Individual Placement & Support

Why Individual Placement and Support?

Individual Placement and Support (IPS) formerly known as Evidence Based Practice Supported Employment (SE) 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.

The goal of IPS is to help people with serious mental illness and/or co-occurring substance use disorders find and keep competitive jobs. IPS facilitates the recovery process by supporting individuals who are interested in working in their efforts to get on with life beyond illness.

What is Individual Placement and Support?

IPS is a strengths-based and outcome focused approach to vocational rehabilitation for people with serious mental illness and/or co-occurring substance use disorders. IPS emphasizes helping people obtain competitive work in the community and providing the supports necessary to ensure success in the workplace. IPS programs help individuals find jobs in integrated settings. These jobs pay at least minimum wage or the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals who are not disabled.

The overriding philosophy of IPS is the belief that every person with a serious mental illness and/or co-occurring substance use disorder is capable of working competitively in the community. Individuals are offered help finding and keeping jobs that capitalize on their personal strengths and motivation. The primary goal of IPS is to find a natural “fit” between individuals’ strengths and experiences with jobs in the community.

As individuals succeed in working in the community, their self-perceptions often change, and they view themselves as workers and contributors to society. Furthermore, as people in the community see individuals working, stigma about mental illness lessens, and social acceptance increases.

Core components of Individual Placement and Support 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

IPS programs are based on a core set of practice principles. These principles form the foundation of the program.

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.

Competitive employment is the goal of IPS services. Competitive jobs are regular jobs that anyone in the community can apply for. They are not jobs set aside for people with disabilities. Employment specialists help consumers of mental health services find regular part-time or full-time jobs that pay a minimum wage or more. Consumers are paid the same as other people who perform similar work. SE/IPS endorses competitive jobs for several reasons:

• They reduce stigma and discrimination by enabling consumers to work side-by-side with people who do not have psychiatric disabilities.
• They promote self-sufficiency, financial stability, and career development over time.
• They support positive self-worth.

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.

All people who want to work are eligible for employment services and receive help even if they:

• Have experienced job loss(es) in the past
• Lose a job(s) while enrolled in IPS
• Are still experiencing symptoms of mental illness
• Experience cognitive impairments (e.g., memory, problem-solving difficulties)
• Have a criminal history
• Do not know how to fill out an application or talk to employers
• Do not have previous job training or work experience
• Are afraid they might not learn the job fast enough
• Are afraid they might not fit in with others
• Are still using alcohol or other drugs

The use of alcohol and other drugs may limit job choices because many employers test for drug use. If job applicants can pass a drug test, their choices of jobs typically increase.

3. Integration of Rehabilitation and Mental Health Services

IPS programs are closely integrated with mental health treatment teams.

IPS is integrated with (embedded in) mental health services. 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, such as the following:

• Medication side effects (e.g., drowsiness)
• Persistent symptoms (e.g., hallucinations)
• Cognitive difficulties (e.g., problem-solving skills)
• Other rehabilitation needs (e.g., social skills, transportation, childcare)

4. Attention to Client Preferences

Services are based on clients’ preferences and choices, rather than providers’ judgments.

Service providers keep their attention focused upon the employment goals of people they serve and do not impose their ideas or plans. Service providers utilize motivational approaches to help individuals identify their personal strengths, skills, and job interests. People who find jobs that they want tend to experience a higher level of satisfaction and tend to keep their jobs longer. Individual preferences guide all aspects of the employment process, such as:

• Job searches
• Decisions to disclose personal issues to employers or not (e.g., disabilities, symptoms)
• Level of ongoing support from service providers

5. Personalized Benefits Counseling

Employment specialists help clients obtain personalized, understandable, and accurate information about their Social Security, Medicaid, and other government entitlements.

It is important for individuals to know how their jobs (earned income) might impact benefits such as Medicaid, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), and housing subsidies. To help people make informed choices about their financial futures, employment specialists and other service providers learn the basics of benefits information. They also

• Help individuals understand benefits requirements (rules) and other regulations related to benefits & employment
• Help find benefits planners, who calculate the impact that income from employment will have upon various benefits
• Assist with reporting of income to different benefits providers
• Assist with identifying and documenting available work incentives

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.

