Delivering results through IPS using IPS to improve

Delivering results through IPS: using IPS to improve job outcomes for people with severe mental health problems Jan Hutchinson – Centre for Mental Health Becky Priest – Centre for Mental Health Jonathan Allan – Shropshire Council Dean Atkinson – Coventry City Council

Individual Placement and Support Jan Hutchinson Director of Programmes Centre for Mental Health

The question. . How do we provide effective support for people with mental health problems to return to work?

The Individual Placement and Support approach 8 evidence-based principles: 1. Eligibility for the service is based on individual choice; 2. Employment support is integrated with treatment; 3. Open ‘ordinary’ employment is the goal; 4. Job search begins rapidly (within 4 weeks); 5. The job finding action plan is individualised; 6. Employers are approached with individuals in mind; 7. Follow-along supports are multiple and not time-limited; 8. Financial planning is provided.

Integration of IPS It would be nice to have a job. . . Referrals IPS Service Provider Benefits advice Employer engagement Rapid job search Long term employee support Psychiatric Support and Medication Psychological Support and CBT Care coordination and self management support Employment support and benefit advice

Research Studies Compare IPS with the best alternative Many US studies European study – EQOLISE (2007) London site 60% Percentage who obtained competitive employment 50% 40% 30% 20% 10% 0% IPS support Control service

Elements of fidelity 20 -25 clients per Employment Specialist Do not provide any ‘general’ on employment support Make 6 face-to-face employer contacts per week Spend 65% of time out of the office Integration of employment support with clinical care and treatment NHS top level support for IPS Linking with Job Centre and Work Programme Accurate benefits advice Planned disclosure of mental health history Tailoring support for ‘in employment’, not ‘before employment’ Finding jobs according to individual preferences Support continues for as long as necessary to achieve steady employment

UK Centres of Excellence Centre for Mental Health carried out independent fidelity reviews and recognises the quality of services in: Central & North West London Shropshire Coventry Somerset Devon South West London & St George’s Essex Sussex Leeds Walsall Nottingham Worcestershire

Turning evidence into outcomes: The Sussex Experience Becky Priest, Clinical Specialist OT, Sussex and Associate of Centre for Mental Health,

Sussex Population of 1. 55 million, mix of coastal, urban and rural towns Supports 10, 000 people with a mental health problem every year across 3 local authorities 32 clinical teams (including early intervention and assertive outreach) 19 employment specialists, employed by Southdown supported employment a not for profit organisation Attached to and embedded within clinical teams Every mental health team has a vocational champion

Regional trainer Modelled on state trainer programme Successful results in 13 states over ten years Translates the research into practical ‘on the ground’ advice Accelerates implementation and therefore outcomes

The role of a UK trainer Fidelity reviews, preparing, conducting and action planning Demonstrate a learning culture, targeting specific staff groups ‘Lets talk about work’ training- how to ask and just ask Regular meetings with senior leaders utilising data such as NI 150 Internal magazine articles Reports to Trust exec board Field mentoring

Paid work outcomes against target Apr 2010 -Oct 2011 Introduction of the Regional Trainer in November 2010 Reproduced with permission of Southdown Supported Employment

Additional outcomes Profile for employment has been raised across the Trust and in specific staff groups Further embedded partnership Positioning the role in the Centre for Mental Health helped with this Ensuring employment is everyone's business not just the ES Developing real employment focused health care

“I’m a bit embarrassed really. When (the employment specialist) first came to our team I thought, what are they hear for? We work with people who are really ill, you know? I refer people now who say they want to work even if I think it’s impossible for them to ever get a job as I’m constantly proved wrong. ” Community Psychiatric Nurse, Sussex

The IMPROVE Project developing IPS in the West Midlands Jonathan Allan, Enable Supported Employment Service, Shropshire Council enable

Enable • Provided a mental health employment service for 17 years • Shropshire is an IPS Centre of Excellence as part of the Centre for Mental Health’s Co. E programme • LD employment • Other disability / substance misuse employment via personal budgets enable

The Improve Project 2011 - 12 • Regional project in partnership with the Centre for Mental Health • IPS Regional Development Manager = UK version of State Trainer in the US • Working with 6 services to improve performance and quality in mental health employment using IPS • Coventry, Birmingham, South Staffordshire, Worcestershire, Walsall & Dudley, Shropshire (south) • Provided training in theory and practice of IPS, self assessment, employment engagement, training and mentoring and Fidelity Reviews (via Cf. MH). enable

Key Objectives • Act as IPS lead in the West Midlands (with Cf. MH) • Work with frontline mh services in the W. Midlands to develop their IPS services through coaching and training • Work with senior managers in NHS Trusts and local commissioners • Commission the Cf. MH to varry out Fidelity Reviews enable

Areas covered • • • Walsall / Dudley Coventry Worcester South Staffordshire Birmingham Shropshire (south)) enable

Implementation • Introduction: getting to know the teams, agreements, data • Self assessment against FR criteria and action planning • Regional IPS leads project meetings • Training of staff • Individual and team coaching • Fidelity Reviews by CMH enable

Role of regional trainer in W. Mids • Previously supervised Enable’s IPS service in Shropshire • Putting IPS theory into practice – working with service users, employer engagement, disclosure, working with clinical teams, marketing IPS , barriers to employment, Caseloads, supervision • Challenges – variation in services, service barriers, commitment levels, mh services change, economy eable

Lessons learned, progress made • Raising performance - average job starts increased by 73% • Increasing quality: 5 services FR: originally: 2 “not SE”, 3 “Fair” went to : 2 “Fair” and 3 “Good” (C of E) • Five years to establish a full working IPS service – we made these improvement s in 9 months • Staying close to Fidelity is crucial enable

For more information Jonathan Allan Tel: 01743 276900 www. shropshire. gov. uk/enablemarketing jonathan. allan@shropshire. gov. uk enable

www. coventry. gov. uk The Employment Support Service (TESS) Implementing IPS in Coventry Dean Atkinson

www. coventry. gov. uk Overview of TESS § Started in March 1993 § Client groups § Supported Employment § Part of the Council’s Employment Team § Partnership with Adult Social Care & Health

www. coventry. gov. uk Some of the challenges • Research project • Changing practices • Increasing employer engagement • Gaining commitment • Changing attitudes • Resources

www. coventry. gov. uk Our journey • • Part of the Improve project Fidelity self-assessment & plan Focus purely on paid employment To disclose or not to disclose? Work with health and social care colleagues Greater integration The Fidelity Review

www. coventry. gov. uk Being part of the Improve Project • Information & guidance • Training • Mentoring & support • Fidelity Review

www. coventry. gov. uk Progress so far • Moved from Fair to Good Fidelity • Increased client and employer contact time • Increased job outcomes • Increasing integration into CMHT’s • Centre of Excellence

www. coventry. gov. uk • Remain focused on IPS • Further investment • Develop stronger partnerships • Ongoing review • Share what we are learning • Promote success and learn from the rest!

www. coventry. gov. uk Thank you

Thank you Any questions? jan. hutchinson@centreformentalhealth. org. uk becky. priest@centreformentalhealth. org. uk dean. atkinson@coventry. gov. uk jonathan. allan@shropshire. gov. uk