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                 From the Field, May 2003
By combining financial resources, the Minnesota Rehabilitation Services and Department
of Mental Health collaborated to create the Coordinated Employability Projects. Since the
early 1990s, this partnership has funded 29 local demonstration projects for the expansion
of employment services for people with mental illnesses. The core mechanism is the use
of Department of Mental Health funds to match federal vocational rehabilitation funds.
The strong working relationship between a middle manager from each agency has made
this a productive and respected collaboration. Sandie Brown and Claire Courtney discuss
the value of this collaboration and present some challenges, strategies, and outcomes that
have strengthened the collaboration between their two agencies.

So, Given All the Challenges to
Interagency Collaboration, Why Bother?
Sandie Z. Brown and Claire T. Courtney

Interagency agreements are one strategy to formalize collaboration. To reach the goal of
increased supported employment for people with disabilities, interagency agreements
may outline a specific plan to:

      Share resources
      Continue a successful activity
      Establish an initiative
      Expand joint efforts
      Affect systems change

Interagency agreements need to be action-oriented. This means tasks, roles &
responsibilities, resources, and expected outcomes are clearly defined.

Since the 1970's the Federal government has encouraged state and local rehabilitation
services and mental health agencies to develop ways of working together to serve the
vocational needs of people with serious mental illness. Minnesota has had a collaborative
agreement between the two State agencies in place since 1985, but significant differences
between the two systems -- with different missions that developed to meet different needs
and different goals -- have often made it difficult for local practitioners to develop
collaborative strategies that can be implemented in their own communities. Local
collaboration is strong in some areas and communities, and in others the mental health
and rehabilitation services systems continue to operate independently of each other, often
to the frustration of people with mental illness and their family members.

Given the Challenges to Interagency Collaboration,
"Why Bother?"
      From a public policy perspective, people with serious mental illness should have
       access to and expect responsive assistance from the same services that are
       available to people with other disabilities and other people who are under or
       unemployed. People with mental illness represent the largest single client group
       potentially eligible for rehabilitation services. In many states, this is currently the
       largest single disability group served by the rehabilitation services program. As
       such, they have a large stake in the services and outcomes of the public
       rehabilitation services program.
      The public rehabilitation services program can be a valuable resource for people
       with mental illness. Rehabilitation counselors are familiar with the community
       resources that can be used to assist people with mental illness to achieve their
       goals for employment, and the program can lend its resources and funding toward
       the achievement of these goals. Rehabilitation counselors have expertise in career
       counseling, vocational planning, job placement, job skill development, vocational
       assessment, job development and can be a valuable resource to mental health
       professionals and consumers. Over time, the public rehabilitation service has
       proven to be a wise investment of public resources. Additionally, despite the
       systems issues, the public rehabilitation services program can be flexible and
       services do follow the individual.
      In most states, public resources for community social services including mental
       health services and rehabilitation services are not expanding to keep pace with the
       unmet needs of people with severe disabilities. Collaborations between state
       agencies with shared missions maximize the use of limited resources. Current
       research clearly shows that integration of mental health and rehabilitation services
       result in better employment outcomes for people with serious mental illness.

The Minnesota Experience
Minnesota's mental health and rehabilitation services agencies' interagency collaboration
presents a model which highlights the value that, as we face the challenges of economic
development and preparation of this country's workforce, no one should be left behind.
So why do we continue to bother to collaborate? Because we believe, and have
demonstrated, that when agencies have caretakers of the vision to improve services, the
goals remain fluid and alive and result in services that are continually being improved.

The Role of Advocates
Because of longstanding interagency collaboration and a joint mission between state
agencies in Minnesota, mental health advocacy groups have coalesced around the topic of
employment of people with serious mental illness and have played a significant role in
developing legislative proposals to expand services. The support of mental health
advocacy groups has increased and heightened awareness of the need for employment
services and job retention supports in the mental health community and ultimately
resulted in increased legislative appropriations.

Dealing with Challenges

Resource Commitment

Challenge 1: An inability to obtain a new legislative appropriation for ongoing funding
for a set of 5 time-limited rehabilitation services funded Supported Employment projects
for people with serious mental illness.

Interagency Strategy 1: The mental health agency and the rehabilitation services agency
worked with our State Mental Health Advisory Council to approve one-time bridge
funding of these projects with Federal Block Grant funds so the projects would not
terminate prior to the next opportunity to seek a new legislative appropriation. Through
the MN Human Services Department's budgeting process, the mental health department
requested $1 million in new funding to transfer to rehabilitation services to continue
existing projects and fund new ones. This proposal was not included as a priority in the
Human Services Department's legislative request and the rehabilitation services agency
was not allowed to request any funding for service increases.

