NOTE FOR USERS:

This manual is intended to assist Supported Employment programs in integrating a greater array of educational
supports and services to better serve transition age youth and young adults with mental health conditions developing
meaningful, self-sufficient careers.

This manual is not intended for programs that do not have in-depth knowledge and competencies of a high-quality
Supported Employment program.

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SECTION 1: Notes
INTRODUCTION AND OVERVIEW
A career can not only provide meaning and resources for a financially viable future, but
can also offer other positive benefits, such as structure, social connections, and a sense of
direction in life. However, for many young people who have experienced emotional and
behavioral challenges at home and in school, career development often takes a backseat
to symptom management and behavioral control. Although employment programs for
both adults and youth with mental health conditions are becoming increasingly common,
they do not always implement best practices or provide a high quality of service and have
historically focused on rapid job placement rather than on the pursuit of higher education
(Murphy et al., 2005; Bond, 2004). This lack of an educational focus may actually decrease
an individuals chance of obtaining a career, as, the biggest boost to economic success
and social mobility comes from having a college degree (Putnam, 2015, p. 197). Because

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postsecondary education leads to greater employment opportunities, vocational stability,
and income, services that actively focus on helping youth with mental health conditions
successfully pursue higher education to promote achievement of their long-term career
goals are critically needed.
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The purpose of this manual is to describe the policies, procedures, and program elements
needed for agencies and practitioners to deliver effective services to youth and young
adults that incorporate educational supports into employment services, with the aim of
facilitating achievement of their goals for a meaningful career and to develop a financially
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viable future that allows for thriving, rather than mere surviving. This manual was
designed to help agencies and practitioners adapt their Supported Employment (SE)
services in order to deliver a career services approach that will better match the needs of
young people and support them in developing long-term views of their career goals and
pursuing and achieving educational goals as a part of their employment plan. HYPE,
Helping Youth on the Path to Employment, is an approach that is based off of services that
blended employment and education for adults that began implementation in 2008 and
has been modified to meet the unique needs of transition age youth and young adults. It
aims to prevent some of the pervasive issues (such as inconsistent employment histories,
interrupted educational pursuits, and Supplemental Security Income cash-benefit receipt)
that affect the pursuit and maintenance of employment of adults who are in the community
mental health service system.

The HYPE model described in this manual differs from typical SE services in that the
emphasis is on entering and completing higher education as early as possible. This often
means that education becomes the primary vocational pursuit to long-term employment
as compared to rapid job placement. It is our position that education is a critical vocational
step rather than a goal in and of itself. While education is a meaningful and often long
process, it is the mechanism by which one is able to secure a desired position in a chosen

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field with a salary that can support an adult lifestyle. Typically, after a degree has been Notes
obtained, individuals either enter into the workforce that is consistent with their studies or
continue their education to be better positioned to enter into their chosen field. Therefore,
completing a degree is a step towards meeting a long-term career goal and should be seen,
supported, and funded/resourced as a vocational step.

RATIONALE FOR DEVELOPING A NEW MODEL

The Individual Placement and Support (IPS) model of Supported Employment (SE) is
the foundation of the Helping Youth on the Path to Employment (HYPE) model. IPS has
revolutionized the way the mental health service system views those with mental health
conditions by changing the expectations about the role of work and recovery among this
population. Although IPS is applauded for its efforts to change the vocational supports for
those with mental health conditions and has demonstrated great success over other models
of supported employment. Yet, the outcomes associated with IPS are not overwhelming

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optimistic for developing economically self-sustaining careers. While IPS is the best SE
approach currently documented in the literature, the variable rate of variable programs
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is concerning (ranging from 27-75% of those participating in services are employed;
Kinoshita, Furukawa, Kinoshita, et al., 2013). Unfortunately, for those who do become
employed, these positions are typically low-level with low wages and have a short tenure
(Kinoshita, et al, 2013). As such, adults who receive Supplemental Security Income (SSI), as
well as their employment supporters, are less willing to give up a guaranteed monthly SSI
check (which provides an annual income that falls below the federal poverty level) because
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the jobs typically secured in SE are part-time and short-lived (Leff, Cook, Gold, et al., 2005;
Resnick, Neale, & Rosenheck, 2003). These types of positions then make coming off of SSI
as risky and are often not good enough for those seeking SE services (or SE providers) to
feel confident exiting SSI despite the fact that nearly any position secured in the competitive
labor market would pay more than SSI (Stapleton, 2007). What is commonly seen in SE
services are job seekers accepting employment opportunities contingent upon retaining
their SSI benefits while maximizing work incentives. Unfortunately, employment services
are then provided within the context of maintaining disability benefits and therefore, still
result in people prioritizing benefits over work.

