The Evidence Based Practice of Supported Employment

Individual Placement & Support (IPS)

Introduction for State Rehabilitation Council (SRC)

May, 2014

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“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”.

-Dr. Robert Drake, VCU Web Course Interview,

Supported Employment for Persons with Severe Mental Illness

Setting the Stage

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1. Un-established practices are not based on research

Have no data to support effectiveness

Based on anecdotal evidence and/or professional judgment

Defining Practices: Source: Valaerie L. Mazzotti, Dawn A. Rowe, Renee Cameto, David W. Test and Mary E. Morningstar. Career Development and Transition for Exceptional Individuals 2013 36: 140 originally published online 24 September, 2013

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2. Promising practices are based on research

Have demonstrated limited success

Have used a “weak” research design for example: No Randomized Controlled Trials/RCTs

Defining Practices, cont’d:

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3. Evidence-Based Practices based on rigorous research

designs Efficacy & effectiveness empirically

validatedthrough a body of rigorous research replicated in a wide range of settings by multiple investigators

Randomized Controlled Trials (RCTs) Have undergone systematic review

process using quality indicators to evaluate level of evidence.

Defining Practices, cont’d

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Research-based:Efficacy and effectiveness empirically validatedthrough a body of rigorous research replicated in a wide range of settings by multiple investigators.

Standardized practice guidelines that describe critical ingredients of a well-defined and

“manual-ized” service approach.

Developed by real practitioners

Over Sixteen RCTs and meta analysis all support the same results-Improved Employment Outcomes

25 Item Fidelity Scale to measure implementation

IPS is an Evidence-Based Practice (SAMSHA)

IPS Model (Becker & Drake) researched and disseminated in the early 1990s with a few refinements.

IPS=EBP-SE

Becker & Drake: “A Working Life” (1991)

Findings~> Produces superior employment outcomes when

fidelity to the core practices is maintained. There is no research evidence that anything

“adverse” happens to employed persons with psychiatric disabilities. (Bond, 2001)

IPS research is robust & compelling

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11,159 people enrolled 40% of those people worked in a competitive job during the quarter. (Jan-March, 2013) 2013 Average across all quarters = 43% (range 38%-55%)

Transformation to IPS Program (former EE SMI)

State Grant Application

Agencies must be CARF accredited and have PT contracts with VRS. This allows for agencies to use both VRS purchase of service funds for job placement time limited services and State grant fund dollars for extended employment supports (aka long term supports)

In SFY 14 & 15: the historic EE SMI program is transforming to IPS because of changes to the funding language for the program made in M.S. 268A. 13-14 made in 2013 Legislative Session

Historic “EE SMI” projects are transformed to IPS.

2013 Minnesota legislature (Minnesota Session Laws of 2013, Chapter 85, HF 729 for “d) grants to programs that provide employment support services to persons with mental illness under Minnesota Statutes, sections 268A.13 and 268A.14.”). These funds were intended to transform projects historically funded as EE SMI projects to the Individual Placement and Support (IPS) approach, also known as the evidence based practice of supported employment.

$1.55 million, plus $500,000 additional in one-time funds for SFY 14-15

2013 Changes in Minnesota Legislation effective 7/1/13 (SFY 14) under 268A.13

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IPS GrantsSFY 13 = $470,000 in VR grants; $285,00 in SMI grants= $755,000

167 individuals working across six agencies Average wages/hour = $9.80 Average hours worked/week =19 Average hours per week worked=22 Total wages-$685,000

Johnson and Johnson Corporate Contributions and Dartmouth PRC

Started in 2001 with 3 States Minnesota joined in 2006 and

received a 4 year grant for implementation and training

16 States (including D.C. & a County in CA)

International: Spain, Italy & Netherlands

Six projects were established between 2006 and 2013 with VR grant funds

J & J Dartmouth International Learning Collaborative

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States Participating in IPS Learning Collaborative (2013-14)

ppt-toolkit.com

U.S.: Colorado, Connecticut, Illinois, Kentucky, Kansas, Maryland, Minnesota, Missouri, North Carolina, Ohio, Oregon, South Carolina, Vermont, Wisconsin, District of Columbia & Alameda County, California.

IPS in MN

2013

14

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IPS grant funds in 2014Green=Established

Blue=Transformation

Light Blue=Not grant funded (includes 2 Goodwill/Easter Seals projects in Ramsey County)

IPS in Minnesota in 2014

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What to expect from the IPS transformation in SFY 2014

Increased IPS services for up to 200 individuals with SMI Nine NEW community MH Program Partners: Blue Earth

County-the Hub, Lee Carlson Center/Bridgeview, Hennepin County MH Center, Hiawatha Valley MH Center, SW Mental health Center, Western MN Center, NW MH Center, Sanford Health, Woodland Centers.

