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The Evidence Based Practice of Supported Employment Individual Placement & Support (IPS) Introduction for State Rehabilitation Council (SRC) May, 2014.

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Presentation on theme: "The Evidence Based Practice of Supported Employment Individual Placement & Support (IPS) Introduction for State Rehabilitation Council (SRC) May, 2014."— Presentation transcript:

1 The Evidence Based Practice of Supported Employment Individual Placement & Support (IPS) Introduction for State Rehabilitation Council (SRC) May,

2 “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 2

3 1. Un-established practices 1. Un-established practices are not based on research  Have no data to support effectiveness  Based on anecdotal evidence and/or professional judgment 3

4 Promising practices 2. Promising practices are based on research  Have demonstrated limited success  Have used a “weak” research design for example: No Randomized Controlled Trials/RCTs 4

5 Evidence-Based Practices 3. Evidence-Based Practices based on rigorous research designs  Efficacy & effectiveness empirically validated through 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. 5

6  Research-based: Efficacy and effectiveness empirically validated through 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

7 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) 7

8 8 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%)

9  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 made in 2013 Legislative Session

10  Historic “EE SMI” projects are transformed to IPS 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

11  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

12  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 12

13 States Participating in IPS Learning Collaborative ( ) 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.

14 14

15 15 IPS grant funds in 2014 Green= Established Blue= Transformation Light Blue=Not grant funded (includes 2 Goodwill/Easter Seals projects in Ramsey County)

16 16

17  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

18 Quarter=SnapshotQuarter Quarter Quarter Quarter Number Served Number Working Employment Engagement Rate 48%51%58%56% 18

19 19

20 1) Integration of employment with mental health treatment 2) Zero exclusion 3) Individual preferences are honored 4) Rapid engagement 5) Systematic job development 6) Focus on competitive employment 7) Proactive benefits counseling 8) Time unlimited individualized job supports 20

21 Video produced by Johnson and Johnson Dartmouth Community MH Program 21

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

23 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

24 Why Integrate? (Bond, 2001) ◦ Lower dropout rate for consumers/customers ◦ Better communication ◦ Clinicians get involved ◦ Clinical information incorporated into employment plan

25 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 Managers Substance Abuse specialist Psychiatric Nurse Psychologist Public VR Counselor Employment Specialist Housing Supports Rehab Option Staff & Peer Specialists Psychiatrist Mental Health Treatment Team

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

27 “ Employability is a given, not a line to cross” -Dale DiLeo People are ready to work when they say they are ready to work 27

28 SOCEmployment  Pre-contemplationnot thinking about work  Contemplation considering work  Preparationwants to start job search  Actionjob search/employment  Maintenancefollow along supports No Readiness Individual’s Stages of Change

29 3. Individual preferences are honored

30 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) 30

31 4. Rapid Engagement in Job Search The job search starts soon after a person expresses interest in working

32 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 Development  Employment specialists build relationships with employers

33 "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..." 33

34 6. Competitive jobs are “The Goal”

35  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. 35

36 7. Proactive Benefits counseling Personalized benefits counseling is provided

37 8. Individualized job supports areTime-UN-limited

38  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 38

39 Dartmouth Psychiatric Research Center 39

40 Claire Courtney, M.S., CRC MN DEED –Vocational Rehabilitation Services Senior Rehabilitation Program Consultant Melinda Shamp, M.S., LSW, CPRP DHS - Adult Mental Health Division Mental Health Program Consultant/Employment Policy


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