Across the country, conversations are taking place about integrated, community- based employment for individuals with disabilities. There are also conversations about housing individuals with disabilities in the community, in the least restrictive environment. Traditionally, issues of housing and employment are addressed separately and left to compete as priority issues for purposes of funding. In Rhode Island, we are creating systems that are recovery oriented with the end goal of providing client choice. The Department has adopted the definition of recovery within the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Recovery Oriented System of Care : recovery is a unique journey through which an individual strives to reach his/her full potential; persons in recovery improve their health and wellness by taking responsibility in pursuing a fulfilling and contributing life while embracing the difficulties one has faced. This definition is the foundation on which our Housing First and Employment First initiatives have been established. And when looking across disabilities, it directs us to continually challenge ourselves to create policies and practices that are person-centered.
The mantra of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) has been, “housing and employment is the foundation for recovery”, but what does that mean? In order to create a person-centered, recovery-oriented approach, we must overhaul our entire system. Person-centered services and client choice cannot be a mandate, but must be operationalized within the policies and practice of our system. Eight years ago, I attended a Supported Housing Leadership Forum sponsored by CSH (www.csh.org). The theme was Laying the New Foundation: The Key Components to Systems Change. The key elements included power, money, habits, technology and skills, ideas and values. In preparing for the kick off of our State’s Employment First initiative, I reviewed these critical components and focused the work around them. State government is constantly vying to address critical needs and emerging crises in the shadow of the looming budget shortfalls. In order to successfully implement our strategies and to achieve our goals, it is critical to view our work in a holistic manner and, to the extent possible, look to reinvestment or cost- shifting.
We are working at several levels with our partners to address the elements of systems change through communications, leadership development, community education, outreach and organization. Research shows that housing is healthcare, and over the last 10 years especially in the homeless community, the benefits of housing for individuals experiencing long term homelessness, many with complex substance use and mental health issues, has not only changed lives but significantly reduced the cost to emergency systems (www.naeh.org). The Department has collaborated with the State’s Continuum of Care to ensure that we are part of the housing conversation. The goal is to create an array of housing options from sober/recovery models to supported housing/Housing First with options for supportive services that focus on housing retention. BHDDH is looking at the service components and how to create a funding system that is flexible enough to engage community-based organizations that have relationships with our vulnerable populations, but not necessarily the complex infrastructure typically needed to participate in mainstream Medicaid resources.
Employment is being approached in a similar manner. BHDDH is a part of the solution, and we are looking to our partners to develop the policy and financing mechanisms that allow individuals to obtain the services that meet their unique and individual needs. By creating an Employment First Task Force consisting of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, the Department of Labor and Training, the Office of Rehabilitative Services and the Rhode Island Department of Education, we are able to look at policies and funding models across these departments and determine how to, more efficiently and effectively, provide employment and day services. We have also created “Advisory Workgroups” that invite our community partners (advocates, providers, consumers, businesses and State and local government) to provide guidance on barriers, gaps, and best practices. Employment First is running parallel to the Housing First work, with similar needs to realign the system to produce the outcomes desired to improve the quality of life that research shows is connected to individuals with disabilities becoming employed. The impact goes beyond increasing income and provides the community connections, self-worth and sense of purpose that is critical to the recovery concept.
In conclusion, I would like to reiterate the fundamental learning from the Department’s experience in promoting Housing and Employment for individuals with disabilities. The concepts behind the Building Blocks mentioned above: collaborative planning/consensus-building, (re)investment and leveraging of resources, coordination, streamlining and integration of funding, building provider capacity, quality assurance, research and data, and finally, communication and advocacy, are critical components to structural systems change. True partnerships need to be formed, not simply through memorandums of agreement among organizations, but through building trust and shared values. Data collection is often addressed, however, we must move beyond collecting data and begin to share data and create common indicators and outcomes to ensure we are implementing programs that move the work forward. Bringing the unusual suspects to the table, such as business leaders to housing and housing leaders to employment, promotes collaborative conversations; builds buy in among the necessary parties; and establishes political will. It really does “take a village,” and as we begin to expand our network, we bring more resources, expertise and innovation to the table.
There will never be the ideal time to change the system. The days of budget surpluses are atypical; however, there is room in the system for change. We need our leaders to step up, our systems to be permeable and our advocates to push government to bend toward innovation.
Rhode Island’s system is by no means the ideal: the unemployment rate is still one of the highest in the country. Housing needs to be elevated to meet the need for affordability of Rhode Islanders, and we are under the spotlight of the Department of Justice. However, we have a plan which entails taking down the silos and working with the grass tops and the grass roots angle to transform our system. The key is to identify the importance of the holistic approach and not allow one issue to be prioritized to the detriment of the other – Housing and Employment are the foundation.