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Job training and finding work are urgent concerns for all welfare recipients under new Federal and State reform deadlines. But for welfare clients in substance abuse treatment, many needs must be met and barriers overcome before people can work. Even if a client is job ready, he or she may not be employable. This is the problem the Training and Employment Program (TEP) sought to solve.

Integrating Vocational Services

A NIDA-funded pilot study, TEP examined how to integrate vocational services into drug treatment settings. The Research Triangle Institute (RTI) worked with methadone programs to develop two tools to evaluate the needs and abilities of clients: the Vo-cational Readiness Screener (VRS) and the Global Appraisal of Individual Needs (GAIN). In addition, RTI wrote a manual detailing, step by step, proven strategies for providing vocational services. Though developed for methadone clients and programs, these materials can be used as a guide to provide vocational services to any group of hard-to-employ clients. The manual includes a 2-day, 4-session training for primary drug counselors and vocational specialists to help them collaborate effectively. TEP's main goal was to get people em-ployed. But along the way, researchers, counselors, and clients recog-nized another, equally important outcome: TEP improved clients' quality of life.

"There is so much more involved here than just getting a job," according to TEP Project Manager Georgia Karuntzos. "In these clients' lives, welfare reform's imperative to get a job is only one of many issues," she said. "There is often a big gap between being ready for a job and being employable. A client may want a job and have the literacy and skills to perform it, but lack the motivation and sobriety to get and keep work. Or, she may be unemployable for lack of basics such as clothing, equipment, transportation, and childcare. Or, the potential loss of publicly funded health care services for the client and family may be a major motivation not to become employed. And always, there are the treatment issues," Karuntzos said.

Success is Incremental

TEP created tools for service providers to sort through these issues and help clients plan for the future. "You have to find out where the client is in treatment and in other phases of her life, and work with her from that point forward. Success cannot be narrowly defined as just getting a job," Karuntzos said. Rather, success is incremental, a progression of solutions in difficult circumstances. For many methadone clients, getting off the street, treating health problems, and reuniting with family are the intermediate successes that may move them towards employment.

Tools to Measure Vocational Resources

To help primary drug and employment counselors provide job-related services to clients in treatment, Karuntzos and her colleagues created the VRS, a tool that categorizes clients along a continuum of vocational readiness. They also created the GAIN, a clinical instrument comprised of existing scales that, taken together, measure the full spectrum of client functioning. The TEP study specifically addressed the vocational needs of clients in methadone programs in Pittsburgh, Pennsylvania, Santa Clara County, California, and Buffalo, New York. But nonmethadone substance abuse treatment clients and welfare recipients often share similar barriers to employment, including stability in treatment, criminal records, illicit drug use, problematic work histories, or poor work attitudes. Because the VRS includes all the dimensions that determine employability, it can be readily adapted for use by substance treatment providers of all kinds. VRS renders an employability profile that includes work history, motivation, socialization, personal problems (mental and physical health and stress), and financial resources as factors in measuring readiness to work.

Until VRS, assessment tools that measured vocational skills, interests, and abilities were lengthy, costly, and primarily useful for people who were already prepared to seek job placement or educational services. But few substance abuse treatment clients on welfare are ready for immediate job placement or training. These clients often lack the emotional and social support needed to find and keep a job. They may have limited motivation or commitment to vocational rehabilitation. Frequently, they lack the money for child care, transportation, supplies, equipment, or clothing that may be required for a particular job. In addition to paying tuition for continuing education and training, TEP paid for day care, suitable office attire or steel-toed shoes, car repair or a tool kit—whatever the client needed to become and remain employed.

Five Dimensions of Employability
Vocational status, measured as nonvocational, prevocational, training-ready, job-ready, and employed Motivation and interest in vocational activity Sources of social support for training and employment Ancillary needs, such as transportation and child care Barriers to vocational activity

Methadone Clients

Marlene Burks, Deputy Director of The Second Step, worked with RTI over

the 2-year TEP study period to help clients at her agency's publicly funded methadone treatment facilities in Pittsburgh make the difficult transition from "seeing themselves as methadone clients to being a whole person."

About 10 percent of clients got jobs through TEP, and about 25 percent got training, Burks reported. The TEP was "not as successful as we had hoped in terms of really getting people employed," Burks conceded, because of this hard-core population's barriers to employment and a mismatch between client skills and jobs available in the local marketplace. Nevertheless, the study was valuable for the approaches and tools it developed and for reinforcing the importance of work to the drug treatment goals of methadone clients.

"Clients who are working are more responsible," Burks said. There seems to be a reciprocal, positive relationship between holding down a job and success in treatment. "If you can get the addict in a work situation that meets his skill level, he will do better in treatment. Work is therapeutic," Burks said. "If a client could show he had kept a job by producing pay stubs, and if he continued to have clean urines, we gave him take-out status so that he could self administer his medications" and continue working. But, getting methadone clients employed or job-ready within the time frame and constraints demanded by welfare reform remains a major challenge.

Of Second Step's 400 clients, most have no marketable skills. Though 85 percent have a high school diploma or GED, literacy and math comprehension are low for this population, which is characterized by complacency and long periods of inactivity due to indigence or incarceration. Since many clients started using drugs in adolescence, their secondary school education was totally interrupted or a negative experience, and their cognitive development may have been stalled. Most Second Step clients are over 35 years old. About two-thirds are male and a third are female; 60 percent are white and 40 percent are African American.