The emphasis of employment over education is arguably the greatest shortcoming of the
IPS model and is the underlying issue that results in the above stated limitations. While
employment is an important focus, the role of education in career attainment cannot
be overlooked. There is a normative process to sustained, long-term attachment to the
workforce, which later evolves into career development. For most people growing up, first
jobs are often convenient, age-suitable, of some level of interest, and paid (e.g. baby-sitting,
landscaping). These early employment experiences can reinforce the values associated with
work (e.g., feeling productive, helping others), influence employment preferences, and may
inform later educational decisions (e.g. majors in education, health, horticulture). These

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educational endeavors, in turn, can inform future choices, such as different educational Notes
pathways, employment opportunities, and later career pursuits. This education-employment
cycle (e.g. work informing school and school informing work) is critical to identity
development and future vocational success. The refinement of interests, values, strengths,
and preferences are related to both vocational and self-identities, resulting in an outcome
referred to as human capital. Human capital refers to the unique set of skills and abilities
that are only acquired through employment and education (Becker, 1975), such as the
experiences that are described on a resume. To expand on this example, it can be assumed
that the better the resume, often the better the long-term vocational outcomes.
Higher education is often considered a key component of a strong resume and vital to
cultivating human capital. Achieving higher levels of postsecondary education is seen
as insulation from unemployment and as the gateway to better positions, higher wages,
employee-sponsored benefits, and career mobility, which is often referred to as the
characteristics of positions within the primary labor market (U.S. Department of Labor,

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2017). Regardless of economic trends, those with a bachelors degree have higher salaries
and lower unemployment rates than those without a degree as well as the average American
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worker (U.S. Department of Labor, 2017). In addition to better wages and relatively secure
employment options, positions in the primary labor market are designed for adults who
require flexibility at times (regardless of the reason), which can help naturally accommodate
the cyclical nature of mental health conditions. Meaning, during the time of developing
symptoms, employees can take personal, vacation, or sick time off to prevent an exacerbation
of their condition. During this time off, enhanced wellness and self-care strategies and/or
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clinical services may be the only support required. During times of more severe symptom
exacerbation, the Family Medical Leave Act ensures that, after a year of employment at a job,
employees can take up to 12 weeks of leave to care for themselves. Higher education is one of
the main factors associated with accessing the primary labor market.

For young adults, being a student is age-relevant (most people their age are going to school)
and often seen as a prestigious role, however, for many young adults, including those
with mental health conditions, higher education can be a daunting task. The expectations
of the educational environment are often very different than expectations of the typical
employment opportunities at that age. Postsecondary students are managing multiple
classes, differing expectations between instructors, navigating complex systems, constantly
managing deadlines that have differing requirements, and are largely self-directed in
these efforts. Although schooling can be challenging and the settings can be complex (e.g.
multiple levels of administration and varying office requests), the benefits to students are
numerous and include the development of valuable skills that translate to later employment
settings. Furthermore, postsecondary education is flexible in that, students are able to
pick and choose the course load, types of courses, and scheduling of their classwork. With
intentional support and sound advisement, students with mental health conditions do not
need to withdraw from school during times of symptom exacerbation or difficulty, but rather
can adjust their course load based on the constraints and considerations of that semester.

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Maintaining the role of student, even if it means taking only one course, not only continues Notes
positive traction toward the young adults goal, but keeps them grounded in a socially
desirable role, maintains them in meaningful environment, and prevents the development
of disability identity. Additionally, this type of course-load adjustment is not an uncommon
practice among college students. Scaling course loads based on life-factors has become a
normalized experience and a time period for degree completion of five to seven years is now
typical of most college students (Shapiro, Dundar, Wakhungu, et al., 2016).

