beck

IPS

Individual Placement &

Support



The next generation of

Supported Employment

For individuals with serious

and persistent mental illness.

IN THE BEGINNING there was

darkness……



We are just at the dawn of understanding

rehabilitation for individuals with

psychiatric disabilities. Our knowledge is

evolving, and IPS is a new tool.

 The science of physical medicine is about 2

thousand years old and physicians are still

learning.



 The science of psychiatry is about 100 years old

and psychiatrists are still learning.



 The science of psychiatric rehabilitation is only

about 50 years old. We still have much to learn.

IPS, what is it?





“A standardized approach to supported

employment for clients with long-term

impairments due to severe mental illness

(Becker and Drake 1994).”

Based on 8 Principles



1. Services are provided in the community

2. Multidisciplinary team approach integrating

Mental Health Services and Vocational

Rehabilitation Services

3. Clients are not required to complete work

readiness or other vocational assessments

4. Vocational assessment is continuous and

based in competitive work experiences,

rather than in artificial or sheltered settings.

Cont.









5. Providing employment services to all clients

interested in employment

6. Goals are based on each individual's

preferences, strengths, abilities, and

experiences. Job supports are based on client

choices, rather than providers‟ judgments

7. Supports are individualized, flexible, and

available for as long as necessary

8. Provides benefits (SSI/SSDI etc.) counseling

What is different about IPS?



 No assessment in the usual sense

 Rapid job development

 Zero exclusion, illicit drug use and medication

noncompliance do not automatically exclude people

from IPS

 VRC and job developer work closely with the treatment

team at the mental health facility.

 Employment supports might be on the job or around

the job. Job coaching is less likely to be used.

 Benefits planning is provided.

 The IPS provider is rated using a fidelity scale.

Why is it called IPS?





Evidence-based supported employment is

also known as Individual Placement and

Support (IPS). The term „supported

employment‟ is not synonymous with

evidence-based supported employment .

So we use the term IPS to replace SEMI.

Who gets IPS ?

Where do they get it?



 IPS is ONLY provided to individuals with

serious & persistent mental illness that are

Most Severely Disabled.

 ONLY for individuals receiving services from

community mental health providers with

SESP agreements to provide IPS. (IPS

replaces SEMI in DVR fee schedule.)

Why is IPS limited to these clients?





 Follow along supports must be available from

the mental health center, usually provided by

the case manager or community support

worker.

MO. IPS PROVIDERS



 Tri-County Mental Health Services, Kansas

City

 Truman Employment Services, Kansas City

 Arthur Center/Options Unlimited, Mexico

 BJC Behavioral Health, St. Louis

 Independence Center, St. Louis

 Pathways Behavioral Healthcare, Clinton

How did IPS get started?



 SE began in the 1980s for MR-DD population. Prior to the 1980s most

people believed that folks with MR-DD were safer and happier in

sheltered workshop settings.

 Mainstreaming was revolutionary. The place-train model with job

coaching changed the employment outcomes for many with MR-DD.

 IPS for MI grew from the SE for MR-DD model.

 Traditional train-place approaches involve pre-employment activities

such as, work adjustment, sheltered workshops, transitional

employment, enclave jobs or volunteer jobs. This approach assumes

that folks benefit from preparation in an artificial setting. There is no

evidence that this approach produces good outcomes.

 IPS is a place-train model that recognizes that recovery is a lifelong

process and employment is a powerful force for recovery. It is

evidence-based, with multiple research findings that it produces better

outcomes.

 SE-SEMI-IPS

Who brought IPS to Missouri?







Johnson & Johnson (the Band-Aid and Q-Tip

Company) provided funding for Dartmouth

University to develop IPS, to do outcome

research and to train state mental health and

vocational departments to implement IPS.

Missouri is the 11th state to implement IPS.

Currently 12 states participate.

Does IPS work?



 The employment rate for the MI population

using traditional approaches is about 10%.

 Using the place-train IPS model, employment

outcomes increase to about 40%.



MODVR agency mission is putting people to

work

More Questions ????







The Nuts

& Bolts

IPS Fidelity Scale



 The supported employment scale is a quality

improvement tool that programs can use to

develop a plan to achieve better client

outcomes.

 Programs wishing to implement, or sustain,

supported employment use a 25-item scale

to ensure fidelity to the model.

How might you use the fidelity scale to

increase outcomes in your organization?





 an internal reviewer who is not part of the

supported employment program (for

example, a quality assurance director) can

take time to learn about the evidence-based

practice and help the program identify steps

to improve fidelity to the model. The

Supported Employment Fidelity Kit is highly

recommended for all fidelity reviewers (see:

http://dms.dartmouth.edu/dsec).

 The scale is divided into three sections:

staffing, organization, and services. In

addition, scoring fidelity items uses a 5-point

continuum with scores of 4 or 5 indicating

good implementation

Staffing



Caseload size:

1= Ratio of 41 or more clients per employment

specialist.

2= Ratio of 31-40 clients

3= Ratio of 26-30 clients

4= Ratio of 21-25 clients

5= Ratio of 20 or fewer clients

Organization



Collaboration between employment specialists

1= Employment specialists and VR counselors have client-related

contacts (phone, e-mail, in person) less than quarterly to

discuss shared clients and referrals. OR Employment

specialists and VR counselors do not communicate.

2= at least quarterly

3= monthly

4= scheduled, face-to-face meetings at least quarterly, OR have

client-related contacts weekly

5= scheduled, face-to-face meetings at least monthly and have

client-related contacts weekly

Services



Rapid job search for competitive job:

1= First face-to-face contact with an employer by the

client or the employment specialist about a

competitive job is on average (> 9 mos.) after

program entry.

2= average (5-9mos.) after program entry.

3= average (2-5mos.) after program entry.

4= average (1-2 mos.) after program entry.

5= average within 30 days (one month) after program

entry.

Tools



 Vocational profile

 Employer contact logs

 Job search plans

 Job follow-along

 Documentation of job supports

 Documentation of attempts to provide outreach

 Documentation of Monthly Supported Employment

Program Outcomes

 http://www.dartmouth.edu/~ips

IPS Vocational Profile



 A living document, updated as jobs and job

goals change.

 describes an employment goal/job direction

with individualized strategies for job seeking.

 is agreed upon by the client and

multidisciplinary team.

 Can be found on Dartmouth web page. It can

be modified to suit your agency needs.

 Sample handout

How can I learn more about IPS?





Recommended reading:

A WORKING LIFE FOR PEOPLE WITH SEVERE MENTAL

ILLNESS

By Deborah R. Becker and Robert E. Drake

Oxford University Press, 2003



SUPPORTED EMPLOYMENT: EVIDENCE FOR AN EVIDENCE-

BASED PRACTICE

By Gary R. Bond

Psychiatric Rehabilitation Journal, Spring 2004, Volume 27

number 4

http://www.dartmouth.edu/~ips