OLR Research Report

April 15, 2008




By: Saul Spigel, Chief Analyst

You asked about the Department of Mental Health and Addiction Services' (DMHAS) employment services for people with substance abuse disorder.


In 2003, DMHAS convened a group of experts, providers, and consumers to develop a set of principles and actions for the agency to take to establish a “recovery-oriented” system of employment services for its mental health and addiction services systems. This process resulted in recommended principles and practices and 35 short-, intermediate-, and long-term action steps. These cover access to and information about employment services, integrating clinical and employment services, collaborating with the various agencies that provide employment services, and measuring employment-related outcomes.

Since 2003, DMHAS has added three employment specialists to its central office staff, initiated collaborations with various state agencies and providers, trained providers on various employment topics, and contracted with several providers for employment services to people in substance abuse treatment and recovery. On a local level, local mental health authorities have adopted recovery-oriented employment principles and strategies to integrate employment services in the clinical treatment system and distributed employment-related information to all new admissions.


“Employment before or during substance abuse treatment predicts both longer retention in treatment and the likelihood of a successful outcome,” according to the federal Substance Abuse and Mental Health Services Administration (SAMHSA). Employment, it says, also helps moderate the occurrence and severity of relapse to addiction.

SAMHSA's Treatment Improvement Protocol, “Integrating Substance Abuse Treatment and Vocational Services,” contains a series of recommendations on issues such as the need for vocational services, programs and resources, service integration, and collaboration. While these are addressed to treatment providers, some may also be useful to policymakers. These include:

Vocational services, including screening and functional assessment, should be an integral component of all substance abuse treatment programs.

Employment and vocational services should be a priority in treatment programs, and treatment plans should address employment.

Treatment programs should have at least one vocational rehabilitation counselor on staff or accessible to the program.

The vocational services provided to clients must focus on pathways into careers, job satisfaction, ways to overcome barriers to employment, and skills needed to maintain employment.

Collaboration is crucial for preventing clients from falling through the cracks among independent and autonomous agencies providing disparate and fragmented services. Federal and state policymakers should create financial incentives for collaboration.


2003 Recommendations for DMHAS Action

DMHAS' over-arching goal is to foster the development of a “recovery-oriented” system of care for people with behavioral health and substance abuse disorders. DMHAS defines “recovery” as a “process of restoring or developing a positive and meaningful sense of identity apart from one's condition and then rebuilding one's life despite, or within the limitations imposed by that condition.”

Toward this end, and in recognition of the role employment plays in the recovery process, in April 2003 DMHAS consulted with experts, providers, and consumers to generate recommendations to guide it in developing comprehensive career development services for its behavioral health and substance abuse care systems. This process generated recommended principles and practices and 35 short-, intermediate-, and long-term action steps. These actions apply to both mental health and substance abuse service systems.

Short-Term (less than one year) Recommendations. These recommendations included:

1. people should be able to access employment services without a clinician's approval; people who are not receiving clinical care should continue to have access to employment services;

2. people who are new to the DMHAS system should be informed of available employment resources, both in and outside of the DMHAS system, and have the opportunity to consult with an employment specialist;

3. program staff should receive materials on the effect of wages on disability benefits, including contact information for state offices, like the Bureau of Rehabilitation Services (BRS), that offer benefits and planning services;

4. DMHAS should (a) work with provider and consumer organizations to disseminate recovery-oriented approaches and best practices in employment services for people with substance abuse disorders and (b) coordinate employment services with other state agencies such as BRS, the Labor Department, and community colleges; and

5. employment specialists in DMHAS facilities should be members of clinical treatment teams.

