1. NZDSN National Employment Symposium “Why Work Matters”
Helen Lockett
Wisegroup
Responding to the employment aspirations of people who experience mental health conditions

2. Responding to the employment aspirations of people who experience mental health conditions
Helen Lockett
Strategic Policy Advisor, the Wise Group
Doctoral candidate, the University of Auckland

3. Presentation
Why we need to apply evidence-based practices in supported employment
An overview of the Individual Placement and Support (IPS) approach
The importance of technical assistance for improving programme quality
What does this mean for policy and practice
Dorothy from the wizard of oZ, red shoes, tornado

4. What’s my tornado
There is a huge difference between the employment aspirations of people who experience mental health conditions and their participation in the labour market
This should not and does not need to be the case
Dorothy and her dog toto got whisked away in a tornado to the land of Oz, and she
This Photo by Unknown Author is licensed under CC BY

5. Labour force participation by impact of health condition
70-90% say they would like a job
Yet between 70-90% say they would like a job
Source: Lockett et al., under review

6. There is a yellow brick road we can follow…
This Photo by Unknown Author is licensed under CC BY-SA

7. Intensity of employment support services
Low intensity
Yet between 70-90% say they would like a job
High intensity

8. An overview of evidence-based practices: the Individual Placement and Support approach
HL lead
Main point: Introduce session
Talk through each point
Explain why we have a moral obligation to do this
Explain quiz concept

9. Individual Placement and Support (IPS) Drake & Bond, 2014; Marshall et al., 2014; Kinoshita et al., 2013
A method of supported employment developed 30 years ago by a team of psychiatrists and academics in New Hampshire, USA
Examined the properties of high performing and low performing employment programmes
Developed the IPS approach based on a set of principles shared by the high performing programmes
Well-defined and well-research programme, supported by over 20 randomised controlled trialled, 12 systematic reviews and a recent Cochrane review.
IPS is an evidence-based intervention

10. Barriers to getting and keeping employment
Sustained employment
Job Acquisition
People often don’t even get referred to employment support services, if they do, they are frequently not intensive enough to meet the person’s support needs or if not specialist in working with people with MHPs the person can face stigma / discrimination (especially the mis-assumptions that people with schizophrenia, bi-polar etc can’t work)
If a person does get to the right type of support service, they have to deal with applications – need expert advice to discuss the pros and cons of disclosure, (saying what to whom at what point), need a good job match
Then if a person does secure a job, they then deal with having an on-going fluctuating long term conditions, so may need ongoing support- adjustments at work, input from the clinical team to stay at work etc…

11. Principles of Individual Placement and Support
Sustained employment
8. Financial guidance
On-going support to employee and employer
6. Integrated employment and clinical support
5. Job Development
Job Acquisition
4. Focus on competitive employment
3. Individually tailored
2. Rapid job search
1. Open access

12. HL lead
Main point: huge amount of evidence
Taken from: Drake, R. E. and Bond, G. R. (2014). Introduction to the special issue on Individual Placement and Support. Psychiatric Rehabilitation Journal 37(2),

13. Cultural change
“I’m a bit embarrassed really. When (the employment consultant) first came to our team I thought, what are they here for? We work with people who are really ill, you know? But they showed me I was wrong. I refer people now who say they want to work even if I think it’s impossible for them to ever get a job as I’m constantly proved wrong” Psychiatric Nurse

14. The IPS fidelity scale Three parts staffing, organisation, services
25 items, each scored out of 5
Maximum score is 125

