Supported Employment: The Individualized Placement and Support IPS Approach

1. Supported Employment: The Individualized Placement and Support (IPS) Approach Sarah Swanson Dartmouth PRC, 11/09

2. IPS Supported Employment Approach designed for persons with serious mental illness who wish to work An evidence-based practice

3. Presentation Outline Evidence for effective employment services Components of IPS/Evidence-Based Supported Employment Implementation lessons from the National EBP Study and Johnson & Johnson-Dartmouth Community Mental Health Program

4. Where we�ve been�where we are� Research for IPS supported employment began in the mid 1980�s Johnson & Johnson-Dartmouth Community Mental Health Program: 12 state learning collaborative Focus on VR partnership; 140 sites National EBP Project taught us about implementation

5. Where we are� Revised fidelity scale in 2008: Approach is more carefully defined with a longer scale Focus on job development that was not included in previous scale Stronger focus on role of agency administration in helping with implementation and sustainability Partnership with VR Mental Health Treatment Study with SSA

6. Where we are going Johnson & Johnson-Dartmouth Program is to work with other countries. Interest in learning about best approaches for providing help with supported education within IPS Early intervention and IPS Understanding the variability between employment specialists and programs

7. �Supported Employment? Oh, we do that!�

8. Evidence for Supported Employment 11 completed randomized controlled trials of good fidelity SE/IPS 6 day treatment conversion studies 7 correlational studies of fidelity and supported employment (Bond, 2008)

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10. Summary: RCTs of Supported Employment/IPS In 11 of 11 studies, SE had significantly better competitive employment outcomes than controls Mean across studies of consumers working competitive at some time: 61% for supported employment 23% for controls (Bond, 2008)

11. 6 Day Treatment Conversions to Supported Employment Day treatment programs discontinued. Day treatment staff reassigned to other positions in center. Supported employment staff hired.

12. Similar Results in All 6 Day Treatment Conversions Large increase in employment rates. No negative outcomes (e.g., relapses) Consumers, families and staff liked the change Most people got out into the community, even if not working Some people missed social (place for consumer operated services?)

13. Mean Competitive Employment Rates in 6 Day Treatment Conversions

14. Correlation Between IPS Fidelity & Competitive Employment

15. Nuechterlein Study of First-Episode Schizophrenia

16. Long-term IPS Follow-Up Studies Salyers (2004). 10 year follow-up: - 47% still working. - 92% worked during follow-up. - Of those that worked, 33% worked more than half the follow-up period. Becker (2007) 8 &10 year follow up: - 71% still working. - 82% worked during follow-up. - Of those that worked, 71% worked more than half the follow-up period.

17. Other Outcomes Work outcomes improve over time. Costs decrease dramatically for consistent workers (Bush, in prep)

18. Positive Outcomes from Competitive Work Higher self-esteem Better control of psychiatric symptoms More satisfaction with finances and leisure (Bond, et al., 2001)

19. Positive Outcomes from Competitive Work No increase in psychiatric hospitalizations or any other negative outcomes. Significantly greater reduction of hospitalization for IPS participants in two studies. (Burns, 2007; Henry, 2004)

20. Evidence-based Supported Employment Principles All interested clients are eligible Team approach Competitive Employment Personalized benefits planning Rapid job search Continuous follow along supports Client preferences are important

21. 1. We Can�t Predict Who Will Work

22. 2. Supported Employment is Integrated with Mental Health Treatment Employment specialists communicate frequently with mental health practitioners to celebrate successes, suggest employment for clients and to generate solutions for clients.

