1. IPS Research Update Bob Drake Dartmouth Medical School 2011

2. Dilemma in 1990 3-5% population disabled by mental illness People with severe mental illness identify work as their top goal –More than 70% want to work Less than 10% working No effective interventions Bond, 1992

3. The President’s New Freedom Commission Report (2003) “The main goal of the mental health system is to help people to live, learn, work, and participate fully in their communities” “The main goal of the mental health system is to help people to live, learn, work, and participate fully in their communities” Mike Hogan (2006): “Work is the most direct step to recovery” Mike Hogan (2006): “Work is the most direct step to recovery”

4. Current Status of IPS IPS model is simple and effective IPS model is simple and effective Other benefits accrue with consistent work Other benefits accrue with consistent work Work outcomes improve over time Work outcomes improve over time IPS is relatively easy to implement IPS is relatively easy to implement

5. Competitive Employment Rates in 16 Randomized Controlled Trials of Individual Placement and Support

6. CT Supported Employment Study (Mueser, 2004)

7. Impact on Other Outcomes Improved self-esteem, symptom control, quality of life Improved self-esteem, symptom control, quality of life Related to sustained competitive employment Related to sustained competitive employment No changes with sustained sheltered employment No changes with sustained sheltered employment (Bond, 2001)

8. Long-Term Outcomes 4 studies with 10-year follow-ups 4 studies with 10-year follow-ups (Test, 1989; Salyers, 2004; Becker, 2006; Bush,2009) Work outcomes improve over time Work outcomes improve over time Costs decrease dramatically for consistent workers (Bush, 2009) Costs decrease dramatically for consistent workers (Bush, 2009)

9. 8-12 Year Follow-up: Day Treatment to IPS 71% working at follow-up 71% working at follow-up 85% in competitive jobs 85% in competitive jobs 71% worked more than 50% of FU 71% worked more than 50% of FU 90% still receiving benefits 90% still receiving benefits (Becker, 2006) (Becker, 2006)

10. Cost Savings  Each person with a SMI who becomes employed achieves an average savings in health costs of $5,000 per year ( Bush et al. 2009)

12. Johnson & Johnson- Dartmouth Project Mental health-vocational rehabilitation collaboration Mental health-vocational rehabilitation collaboration implement evidence-based SE = IPS implement evidence-based SE = IPS Local programs selected by states Local programs selected by states Dartmouth provides training, consultation, evaluation Dartmouth provides training, consultation, evaluation National Learning Collaborative National Learning Collaborative States: CT, DC, KS, MD, OR, SC, VT, IL, MN, MO, OH, KY, WI States: CT, DC, KS, MD, OR, SC, VT, IL, MN, MO, OH, KY, WI Special Projects: NJ, OH, IL Special Projects: NJ, OH, IL International Collaborative International Collaborative (Becker, 2011) (Becker, 2011)

13. J&J-Dartmouth Program: Real World Agencies

14. Early Intervention First episode psychosis (Nuechterlein, 2005; Rinaldi, 2009; Killackey, 2009) First episode psychosis (Nuechterlein, 2005; Rinaldi, 2009; Killackey, 2009)

15. Early Intervention (Nuechterlein, 2005)

16. Addressing Cognition Concentration, memory, reaction speed, and problem-solving Concentration, memory, reaction speed, and problem-solving Job match Job match Improve cognitive function Improve cognitive function Compensatory strategies Compensatory strategies (McGurk, 2008)

17. Cognitive Training Practicing cognitive tasks may create new neuronal connections Practicing cognitive tasks may create new neuronal connections Tasks directly relevant to work tasks Tasks directly relevant to work tasks New capacity may translate to work New capacity may translate to work (McGurk, 2005)

20. Benefits Reform People are socialized into disability People are socialized into disability Changing benefits structure essential Changing benefits structure essential

21. Policy Changes People with disabilities need cash, health insurance, and a job They do not need to be assigned to a lifetime of unemployment and poverty in order to get health insurance Legislative change is critical Carl Suter, CSAVR (2006)

22. Federal Funding Reform We need simple payment system Federal committees Advocacy

23. Conclusions IPS has created hope for for people with psychiatric disabilities, their families, and MH/VR practitioners IPS has created hope for for people with psychiatric disabilities, their families, and MH/VR practitioners Outcomes can be enhanced further Outcomes can be enhanced further New research New research Policy changes Policy changes

24. Financial Support Grants from NIDA, NIDRR, NIMH, RWJF, SAMHSA Contracts from Guilford Press, Hazelden Press, MacArthur Foundation, Oxford Press, New York Office of Mental Health, Research Foundation for Mental Health Gifts from Johnson & Johnson Corporate Contributions, Segal Foundation, Thomson Foundation, Vail Foundation, West Foundation

25. Many Thanks Deborah Becker Gary Bond Greg McHugo Haiyi Xie Jon Skinner Phil Bush Will Torrey Kim Mueser Rob Whitley Susan McGurk Eric Latimer Elizabeth Carpenter-Song Matt Merrens Paul Gorman Sarah Swanson David Lynde Howard Goldman Sandy Reese Kikuko Campbell Will Haslett Saira Nawaz Crystal Glover

26. Information: books, videos, research articles Patti O’Brien Patti.O’Brien@Dartmouth.edu 603-448-0263 http://dms.dartmouth.edu/prc