Trading the Workshop for the Work Site -

Building Competency and Confidence Among

People with Psychiatric Disabilities in Hong Kong

The Challenge

Too many dischargees from the New Life sheltered workshops for people with psychiatric disabilities were returning. In 1992, many of them reported failing in open employment. They said it was too scary. They claimed they needed more training. New Life staff believed the dischargees were seeking refuge from the challenging coping difficulties in the open employment situations. As more dischargees returned, the staff realized that even though they had learned employable skills, the former clients had not been well prepared for adjusting to the public work environment.

Among the several issues affecting the returning clients of New Life was the rejection of their job applications. Or when hired, they found it difficult to cope with the changes that occur with new tasks or meeting new people.

In 1992, staff members of the New Life Psychiatric Rehabilitation Association in Hong Kong recognized "a need to change" and offer "more realistic and comprehensive vocational services". If people with psychiatric disabilities were to move out of sheltered situations and into open employment, they needed to build confidence as well as vocational competency. The public also needed to develop a more receptive attitude toward people with psychiatric disabilities and their abilities. How could all three needs be engaged in one programme?

Meeting the Challenge

New Life decided to take the workshop outdoors. Specifically, it realized that training in real-work situations with ongoing support from a job coach is the more effective learning experience. Instead of training people who had psychiatric disabilities in a sheltered setting, New Life created businesses and found jobs requiring crews of workers. Cleaning and sweeping up around campgrounds is one of the more recently contracted business.

There are some 200 people a year in the New Life programme benefiting from the Association's Supported Employment Service. New Life's new approach covers many bases:

• Job sites vary so as to provide a range of options.
• Workers start with simple tasks and progress through job promotions and advanced skills training.
• Workers can be hired in groups with ongoing support from job coaches and workers' meetings.
• Monetary incentives are provided to encourage upward mobility and worth ethic.
• Preparations are made for open employment with ongoing support provided as well.

The shift required New Life staff become job coaches and work alongside its trainees. Social skills are heavily emphasized in this approach. Work skills are taught on the job. The staff devised a system for building confidence through a gradual increase of responsibility. Work settings that integrate trainees among the public are preferred. These settings offer preparation for dealing with strangers and changing workplace demands. They also offer a chance for the public to learn about people with disabilities and adjust its biases.

The Good Practice: Supported Employment Service in a Variety of Fields

Background

The supported employment component joins an already comprehensive programme at New Life. The Association began in 1959 when a group of former patients in psychiatric hospitals organized the New Life Mutual Aid Club. In 1965 it reorganized as the New Life Psychiatric Rehabilitation Association with a variety of services. These now include temporary residential facilities for free or modest terms, vocational training, sheltered employment and recreational and rehabilitation activities. New Life currently operates two long-stay care homes, one hostel, one supported housing unit, eleven halfway houses, six sheltered workshops, one aftercare service, two training and activity centres, three hostels and a restaurant.

The job-site projects are directed at people with psychiatric disabilities in the New Life sheltered workshops and halfway houses. This approach, which New Life calls "placement training", includes the cleaning of recreational facilities, car washing, delivery service, selling vegetables in a stall or snacks and handicrafts in a kiosk in parks, retailing in a convenience shop and operating a restaurant. The Association also still provides classroom training in woodworking, handicrafts, sewing and printing.

When New Life opted to change most of its training to real-work situations, it first created a vegetable selling stall. Then it opened a convenience store in a hospital. The New Life restaurant opened in 1998. It currently engages 35 people. The business has grown from HK$1,000 to HK$7,000 daily. In 2001-02 fiscal year, the restaurant did HK$2.5 million in trade. The restaurant serves as a training space for many people with disabilities. They learn restaurant skills as well as how to deal with a crowd of constantly changing strangers, which helps build their confidence in working with the public. As there are several non-disabled employees also, the trainees learn to work with a variety of colleagues, which prepares them for coping with co-workers in open employment.

New Life currently operates six businesses. It calls them "simulated businesses" because the people working in them are considered trainees and not employees, though they do earn wages. For work crew experience, staff members pursue contracts that are bid in the open market for the cleaning services. The first work crew contract that New Life acquired was cleaning a small barbeque area of a country park. It required New Life to recruit staff and train them to operate cleaning equipment and grass mowers. As well, they had to learn the Government's occupational and safety regulations.

How the Supported Employment is Structured

The trainees generally are clients living in New Life's halfway houses. They can choose a training mode from three possibilities:

They can stay in a sheltered workshop for work training. This is typically for people who aren't ready for employment.

They can find a placement in open employment, such as in an office. This is typically for people who require minimal, if any, training. A job coach works with both the trainee and the employer to prepare for the employment.

They participate in the job-site training, either in a business or in a work crew. A job coach is an important part of the training structure.

The supported employment service refers to the job-site training, which this report describes.

