The Evidence Based Practice of Individual Placement & Support (IPS) Supported Employment

1. The Evidence Based Practice of Individual Placement & Support (IPS) Supported Employment 10-16-2018 MHDS Statewide Evidence Based Practices Conference Sherry Becker, Scott Witte, Kim Wilson, Russell Wood

2. WHO, what, why……… Q: How many People with Serious Mental Illness are working in integrated competitive employment? • less than 15% • The number hasn’t changed much since the 1990s! • The ADA has had little impact Q: How many People with SMI want to work? • 2 out of 3 prefer to work

3. WHATisIndividual Placement and Support?

4. WHAT is the desired outcome of IPS?

5. WHY should a MH system focus on employment? • Work is the most normalizing goal we can help people achieve in this society • Don’t ask IF people should work or not…ask how you can assist people in achieving their work goals • Employment is a central clinical concern • Work is a way to approach other treatment goals. • It helps people identify with a “worker” image versus a patient or consumer

6. IPS REDUCES FRAGMENTATION • IPS integrates evidence-based vocational services with mental health services. • People with mental illness interact with many agencies, all of which have different policies, cultures, values, and eligibility requirements

7. IPS………the only Evidence-Based Practice (SAMHSA) that focuses on employment Research-based: Efficacy and effectiveness empirically validated through a body of rigorous research, replicated in a wide range of settings by multiple investigators. Standardized practice guidelines Critical ingredients are well defined. “Manual-ized” service approach measured via a fidelity Scale Developed by actual practitioners in the field.

8. IPS Is Effective Across Many Subgroups of People with Serious Mental Illness (Campbell, 2011) • Men and women • All age groups • Diverse ethno-racial backgrounds • Both extensive and little or no work history • All levels of educational attainment • Mild or severe psychiatric symptoms • Extensive hospitalization history

9. IPS FINDINGS

10. IPS Initial launch 2006-2012 6 programs IPS Transformation 2013-2014 IPS Expansion 2015-2016

11. How is IPS different from other types of “Supported Employment”

12. Can IPS work in Rural Areas? Implementation issues in rural areas include broad factors that are true everywhere: Financing, leadership, quality improvement Rural geography (under 50,000 population) adds further unique challenges: • Low population density • Travel time/windshield time for ES • Higher cost of mileage reimbursement for ES • Greater lack of transportation for participants • May impact fidelity score for vocational unit and IPS supervision • Potentially fewer options for job matching • Confidentiality: Everyone knowseveryone& stigma

13. Rural IPS evidence suggests: • Barriers can be overcome (2014) • Fidelity scores do not differ • Access to IPS is similar • Employment rates may be slightly higher in urban areas (43% v. 40%) • Skillful persistent job development is still a key to success!

14. SUCCESS STORIES T 3 Faces, Part One: Scott’s Story 3 Lives www.IPSworks.org

15. IPS Works “Nothing that I have studied has the same kind of impact on people that employment does. Medication, case management, and psychotherapies tend to produce a small impact on people’s overall adjustment. But the differences are often striking and dramatic with employment”. -Robert Drake, M.D.

16. Eight principles of IPS • Integration of employment with mental health treatment • Zero exclusion • Individual preferences are honored • Rapid engagement • Systematic job development • Focus on competitive employment • Proactive benefits counseling • Time unlimited individualized job supports

17. Principles of IPS#1: Integration of employment services and MH treatment services Why Integrate? (Bond, 2001) • Lower dropout rate for consumers/customers • Better communication • Clinicians get involved • Clinical information incorporated into employment plan

18. 3 Legged Stool Ensures that the team adheres to IPS principles, providing the best opportunity for individuals with mental illness to not only find a job but also to continue receiving the job supports that help them to keep the job Mental Health Services Funding Source Community Employment Services

19. Person Centered Indicators of IPS Integrated MH and Employment Services • All team members give the same hopeful message about employment to the person • The individual is aware that the ES and the MHT are working as a team sharing information about the person for their benefit • The MHT takes full responsibility for coordinating services, not the person being served

20. Person Centered Indicators Of IPS Integrated MH And Employment Services • A person’s vocational career profile, plans, and goals are recorded in person friendly language • A job match includes jobs and work environments that allow for a person’s illness management and coping strategies • Meetings with the individual are scheduled around their employment schedule

21. Getting the IPS Ball Rolling Referral and Service Process: ES provides full range of employment services Time Unlimited Step Down Supports Mental Health Treatment Team Weekly MH Treatment Team Meeting ES attends weekly MH Treatment Team Meetings

22. Principles of IPS #2: Zero Exclusion Every person who wants to work is eligible

23. Reframing “Readiness For Employment”: A Paradigm Shift “ Employability is a given, not a line to cross” -Dale DiLeo People are ready to work when they say they are ready to work

24. Principles of IPS #3: Individual preferences are honored

25. Preferences Are Honored Research shows people with serious mental illness generally: • Have realistic ideas about what work they can do, • Know how many hours a week they can work, and • Know what work environments are good or bad for them. (Becker& Drake, 2003)

26. Principles of IPS #4: Rapid Engagement in Job Search The job search starts soon after a person expresses interest in working

27. #5: Systematic Job Development Principles of IPS Based on person’s work preferences, face-to face with multiple visits Focus on the employer’s needs Find jobs that may not be advertised Gather information about upcoming job needs Periodic visits to employers —networking is how jobs are found!

28. Systematic Job Development“Three Cups of Tea Approach” Employment specialists build relationships with employers: • "The first time you share tea with a Balti, you are a stranger. • The second time you take tea, you are an honored guest. • The third time you share a cup of tea, you become family..."

