviewing Skills. The Grooming Skills module leads logically to the interview situation. Like other modules, this is tailored to consumers' anxieties about successfully negotiating interviews. Issues pertaining to dress, communication basics, interpersonal relationships, and interpretation of one's disability are covered. Several sessions are devoted to this topic since considerable time is given to mock interviewing, a process particularly valued by participants. Some participants chose opportunities to practice interviewing skills and to capture these interviews on videotape which can be reviewed, studied and evaluated by participants. Consumer evaluation of the overall program revealed this module to be valued highly.

7. Job Search Process. This module addresses consumers' interest and concerns about actually undertaking the process of looking for a job. Both formal and informal means of job search are discussed and the use of informal networks to locate employment are identified. The self-directed aspects of job search are reviewed including sustaining one's motivation, using the hidden job market including friends and family contacts, and maintaining a weekly commitment to the search.

8. Job Behaviors and Coping with Disabilities on the Job. As the final module, this component assists participants in the self-identification of behavioral challenges that can emerge on the job -- especially when one is experiencing environmental stress and demands. Developing and obtaining supports from an immediate supervisor and from co-workers are emphasized as well as giving supervisors and co-workers an understanding of what challenges are created by psychiatric disability. A panel of working consumers provide guidance and information on how they coped wmth their own disabilities in actual work settings.

Conclusion

The issues presented in these modules are consistent with the original interests and desires of the consumers themselves which, from the authors' perspective, define this program as a client-initiated support. In addition to the substantive content of the training, consumers' concerns about delivery are also incorporated into the model. These issues relate to pace of coverage, the use of experiential content, the focus on consumers' strengths and prior experiences, and the incorporation of follow-up sessions.

This project reflects some of the basic strategies that consumers can use in initiating their own support systems. First, it is very important for consumers themselves to define their own mission. A mission has two purposes. One is to define what consumers want to achieve and why they want to achieve it. By defining a clear mission, consumers will be more likely to achieve a focus on what they want--and are thereby more likely to avoid perspectives introduced by providers. This focus can be different from what providers may define as a desirable mission. In the context of the job search skills training, many consumers saw this opportunity as a way to start thinking about moving into the job market either through volunteer or competitive employment. Not all of the consumers defined the outcome as achieving competitive employment. Several saw this as an opportunity to reduce their anxiety about job search, to identify an ultimate end for themselves as a result of participation in additional psychosocial rehabilitation supports, or as a way of augmenting their knowledge about work requirements which they can possibly put to use later on.

The case study also suggests a second important strategy. Consumer-provider collaboration is feasible within the context of consumer initiated supports. What is distinctive about this joint undertaking is the project's implementation within a technical assistance framework in which providers develop content and delivery relative to issues identified and defined by consumers themselves. In other words, this technical assistance unfolds within the context of the mission defined by consumers. Providers assume roles as consultants as opposed to those of clinicians. Of course, the model of collaboration identified in this paper is strengthened by training members of the support group to deliver the training themselves. Perhaps this activity can be an outcome of future collaboration between COVA and Friends Reaching Out to Friends.

Finally, a project of this character, with an emphasis placed on consumer-provider collaboration, may not occur without enlightened state policy. The tremendous progress the state of Ohio made, during the Eighties, to implement the consumer empowerment philosophy of both the community support system model and psychosocial rehabilitation established the framework for the implementation of these types of supports. Although these projects can be undertaken without policy support, their importance and feasibility--through the provision of technical assistance funds--certainly can be heightened through an adoption of a policy and programmatic framework emphasizing consumer-initiated supports.

This small innovation, undertaken in a rural community, is important because it is among a number of consumer-initiatives within the state of Ohio that have gotten off the ground successfully. These initiatives may represent the evolving character of the consumer movement, community support systems, and psychosocial rehabilitation. The project reviewed in this paper demonstrates the feasibility of consumer-provider partnerships. Perhaps such projects, taken on a collective basis, represent a systemic change in which consumer-initiated alternatives may be gaining much more legitimacy in contemporary mental health systems.

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David P. Moxley, School of Social Work, Wayne State University, 321 Thompson Home, Detroit, MI 48201.