Teri:  Hi welcome to this online seminar on Customer Driven Services.  I'm Teri 
Blankenship.  Our guest today is Jesse Price.  Jesse, thank you for joining us 
today.

Jesse:  Thank you Teri for inviting me.  This is a great opportunity.

Teri:  Let's get started by having you give us a little of your background and 
your perspective on being a customer interested in pursuing employment.

Jesse:  Thank you very much Teri.  I have been receiving services from the 
mental health system in Washington D.C. for more than 32 years.  It began when I 
was in my 5th year of graduate school.  I was having some problems with a 
friend, and I sought services in a private mental system.  At the time they 
didn't have any beds at the hospital that I went to, so I was placed in a 
public mental hospital under the court order for 2 weeks.  I'd never been 
arrested or spent a night at any place other than my own home. It was quite a 
shock to me, and it really changed my life.  For nearly two decades, I was in 
and out of the hospital.  

The first diagnosis was not the correct one, so I was given the wrong 
medication.  It was in 1972 at the time when any medication was intended merely 
to control symptoms.  They were very strong medications.  You had a sick look 
about you once you started taking them.  You didn't feel well and you were very 
sedated most of the time. After about 20 years, I guess partly out of just 
getting older and having a good treatment team for 5 years, I stopped cycling in 
and out of the hospital.  I got a proper diagnosis after about 4 or 5 years, and 
got on a good medication plan with which I stuck. 

Around 1993 onward, I began to return to work versus volunteering.  Then keeping 
my treatment team together, I was at a training position with a company and 
later on competitive employment for about a year.  Now I'm looking at some 
things in terms of some private business ventures and continuing to look and 
learn as much as I can about customized employment.

Teri:  Thank you Jesse for sharing your background with us.  Why do you think 
customized employment is so important?

Jesse:  I think it's important, Teri, because it's the right thing and it's come 
at the right time.  We're all aware of the problems that every state is having 
with shrinking financial income from taxes and other revenue streams.  We're 
also aware of the fact that more and more people are in need of these services.  

For example, in the District of Columbia, since the inception of the Department 
of Mental Health in 2001, we've gone from 8000 people on our roles to nearly 
16,000 and many of these people are [unemployed]. Employment for persons with 
mental illness is something like only 25% [15% based on latest figures], 
but nearly every study indicates at least 75% of these people could be employed 
and many of them want employment. I think there should be a job for everyone who 
wants a job.

Teri:  How would you work with an employment specialist that feels that a 
person's not really ready to work?  What would you say to that employment 
specialist?

Jesse:  “Ready” should not be part of the model that we're talking about, 
customized employment, the model that VCU and others have been working with.  I 
think it was a gentleman named Drake that I remember reading about in one of the 
classes that I took from VCU.  There's a zero barrier reject approach.  We don't 
put up hurdles. We don't put up barriers. We don't filter out. We don't cherry 
pick only those people who are going to make us look good in the stats at 
evaluation time. Anybody who comes through the door, who expresses a legitimate 
desire for employment [at the same time, we don't push people out there who 
don't want to go] should have a job. 

Teri:  What would you tell that customer if he/she is faced with that employment 
specialist who's telling them that?

Jesse:  Get another one.  I know in DC you have the right to seek another case 
manager or another corporation.  We're organized kind of like an octopus, 
springing from the major Department of Mental Health, that has a public agency 
that you can go to. There are about seven or eight other [public agencies]. 

If one [agency] does not give you the services and information [that you need], 
you have the right to seek [another agency].  We don't have employment 
specialists in all of them now, but eventually we will.

Teri:  How do you assist a person in making the decision versus the employment 
specialist making those choices for the person?

Jesse:  That's a tricky one, but to me it stands on two different legs.  It 
depends upon the person's background.  If it's a person who has only been in the 
system a few weeks, this might be a student, a lawyer or some other 
professional, the person has been running his or her own affairs. They merely 
have stumbled, having a difficulty such as a bad divorce or serious loss, then 
after a few weeks of hospitalization or maybe just several doctor visits setting 
up an outpatient schedule, they’re ready to return to their work or reestablish 
their routine.  They're used to making choices. 