Expansion with Canvas Health, Lakeland MH Center and Central MN MH Center and Guild Incorporated

Five NEW Community Rehab. Partners doing IPS: MRCI,WORC, PAI, Hope Haven and ODC

Eleven new VRS offices partnering and expansion with two VR offices

Increased IPS service delivery in at least 17 new counties: Dakota, Sherburne, Stearns, Benton, Ottertail, Wilken, Hennepin, Winona, Fillmore, Houston, Wabasha, Nobles, Cottonwood Jackson, Rock, Blue Earth and Douglas.

Expansion of IPS in at least two counties: Anoka and Washington

Quarter=Snapshot Quarter 1-2013 Quarter 2-2013 Quarter 3-2013 Quarter 4-2013

Number Served 188 205 186 225

Number Working 90 104 108 126

Employment Engagement Rate

48% 51% 58% 56%

MN Data from last Quarter-reported to Dartmouth PRC 6 projects (Calendar Year 2013)

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1) Integration of employment with mental health treatment

2) Zero exclusion3) Individual preferences are honored4) Rapid engagement5) Systematic job development6) Focus on competitive employment7) Proactive benefits counseling8) Time unlimited individualized job

supports

Eight principles of IPS

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Video produced by Johnson and Johnson Dartmouth Community MH Program

3 Faces, 3 Lives

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1. IPS employment services are integrated with mental health treatment services

Eight Principles of IPS

Types: Under One Roof ~OR~ Part of Neighborhood

Components: Collaboration, not a Referral only, & Not brokered services

Maximize Braided Funding with emphasis on Partnering

Employment is focus of collaboration-not a separate event

Formation of multi-disciplinary team structured to work together

Minnesota’s Models of Collaboration Key Components

Why Integrate? (Bond, 2001)

◦ Lower dropout rate for consumers/customers

◦ Better communication

◦ Clinicians get involved

◦ Clinical information incorporated into employment plan

Integration of employment services and MH treatment services

What is a “ Treatment Team” ?

Regular daily contact

Ideally, ES is co-located with MH Team

Meet as least weekly to discuss cases & share clinical information

Shared treatment plan decision making (consumer makes the final call)

ES coordinates employment plans with treatment team.

Ideally, one integrated case record

People receiving

MH Services

Case Manag

ers

SubstanceAbuse

specialist

Psychiatric Nurse

PsychologistPublic

VR Counselo

r

Employment

Specialist

Housing Support

s

Rehab Option

Staff & Peer Specialists

Psychiatrist

Mental Health Treatment Team

2. Zero Exclusion: Every person who wants to work is

eligible

Principles of IPS

SOC Employment Pre-contemplation not thinking about work

Contemplation considering work

Preparation wants to start job search

Action job search/employment

Maintenance follow along supports

No ReadinessIndividual’s Stages of Change

3. Individual preferences are honored

Principles of IPS

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Research shows people with serious mental illness generally have realistic ideas about what work

they can do, how many hours a week they can

work, and what work environments are good

or bad for them. (Becker& Drake, 2003)

Preferences Are Honored

4. Rapid Engagement in Job Search

The job search starts soon after a person expresses interest in working

Principles of IPS

Principles of IPS

Established based on person’s work preferences, face-to face with multiple visits

Focus on the employer’s needs Find jobs that they may not be

advertised Gather information about

upcoming job needs Periodic visits to employers—

Networking is how jobs are found!

5. Systematic Job DevelopmentEmployment 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..."

Systematic Job Development, cont’d

“Three Cups of Tea Approach”

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Principles of IPS

6. Competitive jobs

are “The Goal”

Competitive EmploymentIPS definition

Pays at least minimum wage and the wage that others receive performing the same work,

In community settings alongside others without disabilities,

Open to anyone to apply for-not reserved for people with disabilities.

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Principles of IPS

7. Proactive Benefits counseling

Personalized benefits counseling is provided

Principles of IPS

8. Individualized

job supports are

Time-UN-limited

People with severe mental illness can work in competitive employment

Programs following evidence-based principles of supported employment /IPS have better outcomes

Integration of employment and mental health is what makes IPS different than other approaches to supported employment

Programs must address financial and organizational barriers to be successful

Summary

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Dartmouth Psychiatric Research Centerhttp://www.dartmouth.edu/~ips/

Resources on IPS Supported Employment

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Claire Courtney, M.S., CRCMN DEED –Vocational Rehabilitation Services

Senior Rehabilitation Program Consultant651-259-7346

claire.courtney@state.mn.us

Melinda Shamp, M.S., LSW, CPRPDHS - Adult Mental Health Division

Mental Health Program Consultant/Employment Policy

651-431-4375melinda.m.shamp@state.mn.us

Minnesota State IPS Implementation Team

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