Interagency Strategy 2: Mental health advocates were able to use the information and
program outcome data noted in a legislative report published by the two agencies 'The
Status and Evaluation of the Coordinated Employability Projects' to demonstrate to the
legislature the success of the projects in improving the employment of people with
serious mental illness. This report, which is a pdf file, can be found at


Advocates were successful in obtaining a new ongoing state appropriation for the projects
in the amount of $500,000 per year during this past legislative session. Advocates and the
providers they organized to lobby used this information in a grassroots campaign that
successfully obtained increased funding ($500,000 per year ongoing) for the projects
from the Minnesota legislature.

Challenge 2: Local mental health initiatives want to use new flexible mental health
funding to assist consumers to become self-employed. There is, however, an inherent
conflict in having social service agencies assume a "banker" role with public funds and in
acquiring the skills to evaluate the viability of business plans. Although the rehabilitation
services agency has a mandate to assist consumers with self-employment plans,
rehabilitation counselors consistently report that they have neither the time nor expertise
to assist consumers directly with business plan development and financing strategies nor
a place to refer consumers for the assistance they need.

Interagency Strategy: Given the considerable failure rate for business start-ups in our
country, mental health and rehabilitation services agencies contracted with Partnership
Development Corp. to provide technical assistance on Consumer-self-employment to our
agencies. Partnership Development Corporation recently conducted a resource inventory
of the banking and business development agencies in our large 7 county metro area and
have developed recommendations (now under consideration) for how the public systems
could partner with other community resources to better meet consumers self-employment

Expanding Capacity

Challenge: The need for more employment resources for the urban metro area, minority
populations and several large rural geographic pockets still exists, as well as the need to
expand capacity building in ongoing supported employment projects. Also, our mental
health system is in the process of implementing the Medical Assistance Rehabilitation
Option and targeting "best-practices" which will result in considerable changes in mental
health service delivery-including a reduction in traditional day treatment services.

Interagency Strategy: Rehabilitation services in conjunction with mental health in a
recent new "best practices" RFP process targeted the areas most in need for new services
by giving priority to the urban metropolitan area, services to immigrants, rural unserved
areas, supported education and conversion of day treatment programs to supported
employment. Funded were: two rural projects including one that will incorporate a
supported education component in conjunction with 2 universities, one urban model that
will convert a day treatment program to supported employment for people who are
southeast Asian and another urban project that will incorporate vocational services with
intensive community case management teams in 2 counties.

Tracking Outcomes

Challenge: The Coordinated Employability Projects appeared to be an effective strategy
for improving employment for people with serious mental illness, but comparative
statewide data was lacking. This lack of outcome measurements to document the
effectiveness of employment programs for people with serious mental illness is an
impediment to securing funding for expansion.

Interagency Strategy: In conjunction with providers of these services, the two state
agencies developed and implemented a state-of-the-art statewide longitudinal electronic
provider reporting system for the Coordinated Employability Projects. From 1999-2000,
13 providers reported demographic, specific employment and job retention support
information on 542 program participants receiving supported employment. The report
also documented a lack of statewide coverage of the services. Data from this reporting
system was compiled by program staff and submitted to the Minnesota Legislature in
December of 2000. Highlights from this report (This is an adobe pdf file. It can be found
at include:

      The combined earnings of program participants totaled over $2.5 million in
      Most program participants earned well over the federal minimum wage, with
       average wages of $6.98/hour.
      Most program participants worked part-time, with an average number of hours
       worked per week of 14.
      The average number of support service hours provided to participants was 1.52
       hours per week with a range of .05-14.69.
      Less than 2% of job terminations were attributed to psychiatric hospitalization. In
       16% of job terminations the worker left a job to accept a different job with the
       same employer and in most cases this was a job upgrade.
      Consistent with a philosophy of helping program participants to upgrade their
       employment (career ladders), the average number of jobs held by participants
       over a two-year period was 2.4. The average length of time people had been
       employed was 31 weeks.
      Many individuals are accessing employment in service and clerical occupations
       (63%) which are most readily available to people who have had interrupted work
      More than 50% of the support service hours provided to participants were
       provided to individuals on their job sites. The most frequent category of services
       was on-site job coaching (57%), followed by supportive counseling provided off-
       site at 20%.

Sandie Z. Brown is a Mental Health Program Consultant in the Minnesota Department
of Mental Health.

Claire T. Courtney is a Rehabilitation Specialist for Mental Health with the
Rehabilitation Services of the Minnesota Department of Economic Security.
Butterworth, J., Foley, S., & Metzel, D. December 2001. Developing interagency
agreements: Four questions to consider. Boston: Institute for Community Inclusion,
University of Massachusetts.

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