IPS in Iowa

1. IPS in Iowa Jackie Pogue, IPS Employment Center Lin Nibbelink, DHS-MHDS Sue Ann Morrow, U of IA UCEDD Iowa Community of Practice July 16, 2019

2. True or False: IPS doesn’t work for people with serious mental illness who have a lot of problems. • True or False: IPS requires that you get someone a job as quickly as possible. • True or False: People with mental illness deserve to live full lives in their communities, including meaningful activity, meaningful relationships, and other aspects of recovery.

3. Iowa’s Employment Vision “Employment in the general workforce is the first priority and the expected and preferred outcome in the provision of publically funded services for all working age Iowan's with disabilities.”

5. 2019 Focus Bring Individual Placement and Support (IPS) to select Mental Health and Disability Service Regions. IPS has been shown to work very well for people with serious mental illness and multiple challenges.

6. EFSLMP Deliverable: Train & provide TA on IPS to staff from a community mental health center, an integrated health home provider, and participating employment-service agencies.

7. Technical Assistance Southern IA SME (SEIL Region): Jackie Pogue, Westat, IPS Employment Center Northern/N-Ctrl IA SMEs (Sioux Rivers, NWICC, CICS Regions): Claire Courtney, Sr Rehab Consultant, MN VR Kari Olson Lleva, MN IPS Trainer, KOL Consulting

8. Positives • Great Baseline fidelity review scores • 42% - 50% of active IPS clients in 3 pilots are currently working due to IPS • $$: 60% Medicaid MCOs, 40% Voc Rehab • Mental Health team well established in 1 location & significant progress elsewhere • Excellent collaboration among partners • Referrals flow as IPS becomes “known”

9. Challenges experienced • Team formation (co-location; record-sharing) • Staff turnover • Low # of initial referrals • Dedicated commitment from participants (time to invest) • Fully funding IPS (enabling providers to cover their costs; funding IPS Trainers, Fidelity Reviewers) • Documentation, tracking

10. Learning from other states… • How have they done it? • What tips do they have for us? • Who? … # IPS sites? Since? • Illinois 55 2007 • Kentucky 14 2010 • Colorado 14 2011 • Utah 11 2014

11. Why Focus on Employment? Employment and education are seen by many as an essential part of their mental health recovery. Research tells us that 60-70% of people with serious mental illness want to work. However, fewer than 15% are employed.

12. Why Focus on Employment? Work and school are typical roles for adults Employment is associated with increased income, improved self-esteem and social networks, increased quality of life, better symptom control, and reduced substance abuse Unemployment can lead to increased poverty, alienation and apathy, more substance abuse, and more health problems Steady workers have reduced treatment and public benefit costs

13. Why IPS? • IPSworks the best for people with mental health challenges. People are almost 2.5 times more likely to get a job with IPS than other vocational approaches. • Also shown effective for people receiving TANF, people with SUD, PTSD, spinal cord injuries, older adults, people who are homeless, people with criminal justice involvement, and young adults.

14. Quotes from IPS Clients I’m respected now. I don’t wake up mad and upset anymore. I like making money to help my family pay the bills. I’m doing exactly what I want to be doing. Now there is more peace and certainty in my life. I like being in mainstream society as opposed to living a sheltered life. Working helps me manage my depression. My mood is more positive. I feel like I have a purpose now and every day I get up feeling good that I have a job. I feel better about myself now that I am working and contributing to society.

15. 8 Practice Principles of IPS Zero exclusion: eligibility is based on the person’s choice. IPS services are closely integrated with mental health treatment. Competitive employment/education is the goal. Personalized benefits and work incentives planning is provided.

16. 8 Practice Principles of IPS, Cont. • The job search starts soon after someone expresses interest. • IPS specialists develop relationships with employers and schools based on people’s preferences. • Retention supports are continuous. • People’s preferences are honored.

17. IPS Research Evidence • 26 Randomized controlled trials (RCTs) • RCTs are the best evidence available on effectiveness • 12 U.S. studies and 14 outside U.S. • 2/3 of studies had at least 18-month follow-up • Total enrollment = 5,877 participants • In most studies, the control group received services as usual (sometimes best practices)

18. Details of 26 IPS RCTs

19. Competitive Employment Rates in 26 RCTs of IPS

20. Overall Findings for 26 RCTs • 25 of 26 studies showed a significant advantage for IPS (Study in China was borderline significant) • Mean competitive employment rates for the 26 studies: • 55% for IPS • 23% for controls

22. IPS Is Effective Across Many Subgroups of People with Serious Mental Illness • Men and women • All age groups • Diverse ethnic and racial backgrounds • Both extensive and little or no work history • All levels of educational attainment • Mild or severe psychiatric symptoms • Extensive hospitalization history

23. Expanding IPS to new populations People with: • Spinal cord injuries • Autism spectrum disorders • Intellectual disabilities • Substance use disorders • Common mental disorders • Chronic medical conditions • TANF benefits (Temporary Aid to Needy Families)

24. Competitive Employment Rates in Evaluations of IPS for New Populations

25. IPS Fidelity • Quality improvement tool that leads to improved outcomes • Well-validated, 25-item fidelity scale • Each item is scored from 1-5, with 5 being full implementation. Max of 125 points. • Ratings made by independent fidelity assessors during 2 day site visit

26. International IPS Learning Community 24 states/regions in US 6 countries ~20,000 clients served per quarter

27. International IPS Learning Community

28. Role of the IPS Specialist • Provides only employment and education services • Carries out all phases of the vocational service for each person • Maintains a caseload of up to 20 people who are at varied stages of job searching, job retention, and education status • Spends at least 65% of entire work week in the community providing services and job developing • Is included as a full member of the clinical team and attends weekly meetings

29. Role of the IPS Supervisor • Provides weekly supervision to the IPS specialist; if supervising more than one specialist, also provides a weekly IPS team meeting • Conducts monthly field-based supervision where employers are visited • Tracks data and outcomes and reports quarterly • Champions the value of work to the clinical team and helps solve operational problems

30. Discussion

31. Iowa Contacts Lin Nibbelink, LISW, Employment Policy Planner DHS Division of Mental Health & Disability Services 1305 E Walnut St, Des Moines IA 50319 Email: lnibbel@dhs.state.ia.us Ph: (515) 281-3023 Fax: (515) 242-6036 Sue Ann Morrow, PhD., Money Follows the Person University of Iowa, UCEDD/CDD Mount Pleasant IA Ph: (319) 430-8710 Mobile Email: sueann-morrow@uiowa.edu

32. Contact Information Jackie Pogue, MA Research Associate and IPS Trainer IPS Employment Center 85 Mechanic St, Suite C3-1 Lebanon, NH 03766603-676-7552jackiepogue@westat.comwww.ipsworks.org