gene oulvey, ph.d. illinois department of human services ...€¦ · impact of competitive...
TRANSCRIPT
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Individual Placement and Support Pathways to Success
Gene Oulvey, Ph.D.Illinois Department of Human Services
Division of Rehabilitation Services
IATP State Conference 2019
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Objectives of the session
Participants will be able to:
• Identify the core components and associated practices of evidence-based supported employment (IPS)
•Understand the proof that IPS is effective
• Understand how IPS promotes independence and access
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Overview for the sleep deprived
•IPS is an effective evidence-based practice
•The long-term perspective is even better
•Implementation is critical
•What amplifies effectiveness: More people and more hours
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Other Disability Populations
•The principles and practices that comprise IPS are familiar to Vocational Rehabilitation
•The research and practical experience that surrounds the IPS Model helps us focus on what is likely to be effective
•Bottom line: IPS is a good idea and may be a best alternative even where the evidence does not exist for an Evidence-Based Practice
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IPS International
• Australia• Bulgaria• Canada• China (Hong Kong)• Denmark• Finland• Germany• Ireland• Italy
• Japan
• Netherlands
• New Zealand
• Norway
• Spain
• Sweden
• Switzerland
• United Kingdom
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Randomized Controlled Trials (RCTs) of Supported Employment
•Strongest scientific design for evaluating whether a treatment works
•Studies include: • More than 30 conducted for IPS across four continents•At least 25 used full implementation of IPS
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Competitive Employment Rates: IPS Studies
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Overall Findings for 23 RCTs
All 23 studies showed a significant advantage for IPS
Mean competitive employment rates for the 23 studies:
55% for IPS
23% for controls
(Each study weighted equally in calculating mean rates)
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Impact of Competitive Employment on Nonvocational Outcomes
•Domains with positive impact reported in multiple studies:•Self esteem – 100% (3/3 studies)•Symptoms – 57% (4/7 studies)•Life satisfaction – 33% (3/9 studies)
(Luciano, Bond, & Drake, 2014)
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Clients also reported:
•Greater self-confidence and hopefulness
•More energy
•Less loneliness and boredom
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Studies of Long-Term Outcomes
from Supported Employment
Test: 10 years
McHugo: 3.5 years
Bond: 3.5 years
Salyers: 10 years
Becker: 8-12 years
Drake: 10 years
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Mean Tenure of Longest-Held Jobin Two IPS Studies
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10-Year Follow-up of Day
Treatment to SE Conversion
92% worked during follow-up
47% currently working
33% worked at least 5 years
Many reported increases in hope, self-esteem,
relationships
(Salyers, 2004)
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8-12 Year Follow-up of
SE
71% working at follow-up
Nearly all in competitive jobs– 7% sheltered, 10% volunteer
71% worked more than 50% of FU
But 90% still receiving benefits
(Becker, 2006)
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Limitations of SE
One-fourth do not work
Most people do not work full-time
Most people stay on benefits
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Explaining the variance
•25% the local economy
•25% the IPS fidelity score
•50% personal characteristics
(Becker, 2006)
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Amplifying the Effects
– Existing and emerging technologies
(Smith, Lord, Do)
– Ethnic & racial minorities (DRS)
– Youth (Noel)
– Role of VR (Oulvey, Carpenter-Song)
– Cognitive training (McGurk)
– Medications (MATRICS)
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Definition ofSupported Employment
•Mainstream job in community
•Pays at least minimum wage
•Work setting includes people who are not disabled
•Service agency provides ongoing support
•Intended for people with most severe disabilities
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Evidence-Based Principles
•Eligibility is based on consumer choice
•Supported employment is integrated with treatment
•Competitive employment is the goal
•Personalized benefits planning is provided
•Job search starts soon after a consumer expresses
interest in working
•Follow-along supports are continuous
