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Updated 2/12/14 by Gary Bond

Evidence for the Effectiveness of Individual Placement and Support Model of Supported Employment. Updated 2/12/14 by Gary Bond. Presentation Outline. Role of work in recovery Core principles of Individual Placement and Support (IPS) Evidence for effectiveness Implementation strategies.

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Updated 2/12/14 by Gary Bond

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  1. Evidence for the Effectiveness of Individual Placement and Support Model of Supported Employment Updated 2/12/14 by Gary Bond

  2. Presentation Outline • Role of work in recovery • Core principles of Individual Placement and Support (IPS) • Evidence for effectiveness • Implementation strategies

  3. Why Focus on Work? • Most clients want to work! • Most clients see work as an essential part of recovery • Being productive = Basic human need • In most societies, typical adult role • Most clients live in poverty • Working may prevent entry into disability system

  4. Most Clients Want Jobs in Competitive (Open) Employment • Regular community job • Pays at least minimum wage • Nondisabled coworkers • Not temporary or “make work” • Job belongs to the client, not to the mental health or rehabilitation agency

  5. Expressed Interest in Employment Reported in 8 Surveys

  6. The Gap Between Need and Access • 2/3 want to work • 1%-2% have access to evidence-based employment services (SAMHSA, 2009; Brown, 2012, Twamley, 2013) • 15% employed at any time (Lindamer, 2003; Pandiani, 2012; Perkins, 2002; Rosenheck 2006; Salkever, 2007)

  7. Core Principles of the Individual Placement and Support (IPS) Model

  8. TraditionalIPS AssumptionsAssumptions

  9. IPS Principles • Open to anyone who wants to work • Focus on competitive employment • Rapid job search • Systematic job development • Client preferences guide decisions • Individualized long-term supports • Integrated with treatment • Benefits counseling included

  10. Research Evidencefor Effectiveness

  11. 6 Day Treatment Conversions to Supported Employment: Common Study Design • Discontinued day treatment • Reassigned day treatment staff to new positions • Implemented new supported employment program • Compared to 3 sites not converting Sources: Drake and Becker

  12. Cumulative Employment Rates for 6 Sites Converting to IPSvs. 4 Control Sites

  13. Similar Results in All Day Treatment Conversions • Large increase in employment rates • No negative outcomes (e.g., relapses) • Clients, families, staff liked change • Overall, all former day treatment clients got out into community more • Resulted in cost savings

  14. 20 Randomized Controlled Trials (RCTs) of Individual Placement and Support (IPS) • Best evidence available on effectiveness • RCTs are gold standard in medical research: Random assignment = Participants assigned by a flip of a coin

  15. Competitive Employment Rates in 20 Randomized Controlled Trials of Individual Placement and Support

  16. Overall Findings for 20 RCTs • All 20 studies showed a significant advantage for IPS • Mean competitive employment rates for the 20 studies: • 57% for IPS (Median = 60%) • 24% for controls (Median = 26%) (Each study weighted equally in calculating mean rates)

  17. Four Measurement Domains of Employment Outcomes • Job acquisition (% employed) • Job duration (weeks worked) • Hours worked per week • Total hours worked/earnings (Bond,Campbell, & Drake, 2012)

  18. 18-Month Competitive Employment Outcomes in 4 Controlled Trials of IPS (Bond, Campbell, & Drake, 2012)

  19. Competitive Employment Duration 2-Year Follow-up After IPS Job Start (Bond & Kukla, 2011)

  20. IPS for SSDI Beneficiaries Mental Health Treatment Study (MHTS) (Drake et al. submitted) • Large multi-site controlled trial • Recruited SSDI beneficiaries with mental illness • Most were not receiving community mental health services • Unemployed at baseline

  21. MHTS Design • Study population: Cold calls to SSDI beneficiaries on SSA rolls • 23 communities throughout US • Randomized controlled trial • Intervention group: IPS + other mental health services • Control group: Usual services • Two-year follow-up

  22. MHTS Sample • 14% of nearly 16,000 beneficiaries contacted agreed to participate • Final sample: 2,055 Intervention: 1,004 Control: 1,051

  23. Monthly Paid Employment Rates in MHTS Overall Employment Rates: Intervention: 61% Control: 40%

  24. What About Long-Term Outcomes? • Many psychosocial interventions produce improvements in short-term outcomes • BUT improvements often disappear over the long term • True for IPS?

  25. 2 Long-Term IPS Follow-up Studies (Salyers 2004; Becker, 2007) Clients also reported: Greater self-confidence and hopefulness, more energy, less loneliness and boredom

  26. Conclusion: IPS Has… Strong Evidence for Effectiveness Across a Range of Employment Measures, Including Long-Term Outcomes

  27. Impact of IPS on Recovery

  28. Is Work Too Stressful? • As compared to what? • Joe Marrone: If you think work is stressful, try unemployment

  29. Benefits of Steady Competitive Employment • Improved self esteem • Improved social networks • Increased quality of life • Reduced psychiatric symptoms • Reduced substance use • Less use of disability system Arns, 1993, 1995; Barreira, 2011; Bond, 2001; Burns, 2009;Drake, in press: Fabian, 1992; Krupa, 2012; Kukla, 2012; McHugo, 2012; Mueser, 1997; Van Dongen, 1996, 1998; Xie, 2005

  30. Conclusion:Steady Employment Contributes to Long-Term Recovery

  31. IPS Implementation • National EBP Project (McHugo, 2007) • IPS Learning Collaborative (Becker. 2011)

  32. Fidelity • Fidelity defined as: the degree to which a service model is implemented as intended • Working hypothesis: Better implemented programs (with higher fidelity) have better outcomes

  33. Implementation Factors in National EBP Project • After 2 years, 29 (55%) of 53 sites implemented at high fidelity • Training, staff attitudes, and barriers not predictive • Strongly predictive: • Leadership at all levels • Integration of new practices into work flow (Torrey, Bond, et al., 2011)

  34. 8 Keys to Implementing IPS • End old ways of doing things (e.g., day programs) • Use fidelity reviews as guide • Exercise leadership: • Agency directors provide resources • Supervisors set firm behavioral expectations

  35. 8 Keys to Implementing IPS(continued) • Hire and retain staff suited for IPS • Provide field mentoring • Collaborate closely with treatment teams • Track indicators you want to improve (Bond et al., 2008)

  36. IPS Learning Collaborative(Becker et al., 2011) • Launched in 2002 • Grown to 130 programs in 14 states • 83% of programs joining since 2002 have been sustained

  37. .

  38. Features of IPS Learning Collaborative • Provide time-limited seed money • Create position of IPS state leader • State agency buy-in (MH and VR) • Start small, grow gradually • Commit to fidelity and outcome reporting • Nurture mechanisms for sharing of experiences

  39. IPS Fidelity and Outcomes in 88 Sites in Learning Collaborative (Bond et al., 2012)

  40. Conclusions • Employment is a key to recovery • IPS is an effective program to achieve this goal • Learning collaborative best way to implement IPS widely

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