[Making choices is] a problem to a person who's been institutionalized for 25 
years.  People are telling them when to eat, what to eat, what time you go to 
bed, the word “choice” has little meaning for them.  So almost before you can 
begin to deal with the issue of choice, the person has to begin again to 
make decisions and sometimes you have to begin with baby steps.  You may give 
them the opportunity to say, "Where would you like to meet?" Then you may give 
them some suggestions such as "Well, there's a McDonalds near your house, or do 
you want us to come to where you stay?" if they're living with their parents.  
That's very important, not just to chose, but being clear the person understands 
what a choice is.  There have been unfortunate circumstances where people say, 
"Would you like to work at McDonald's or you're not interested in going to 
work?"  That's not choice.

Teri:  Right.  That is not “choice”.  Let's take that scenario and say that the 
employment specialist and the customer meet at a coffee shop. What do you think 
would be the natural progression for the next choice that the customer might be 
able to make?  

Jesse:  I think early on we need to gain a sense of his career direction. I 
don't think we need to talk about jobs, I think the biggest mistakes made in the 
field of customized employment, is the concept of a job.  We were talking about 
careers.  Where will you be 6 months from now, a year from now, eighteen months 
from now?  Studies have shown people may blow their first three jobs before 
they're in for the long term.  We may not be talking about 40 hours for 
everybody.  Some persons may only work 5 hours a week or 10 hours.  We're not 
talking about volunteer work, but that may be where some people have to begin.  
It's important to get a sense of where the person is in terms of the job 
spectrum.

Teri:  If a person goes through three jobs, how does one keep up his/her 
motivation? What is the role of the employment specialist in that part?  

Jesse:  I think we need support groups. That's the whole part of the support 
piece. They need to be natural supports.  A person may have a good rapport with 
a group from their church. There may be a group of friends with which they 
hangout. There may be some other group, some other natural setting, with which 
they're already involved.  Use that as much as possible. They definitely need 
encouragement, especially when they start hitting the bumps; or they get on a 
job and somebody picks at them, because they may have a tick or some other thing 
that they cannot hide related to their illness or their medications.

Teri:  What advice would you give to an employment specialist that thinks a 
career track that a person has chosen is not possible?

Jesse:  That's difficult because realism is part of success.  Like in my 
business plan, a person asked me one time was I realistic. I said, " I 
understand how important it is to plan a business.” Statistics have shown that 
customers are more likely to succeed in the business world, than someone who 
hasn't had a mental health experience. 

Realism is important. For example, if a person wants to be a doctor, just 
because they want to wear a white coat, maybe there's another area where they 
could wear the white coat without going straight to medical school.  You can 
help them see the steps in getting where they're going.  Maybe they'll end up as 
an x-ray technician, but at no point should we say, "No you can't do that."

Teri:  How would you recommend that an employment specialist get to know that 
person's strengths, and then perhaps that will change their expectations of the 
person?  How would they develop that relationship where they can learn that 
person's strengths?  

Jesse:  I've learned in my relationship with VCU over the last 3 years; don't 
let prejudgment be the final judgment.  Don't pick up a 6-inch file that says 
this person hasn't done anything and can't do anything and just close the book 
on them.  In order to find out what a person can do you'll use a different 
methodology, such as onsite evaluations, talking to their family and friends 
about what are their ambitions. Most important of all, talk to the customer, not 
about his failures or her failures, but about his/her dreams.  Don't be afraid 
to let them dream, and dream with them.  Don't let age, sex, race, or language 
be barriers, because if that's the case, there will always be a barrier.

Teri:  It sounds like that this requires some time and cultivating. It's not a 
quick fix.