In order for young adults with mental health conditions to have the similar outcomes
as those that do not have mental health conditions, the normative, developmentally-
relevant, employment-education cycle should be the model of services for young adults.
Employment services, as currently developed and funded, are inadequate to best prepare
young adults to become economically self-sufficient. Aligning resources that intentionally
develop human capital among those with mental health conditions in order to become

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competitive for positions in the primary labor market is therefore a better way of designing
services to prevent disability, reliance on social security, and high rates of unemployment.
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The alternative is to continue to work within the context of SSI, which is an unsustainable
model given the dire forecast of SSA and has devastating personal effects as it is a triggering
mechanism for system dependency and illness identity.

Illness and disability identities are strong factors that contribute to the erosion of
expectations that adults with mental health conditions have about their role and ability
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as worker and student. It is also our belief that the application to and receipt of SSI are
powerful factors in solidifying the illness and disability identities. The intentional and
purposeful development of identities related to student and employee is critical in order to
prevent young people from later developing such corrosive perspectives about their abilities
and aptitudes.

TARGET AUDIENCE
This manual was specifically designed for SE practitioners who are currently providing
services to adults so that they can build competencies in providing a career service approach
to the young adult population. This manual can also enrich the skill sets of existing
practitioners working with youth and young adults to support their career development.
Since Helping Youth on the Path to Employment (HYPE is conceptualized as being
embedded in high-quality supported employment programs, some knowledge is assumed,
such as readers familiarity with the most researched supported employment approach, the
Individual Placement and Support (IPS) model.

For practitioners who are not familiar with or experienced in the IPS model of supported
employment, or who do not have a background in offering employment services, this
manual still offers useful information on the specific needs of youth and young adults and

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educational supports however, it does not cover all crucial activities given the knowledge Notes
of the intended audience. Information on IPS is readily available through the federal
Substance Abuse and Mental Health Services Administration (SAMHSA; www.samhsa.
gov) in its Evidence-based Practices kit series. SAMHSA also has published a toolkit on
supported education, which also contains relevant important content. However, since the
educational backgrounds and training experiences of practitioners who work with youth
and young adults is greatly varied, this manual touches on a wide range of relevant topics,
and we refer the reader to additional resources for further learning throughout the manual.
Additional resources and references are also listed in Appendix B: Resources & Information.
This manual can also be helpful to practitioners who are knowledgeable about employment
and/or educational supports and work in other settings, such as drop-in centers for youth,
clubhouses, supported education programs, and campus disability services.

In addition to the knowledge and competencies associated with Supported Employment

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(SE), this manual is written for audiences who have good working knowledge of the
Transtheoretical Model (TTM; Stages of Change; see Prochaska, DiClemente, & Norcross,
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1992) and Motivational Interviewing (MI). The knowledge and skills associated with these
two models are critical to the HYPE model. TTM and MI help to structure services and
supports as well as communication and counseling techniques. For those who are not
familiar with either or both of these approaches, it is strongly encouraged for practitioners
to develop expertise in these areas to enhance their clinical skill sets and quality of service.
For some practitioners, self-study in TTM may be sufficient [see book entitled Changing
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for Good by Prochaska, DiClemente, & Norcross, 1994]. However, MI proficiency is often
a result of training, supervision, mentorship, and personal commitment to integrate into
practice. Practitioners should seek out training opportunities and supervisors should ensure
that practitioners have the skill sets required, either upon hiring or during the initial phases
of employment, to help young adults move through the change process.

SUPPORTED EMPLOYMENT
The Individual Placement and Support (IPS) model of Supported Employment (SE) has
outlined many of the principles that are essential to high quality employment services. To
utilize this manual, a program does not need to implement the IPS model, but rather should
offer high quality supported employment services. As described earlier, the intention of
this manual is not to review the core services to support employment goals, but instead
how to integrate educational supports into employment services. So, in addition to skilled
SE practitioners, programs that have services in-line with the following principles are good
candidates to utilize this manual:

1. Services are individualized and flexible to meet the unique needs of the young person;
2. Services are time-unlimited, with supports provided throughout the course of
education/ training and employment;

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3. Services are based on need and vary in intensity, which flexibly meet the needs of the Notes
young person and could range from frequent to occasional contacts as needed;
4. Services do not exclude those who are interested in work or school; anyone who wants
to go to school or work can receive services;
5. Services are based in the community and are mobile to meet the young person where
they need services, which could mean at home, at school, or local coffee shop;
6. Services are coordinated with other mental health providers, family, and other people/
entity who the young person sees as critical to their success;
7. Services encourage integrated settings for education and employment; and
8. Services philosophically believe that young people can succeed in school and work and
emphasize the importance of independence, including delaying or avoiding application
for Social Security benefits and other entitlements, although assistance will applications
is provided as necessary in times of extreme need.