As soon as people express an interest in employment, service team members connect them with employment specialists. Within the first 30 days, employment specialists are helping consumers explore the job market, fill out applications, and interview with potential employers. Specialists do not require individuals to complete pre-employment assessments, training, workshops, and intermediate work experiences. A rapid job-search honors each person's desire to work.

7. Systematic Job Development

Employment specialists build an employer network based on clients’ interests, developing relationships with local employers by making systematic contacts.

Getting to know employers helps people find jobs that meet their strengths, needs, abilities, and preferences. Employment specialists build relationships with employers through in-person contacts over time. The face-to-face time enables specialists and employers to work together to find the right fit (or match). Employment specialists keep in mind the job preferences of the people they represent and ask about and listen for many different opportunities at each worksite. Specialists keep themselves attuned to the quality of work environments, the potential for flexible hours, and the potential for workplace adjustments that will accommodate individual strengths, skills, symptoms, and coping skills.

8. Time-Unlimited and Individualized Support

Follow-along supports are individualized and continued for as long as the client wants and needs the support.

Systematic follow-along services help people through their work and recovery journeys.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.

Suggested retention topics include but are not limited to the following: Basic Social Skills, Empathy, Dealing with Conflict, Overcoming Dilemmas, Developing a Positive Attitude, Recognizing Accomplishments, Setting Goals at Work, Self Esteem, Self Care, Time Management and Budgeting, Boundaries in the Workplace.

The goal of time-unlimited support is to help individuals become as independent as possible.

