Individual Placement and Support IPS/Supported

Employment: An Evidence-Based

Practice

Debbie Homan- CRSS-E DMH Williams/Colbert IPS Trainer

Matt Christensen- DMH IPS Trainer Region 1 & 2

Objectives

What is IPS Supported Employment

Employment and Recovery

Principles of IPS

Implementing IPS with Job Seekers

IPS Fidelity

Prevalence and Expansion of IPS

Philosophy

Belief that every person with

a disability is capable of

working competitively in the

community if the right kind of

job and work environment

can be found

IPS is an

Evidence-

Based

Practice

“An evidence-based

practice is a CLINICAL

INTERVENTION which has

been consistently shown

in several research

studies to assist

CONSUMERS in achieving

their desired goals of

health and wellness.”

www.mentalhealthpractices.org

Evidence Based Practice

Program model validated by rigorous research (different investigators)

Definable Measurable Outcomes

Has guidelines describing critical components

Has a treatment manual

Statistics on Supported EmploymentCompetitive Employment Rates

25 Randomized Controlled Trials of IPS

Overall

Findings

for 25

RCTs

All studies showed a significant

advantage for IPS

Mean competitive employment rates:

•56% for IPS

•23% for controls

Job Seekers in IPS:

•Attain employment faster, hold jobs longer and work more hours.

Long Term RCT for IPS:

•3x more likely to achieve employment

•Worked 4x as many hours

For most people Employment is

a part of Recovery

2/3 of people with serious mental illness want to work

but only 15% are employed.

Until the 1990s, no models found effective in helping

people with SMI get stable competitive employment

Work is the best treatment we have for serious mental

illness (i.e., people with schizophrenia spectrum

disorder, bipolar, or depression). (Luciano, Bond, &

Drake, 2014).

Only 2.1% of clients with SMI in the U.S. public mental

health system receive IPS

Benefits of Steady

Competitive Employment

Increased Income

Improved Self Esteem

Improved Social Networks

Increased Quality of Life

Better Control of Symptoms

Reduced Substance Use

Viewed by Many as Essential Part of Recovery

Typical Role for Adults in our Society

Cost-effective Alternative to Day Treatment

Reduced Use of Mental Health Services

8 Principles of

IPS Supported

Employment

Evidence-Based IPS

Principles

Competitive Employment is the Goal

Zero Exclusion

Client Preferences Honored

Integration of Vocational and Mental Health Treatment services

Benefits Counseling

Rapid Job Search

Employment Specialists Build Relationships with Employers

Follow Along Supports are Time Unlimited

Competitive Employment is

the Goal

Focus on community jobs

Work settings includes

people who do not have a

disability

Pay at least minimum wage

Part-time and full-time

Volunteer jobs, enclaves, or

training programs are not the

goal

Zero Exclusion IPS programs welcome any person who

expresses interest in work

People are never excluded due to

Legal Histories

Symptoms of MI

Decisions about Treatment

Personal Presentation

Missed Appointments

Substance Use Disorder

Homelessness or Unstable Housing

Cognitive Disorders

Past Problems with Employment

• Eligibility based on job seeker choice

Client Preferences are Honored

Choices and decisions about

work and support are

individualized

Based on the person’s

preferences, strengths, and

experiences

Not on a pool of jobs that are

available

Even the way that SE services

are provided should be based

upon client preferences

Integration of Vocational and Treatment Services

Coordinated services between

the treatment team that are

seamless (mental health

team, voc team, therapist,

psychiatrist, housing etc.)

Family (if possible and as self

defined) should be involved in

integration

Integrated, multidisciplinary

approach- not parallel

interventions in separate

agencies or systems

Personalized Benefit Planning is Provided

Important part of decision making process

Clear information of how work will affect ones entitlements is vital

Should happen as soon as job seeker is starting to talk about work

One-on-one benefits planning sessions between job seeker and an expert (State benefit planner, City of Chicago benefit planner, DRS, etc.) should be set-up by employment specialist

Rapid Job Search

Job search starts soon after job

seeker expresses interest in

working

No extensive pre-employment

assessment and training

Initial assessment is done quickly

Gathers information

Discuss with treatment team

Develop employment plan

Adjust as needed

Employment Specialists Build

Relationships with Employers

Employment specialists build relationships with employers based upon job seeker interests

Employment specialists meet face-to-face with employers over time to learn about their business needs and the positions in their business

Each specialist makes at least six employer contacts each week with a person who has hiring responsibilities

If job seeker does not want to disclose ES can still gather and share information about a business or opportunity

Job Supports are Time

Unlimited

Individualizes supports

to maintain

employment

Time Unlimited- as

long as job seeker

want the assistance

Types of supports are

diverse

Implementing

IPS

Implementing IPS

Referral

Get the Word Out

Process Simple

Engagement

• Identify Supports/Strengths

• Treatment team involved

• Discuss Benefit Counseling

Assessment

Develop Voc Profile

Gather Information

Revise and Update Job Finding

Begin Individualized Job Search (30 days)