23. VR Collaboration Some evidence to suggest that when people have access to both systems? better outcomes. Monthly meetings, shared office space, VR liaisons�

24. 3. Competitive Employment Is the Goal Nobody had the goal of working in a janitorial enclave when they were in high school. Consumers interested in employment are not steered into volunteer jobs, enclaves, or sheltered work. Research has been published on the conversion of 6 different day treatment programs to supported employment in New Hampshire, Rhode Island, and Massachusetts. The findings have been consistent: Better employment outcomes, especially for regular attenders of day treatment (If you can make it to day treatment, you probably are going to be conscientious about making it to a job.) No negative outcomes (no increase in hospitalizations, dropouts, symptoms, homelessness, etc.) Programs that treat supported employment as an add-on while retaining other vocational options have poorer employment outcomes (Drake, 1998; Gowdy, 2000) Agencies that devote resources to sheltered workshop, agency-run businesses, and other noncompetitive work options often become diverted from the goal of competitive employment (Mank, 1994). Research has been published on the conversion of 6 different day treatment programs to supported employment in New Hampshire, Rhode Island, and Massachusetts. The findings have been consistent: Better employment outcomes, especially for regular attenders of day treatment (If you can make it to day treatment, you probably are going to be conscientious about making it to a job.) No negative outcomes (no increase in hospitalizations, dropouts, symptoms, homelessness, etc.) Programs that treat supported employment as an add-on while retaining other vocational options have poorer employment outcomes (Drake, 1998; Gowdy, 2000) Agencies that devote resources to sheltered workshop, agency-run businesses, and other noncompetitive work options often become diverted from the goal of competitive employment (Mank, 1994).

25. 3. Competitive employment is the Goal Programs that treat supported employment as an add-on while retaining other vocational options have poorer employment outcomes (Drake, 1998; Gowdy, 2000)

26. 4. Personalized Benefits Planning is Provided Benefits planning (work incentives planning) and guidance help clients make informed decisions about job starts and changes. Help reporting income as needed.

27. 5. Job Search Starts Soon After A Consumer Expresses Interest in Working Typically face-to-face contact with employers beings within a few weeks of meeting with an employment specialist.

28. 6. Follow-Along Supports are Continuous Employment specialists provide supports for as long as desired by clients until the job is stable. Typically, SE supports are provided for at least a year. Mental health practitioners may help with longer term supports.

29. 7. Consumer Preferences are Important Job finding is based on consumers preferences, strengths and anticipated needs, rather than jobs that are easy to find.

31. Supported Employment Fidelity Fidelity refers to providing the service in a manner consistent with the model that has been shown to be effective. Can be used as a quality improvement tool. Scale was revised in January 2008.

32. Supported Employment Fidelity External fidelity reviewers are highly recommended. Written action plans to improve fidelity will help agency move forward. Fidelity kit is available from: http://dms.dartmouth.edu/prc/employment

33. Implementation Lessons from the National EBP Project 5 evidence-based practices: SE, IMR, FPE, ACT, IDDT 53 sites in 8 states Programs studied for 2 years.

35. National EBP Study

36. Key Factors in Implementation Build Consensus Maximize Financing Use the Supported Employment Fidelity Scale (updated 1/08) Sustain through ongoing training and outcomes The three phases of implementing a program include: motivating, enacting, and sustaining. Six stakeholder groups participate in each of these phases: consumers, families, practitioners, program leaders, state and county mental health authorities.The three phases of implementing a program include: motivating, enacting, and sustaining. Six stakeholder groups participate in each of these phases: consumers, families, practitioners, program leaders, state and county mental health authorities.

37. Summary People with serious mental illness can work in competitive jobs. Programs that follow evidence-based principles (and use fidelity) have better outcomes. Programs should plan implementation strategies.

38. Resources Available from Dartmouth PRC Supported Employment: A Practical Guide for Practitioners and Supervisors (2008) SE Fidelity Toolkit (includes revised SE fidelity scale, DVD�) Posters, demonstration DVDs, brochures, SE newsletter: http://dms.dartmouth.edu/prc/employment

39. For More Information: �including an online training program, training manuals, employment posters, demonstration DVDs, fidelity materials, and program tools, visit our website: http://dms/dartmouth.edu/sec