29. Principles of IPS #6: Competitive jobs are the goal

30. Competitive EmploymentIPS Definition

31. Principles of IPS #7: Pro-active benefits counseling Personalized benefits counseling is provided early & ongoing

32. Principles of IPS #8: Individualized job supports are time-unlimited and involve both ES and MH Practitioners

33. SUCCESS STORIES T 3 Faces, Part One: Matt’s Story 3 Lives www.IPSworks.org

34. Supported Employment Fidelity Scale

35. Why Measure Fidelity? • Sets the standards of practice • Faithful implementation of fidelity to the practice leads to desired consumer outcomes

36. Not ALL Supported Employment is CREATED EQUAL

37. Supported Employment Fidelity Scale • Practice guidelines for implementation and quality improvement. • 25-item scale • Three main sections: - Staffing - Organizational Structure - Services

38. Supported Employment Fidelity Scale 5-point response format (Likert scale) • 1 = no implementation • 5 = full implementation • Total Score=Degree of IPS implementation Scoring Scale • Exemplary Fidelity 115-125 • Good Fidelity 100-114 • Fair Fidelity 74-99 • Not EBP Supported Employment 73 and below

39. Three Main Areas in Fidelity Scale 1. Staffing E.g. Caseload Size – Full time Employment Specialists have no more than 20 clients. 2. Organization E.g. MH Executive team support for SE Executive team support for SE – MH provider ED, Clinical Sup, etc. assist with supported employment implementation & sustainability. 3. Services E.g. Rapid Job Search – First face-to-face employer contact by ES or client about a competitive job occurs within 30 days.

40. MH Funding for IPS

41. Costs Associated with IPS • Training and Consultation Phase 1-5 includes -Formation of Steering Committee -Readiness Assessment -Individual Region Training and Consultation -Fidelity Assessment -Evaluation of Pilot and Development 3 Region Collaborative total costs estimated at $40,000Over 15 month period

42. Costs Associated with IPS Continued • Employment Specialist Position -Full time Position Salary/ Benefits Training Office Space and Supplies Mileage/Travel 12% Indirect Costs Total Estimated Cost- $113,000 * over 15 month period (2018 rate for the NWIACC and the Sioux Rivers Region through contracted provider) *Subject to local costs of employment and level of offset due to reimbursement from other funding sources

43. Contracting • IPS Pilot Project includes Training and Consultation and IPS Employment Specialist Contracting with Employment Provider and between Regions (when collaboration is present); • Evaluation of Coordination with IVRS and MCO funding completed; • Review of the Program for Achievements in Individual Job Placement and Retention along with Program Community Based Progress may result in continued funding through regional contracting or other funding sources.

44. Resources on IPS Supported Employment IPS works.org IPS Employment Center

45. Iowa IPS Development & Implementation • IPS model presented to Hope Haven, Inc. Funders, Mental Health Providers, Regional, and State partners by TAC IPS • April 2015 – July 2017: Discussions between Hope Haven, Northwest Iowa Care Connections Region and Sioux Rivers Region • September 2015: TAC IPS presents at Iowa APSE Conference • August 2017: Minnesota DEED/VRS IPS Project Manager & TAC IPS staff present to Hope Haven, Inc. Funder, Mental Health Provider, and Regional partners • November 2017: Central Iowa Community Services Region joins IPS conversation with Hope Haven, Northwest Iowa Care Connections Region and Sioux Rivers Region • December 2017: Combined meeting of the three Regions, Funders, & State partners receive overview on IPS by TAC IPS and partners agree to move forward with creation of grant proposals for each Region, and to seek consultant(s) • February 2018: Secured personal Consultation & Training proposals from Claire Courtney & Kari Olson Lleva who fill those roles for MN DEED/VRS. Prepared 13 month operations grant proposals for Regions • February – March 2018: Three Regions each approved joint Consultation & Training proposal and operations grant proposals • March 2018: First meeting with IPS Consultant with Employment Service Provider, Funder, Mental Health Provider, and Regional partners • June 2018: Combined project “Kickoff Meeting” • July 2018: Service launches in each Region.

46. Consultation and Training:Service Delivery Planning • Phase #1: Formation of IPS Pilot Regional Steering Group • Phase #2: IPS Readiness Assessment (IPS Employment Center Tool) • Phase #3: IPS Introductory Kick-off Training – June 2018 • Phase #4: Individual Region Training and Consultation – March 2018 to June 2019 • Phase #5: Baseline Fidelity Assessment - conducted with each pilot/region • Phase #6: Evaluation of Pilot and development of next steps

47. Regional IPS Staff Training and Consultation • Systematic Job Development (1 day) – Employment Specialists • Using outcomes to supervise IPS (1 day) – IPS Supervisors • Specific training for MH partners/MH professionals – supporting integration of employment in mental health (half day) • Monthly technical assistance/consult with consultant and trainer for each region – one hour per month per Region • Monthly "Cross-Pilot Conversations" – phone/video with each Pilot facilitated by consultant.

48. Data Reporting • IPS Employment Center: National portal for states that join the IPS Learning Community Principles: • Simple • Transparent • Quarterly • Aggregate snapshot • Not longitudinal • No individual participant characteristics or demographics are reported

49. Data Elements • Number of New Enrollees • Number on caseload of ES • Number on caseload working during the quarter (unduplicated). • Number with new job starts in quarter • Number with exits during the quarter • Not employed at exit • Employed at exit • Number enrolled in and entering P-S Education • Number and FTEs of ESs • Number of people on Employment Supervisors’ caseload (if any)

50. IPS Supported Employment Sites - Quarterly Outcomes Report Report Period (check one): January – March July – September April – June October – December