Individual Placement and Support (IPS) BRENDA RUTKOWSKI – BAY ARENAC BEHAVIORAL HEALTH, VOCATIONAL SERVICES COORDINATOR AND MIFAST FIDELITY REVIEWER DOMINIC D’AGUANNO – SOUTHWEST SOLUTIONS, EMPLOYMENT SPECIALIST AND MIFAST FIDELITY REVIEWER JOE LONGCOR – BEHAVIORAL HEALTH & DEVELOPMENTAL DISABILITIES ADM INISTRATION (BHDDA), SUPPORTED EMPLOYMENT SPECIALIST
Introductions
What is IPS? ➢ The Individual Placement and Support (IPS) model (developed by Robert Drake and Deborah Becker) ➢ Supported Employment model that is one of the federally recognized Evidence Based Practices for Persons with Mental Illness. ➢ Extensively researched – To date, 25 randomized controlled trials of IPS have been conducted ➢ Across the 25 studies, IPS showed an average competitive employment rate of 56% compared to 23% of controls (IPSworks.org) ➢ Found to be effective at achieving integrated community employment for persons with SMI ➢ 29.5% of individuals enrolled in IPS programs in Michigan during the 3 rd quarter of 2017 were employed
IPS Fidelity ➢ 125 point Scale with three sections: Staffing, Organization, and Services ➢ https://ipsworks.org/index.php/documents/ips-fidelity-scale ➢ https://www.improvingmipractices.org/practice-areas/individual-placement-and-support ➢ Rating:
IPS in Michigan ➢ Currently 21 IPS Sites in Michigan covering 18 counties ➢ Some counties have more than one IPS service provider (Wayne – 10, Oakland - 3) ➢ Of the 21 IPS Sites in Michigan: ➢ Five (5) sites are located within CMHSPs ➢ Sixteen (16) sites are non-CMHSP contracted service providers ➢ The breakdown of sites based on fidelity rating: ➢ Exemplary (115-125) – 5 sites ➢ Good (100-114) – 8 sites ➢ Fair (74-99) – 8 sites
IPS in Michigan ➢ 2017 IPS Annual Data Report ➢ Collection of data from all sites throughout Michigan from April 1, 2017 through June 30, 2017 (FY 17 – 3 rd Quarter) ➢ There were 22 IPS sites at the time of the report (one agency has since closed) ➢ Data: ➢ 1,317 individuals were actively enrolled in IPS services ➢ 389 unduplicated new job starts ➢ Cumulative average wage per hour: $10.10 ➢ $1.20/hr more than minimum wage at the time of the report - $8.90/hr minimum wage in 2017 ➢ Cumulative average hours per week: 26.31 hours ➢ Overall percentage of actively enrolled in IPS services employed: 29.5%
8 Core Principles of IPS
1. Eligibility Based on Client Choice ➢ IPS services are provided to all people who identify themselves as having competitive employment as a recovery goal (SPMI) ➢ People are not excluded because of severity of symptoms ➢ People are not excluded because of staff’s or program beliefs about people not being ready for employment
2. Integration of Rehabilitation and Mental Health Services ➢ The employment specialist works in a collaborative and coordinated way with the other members of the person’s mental health treatment team (for example, case manager, therapist, psychiatrist, nurse, etc …) ➢ Employment specialists attend team meetings and work closely with case managers, psychiatrists, and other professionals to help people achieve their employment goals. Team members openly discuss and find solutions for issues that affect work and recovery
3. Focus on Competitive Employment ➢ Employment opportunities are identified and developed to fit the goals, preferences, strengths, and talents of each individual person ➢ Individuals are not groomed nor developed to fit into pre-arranged work slots ➢ Jobs are developed to fit each person’s individual preferences ➢ Competitive Employment is defined as jobs anyone can apply for, pay at least minimum wage/same pay as coworkers with similar duties, and have no artificial time limits imposed by the social service agency
4. Personalized Benefits Counseling ➢ Each person in IPS has access to good, accurate work incentive planning that is based on their individual situation ➢ Work incentive planning helps people to determine what role benefits will play in their recovery ➢ People are empowered to make their own choices about benefits and are not directed to “earn less than Substantial Gainful Activity as measured by Social Security”
5. Attention to Client Preferences ➢ People are helped to find work that matches with their individual preferences, strengths, and work experiences ➢ People are not directed into readily available jobs to prove they really want to work
6. Rapid Job Search ➢ When people start IPS, their goals to obtain competitive jobs are respected ➢ People are not required to participate in pre-employment assessments, skill building activities, or trial work periods ➢ Initial employment assessment and face-to-face employer contact by the consumer or the employment specialist about a competitive job occurs within 30 days after program entry. ➢ Note: This does not necessarily mean the person is working within 30 days but is actively engaged and supported in job searching.
7. Systematic Job Development ➢ Employment Specialist builds an employer network based on consumers’ preferences and skills ➢ Employment Specialist identifies the needs of the employers ➢ Employer relationships are developed by making systematic contacts
8. Time-Unlimited and Individualized Follow Along Support ➢ The agency helps employed people to be successful at work by providing follow along supports for employment ➢ Follow along supports are based on each individual’s unique situation and needs ➢ Consumers are transitioned to step down job supports following offer of employment. These supports are provided by employment specialists and clinical staff that help develop/recognize natural supports including family members, friends, co-workers, and other peers.
New IPS Learning Community Members include: Oklahoma, Alaska, New Zealand and Montreal West Island CIUSSS, Canada As(of(May(2017 2015 2002 2006 2002 2002 2010 2017 2002 2005 2016 2005 DC,( 2013 2002 2008 2009 2002 Alameda( 2013 Co.,(CA( 2014 2012 2002 2012 2015 Broward( Co.,(FL( 2012 2017 2013
Competitive Employment Rates in RCTs of IPS for Special Populations 76% 80% 70% 60% 52% 50% 50% 42% 40% 33% 31% 30% 28% 30% 20% 12% 7% 5% 4% 10% 0% Vets/spinal Opioid users Affective Justice SSDI Vets/PTSD cord injury (Lones 2017) disorder involvement beneficiaries (Davis 2012) (Ottomanelli (Bejerholm (Bond 2015) (Drake 2013) 2012) 2017) IPS Control
One-Year Follow-up of Illinois Balancing Incentives Program 8 IPS Programs for Transition-Age Youth (Noel, 2015) Conclusion: IPS suitable for transition- age youth with developmental disabilities
IPS in Michigan…Moving Forward? Proposed Inclusion of IPS in the Medicaid Provider Manual (MPM) ◦ As a separate “supported employment” model option for persons with mental illness ◦ As needing State (BHDDA) approval to implement ◦ As having specific requirements to retain IPS status ◦ At least FAIR fidelity, consistent external reviews, reporting requirements, etc. Potential growth to 25 – 30 IPS sites across Michigan ◦ Perhaps up to 14 or 15 CMHSPs (currently 22 sites in 10 CMHSPs) Possible Pilots or Demonstrations of IPS as a “promising practice” supporting: ◦ Individuals with Intellectual/Developmental Disabilities ◦ Transition-age youth/young adults ◦ Substance-use disorders
Questions & Answers? ➢ Contact Information: ◦ Brenda Rutkowski - brutkowski@babha.org ◦Dominic D’Aguanno – daguannod@gmail.com ◦ Joe Longcor – longcorj@michigan.gov
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