Intermediate-Term (one to two years) Recommendations. These recommendations included:

1. all treatment plans for people unemployed for over three months should address employment outcomes;

2. program clinical and employment staff should develop formal linkages to BRS benefits counselors to better access accurate and comprehensive information about the effect of earnings on benefits;

3. DMHAS' Recovery Institute (an education and training program for providers and consumers) should disseminate preferred employment practices;

4. DMHAS' data reporting system should be realigned to reflect meaningful employment outcomes (e.g., numbers entering competitive employment or other job-related activities) and should track employment outcomes over time;

5. DMHAS' contracts with providers should specify the evidence-based services being purchased (e.g., rapid job search, integrated treatment and employment services); and

6. DMHAS should designate a portion of its employment funds for underserved populations (e.g., ex-offenders, minorities) and special services (e.g., transportation).

Long-Term (two to four years) Recommendations. These recommendations included:

1. all treatment teams in DMHAS facilities should provide employment services;

2. DMHAS should disseminate “report cards” that show performance outcomes in key areas, including employment (e.g., percentage of people working, hours worked, consumer satisfaction), for the DMHAS system and individual providers;

3. DMHAS should consider using flexible funding options (e.g., client vouchers, funding pools) and incentives to reward providers with the best outcomes;

4. DMHAS should convene a task force of state agencies, including BRS and the education, higher education, and labor departments, to develop memoranda of understanding to guide service planning and delivery; and

5. all providers should enhance their knowledge of available community supports. They could create local collaboratives that include agencies in and outside the treatment system, such as BRS, regional workforce development boards, community colleges, and local chambers of commerce, to inventory local resources. DMHAS should create or designate staff as “community resource coordinators to facilitate these collaboratives.

Recent DMHAS Activities. DMHAS has taken many steps in the past five years to address the 2003 recommendations. It has:

1. created three statewide employment coordinator positions, one each for substance abuse and mental health and the third to provide technical assistance to providers;

2. formed an interagency, recovery-oriented employment services team, which includes state agencies (Labor Department, Corrections, BRS, Court Support Services, Office of Workforce Competitiveness) providers, and consumers and their advocates, that has developed principles and practice guidelines (these are awaiting the commissioner's approval);

3. through its Recovery Institute, trained providers on various employment topics (e.g., job development strategies, assets accumulation, helping people with co-occurring disorders, the role of housing case managers);

4. collaborated with community college and technical school staff;

5. collaborated with the Corporation for Supported Housing, Office of Workforce Competitiveness, the Labor Department (DOL), and three regional workforce boards to promote employment service linkages between DOL's One-Stop Centers and supportive housing residents; and

6. most recently, awarded a three-year, $225,000 contract to the Alcohol and Drug Recovery Centers and the Connecticut Community for Addictions Recovery (CCAR) to provide employment services to people in two DMHAS regions who are in treatment and the early stages of recovery. The contract will enable the agencies to hire two staff to provide employment services through CCAR centers in Hartford, Willimantic, and Waterford and a third to inventory community resources in both regions. The work is expected to start in May 2008.

DMHAS allocates approximately $600,000 of its $10 million vocational services budget specifically for services to people with substance abuse disorders. Most of these funds ($450,000) go to the APT Foundation in New Haven and the John J. Driscoll United Labor Agency in Middletown. The contract with these agencies calls for them to (1) conduct vocational assessments and counseling; (2) develop individual vocational plans that describe each client's vocational deficits and goals and set an estimated time frame for achieving the goals; (3) review the plans at least every 30 days; (4) provide work-adjustment, job preparation, and job search skills; and (5) follow up clients' progress at regular intervals after they are employed.

DMHAS has also worked with local mental health authorities (LMHAs) to address the 2003 recommendations. Some or all LMHAs have:

1. over the past three years, developed annual plans to implement recovery-oriented employment principles, including integrating employment services in the clinical treatment system, adopting evidence-based practices, collaborating with local employment resources, and basing quality improvement on employment outcome data;

2. teamed with DMHAS and the Dartmouth Psychiatric Research Center to introduce evidence-based supported employment strategies at six LMHAs;

3. distributed information about incorporating employment goals in treatment and recovery planning to everyone admitted to the system; and

4. co-located BRS counselors at their facilities to develop joint protocols that enable providers to link people in recovery with BRS benefits counselors.