15. The IPS-25 fidelity scale
Staffing
Services 1.
Caseload size
12.
Financial planning / benefits advice 2.
Employment services staff
13.
Disclosure 3.
Vocational generalists
14.
On-going work-based vocational assessment
Organisation
15.
Rapid job search for competitive employment 4.
Integration of rehabilitation with MH treatment – team assignment
16.
Individualised job search 5.
Integration of rehabilitation with MH treatment - frequent team contact
17.
Job development – frequent employer contact 6.
Collaboration with Work and Income
18.
Job development – quality of employer contact 7.
Vocational unit
19.
Diversity of job types 8.
Role of employment supervisor
20.
Diversity of employers 9.
Zero exclusion criteria
21.
Competitive jobs
10.
Agency focus on competitive employment 22
Individualised on-going support
11..
Executive team support
23.
Continuous on-going support
24.
Community-based services
25.
Assertive engagement and outreach by integrated treatment team
1. Caseload size
4. Integration with mental health treatment – team assignment
17. Job development – frequent employer contact
MAIN POINT: the project did two main things, cultural change and alignment to the evidence base through fidelity reviews
Score 5: 20 or fewer clients per employment specialist; 1 = 41 or more; (4 = 21-25)
4. Score 5 – attached to one or two MH treatment teams from which % of their caseload is comprised; score 1 – ES is part of a vocational, programme that function separately from the MH treatment
17. Score 5 if ES makes 6 or more face to face employer contacts that are client specific per week
Score 1 if ES makes less than 2 face to face employer contacts that are client specific per week

16. The importance of technical assistance (implementation support) for improving programme quality
HL lead
Main point: Introduce session
Talk through each point
Explain why we have a moral obligation to do this
Explain quiz concept

17. IPS Implementation Support project in Auckland and Counties Manukau DHBs
Employment support services are purchased by the DHBs through a contract with an NGO provider
Clinical services are provided through 5 community mental health centres (CMHCs) in ADHB and 4 in CMDHB +
Technical assistance: a dedicated IPS implementation expert
BP lead
Configuration in ADHB has caused the support to be so diluted it affects effectiveness . Each of these ‘centre’s’ has multiple teams EI, 2 x care and recovery, urgent response, crisis so one per centre is not enough

18. Total fidelity scores

19. “We had to examine the thought that we were becoming barriers to people starting work, rather than helpful, because we were determining when we felt they were ready to go to work – as if that was something we had ownership over”.
CMHC team manager, ADHB
Source: Te Pou o te Whakaaro Nui, 2016
Give out A3

20. “We have a ‘whatever it takes’ approach… we have dropped medication into workplaces before and arranged to have blood tests done on-site (with permission) so the person can keep working.”
ADHB Clinician
Source: Fidelity Review, 2016
Give out A3

21. “When I am waiting for appointments there is this amazing display that has other people’s recovery stories on it to help me feel inspired to take leap myself”. Service user, during a fidelity review, 2016
Give out A3

22. More people are referred to employment specialists

23. Employment specialists work with more people
35-40% of accepted referrals have a diagnosis of psychosis

24. Some of the outcomes 40-50% of people accepted obtained jobs
People secured jobs on average 2-4 months after referral
Three-quarters secured jobs more than 16 hours per week
Average hourly wage $ $18.50
Te Pou, 2017

25. Availability in NZ
Still only 6 DHBs purchase employment services that align with evidence-based practices
A number of other DHBs are starting to explore how to increase availability of these practices
We should have full coverage over New Zealand (that would start to address my tornado!)
Auckland, Counties, Lakes, Taranaki, Waikato, Northland
Wellington?
Even where they purchase EBPs not everyone has access to them

26. How policy can help
Revise Health policy so that return to work support is a routine part of healthcare treatment and work status is a performance measure of the health system
Welfare policy should include IPS in strategies to reduce the numbers of people on welfare benefits
Disability policy should recognise the specific employment assistance needs of people who experience mental health conditions
Funding and contracting needs to be co-ordinated across government agencies
Lockett et al, submitted under review

27. Implications for practice – what we can do
Share this information
Describe your employment support services based on the level of intensity they offer
Use the Individual Placement and Support fidelity scale to review and improve your services
Publicise your track record
The new NZDSN employment practice guidelines complement Individual Placement and Support principles
When Dorothy missed the balloon the Wizard was in, she thought her chances of returning home had gone. The Witch of the North told Dorothy that she always had the power in herself to get home, she just needed to click her heels together 3 times
We have the power if we work together to change this appalling inequity
So we can make sure we target different services appropriately

28. Ngā mihi ki a koutou
Helen Lockett