•Consumer preferences are important
•Build relationships with employers
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IPS Is Effective in a Wide Variety of Target Populations
➢PTSD diagnosis➢Frequently hospitalized➢Mental illness + substance use➢Older adults➢Homeless➢Criminal justice history➢On disablilty benefits➢African American➢Hispanic
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VA Study: PTSD
- RCT assigned groups to IPS (N = 42) or to traditional VR services (N = 43)- Tracked employment rate for 12 months- 76% of the IPS group sustained competitive employment vs. 28% of the VR group- The IPS group worked 42% of the eligible work weeks vs. 16% for the VR group- The IPS group was 2.7 times more likely to secure competitive employment vs. the VR group- Current VA study including TBI to be published
(Davis, et al., 2012)
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VA Study: Spinal Cord Injury
•RCT: Total N = 201; IPS sites N = 81, VR sites N = 76, No IPS sites N = 44
•Ages 18 – 65
•Benefits: 13% SSI, 59.9% SSDI, 57.4% VA
•The IPS group was 2.5 x more likely to obtain competitive employment than the VR group, 11.4 x more likely than No IPS sites
•Poor implementation at the VA sites
resulted in lower outcomes
(Ottomanelli, et al., 2012)
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BIP: New Populations
•Adults and youth with developmental disabilities
• - Intellectual disabilities
• - Autism Spectrum
• - Physical developmental disabilities
•Cross-training in Customized Employment
• - Vocational assessment
• - Employer relationship development
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BIP IPS Sites
• 4 Urban, 4 Suburban, 7 Rural
15 agencies
• African American community
• Hispanic and Latino community
• East Asian community
3 sites targeted minority populations
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Diagnostic Groups across 15 Sites
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Communities
• - Illinois Asian community
• - Illinois Latino community
• - Refugees, victims of torture
• - Rural communities
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Transition-age youth
• - Teams focusing on Chicago Public School system
• - Teams focusing on suburban school systems
- Teams focusing on rural school systems
- Teams focusing on youth with mental illness
- Teams focusing on youth with developmental disabilities
-Teams focusing on youth with multiple disabilities (e.g., learning disabilities)
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PRJ Article: Neuchterlein et al.
IPS effective for assisting youth with
severe mental illness to sustain
employment
Also effective for assisting youth to
complete schooling, including advanced
education
Evidence of recovery, long-term
studies
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IPS Supported Employment for Clients with First-
episode Schizophrenia
0
20
40
60
80
100
Baseline 6 Months 12 Months 18 Months
% o
f E
mp
loy
me
nt
or
sc
ho
ol
IPS
SAU
Early Psychosis Study (Nuechterlein, 2005)
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8 Follow-up Studies of Early Intervention Programs Providing IPS
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Diversion from Disability Benefits
•Help Young Adults Avoid a life in Poverty
•Better for Our Country
•A promising area for cost savings is young adults who are experiencing early psychosis. If supported employment were available economist estimate the nation could save $368 million annually in
•Medicaid, Social Security and other state programs
Source: David Salkever Ph.d
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What About Supported Education?
•Consumer choice always a primary consideration
•Education and training expand options
•SE program should help consumers enroll in community programs (GED classes, colleges, technical schools)
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Technology
• - Virtual reality Job Interviewing Training
• - 9 X better outcomes vs. control group
• - Next: Virtual Reality soft skills development
•- Dartmouth Center for Supported Employment Technology
•- Identifor, WorkingWell, Dartmouth suite for administration of IPS programs
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Enhancing IL Human Service System
• - IPS is the only evidenced-based Vocational Rehabilitation model. Predictive fidelity scale.
• - High success rate with diverse populations and high cost effectiveness has lead to great interest from other human service and allied systems.
• - Dept. of Corrections, Juvenile Justice, DCFS, Chicago Public Schools, Healthcare & Family Services, etc.
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Do Client Characteristics Predict Success in Supported Employment?