An orientation programme: Every trainee is orientated through a site visit and trial training period for about one month. Trainees are introduced to the workplaces and assessed for their starting level. They spend about four weeks actually working in jobs they have chosen to assess their suitability. Job coaches assess their work adjustment as well as performance and after that they will be admitted as trainees for the project.

Meeting individual needs with a rehabilitation plan: After a trainee chooses a field, he or she and a job coach set goals in an individual rehabilitation plan for the necessary skills needed for a specific job. He or she agrees to spend six months in training before seeking open employment.

Many options. The job sites offer a wide range of work activities that meet the different functional abilities of the workers. In the work crews, for example, simple tasks such as sweeping and general cleaning, are suitable for workers with lower functional ability or newly admitted workers-in-training. Experienced workers take on more complicated tasks, like tidying rooms and those requiring skills such as using advanced machines and chemicals.

Not all jobs involve full-time work. Some job sites require service only two days a week.

Work-habit building. The training elements focus on five objectives:

1) Developing good work habits through demands for attendance, punctuality and work concentration.

2) Building a good work attitude that is reflected in self-motivation, responsibility, problem solving, overcoming difficulties, work quality, discipline and flexibility.

3) Enhancing social skills through relationships with co-workers, communication skills with supervisors, personal hygiene and image, seeking assistance when necessary, expressing emotions, controlling anger, cooperation and team spirit.

4) Teaching work skills in cleaning, using tools and equipment, facility maintenance, following regulations, handling enquiries, following safety practices, etc.

5) Managing stress.

The intensive interaction with colleagues and customers who are non-disabled greatly improves interpersonal and communication skills. Support network and positive norms are cultivated among the workers so that they can lean on each other in times of frustration and difficulties. The work experiences build up a trainee's self-confidence and self-awareness. Direct assistance from job coaches help the workers upgrade their skills and build up their work attitude.

Monetary incentives. The capabilities of New Life clients tend to vary depending on the rehabilitation progress. To encourage improvements in a trainee's confidence and skills, New Life adopted a progressive training allowance scheme that links income and performance. A range of allowance, or payment, reflects the trainees' actual performance. It averages, however, about HK$140 (US$20) per day.

On top of the training allowance, workers receive an incentive payment of (US$58) per month for good performance. They receive another ($26) per month for their full attendance. An additional allowance is given to night shift workers. The monthly wages of workers could reach around ($640) in a typical month. It could go higher if they work more than 26 days a month. The resulting pay is nearly comparable to open employment conditions. In the businesses, the generated income covers the salaries. The contract fee includes the wages of the trainees in the work crews.

Other incentives. In addition to the pay incentive, a promotion path helps motivate trainees to perform more professionally. Workers start as "trainees" and graduate to "worker" status, which provides the first experience of upward mobility. More experienced workers can be promoted to foreman. The graduated positions give trainees a chance to work toward and carry out leading roles. And when in the leading role, they have a chance to help guide other trainees. This helps further develop their social skills as well as boosts their confidence. The system inspires the participants to work harder. It also provides a continual source of empowerment. Following the promotion path from trainee to worker to foreman gives the participants the varied opportunity to explore their potential and to develop a sense of achievement. They are required to work independently, to make decisions and to work with commitment. Combined, this helps to prepare them for open employment.

Advanced skills development: As trainees progress with gradual increase of responsibilities, they are taught new skills. These are relative to their competency with more demanding tasks, such as outdoor sweeping machines and indoor floor polishers.

On-the-Job Guidance

Job coach. Staff trainers act as job coaches with two duties:

Oversee that the contract duties are carried out, with good quality service.

Provide supervision and support to the trainees.

 

The amount of time a job coach spends with the trainee depends on the nature of the job and the person's level of ability. Someone placed in a clerical position may require little supervision whereas someone in a store will need daily guidance in learning how to maintain a store and sell things. As a trainee's competency increases, the job coach withdraws gradually to help build the person's confidence.

In addition to the support provided by the job coach, the team set-up among the work crews creates a support network. Trainees can lean on each other for support. Being a team member also helps them value their own work ability and contribution.

Workers' meetings are conducted each day to discuss any difficulties or to highlight the efficiency of the group. Discussing the day's progress helps to further instil confidence in the workers and build stronger relationships among co-workers.

Counsellors. New Life social workers give counselling, advice and referrals for other services, such as house hunting or financial problems, such as social security difficulties.

Open Employment Preparation

With Follow-Up and Ongoing Support

Trainees work on average of two years. They are discharged when they reach a level of independence. "We don't want them training forever," says Deborah Wan, New Life Chief Executive Officer. "They have to find a job."

When they reach a satisfactory work performance level, they prepare for discharge from New Life. To prepare to find a job in open employment, they receive guidance in completing job applications, making interview appointments, interview skills and follow-up. New Life staff help them find job vacancies through the government placement agency or through newspaper want ads.