Jesse:  Most people, who have mental illness, didn't wake up sick.  Many times, 
it goes undetected for half a life time.  In my case, I was 26 years old and 
maybe on the way to a successful career.  So you have to be in for the long 
term.  That's the reason that natural and community supports are so important, 
because customized employment does not succeed without ongoing supports.  

The big dollars are in the community. I got information, about a couple of years 
ago about a project in Atlanta, GA called the Georgia Peer Specialist Program. 
If you want more information on it, you can look up GACPS.org on the web. In 
Georgia, they were able to use Medicaid dollars to buttress the development of a 
career workforce for Peer Specialists in the state of Georgia. That worked all 
over the state with a variety of workforce. It wasn't just in a segregated 
workforce, with just other customers, but in a variety of work areas using 
Medicaid dollars. The state only had to put up 40% of the match.  In D.C., we 
could do the same thing, but only 30% of the dollars.  I think it's very 
important, because it gives ongoing life to the work.  It gives an incentive for 
the employer to make a commitment, if they only have to come up with 30% of the 
salary against 100%.

Teri:  Jesse we'll put that website link on this page for the viewers.

Jesse:  Wonderful.

Teri:  How should an employment specialist provide support to someone who's 
consistently taking prescribed medications, for example?

Jesse:  You're talking to one. I love it. People keep saying to me, "You don't 
look sick."  I say, "Well that's what it's for."  You're not supposed to look 
sick.  That was one of the great tragedies of the earlier years of our field.  
Where we will be hosed down, chained in our rooms, literally.  People were 
chained to beds for the rest of their lives.  There was something called a "back 
ward."  I hope as long as I live that word is never used again.  A good mental 
health [treatment plan] has you back, if there is such a thing, in the main 
stream.  You look normal.  It's about natural supports. And yes, you shouldn't 
look mentally ill.

Teri:  Once the employment specialist and the customer have some ideas about the 
types of jobs the person's interested in, how would you recommend that the 
employment specialist assists the person in actually finding a job?

Jesse:  Let the customer take the lead.  Even if it's to the point of coming in 
with some recommendations that the job coach might have never thought of.  [It 
could be] flipping through a newspaper, or some job he had before that he didn't 
do well in and now he is in a situation that's improved.  Now, he may be able to 
go back there or even get a reference from there. [It could be] talking with 
family members that he can connect you with or get a list of his contacts in his 
network.  I think the core to it, is to build around his strengths and his 
connections before we do anything else.  


Teri:   Let's shift gears and talk about the work setting and the employer.  How 
much do you think an employer needs to know about an individual’s diagnosis and 
medication and when should the employer know about it?

Jesse:  By law, we're restricted from providing any more information than is 
needed or necessary.  Certainly, we don't want to hold anything that would 
endanger a fellow employee or the person themselves.  If he were taking a 
medication, that allows him to fall asleep, we wouldn't want him around moving 
machinery.  It has to be appropriate for the setting.  The Americans with 
Disabilities Act in no way permits you to just throw out information about a 
person and he/she should be discouraged from blurting it out.  There should be 
role-play and group meetings, so he/she gets comfortable with whatever the 
diagnosis may be.

Teri:  If a customer were watching this, what would you recommend to them, if an 
employer does ask them a question that they're not supposed to be asking?
Jesse:  Explain to the employer that it's not a proper question and that he/she 
doesn't feel, as though, he/she should have to answer it.

Teri:  How should the employment specialist explain his or her presence on the 
job site?  Or if their coworkers see this person with the employee and they 
start asking questions, "Why is this other person hanging around on the job 
site?"

Jesse:  That's another situation where natural supports can come in handy.  If 
there is an onsite career specialist or employment officer, when the person 
comes to the job, let them be in company with the personnel manager or someone 
with which they're already familiar.  The meeting can be in the company 
cafeteria when others may not be there, or at a coffee shop near the job, so 
that it doesn't become quite so obvious.  If necessary, maybe there are one or 
two people on the job, that the company might want to let know about that, who 
would be willing to keep it in confidence.  [This person could be] a manager or 
someone at the plant, not necessarily a person working at the same site with 
him.  

