INDIVIDUAL PLACEMENT and SUPPORT (IPS) Improving Lives Through Work Deborah R. Becker Dartmouth Psychiatric Research Center Amersfoort, Holland March 30, 2006

OVERVIEW of IPS Principles and practice Principles and practice Research findings Research findings Lessons learned Lessons learned

Definition of Supported Employment Mainstream job in community Mainstream job in community Pays at least minimum wage Pays at least minimum wage Work setting includes people who don’t have a disability Work setting includes people who don’t have a disability Service agency provides ongoing support Service agency provides ongoing support Intended for people with most severe disabilities Intended for people with most severe disabilities

Evidence-Based Principles Eligibility is based on consumer choice Eligibility is based on consumer choice Personalized benefits planning is provided Personalized benefits planning is provided Supported employment is integrated with treatment Supported employment is integrated with treatment Competitive employment is the goal Competitive employment is the goal Job search starts soon after a consumer expresses interest in working Job search starts soon after a consumer expresses interest in working Follow-along supports are continuous Follow-along supports are continuous Consumer preferences are important Consumer preferences are important

Primary Evidence for Supported Employment 5 day treatment conversion studies 5 day treatment conversion studies 13 completed randomized controlled trials 13 completed randomized controlled trials 3 correlational studies of work and program implementation 3 correlational studies of work and program implementation

Competitive Employment Rates in 12 RCTs of Supported Employment

Conclusions: Randomized Controlled Trials of Supported Employment In 13 of 13 studies, SE had significantly better competitive employment outcomes than controls In 13 of 13 studies, SE had significantly better competitive employment outcomes than controls Mean across studies of consumers working competitively at some time: Mean across studies of consumers working competitively at some time: –60% for supported employment –22% for controls

Long-Term Follow Up 3 supported employment research studies years 3 supported employment research studies years Similar findings Similar findings –Most worked for pay –Current jobs were mostly competitive –People held multiple jobs over time

Implementation Studies National Evidence-Based Practices Project National Evidence-Based Practices Project Johnson & Johnson - Dartmouth Community Mental Health Program Johnson & Johnson - Dartmouth Community Mental Health Program

Lessons Learned Recovery-oriented environment Recovery-oriented environment Changing voc program vs. new voc Changing voc program vs. new voc Quality improvement team Quality improvement team Eliminate words: motivation, compliance, work readiness Eliminate words: motivation, compliance, work readiness

Recognize strengths rather disabilities Recognize strengths rather disabilities Prepare to talk with employers Prepare to talk with employers Not everyone can be an employment specialist Not everyone can be an employment specialist Role of agency’s employment supervisor Role of agency’s employment supervisor

Track outcomes Track outcomes Outcomes-based supervision Outcomes-based supervision Publicize agency outcomes Publicize agency outcomes Fidelity counts Fidelity counts Peer/staff meetings across agencies (supervisors, employment specialists) Peer/staff meetings across agencies (supervisors, employment specialists)

Partner with clients for training and education Partner with clients for training and education Educate with news articles, public radio, agency newsletters, information sheets, videos Educate with news articles, public radio, agency newsletters, information sheets, videos Work is everybody’s business Work is everybody’s business

Resources Dartmouth Vocational Publication List Dartmouth Vocational Publication List

More Resources A Working Life for People With Severe Mental Illness- Becker and Drake, Oxford University Press, 2003 A Working Life for People With Severe Mental Illness- Becker and Drake, Oxford University Press, 2003 Supported employment resource kit Mentalhealth.samhsa.gov Supported employment resource kit Mentalhealth.samhsa.gov

Summary People with severe mental illness can work in competitive employment People with severe mental illness can work in competitive employment Programs following evidence-based principles of IPS-supported employment have better outcomes Programs following evidence-based principles of IPS-supported employment have better outcomes Programs must address implementation factors to be successful Programs must address implementation factors to be successful