Disclosure Discussion

Build Social Capacity/Network

Planning for Success

Starting a Job First Day Worries

Friends and Family

Work Day Schedule

Transportation

Dressing for Work

Arriving at Work

Revisiting Benefits Counseling

Maintaining a Job Wages and Benefits

Disclosure of Mental Illness

Accommodations and Support

Work Tasks

People at Work

Family and Friends Support

Additional Services

Resume Building

Preparing for Interviews

Job Shadow

Job Exploration

Job Maintenance

Natural Supports

Utilizing Community Resources

Identifying Roles & Responsibilities

Financial

-Education

-Literacy

-Empowerment

Leaving a Job

Appropriate Job Leaving

Maintaining Relationships

Celebrating Success

Working Again

IPS Fidelity

Supported Employment

Fidelity Scale

An accuracy scale that has

been developed to measure

“the adequacy of

implementation” of Supported

Employment programs

125 Criterion:

Scored on a scale of 1-5

115-125 = Exemplary Fidelity

100-114 = Good Fidelity

74-99 = Fair Fidelity

73 and below = Not IPS

Staffing

1) Manage Caseloads of up to 20

2) Provide only vocational services

3) Carry out all phases of vocational service

(engagement, assessment , job

development, job placement, job coaching,

and follow-along supports)

Organization

1) Integration of rehabilitation with mental health

treatment (team assignment)

2) Integration of rehabilitation with mental health

treatment (frequent team contact)

3) Collaboration between ES and DRS

4) Vocational unit

5) Role of employment supervisor

6) Zero exclusion criteria

7) Agency focus on competitive employment

8) Executive team support for SE

Services

1) Work incentive planning

2) Disclosure

3) Ongoing, work-based vocational assessment

4) Rapid job search for competitive job

5) Individualized job search

6) Job development – Frequent employer contact

7) Job development – Quality of employer contact

Services

8) Diversity of job types

9) Diversity of employers

10) Competitive jobs

11) Individualized follow-along supports

12) Time-unlimited follow-along supports

13) Community based services

14) Assertive engagement and outreach

Prevalence and

Expansion of IPS

IPS in Illinois

One-stop source on IPS/Supported Employment for Illinois citizens with psychiatric disabilities, their

employers, and service providers.

Pathways to Employment

Putting Illinois to Work

VISIT US AT: http://www.illinoisips.org/

The Day the Voices Stopped

“…I feel so strongly about the need

to be given meaningful work instead

of the make-busy tasks or rote

assignments that make up the bulk

of what we are offered. If people

are treated as capable they often

surprise everyone and live up to

expectations.”

-Ken Steele

“Recovery”

Beliefs for IPS Programs

• In order to effectively provide

Employment via Individual Placement &

Support programs, all staff providing

mental health services, need to believe

that people with mental illnesses:

• Can and do recover

• Learn, achieve and grow through

success and failure experiences

• Stagnate when they are sheltered

from real life experiences

“If you think work

is stressful

try unemployment” -Joe Marrone at the Institute of Community Inclusion

According to Peter Warr in his book – Work,

Unemployment and Mental Health – “The side effects

of Unemployment in the General Population are the

following:”

Increased Substance Abuse

Reduced Self-Esteem

Increased Physical Problems

Loss of Social Contacts

Increased Psychiatric Disorders

Alienation and Apathy

Contact Information

Debbie Homan CRSS-E

DHS/Division of Mental Health

Williams/Colbert IPS Trainer

Chicago Read

Mental Health Center

4200 N. Oak Park Ave.,

Chicago, IL 60634

Deborah.Homan@illinois.gov

ph: 773-794-4255

Matt Christensen

DHS/Division of Mental Health

Region 1 & 2 IPS Trainer

Chicago Read

Mental Health Center

4200 N. Oak Park Ave.,

Chicago, IL 60634

Matthew.Christensen@illinois.gov

ph: 773-794-4249

References: Becker, D.R. (2005) PSR 101: Supported Employment: A working Life for People

with Serious Mental Illness. An audioconference presented 3/23/05 from

3:00pm – 4:00pm EST

Becker, D.R., Drake, R.E., & Naughton Jr., W.J. (2003) Supported Employment

for People with Co-Occurring Disorders. Psychiatric Rehabilitation Journal, 27(3), 332-338

Becker, D.R., & Drake, R.E. (n.d.) Supported employment for people with severe

mental illness: A guideline developed for the Behavioral Health Recovery Management Project. (Available from Deborah R. Becker, New Hampshire-Dartmouth Psychiatric Research Center, 2 Whipple Place, Suite 202, Lebanon, NH 03766

Bond, G.R., Becker, D.R., Drake, R.E., & Vogler, K.M. (1997). A fidelity scale for

the Individual Placement and Support model of supported employment. Rehabilitation Counseling Bulletin, 40(4), 265-284

Gowdy, E.L., Carlson, L.S., & Rapp, C.A. (2003) Practices differentiating high-

performing from low performing supported employment programs. Psychiatric Rehabilitation Journal, 26(3), 232-239

Gowdy, E.L., Carlson, L.S., & Rapp, C.A. (2004) Organizational factors

differentiating high performing from low performing supported employment programs. Psychiatric Rehabilitation Journal, 28(2), 150-156

Substance Abuse and Mental Health Services Administration. (Draft Version

2002) Supported Employment Implementation Resource Kit for Practitioners and Clinical Supervisors. Chicago, IL

www.mentalhealthpractices.org