Teri:  It can be bundled under career advancement.  What advice would you give 
to an employment specialist if a customer were actually sabotaging their job?

Jesse:  That's something that a customer has to learn.  If he/she doesn't 
appreciate the effort that goes into getting a job, he/she may have to learn 
from his/her mistakes.  One thing that happened in my career development [was 
that] I used to be afraid of success.  I think that some people are afraid of 
the change that comes with success, such as getting up every morning, meeting 
new people, taking on responsibility, and paying taxes at the end of the year.  
You just have to let him/her [learn from mistakes] and hope that he/she comes 
back after he/she have been away from work for a few months and missed that 
check, wants to go back to work and make another effort. 

I don't think you can force them to show up for work or [quit], because a person 
with a mental illness is prone to do this.  I don't think that's the case.  I 
think they are people who are as dedicated as any employee.  There will be 
others, like you said, who will sabotage.  Those who sabotage the efforts. I 
think it may happen the first couple of jobs, because some people are 
afraid of success, afraid of change.

Teri:  I guess an employment specialist would maybe first talk to that employee 
to get a feel for what's going on.

Jesse:  Yes, sure.  Maybe they need a medication adjustment. Sometimes when you 
are faced with responsibility, it may bring up fears of previous situations.  I 
know one of the problems I had were the predatory lenders. The minute I started 
working, credit cards started showing up. When you start out you had too much 
money and now you don't have enough, because as your income increases, so does 
your desire for goods.  I don't know what that's called, but I'm sure there's 
some economic explanation for it.  There may be a reason that you don't want to 
be involved with any of it.

Teri:  That's interesting.  The thought that there's other pressures that a 
person would get, such as getting credit card applications and how to deal with 
that.

Jesse:  I think that should be part of the ongoing supports, knowing how to 
manage your money.  I know of a person who did very well for a decade, but then 
had to declare bankruptcy because they just kept raising her rent.   She was 
having arguments on her job.  But I think we should definitely know how to 
manage money, and there should bridge opportunities.  There should be some way 
we can form financial unions with one another that will bridge periods where we 
may be in a crisis of management situations where our bills will continue to be 
paid.  They won't hit us with late payments or overpayments when we're not 
charging anything.

Teri:  I guess the employment specialist and the employee could explore some of 
those support systems in the HR Department at a company if the person works 
there.

Jesse:  Sure.  Many have what they call an EAP Program, the Employment 
Assistance Programs.  A person may be dually diagnosed. In Washington, we know 
that nearly 2/3 of the people that are in the mental health system are persons 
who have a drug addiction problem as well.  And if you backslide or relapse, as 
it's called, the EAP Specialist may be able to work with you in a situation like 
that, so that you can maybe detox and in a week or two return to work and not 
have to start all over again in the process.

Teri:  Jesse we've talked about a lot of things. Is there anything that you 
would like to talk about that we haven't touched on or that you want to talk 
about a little bit further, that we've mentioned in this interview?

Jesse:  Certainly the incredible project in Atlanta.  I've met Larry Fricks and 
others who did that work. They said that I could talk about it and let people 
know about the information. It was developed with government funds and they want 
the word out. [The project] came from Georgia.  

South Carolina attempted to use the same model. It was stopped in mid-
development because $200,000 from the grant from the State was pulled back.  
We've been promised that we could do it in the District, but it's not yet 
authorized.  Every time somebody emails me another project about consumers, I 
remind them about the one that’s started but hasn’t been finished.  

I would also like to emphasis that we use community supports.  When I was 
working on my business plan, I needed a foreign language. There was a language 
in Spanish being taught at a local church.  I've been a year in that Spanish 
class. We graduated on May 22.  It's part of my resume.  My teacher says I can 
use her as a reference.  Use those things that are already in place.  You don't 
have to reinvent the wheel, especially since money is so short.