•Co-occurring substance use does not lead to lower employment rates.•Consumers generally do better in supported employment than in alternative programs regardless of background characteristics such as: •gender, education, ethnicity, diagnosis, hospitalization history, cognitive functioning
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Job Preferences Are Important
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IPS Team:Recommended Structure
•Minimum of 2 full-time staff
•Staff devoted exclusively to SE
•Full-time leader/supervisor who also provides employment services
•Offices physically located in mental health center
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IPS Team
•Individual caseloads, but help each other (with job leads, etc.)
•Caseloads of about 20 consumers or less is ideal
•Weekly team meetings + individual supervision
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Employment Supervisor Duties
•Manages referrals
•Hires and supervises employment staff
•Ensures employment specialists are learning and using effective skills in:Engagement AssessmentJob development Job support
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Collaboration With Vocational Rehabilitation
•VR counselor meets consumers at mental health agency
•VR counselor is part of the treatment team
•VR counselor conveys same message as the rest of team
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Vocational Rehabilitation
-- VR has a corporate culture that values work-
first and assumes anyone is capable of
employment.
-- VR staff have job placement/development
skills & networks.
-- VR staff have expertise in multi-disability
work accommodations.
-- VR staff have access to an array of
resources.(Oulvey, Carpenter-Song, Swanson, 2013)
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IPS section of VR
Casework Manual
⚫ 10 days from referral to IPS
⚫ Up to 14 days back dating if employed
at referral
⚫ Mandates VR liaison counselor meet
with the rest of the IPS team at least 1x
per month
⚫ Any LPHA can certify diagnosis
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Competitive jobs are the goal
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Employment specialists build relationships with employers based upon client job interests
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Job Search Plan
•Explore jobs by visiting work sites: develop relationships
•Develop employment plan
•Revise assessment and employment plan based on consumer’s experiences
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Individualized Job Search
•Base on consumer’s preferences, strengths, abilities, experiences, and deficits (e.g., substance use)
•Seek:•Permanent competitive jobs •Diverse jobs suiting individual consumers•Different settings
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Job Endings
•Each job viewed as learning experience
•Job transitions are considered normal
•With a job loss, consumer and entire (IPS and treatment) team strategize for next step
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Track Implementation
•Use 25-item SE Fidelity Scale to measure implementation of evidence-based practice
•Staff in supported employment program can see if they are on track
•Basis for giving objective feedback
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Hartford Study: Stable and high fidelity over time after short start-up
IPS Fidelity
60
65
70
75
1 2 3 4 5 6 7
Number of Assessment
To
tal S
co
re
Capital Region
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Costs: New Hampshire Dual
Diagnosis Study
N = 187, persons with psychotic
disorders & co-occurring substance
abuse disorders
ACT: Case management 3 yrs.,
naturalistic follow-up 13 years
Groups: No/low work group N = 136;
Steady increase group N = 51
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Costs: New Hampshire study
Steady worker group declined significantly
in total costs relative to no work group
Average annual cost difference per
participant = $16,619
Average 10-year cost difference per
participant = $166,350
Findings similar for a clustered group of
participants who are alike on baseline
characteristics
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Federal Funding Report 2011
⚫ VR with expanded role
⚫ Full implementation will require
changes in VR practices
⚫ Enhanced Medicaid support
⚫ http://aspe.hhs.gov/daltcp/reports/2010
/supempLR.pdf
⚫ http://aspe.hhs.gov/daltcp/reports/2011
/supempFR.pdf
⚫ Dartmouth PRC newsletter, Fall 2011
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Leadership Roles•Provide necessary resources
•Seek buy-in from consumers, families, and practitioners
•Give recognition to staff and consumer for successes
•Rapp’s finding – Critical role of supervisor in program success
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Make Time Commitment
•Typically, 6 - 12 months needed to develop skills, interest, and confidence for implementing evidence-based supported employment
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Summary
•Programs following IPS supported employment principles have better outcomes
•Effective employment supervisors are key to good implementation
•Resource materials complement training and supervision
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Information: books,
videos, research articlesIPS Center
http://www.ipsworks.org/