Basic Characteristics of Supported Employment

• Employment specialists have individual employment caseloads. The maximum caseload for any full-time employment specialist is 20 or fewer consumers
• Employment specialists provide only employment services
• Each employment specialist carries out all phases of employment service, including intake, engagement, assessment, job placement, job coaching, and follow-along supports before step down to less intensive employment support from another mental health practitioner
• Integration of Employment Services with mental health treatment thru team assignment: Employment Specialists are part of up to 2 mental health treatment teams from which at least 90% of the employment specialist’s caseload is comprised
• Integration of Employment Services with mental health treatment thru frequent team member contact: Employment specialists actively participate in weekly mental health treatment team meetings (not administrative meetings) that discuss individual consumers and their employment goals with shared decision-making. Employment specialists’ offices are in close proximity with their mental health treatment team members. Documentation of mental health treatment and employment services are integrated in a single chart. Employment specialists help the team think about employment for people who have not yet been referred to employment services.
• Collaboration between employment specialists and Vocational Rehabilitation counselors: The employment specialists and Vocational Rehabilitation counselors have frequent contact for the purpose of discussing shared consumers and identifying potential referrals.
• Vocational Unit: At least 2 full time employment specialists comprise the employment unit. They have weekly consumer-based team supervision following the supported employment model in which strategies are identified and job leads are shared. They provide coverage for each other’s caseload when needed.
• Role of employment supervisor: Supported employment unit is led by a supported employment team leader. Employment specialists’ skills are developed and improved through outcome-based supervision. All five key roles of the employment supervisor are present.
• Zero exclusion criteria: All consumers interested in working have access to supported employment services regardless of job readiness factors, substance abuse, symptoms, history of violent behavior, cognitive impairments, treatment non-adherence, and personal presentation. This applies during the course of supported employment services too. Employment specialists offer to help with another job when one has ended, regardless of the reason that the job ended of number of jobs held. If Vocational Rehabilitation has screening criteria, the mental health agency does not use them to exclude anyone. Consumers are not screened out formally or informally.
• Agency focuses on competitive employment: Agency promotes competitive employment through multiple strategies. Agency intake includes questions about interest in employment. Agency displays written postings (e.g. brochures, bulletin boards, posters) about employment and supported employment services. The focus should be with the agency programs that provide services to adults with server mental illness. Agency supports ways for consumers to share work stories with other consumers and staff. Agency measures the rate of competitive employment and shares this information with the agency leadership and staff.
• Executive Team Support for SE: Agency executive team members (e.g. CEO, Chief Operating Officer, Quality Assurance Director, CFO, Clinical Director, Medical Director, HR Director) assist with supported employment implementation and sustainability. All five key components of executive team support are present.
• Work Incentive Planning: All consumers are offered assistance in obtaining comprehensive, individualized work incentives planning before starting a new job and assistance accessing work incentives planning thereafter when making decisions about changes in work hours and pay. Work incentives’ planning includes SSA benefits, medical benefits, medication subsidies, housing subsidies, food stamps, spouse and dependent children benefits, past job retirement benefits and any other source of income. consumers are provided information and assistance about reporting earnings to SSA, housing programs, VA programs, etc., depending on the person’s benefits.
• Disclosure: Employment specialists provide consumers with accurate information and assist with evaluating their choices to make an informed decision regarding what is revealed to the employer about having a disability.
• Ongoing, work-based vocational assessment: vocational profile/assessment occurs over 2-3 sessions and is updated with information from work experiences in competitive jobs. A vocational profile form that includes information about preferences, experiences, skills, current adjustment, strengths, personal contacts, etc., is updated with each new job experience. Aims at problem solving using environmental assessments and consideration of reasonable accommodations. Sources of information include the consumer, MH treatment team, clinical records, and with the consumer’s permission, from family members and previous employers.
• Rapid job search for competitive job: 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.
• Individualized job search: Employment specialists make employer contacts aimed at making a good job match based on consumers’ preferences and needs rather than the job market (i.e. those jobs that are readily available). An individualized job search plan is developed and updated with information from the vocational assessment/profile form and new job/educational experiences.
• Job development - Frequent employer contact: Each employment specialist makes at least six (6) face-to-face employer contacts per week on behalf of consumers looking for work. An employer contact is counted even when an employment specialist meets with the same employer more than one time in a week, and when the consumer is present or not. consumer-specific and generic contacts are included. Employment specialists use a weekly tracking form to document employer contacts.
• Job development - Quality of employer contact: Employment specialists build relationships with employers through multiple visits in person that are planned to learn the needs of the employer, convey what the SE program offers to the employer, describe consumer strengths that are a good match for the employer.
• Diversity of job types: Employment specialists assist consumers in obtaining different types of jobs.
• Diversity of employers: Employment specialists assist consumers in obtaining jobs with different employers.
• Competitive jobs: Employment specialists provide competitive job options that have permanent status rather than temporary or time-limited status (e.g. transitional employment slots). Competitive jobs pay at least minimum wage, are jobs that anyone can apply for, and are not set aside for people with disabilities.
• Individualized follow-along supports: consumers receive different types of support for working a job that are based on the job, consumer preferences, work history, needs, etc. Supports are provided by a variety of people, including treatment team members (e.g. medication changes, social skills training, encouragement), family, friends, co-workers (i.e. natural supports) and employment specialists. Employment specialist also provides employer supports (e.g. educational information, job accommodations) at consumer’s request. Employment specialist offers help with career development (i.e. assistance with education, a more desirable job, or more preferred job duties).
• Time-unlimited follow along supports: Employment specialists have face-to-face contact within one (1) week before starting a job, within three (3) days after starting a job, weekly for the first month and at least monthly for a year or more on average, after working steadily and desired by consumers. consumers are transitioned to step down job supports from a mental health treatment team member following steady employment. Employment specialists contact consumers within three (3) days of learning about the job loss.
• Community-based services: Employment services such as engagement, job finding and follow-along supports are provided in natural community settings by all employment specialists.
• Assertive engagement and outreach by integrated treatment team: Service termination is not based on missed appointments or fixed time limits. Systematic documentation of outreach attempts occurs. Engagement and outreach attempts are made by multiple team members. Multiple home or community outreach visits are provided, including coordinated visits by employment specialist with integrated mental health treatment team members. Connections are made with family members when applicable. Once it is clear that the consumer no longer wants to work or continue SE services, then the team stops outreach.

How we know that Individual Placement and Support is effective

IPS gets results. The IPS model has been the most extensively studied model of vocational rehabilitation for people with serious mental illnesses. Research shows that 60 to 70 percent of people with severe mental illness want to work. Research also shows that Supported Employment responds effectively to consumer needs 58 percent of the people receiving these services are employed in competitive jobs in their local communities.

(Supported Employment/Individual Placement and Support (SE/IPS), the evidence-based practice, 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.)

Some research shows that when individuals succeed in finding competitive work, improvements may occur in symptoms, self-esteem, and satisfaction with finances (Bond, et al., 2001; Mueser, 1997). Many individuals in IPS programs who obtain employment work part time and are able to keep their benefits (i.e., Social Security and health insurance). Others work with their employment specialist and benefits counselors to design a plan for working full time and leaving their cash benefits behind. Work often becomes a meaningful part of their lives.