IPS Supported Employment: An EBP Promoting Recovery NAMI National Convention Working Toward Employment July 9, 2009 Michael J. Cohen Deborah R. Becker Jim Jackson

Learning Objectives Participants will: 1.Be able to identify principles and practices of IPS supported employment. 2.Better understand how IPS supported employment promotes recovery. 3.Learn how to advocate for IPS supported employment services for people with mental illness to employers, community leaders, providers and decision makers.

“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

SAMHSA & EBPs “The Supported Employment toolkit... addresses one of the top priorities of people with mental illnesses and their families... I have long believed that work is treatment!” - A. Kathryn Power, M.Ed., Director

Learning from Psychiatrists “Anyone can prescribe a medication, but helping someone with a mental illness to get a job - now that is something significant.” - Psychiatrist in CT

Why Focus on Employment? An essential part of recovery. A basic human need. Normal adult role promotes dignity and independence. Persons with mental disabilities are ready, willing and able to work; most want to work. Cost-effective alternative to day treatment.

Definition of IPS Supported Employment Mainstream job in community. Pays at least minimum wage. Work setting includes people who are not disabled. Service agency provides on-going support. Intended for people with most severe disabilities; including co-occurring illnesses.

Practice Principle: Competitive Employment is the Goal The agency needs to devote sufficient resources to Supported Employment to permit full access to Supported Employment services for all consumers who seek competitive employment. Consumers interested in employment are not steered into day treatment or sheltered work.

Practice Principle: Consumer Preferences are Given Priority Job finding is based on the consumer’s individual preferences, strengths, and work experiences, not on a pool of jobs that are available.

Practice Principle: Eligibility is Based on Consumer Choice Services are provided to consumers who identify themselves as being interested in competitive employment. Consumers are not excluded from IPS Supported Employment services because of severity of symptoms, substance use or recent hospitalizations.

Practice Principle: Supported Employment is Integrated with Mental Health Treatment Employment specialists coordinate services with the mental health treatment team (e.g., case manager, therapist, psychiatrist, etc.) thru frequent communication.

Practice Principle: Personalized Benefits Counseling is Provided Benefits planning and guidance are provided to help consumers make informed decisions about job starts and changes.

Practice Principle: Job Search Starts Soon After a Consumer Expresses Interest in Working Pre-employment assessment, training, and counseling are not required for consumers and are kept to a minimum.

Practice Principle: Follow-Along Supports Individualized follow-along supports: –Provided to employer and consumers on a time-unlimited basis. Employer supports may include education and guidance. –Consumer supports may include crisis intervention, job coaching, job counseling, job support groups, transportation, treatment changes ( e.g. medication), and network supports ( e.g. peers/friends/family).

Primary Evidence for Supported Employment 11 completed randomized controlled trials of high fidelity IPS. 6 day treatment conversion studies. 8 correlation studies of fidelity and competitive employment.

The Evidence: Supported Employment Works in Programs with High Fidelity* In 11 of 11 studies (randomized controlled trials), supported employment had significantly better competitive employment outcomes than usual care (61% vs. 23%). 2/3 with competitive jobs work 20 hrs or more/week. Time from 1 st contact to get a job was 10 weeks less than the usual care groups. Average time working in a year was 25 weeks. *Bond, Drake, Becker – Psychiatric Rehab Journal, 2008

Non-Vocational Outcomes* Improved self-esteem, symptom control, quality of life were related to sustained competitive employment. No changes with sustained sheltered employment. *Bond, 2001

Nuechterlein Study of First-Episode Schizophrenia

Implementation of Supported Employment in Community Mental Health Programs Fidelity Scale: an instrument used to assess the adherence to the practices and principles of Supported Employment. Data shows that high fidelity scores reflect quality program implementation and correlate with higher outcomes.

Roadmap for SE Quality Improvement Supported employment fidelity kit: –Fidelity review manual. –2008 supported employment fidelity video. –Example reports and action plans.

Staffing: Caseload size; role. Organization: Integration of rehabilitation with mental health treatment; collaboration between employment specialists and VR Counselors; vocational unit; role of employment supervisor; zero exclusion criteria; agency focus on employment; executive team support. Services: Rapid search for competitive job; individualized job search; job development; frequent employer contact; individualized follow- along supports; time-unlimited follow-along supports. Domains for Fidelity Assessment

Services: Work incentives planning; disclosure; work-based assessment; rapid search for competitive job; Individualized job search; job development; diversity of job types and employers; competitive jobs; frequent employer contact; individualized follow-along supports; time-unlimited follow-along supports; community-based services; assertive engagement and outreach. Domains for Fidelity Assessment

Johnson & Johnson – Dartmouth Project Mental health-vocational rehabilitation collaboration. Implement evidence-based supported employment – IPS. Local programs selected by states. Dartmouth provides training, consultation, evaluation, educational materials. National learning collaborative. Project States: CT, DC, IL, KS, MD, MN, MO, OH, OR, SC, VT.