For a six-month period, a job coach follows the progress of a former trainee once he or she has been hired. This may involve visits to the job, talking with the employer and phone calls to the former trainee.

Accomplishments

Before the Supported Employment Service began, more than 75 per cent of New Life residents in its halfway houses had no particular work activity or training or had minimal work. Since the shift in training, the number of people participating in training and moving into open employment has been impressive.

• In 2001, 243 people engaged in the Supported Employment Service. Of them, 95 were women. Sixty-two of them found individual training placement in open employment in jobs such as clerical and positions, cashier and cleaning crews.
• There were 110 people working in mobile crews and 71 working in the New Life businesses. Their salaries range from around HK$1,500 to more than HK$5,500.
• Enhancing the self-confidence and self-image and upgrading the skills of the trainees builds their sense of empowerment, which New Life regards an important output of its projects. That its service users move from a status of welfare dependence at New Life to self-reliance in the society is another highly regarded accomplishment of the programme.

Lessons Learned

Shifting from the workshop environment to real-work situations involves many trial-and-error approaches. It also provides experiences with invaluable insights, such as the following lessons:

A backup pool of workers is critical. Maintaining the contracts for work requires providing professional, reliable and top-grade service. The reality of working with disabled trainees is that it may take them a while to build a good work ethic. They may not show up one day for work, for example. This needs to be anticipated so that a staff person or another trainee can be called upon to fill in.

Earning money while training builds self-respect and results in respect from the community. The empowerment gained from having an active role in a real work environment allows the trainees to build up their self-esteem and independent thinking at a faster pace. The support of job coaches and social workers provided along with the real work training and the demands of a real contract accelerates the rehabilitation process, which pushes many Halfway House residents and sheltered workshop participants more quickly into open employment.

Work experience that involves interaction with strangers in the public offers tremendous training. Without a work project as a transition, there would be few chances for trainees to truly prepare for open employment and self-reliancy. Gradual integration into public situations with the immediate backup of social support from co-workers and the job coach helps trainees adjust to meeting new people. The positive interaction between disabled workers and community members helps build acceptance of people with disabilities.

Looking Forward

The New Life strategy is to remain as it is. Although, staff members do look to expand the variety of training work sites it offers by looking for additional service contracts.

Replication

This type of Supported Employment Service needs first of all, the work sites. To accomplish this requires competent staff members who know how to find, bid and manage contract work. Initial funding is needed for the necessary equipment. And it requires staff who are trained in job coaching techniques and who are familiar with the services required by the contract in order to teach the skills. Management staff in a business such as a restaurant must be competent in food preparation, accounting, managing personnel and overall good business practices. Not all job coaches need to have advanced education. But they do need to have a good attitude and are committed to working with people. Supported employment involves work schedules on weekends and beyond 9 to 5 hours and people need to be willing to accept this structure. Very critical to the success of the programme is maintaining dependable, high-quality professional service in carrying out the contract jobs. Promote the work of the trainees in the media as a way of maximizing public acceptance.

For More Information

Deborah Wan

Chief Executive Officer

New Life

332 Nam Cheong Street, Sham Shui Po

Kowloon, Hong Kong

Hong Kong

Tel: 852-2332-4343

Fax: 852-2770-9345

Email: dw@nlpra.org.hk

Web site: www.nlpra.org.hk

Box

Mr. So lives alone in an apartment. By his measure and that of the New Life Psychiatric Rehabilitation Association staff, his independent living is a success. Four years ago he resided at the New Life Halfway House and had just joined its sheltered workshop for people with psychiatric disabilities. Within three years, he was moved into the cleaning project at the popular SKORC campground. "I realized in the work project that my abilities were beyond what I was doing in the workshop," he says. After only seven months at the campground, he applied for a security guard position with a property management company and was hired. And that's when he went apartment hunting.

Mr. So worked in one of the nine New Life mobile cleaning crews offering trainees preparation for integration back into a community and open employment.

New Life first won the cleaning contract from the Sai Kung Outdoor Recreation Centre (SKORC) in 1998. It was successfully renewed in 2000 and 2002. SKORC is a popular day and over-night campsite offering recreational facilities, such as swimming pool, roller skating rink, squash and tennis courts and educational activities for the public. There are bungalows, dormitories and a variety of indoor and outdoor activity centres.

The contract, which was one in an open bidding, is large scale and requires good coordination, teamwork, advanced skills and cleaning equipment. Because of the many visitors to the campground, tasks are highly demanding and have to be completed within a rigid time limit. There are strict standards of cleanliness that must be followed as well.

The SKORC project has provided many chances for community integration. The workers meet campers (the public) every day and have direct communication with Camp Staff on carrying out duties. Because the work site is a very popular public centre, there is constant interaction with non-disabled people.