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IPS SUPPORTED EMPLOYMENT
The Evidence-Based Practice for Employment
Why Focus on Employment?
Viewed by many as an essential part of recovery
Most consumers want to work A typical role for adults in our
society Cost-effective alternative to
day treatment
Benefits of Steady Competitive Employment
Increased income Improved self esteem Improved social networks Increased quality of life Better control of symptoms Reduced substance use Reduced use of mental health
services
Is Work Too Stressful? As compared to what? Joe Marrone, an employment
trainer:
“If you think work is stressful, try unemployment.”
Stresses of work do not translate into higher rates of hospitalization
Negative Effects of Unemployment in General
Population Increased substance abuse Increased physical problems Increased psychiatric disorders Reduced self-esteem Loss of social contacts Alienation and apathy
(Warr, 1987)
Competitive Employment for People with Severe Mental
Illness: The Gap Say they want to work: 66% Are currently working: <20% Have access to evidence-based
employment services: 2%
Evidence-Based Practice
Program model validated by rigorous research (different investigators)
Has guidelines describing critical components
Has a treatment manual
Quotes from Consumers
“I feel so much better about myself now that I have a job.”
“Holding down my job is not always easy but it has helped my self esteem.”
“When I go to work I don’t hear the voices.”
“Now that I am working again I can buy my daughter presents.”
Quotes from Family Members “I worried that if my son got a job he would
get stressed. But just the opposite happened. He is doing so much better than before.”
“I feel better that she tries working when she has the support of mental health.”
“I was really glad that my son’s employment counselor asked me about work ideas. He landed a job that I suggested.”
Quotes from Employers “Andre is as good as any worker that I
have.” Automotive parts store manager. “I count on Juanita. If she is feeling
stressed, she sits in the back room for awhile. That’s OK; she gets the job done.” Bakery supervisor.
“The employment counselor helped me understand why Tony paces. It’s okay in the security business.” Security business owner.
Competitive Employment Rates in 22 Randomized Controlled Trials of IPS
Overall Findings for 22 RCTs
All 22 studies showed a significant advantage for IPS
Mean competitive employment rates for the 22 studies:
56% for IPS 23% for controls
Definition of Supported Employment
Mainstream job in community Pays at least minimum wage Work setting includes people who are
not disabled Service agency provides ongoing
support Intended for people with most severe
disabilities
Evidence-Based Practice Principles Eligibility is based on consumer choice Competitive employment is the goal Supported employment is integrated with
treatment Personalized benefits planning is provided Rapid job search is encouraged Employment specialists build employer
relationships Follow-along supports are continuous Consumer preferences are important
Eligibility Is Based on Consumer Choice
Consumers are not excluded because they are not “ready” or because of prior work history, hospitalization history, substance use, symptoms, or other characteristics.
No one is excluded who wants to participate.
Competitive Employment Is the Goal
The agency needs to devote sufficient resources to supported employment to permit full access to all consumers who seek competitive employment
Consumers interested in employment are not steered into day treatment or sheltered work.
IPS Is Integrated with Mental Health Treatment
Employment specialists coordinate plans with the treatment team, e.g., case manager, therapist, psychiatrist, and other community providers, e.g., Vocational Rehabilitation
Personalized Benefits Planning Is Provided
Benefits planning and guidance help consumers make informed decisions about job starts and changes.
Rapid Job Search Is Encouraged
Job search starts soon after a consumer expresses interest in working.
Pre-employment assessment, training, and counseling are kept to a minimum.
Employment Specialists Build Employer Relationships
Employment specialists meet face-to-face with employers over time to learn about business needs and positions.
Each specialist makes at least 6 contacts with hiring managers each week.
Follow-Along Supports Are Continuous
Employment specialists continue to stay in regular contact with consumer and (when appropriate) the employer without arbitrary time limits.
Consumer Preferences Are Important
Job finding is based on consumers’ preferences, strengths, and work experiences, not on a pool of jobs that are available.
Job Preferences Are Important
Key Factors in Implementation
Build Consensus Maximize Financing Examine Agency Philosophy Identify Leadership Key on Organizational Structure Provide Ongoing Training Make Time Commitment Track Process and Outcomes
Build Consensus
Commitment of state mental health authority is not enough
Better to involve all stakeholders - consumers, family members, providers, and local and state MH and VR administrators
Maximize Financing
Determine how supported employment services can be funded
Explore funding through Mental Health, Vocational Rehabilitation, and Medicaid
Reallocate resources to supported employment when feasible
What Does IPS Cost? Estimates of per-client annual costs
–$2500 (Latimer et al., 2004)–$4300 (HMC, 2006)–$6400 (Cimera, 2007)
Adjusting for inflation, 2014 estimates range from $3200 to $7300
Factors affect cost: severity of disability, local wages, indirect costs and which clinical services included
Examine Agency Philosophy
Determine if service agency’s philosophy, mission statement, and service paradigm are consistent with recovery-oriented, evidence-based approach to IPS supported employment.
Identify Leadership You need a champion!
–Identify committed leader with sufficient authority to oversee and ensure implementation
Leaders at all levels visibly show support for supported employment
Center director buy-in is critical Leadership from Vocational
Rehabilitation aids collaboration
Leadership Roles
Provide necessary resources Seek buy-in from consumers,
families, and practitioners Give recognition to staff and
consumer for successes Rapp’s finding – Critical role of
supervisor in program success
Organizational Structure Employment specialists
–Join one or two treatment teams.–Share office space with treatment team. –Communicate frequently with
treatment team members. Team integrates supported employment,
benefits counseling, case management, psychiatric services, and dual diagnosis treatment.
Provide Ongoing Training
Initial training for all team members, including medical staff
Continuing access to expert consultation
Ongoing supervision that is outcomes-oriented
Make Time Commitment
Typically, 6 - 12 months needed to develop skills, interest, and confidence for implementing evidence-based supported employment
Track Implementation Process and Outcomes
Track employment outcomes monthly
Set goals: 40% rate of competitive employment is achievable
Use the IPS-25, a 25-item supported employment fidelity scale to measure implementation
Summary People with severe mental illness
can work in competitive employment
Programs following evidence-based principles of supported employment have better outcomes
Programs must address financial and organizational barriers to be successful