J&J-Dartmouth Program: Real World Agencies

Sample Competitive Jobs for J&J Consumers Landscaper Machine Operator Photographer Receptionist Reporter Sales Clerk Security officer Welder

J&J Pilot – Family Advocacy for IPS Supported Employment CT, IL, VT 2-Year initiative. Meeting of families at Dartmouth. Families develop state-specific plan. Bimonthly teleconferences to share progress.

THE ILLINOIS FAMILY TEAM TO EXPAND FAMILY INVOLVEMENT IN INDIVIDUAL PLACEMENT AND SUPPORT EXPERIENCING THE IPS PROCESS BUILDING A FRAMEWORK FOR SUCCESS MOVING TO ADVOCACY

THE IMPORTANCE OF WORK IN RECOVERY - QUOTES FROM CONSUMERS “Working has given me the opportunity to meet some interesting people who also gave me emotional support.” “Working has made me feel more productive and useful.” “When I work I don’t hear the voices.”

THE IMPORTANCE OF WORK IN RECOVERY – QUOTES FROM FAMILY MEMBERS “Working is an incredible experience for my daughter. In one year she’s on her own and feels responsible.” “I worried that if my son got a job, he would get stressed, but just the opposite happened. He is doing much better than before.”

THE IMPORTANCE OF WORK IN RECOVERY – QUOTES FROM EMPLOYERS “Andre is as good as any worker that I have had.” - Automotive Parts Store Owner “I count on Juanita. If she is feeling stressed, she sits in the back room for awhile. That’s okay; she gets the job done.” - Bakery Supervisor

EXPERIENCING IPS QUALITY Participating in a fidelity review provided a picture of what best practice looks like. Observing strong state leadership from the Illinois State Divisions of Mental Health and Rehabilitation Services in the training of IPS Service Providers.

IDENTIFYING BARRIERS TO IPS IMPLEMENTATION Little awareness of IPS within local NAMI sites and among consumers and their families. Different levels of fidelity among IPS service providers. Lack of legislative sponsorship for IPS at the state and local levels.

BUILDING THE FRAMEWORK FOR SUCCESS Our VISION is to help all people with mental illnesses who want to work as part of their recovery goal, achieve competitive employment using the individual placement and support model.

BUILDING THE FRAMEWORK FOR SUCCESS The Illinois Family Project Team’s MISSION is to educate families of individuals with mental illnesses to advocate for, create and expand high quality IPS Programs that result in an increased number of people in sustained competitive employment.

CURRENT SITUATION LOW IMPACT/LOW RESOURCES Impact is defined as increasing the number of people in competitive employment. Resources include cash, staff, volunteers and materials. FUTURE SITUATION HIGH IMPACT/LOW RESOURCES High impact achieved by advocating for increased family awareness of IPS and increased IPS capacity and quality. Resources will increase by recruiting volunteers. MOVING TO HIGH IMPACT ADVOCACY FOR OUR MISSION

OUR MAJOR GOALS FOR Pilot a model of engaging families around IPS by building on existing NAMI educational forums. Recruit consumers and family members to share their experience with supported employment. Develop a Train-the-Trainer capacity to spread family involvement to other Illinois counties.

ADDING VALUE NOW USING THE NAMI MODEL EDUCATION – Building an advocacy base by presenting IPS at NAMI Educational Forums such as Family to Family. SUPPORT – Incorporating the IPS message within forums such as NAMI Connections and In Our Own Voice. ADVOCACY – Reaching out to service providers to create high quality IPS programs.

ADDING VALUE IN THE FUTURE Continuing to help people with mental illnesses envision employment as part of their recovery goal. Working with IPS service providers to develop IPS support in the business community. Working with NAMI Illinois to make IPS part of the legislative/budget advocacy agenda. Working to have family involvement incorporated into the fidelity process.

Summary Employment is a vehicle for recovery. Work outcomes improve over time with focus on fidelity. Families have a role to help promote recovery by advocating for IPS Supported Employment.