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MANUAL FOCUS
Although this manual primary focuses on career services for young adults with mental
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health conditions, some of the information included relates to working with young people
more generally, and thus would likely be relevant when providing services to anyone in
this age range, whether or not the young person has been given a psychiatric diagnosis
or determined to have another potentially disabling condition. Emphasizing the unique
concerns and needs of young people can help practitioners adapt and deliver services
designed to meet those needs. Similarly, this content in this manual may also assist in
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helping adults over 30 as many of the educational strategies and supports are common to all
students. However, just as young adults have unique needs, so do non-traditional students.
This manual may not be helpful in providing unique strategies to assisting a returning
older-student.

Promoting career development effectively involves attending to three trajectories: the

employment path, which is clearly relevant to anyone seeking a meaningful and productive
career; the education path, which increases opportunities, choice, and job stability; and
the path of personal development, which includes the emotional maturity as well as the
foundational skills needed to succeed in work and school. All three trajectories are covered
in this manual, although, as a practitioner, you may wish to pursue additional learning
to increase your level of knowledge and depth of understanding of the many complex
components of each trajectory.

MANUAL CONTENT AND ORGANIZATION

Following this introduction, the manual is divided into four sections, followed by a section
listing references and resources for further learning.

Section 1Introduction and Overview: In addition to the introductory material that

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you have read up until this point, this section includes information on basic practitioner Notes
competencies that are relevant to all effective services, but are especially critical when
working with youth and young adults.

Section 2Understanding Youth and Young Adults: The information in this section sets the
stage for working with young people by describing important issues in the development of
adolescents and young adults, how mental health conditions interact with developmental
issues, how services for young people differ from those for adults, and where service gaps
suggest the need for additional or different programs and interventions.

Section 3The HYPE Career Service Model: Although there is, as of yet, no definitive
research suggesting a single best model for enhancing career development for young people,
this section incorporates best practices into a comprehensive approach. The development
of this approach was informed by practice, an extensive review of the literature, surveys of

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innovative and effective programs and practitioners, consultation with national experts, and
the opinions and experiences of young people with mental health conditions. The principles
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of this approach are presented, along with an overview of the critical activities and program
elements most likely to contribute to successful achievement of the career goals designed by
the young adults using these services.

Section 4HYPE Service Planning: This section details the methods used to develop
effective supports and interventions to best support young adults. HYPE service planning
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integrates the C-G-K-L approach with TTM to tailor goal plans that meet the young adults
need. The goal planning process is detailed as well as the assessments that are critical to
identify strengths, interest, values preferences as well as the critical skills, resources and
accommodations needed to be successful.

Section 5Developing Skills for Successful Careers: Based on the principles and practices of
psychiatric rehabilitation, HYPE emphasizes the development of skills and the provision of
supports. This section identifies 12 skills that are seen to be fundamental critical for success
in work and school. Presented as a workbook, this section includes specific guidance for the
practitioner on how to facilitate skill development. Corresponding worksheets are provided
to use with a young person and include practitioner tips.

Section 6Support Strategies: In addition to facilitating the development of skills, HYPE

emphasizes providing supports in a flexible and individualized manner. Practitioner support
is likely to be especially important early in services, when the young person is actively
working on the development of new skills. A persons individual strengths and struggles
will dictate what supports and accommodations are needed to ensure that, for example, the
individuals cognitive abilities, social skills, and stress management skills are sufficient to
match the demands of work or school. This section provides an overview of types of support
strategies for meeting the unique needs of youth and young adults.

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HOW TO USE THIS MANUAL Notes

This manual is intended to be read in its entirety to assist SE practitioners, administrators,
and programs in developing knowledge and skills related to education. After reading the
manual, programs that are interested in developing career services should begin to revise
paperwork and supervisory practices to include education. Practitioners and supervisors
should partner to develop knowledge, skills, and abilities related to supporting young adults
in educational goals. Based on strengths and needs assessments, practitioners will use the
resources in this manual to best support the young adults during the process of change as
well as with goal attainment. Given the variability of young adults needs, practitioners will
determine which worksheets and skill modules should be used to best meet each young
adults needs and goals.

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