The EvidenceBased 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 Costeffective alternative to day treatment ID: 744157
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IPS SUPPORTED EMPLOYMENT
The Evidence-Based Practice for EmploymentSlide2
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 treatmentSlide3
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 servicesSlide4
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 hospitalizationSlide5
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)Slide6
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%Slide7
Evidence-Based Practice
Program model validated by rigorous research (different investigators)
Has guidelines describing critical components
Has a treatment manualSlide8
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.
”Slide9
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.
”Slide10
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. Slide11
Competitive Employment Rates in 22 Randomized Controlled Trials of IPSSlide12
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 controlsSlide13
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 disabilitiesSlide14
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 importantSlide15
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.Slide16
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.Slide17
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 RehabilitationSlide18
Personalized Benefits Planning Is Provided
Benefits planning and guidance help consumers make informed decisions about job starts and changes.Slide19
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.Slide20
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.Slide21
Follow-Along Supports Are Continuous
Employment
specialists
continue to stay in regular contact with consumer and (when appropriate) the employer without arbitrary time limits.Slide22
Consumer Preferences Are Important
Job finding is based on consumers
’
preferences, strengths, and work experiences, not on a pool of jobs that are available.Slide23
Job Preferences Are ImportantSlide24
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 OutcomesSlide25
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 administratorsSlide26
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 feasibleSlide27
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
includedSlide28
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.Slide29
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
Slide30
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 successSlide31
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.Slide32
Provide Ongoing Training
Initial training for all team members, including medical staff
Continuing access to expert consultation
Ongoing supervision that is outcomes-orientedSlide33
Make Time Commitment
Typically, 6 - 12 months needed to develop skills, interest, and confidence for implementing evidence-based supported employment Slide34
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
implementationSlide35
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