IPS IN ADDICTIONS RECOVERY Kyriacos Colocassis – Vocational Project Manager

1. IPS IN ADDICTIONS RECOVERY KyriacosColocassis – Vocational Project Manager

2. Agenda • Introduction to the Individual Placement & Support (IPS) and Key Performance Indicators • IPS compared with traditional Supported Employment methods (Pre-Vocational Training) • Effective implementation of IPS - Associated Challenges, within Addictions - Employer Engagement - Outcomes achieved by the Addictions Team - Cost

3. SO WHAT IS IPS? • The Individual Placement & Support model • An evidence-based model of employment support • Originally implemented in the US to support people with mental health problems • At the start of our project, IPS had only been used once before in the UK with an addictions client group • CNWL is a Centre of Excellence in IPS services

4. Central Tenets of the IPS Model 1. Eligibility is based on individual choice; 2. Supported employment is integrated with treatment; 3. Competitive employment is the goal; (Not sheltered placements or volunteering) 4. Rapid job search (within 4 weeks), minimal prevocational training 5. Job finding, and all assistance, is individualised; 6. Employers are approached with the needs of individuals in mind 7. Follow-along supports are continuous; 8. Financial planning is provided

5. Benefits IPS interventions have been proven through research to provide statistically significantly better outcomes compared to other forms of employment support. Measurable Outcomes: • Time employed/job sustained • Earnings • Likelihood of dropping out of service/rehospitalisation • Percentage of service users entering competitive employment

6. Number entering employment Sample size – 312; comprised of 156 people accessing IPS, 156 people accessing pre-vocational training Entry criteria – Patients with severe mental illness in six European cities. All subjects had not been in competitive employment in the last year, and wanted to enter competitive work Burns, Tom et al (2007), The Effectiveness of Supported Employment for People with Severe Mental Illness: A Randomised Controlled Trial, Lancet 370, 1146-52.

7. Comparing Competitive Employment RatesIPS vs the traditional service (1996 – 2010)

8. IPS v Work Choice Govt programmeJob outcomes 2011/2012

9. Challenges • Picking up prescriptions when in employment, changing pharmacies and arranging appointments with key worker around employment hours • Discrimination; not covered by disability legislation. (Equality Act 2010 explicitly excludes addiction). • Chaotic, non stable lifestyles, ESs have to work with that in mind • Forensic history • Gaps on CV • Physical problems caused by substance use • Erratic attendance

10. Challenges • Legal limitations on driving, while on replacement medication and company limitations on operating heavy machinery etc • Zero exclusion and Key Workers • Inappropriate referrals – i.e. not seeking employment • Discharge before reaching vocational goal • Disengagement • Clients likely to miss appointments • When engaging in treatment, many find it necessary to detach themselves from their former lives, i.e. drug using friends – leading to isolation

11. Employer Engagement – Addictions • Target driven – face to face employer engagement and client interview targets as well as project targets for employment outcomes • Working with employers around managing risk, reasonable adjustments, unlimited follow along support, mental health and drug awareness training • All clients have return to work and relapse prevention plans • Autonomy for ESs managing their own caseload within IPS guidelines • Support in supervision sessions around employer engagement

12. Keys to successful implementation in the team: • Building a local shared vision for IPS implementation • Team presentations and training • Clear role with key performance indicators (ideally 1 ES per team) • Being clear that the priority is paid employment not voluntary work or training • Agreement around the role of the ES and what we mean by IPS Fidelity • Clear supervision mechanisms in place: needs met jointly through Vocational and Clinical Services supervision

13. SUCCESS SO FAR FOR IPS ADDICTIONS TEAM

14. Performance: When IPS was implemented within K&C/Westminster Early Intervention 80% of those referred were inactive. Within 9 months this fell to 23% *76 clients have entered and remain in employment at the end of the reporting period

15. 212 clients accessed the service; with 102 employment outcomes being achieved by 84 clients. 71 education outcomes and 31 clients accessed voluntary opportunities. • 56 of the clients accessing the service were people recovering from alcohol related problems; 152 from drug and 6 were dual diagnosis/other. • 181(85%) of the clients accessing the service were unemployed and completely unoccupied at the time of referral; by the end of the reporting period this fell to 50 (23%). • The average length of unemployment of clients accessing the service was 3 years and 3 months.

16. Of the 84 individual clients that entered employment, 53 (63%) sustained their employment for a minimum of 13 weeks. At the end of the reporting period: - 37 (70%) have been in employment up to 13 weeks. - 13 (25%) have been in employment between 13 weeks and 6 months. • 3 (6%) have been in employment for over 6 months • At the beginning of the year, 5 clients disclosed illegal activity including prostitution and drug dealing. At the end of the reporting period all but 1of these clients had ceased that activity.

18. FOR FURTHER INFORMATION: Central and North West London NHS Foundation Trust KyriacosColocassis Tel: 020 7621 1657  Mobile: 0956 237 885         Email: gary.colocassis@nhs.net