I read an article in the Richmond Times Dispatch this morning about a person 
who's being kept in an institution, because there's no place in the community 
for him.  There's just no more money. The money's run out. I think it's 
important to use those services that are already in the community, that are up 
and running, that we can match into, not segregated by mental illness, mental 
retardation, or any other [group].

Teri:  You talk about community services, and you talk about a church?

Jesse:  Churches.  There may be a hospital that already has mental health beds, 
rather than building a clinic next to it that does the same services.

Teri:  I know that within our area, there are a lot of community services such 
as parks and recreation, teaching courses, and that type of thing.

Jesse:  Food banks, yes indeed.

Teri:  Before I let you leave today, I want to talk to you a little bit about 
advocacy and the important role that plays into customized employment.

Jesse:  That's a good question.   Advocacy means different things to many 
people.  For example, a job coach/job specialist is an advocate.  The lawyers in 
the mental health field are advocates.  Social workers, psychiatrist, and the 
nurses in some cases can advocate for a person.  Basically, my area is known as 
peer advocacy. I’m a person who's been a patient in a hospital. I take 
medication everyday faithfully. I have a one-on-one person that I see every week 
who advocates for me.  

The training in Georgia was for peer advocates. One of the requirements for 
certification is to take your life experience and filter that out.  Filter out 
what common threads of knowledge that you have gained from that experience.  Add 
in things, like basic first aid, CPR, so that if there's an emergency you can do 
you a hand-off to someone who is more specialized.  

Advocacy in this field is important because quite often people learn about a job 
program from someone who is in a job program.  I was in a work [program] before 
where most of the people that came to the organization for services learned 
about it from people who were already receiving services.  A peer advocate, a 
person who is an advocate, is a very important part of that chain, because they 
give a way of connecting to the community, of connecting to other customers who 
very much need these essential services.  There's no service with the promise of 
success, like a job or returning to work, since the new medications for the 
brain came out during the decade in the last century.

Teri:  I can understand the importance of peer advocating.  A person sees that a 
peer can do this job and they're successful, then I can do it.  

Jesse:  That's the beauty of it.  If you can do it, I can do it.  The beauty of 
it all, there's no limit.  We held a housing conference, just a couple of months 
ago, in the District of Columbia where we were talking about home ownership.  We 
first broached this notion, back in the year of 2000, with a group called the DC 
Mental Health Consumers that I worked with.  People laughed at us.  They said, 
"You all can't buy homes." But the US Government has a program in their public 
housing where you can take the money that you contribute for your housing 
voucher and after 5 years that can be converted into a mortgage.  Other programs 
of pooling resources in condos are possible for customers in the mental health 
field once they return to work.  Working with one’s peers and having advocacy 
programs are so very, very positive.

Teri:  What advice would you give an employment specialist about peer mentoring?  
How would they go about encouraging their customers, who are very successful in 
the job, becoming peers or sharing their story?

Jesse:  Use different types of work formats or just a pizza party once a month, 
where they can share and swap stories, you know like "fishing stories". 
Celebrate victories, one year on the job, and six months on the job.  The little 
victories, I think, are the ones that really make for the big success stories.  

I've been very blessed.  I mean, I live in a nice studio apartment downtown. I 
drive a new car. I've only been out of work a couple of months, and I hope to 
return soon.  I have a business plan that's been well developed for over a year.  
I've been very blessed.  I'm sitting here at VCU, one of the greatest think 
tanks for rehabilitation and people returning to work that I've ever known 
about in this country. Anybody can do it.  If I can do it, the peer sitting next 
to me can do it.  If something happens to you, that's how you can get back on 
your feet.  

I think mental illness, like no other illness in this country, is shrouded by 
fear.  If people would realize, if you break a leg you put a splint on it.  If 
you have a problem with a chemical imbalance in your brain, we can fix that.  
You don't have to drive your car off the ledge.

Teri:  Thank you Jesse for sharing your thoughts today and your information on 
giving good ideas for recognition for those people who are successful in their 
work.

Jesse:  Thank you for inviting me.

Teri:  Thank you so much.

Ended @ 28:12