"TEP was a good beginning," Burks said. But she believes that training and employment programs must do more than point out the factors that inhibit substance abuse treatment clients at an individual level. More careful study of the economic trends in each region would reveal the labor needs of the community and produce a better match between client skills, vocational training offered, and the kinds of jobs available. "You don't want to be training people for jobs they can't get or that don't exist," Burks said. "Another key issue," she stressed, "is the strength of existing education and training programs in your geographical area. How accessible are services, and what do you have to do to get your client in?"

Seven-Step Framework for Vocational Counselors

Review the client's treatment chart and meet with the primary substance abuse counselor to discuss the client's vocational history and other influences on vocational activity (e.g., continued illicit drug use; behavioral, psychological, or physical impairment) Conduct client interviews and administer GAIN and other vocational assessments to determine the client's vocational interests, capabilities, support mechanisms, ancillary needs, and barriers to vocational activity Develop a preliminary plan to meet the client's immediate vocational needs Confer with the treatment staff to make sure that the plan complements the client's substance abuse treatment goals Identify services, agencies, and resources available in the community to meet the client's needs Select the best options and link the client with appropriate services or agencies Review client progress continuously through case conferences with the primary substance abuse treatment staff

Educating the Community

Helen Norman, the employment specialist in Santa Clara County, California, who integrated a vocational component into three methadone
treatment centers, emphasized an-other issue confronting anyone in

treatment who must find a job.
"Initially, the challenge was in educating the community and service providers about the methadone client. We had to convince people to take that risk with one client, to make that one referral a success. This created a new view of methadone clients and it opened doors. We struck a deal with DeAnza-Foothill Community College, which serves this district with excellent vocational training programs. We persuaded them to take five methadone clients and give them a chance. We said, `Let's see if we can make this work.' In the end, DeAnza-Foothill wrote a proposal with us to get funds to expand the program."

Though the TEP study is over, the interventions it initiated are still in place. "This is a long-term success, and not just for individual clients," according to Norman. Within the County of Santa Clara, the agency for drug treatment recognized the program's value and created a permanent position for a vocational counselor. Rehabilitation counselors and others refer clients who are job ready and employable. The county continues to provide a comprehensive support system to a person once he or she is employed, Norman reported, with periodic follow-up at 6 and 12 months.

"And because relapse is always an issue," Norman said, "a vocational counselor is always available, ready to help a client keep a job. Job retention is the main problem. Even if clients overcome their fear of the world of work, other things may threaten their jobs. They may need to go to court over child custody, they may have a child care emergency, and transportation can be precarious. These are all big issues. In Santa Clara, we have identified the programs and services within our county for these clients. We give them access to public health and hospital services."

This systematic approach is essential, Norman believes, to serve a

significant pool of clients who may always need public support. "Those who participate in substance abuse treatment programs, those who feel the impact of welfare reform, those affected by managed care and Medicaid reform—they are all the same people. We are spending a lot of money on the same group of people, but not effectively. It's time that all of the players—including the clients—come to the table to talk about linking all these programs and services in city, county, and regionwide systems of service," she said.

Primary Vocational Activities by Degree of Vocational Readiness

Employed Client Needs Job placement services (for upgrading employment position or status) Work-related equipment Work-related clothing Job-Ready Client Needs Resumé preparation Interview preparation Application assistance Job seeker's workshops Job development Special equipment Support group participation Training-Ready Client Needs Educational services Vocational skills training Training/education related resources Training/education materials Support group participation Prevocational Client Needs GED services Comprehensive vocational evaluations Motivational/personal development Personal counseling (fear of success/failure) Nonvocational Client Needs Vocational assessments (to determine potential abilities to pursue training or employment) Support group participation Medical/psychological assessments (to determine immediate and/or comorbid problems and needs)

References
Dennis, M.L., Karuntzos, G.T., McDougal, G., French, M.T., and Hubbard, R.L. Developing a training and employment program to meet the needs of methadone treatment clients. Evaluation and Program Planning 1993; 16:73-86.

Karuntzos, G.T., Caddell, J.M., Dennis, M.L. Gender differences in vocational needs and outcomes for methadone treatment clients. Journal of Psychoactive Drugs 1994; 26:173-180.

Karuntzos, G.T. Triaging Vocational Services Needs Using a Vocational Readiness Screener. National Methadone Conference; November 1995; Phoenix, AZ.

Karuntzos, G.T., Dennis, M.L.. Vocational Readiness Screener for Determining Employability. National Methadone Conference; April 1994; Washington, DC.

Karuntzos, G.T., Dennis, M.L., French, M.T., and Norman, H.M. Vocational Specialist (VS) Manual-Draft. Washington, DC: Training and Employment Program (TEP), NIDA; February 2, 1995.

CSAT, the Treatment Improvement Exchange, and the editors of the TIE Communiqué thank Ms. Georgia T. Karuntzos, a research associate in the Mental and Behavioral Health Research Program at Research Triangle Institute, North Carolina, where she participated in the development of TEP; Ms. Marlene Burks, Deputy Director of The Second Step; and Ms. Helen Norman, Employment Counselor, Santa Clara County, California.

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