Evidence Based Supported Employment: Individual Placement and Support Model of Supported Employment

Principal Investigator: 
Jonathan Beard, MSSW, LICSW, CPRP
Funding Source: 
King County Regional Support Network
Project Period: 
10/01/2011-12/31/2013
Jonathan R.
Beard
Project Manager & Trainer
Project Summary: 

IPS (Individual Placement and Support) is an evidence-based practice that was developed to help promote the recovery of people who have serious mental illness through work. This model is well defined by eight practice principles and a 25-item fidelity scale.
 
IPS supported employment helps people with severe mental illness work at regular jobs of their choosing. Although variations of supported employment exist, IPS (Individual Placement and Support) refers to the evidence-based practice of supported employment.
 
Characteristics of IPS Supported Employment
* It is an evidence-based practice
* IPS supported employment practitioners focus on client strengths
* Work can promote recovery and wellness
* Practitioners work in collaboration with state vocational rehabilitation
* It uses a multidisciplinary team approach
* Services are individualized and long-lasting
* The IPS approach changes the way mental health services are delivered

Practice Principles of IPS Supported Employment
1. Focus on Competitive Employment: Agencies providing IPS services are committed to competitive employment as an attainable goal for clients with serious mental illness seeking employment. 
2. Eligibility Based on Client Choice: Clients are not excluded on the basis of readiness, diagnoses, symptoms, substance use history, psychiatric hospitalizations, level of disability, or legal system involvement.
3. Integration of Rehabilitation and Mental Health Services: IPS programs are closely integrated with mental health treatment teams.
4. Attention to Client Preferences: Services are based on clients’ preferences and choices, rather than providers’ judgments.
5. Personalized Benefits Counseling: Employment specialists help clients obtain personalized, understandable, and accurate information about their Social Security, Medicaid, and other government entitlements.
6. Rapid Job Search: IPS programs use a rapid job search approach to help clients obtain jobs directly, rather than providing lengthy pre-employment assessment, training, and counseling. 
7. Systematic Job Development: Employment specialists build an employer network based on clients’ interests, developing relationships with local employers by making systematic contacts.
8. Time-Unlimited and Individualized Support: Follow-along supports are individualized and continued for as long as the client wants and needs the support.
The scope of this project began in 2011 with project staff serving as on-site fidelity reviewers for the King County Regional Support as it conducted fidelity reviews of its contracted supported employment providers.  The 25 item fidelity scale was used, which rates providers on a 1-5 scale in the areas of staffing, organization and services, provides narrative comments to support ratings and offers recommendations in areas rated at three or less.
 
In 2013, project staff were asked to serve as lead reviewers due to a change in personnel at the King County Regional Support Network. Project staff led three such reviews in the first half of 2013. Additional duties included pre- site review work such as scheduling reviewers and coordinating the on-site review process with the program to be reviewed, assuring that the fidelity review accomplished its goal of rating all 25 fidelity items, scoring all items, calculating a total score and writing a comprehensive report of the review’s findings with recommendations that can serve as the beginning of a corrective action plan.
 
Project staff are well positioned to train, consult and provide technical assistance to already established and beginning providers of evidence based supported employment.
 

Public Health Relevance: 

Individual Placement and Support, the evidence-based practice of supported employment, was created and is studied by researchers Deborah R. Becker, MEd, CRC, Robert E. Drake, MD, PhD, Gary Bond, PhD, and their colleagues at the Dartmouth Psychiatric Research Center of Dartmouth Medical School.  The Dartmouth PRC has provided leadership for national implementation of SE/IPS via the Johnson & Johnson-Dartmouth Community Mental Health Program.

Seventeen randomized controlled trials were conducted between 1996 and 2012 in various parts of the USA and in a number of countries abroad. Competitive employment rates were significantly higher in programs that implemented the IPS model. More jobs were acquired, for more hours per week, with a shorter period of time to placement on the job, and for better wages, in the IPS model programs than in the controls. Research also indicates that programs that followed the IPS model, conducted fidelity reviews and used the results of fidelity reviews to drive performance improvement had consistently better employment outcomes for enrolled consumers.

Adult Behavioral Health (WIMHRT)