IPS 101 TANIA MORAWIEC EFSLMP SME CALIFORNIA IPS

IPS 101 TANIA MORAWIEC, EFSLMP SME & CALIFORNIA IPS TRAINER

Eight IPS Principles �ZERO EXCLUSION �CONSUMER JOB PREFERENCES ARE IMPORTANT �RAPID JOB SEARCH �COMPETITIVE EMPLOYMENT IS THE GOAL �EMPLOYMENT SPECIALISTS BUILD RELATIONSHIPS WITH EMPLOYERS �INTEGRATION OF MENTAL HEALTH SERVICES AND VOCATIONAL SERVICES IS IMPORTANT �UNLIMITED FOLLOW ALONG SUPPORT �BENEFITS COUNSELING

� There are no dependable assessments The Data Behind Zero Exclusion to predict work ability. � While practitioners cannot accurately predict whether someone will be successful at work, motivation to work has been demonstrated to be a predictor of success. Note that motivation itself is difficult to measure. � Over 60% of clients with severe mental illnesses want to work, but less than 20% are employed. � Only 2% of people who could benefit have access to effective employment services.

� The number of studies showing IPS' The Data Behind Zero Exclusion effectiveness continues to grow. To date, 25 randomized controlled trials of IPS have showed a significant advantage for IPS. Across the 25 studies, IPS showed an average competitive employment rate of 56% compared to 23% of controls. A metaanalysis of 17 randomized controlled trials found that people receiving IPS services were 2. 4 times more likely to be employed than controls (Modini, 2016).

WHY THE SCALE MATTERS �Nine of 10 studies assessing its predictive validity found positive associations with employment outcomes. �Its use in quality improvement was supported by positive reports from seven multisite projects.

SCORE � 115 -125 exemplary fidelity � 100 -114 good fidelity � 74 -99 fair fidelity � 73 and below-not supported employment �Three areas of observation Staffing-3 items Organization-8 items Services-14 items

YOU ARE A HUGE PART OF YOUR PROGRAM’S SUCCESS 25 FIDELITY ADHERENCE LOCAL LABOR MARKET 50 STAFF 25

STAFFING Case Load Size-20 or fewer clients 2. Employment Services Staff-staff provide ONLY employment services 3. Vocational Generalists-ES carry out all phases of employment service 1. Intake Job development Retention supports

ORGANIZATION 1 -8

INTEGRATION Integration With Mental Health Treatment Team Thru Team Assignment 1. ES are part of up to 2 treatment teams from which at least 90% of their caseload is comprised 2. Integration With MH Treatment Team Thru Frequent Contact ES attend & actively participate (shared decision making) in weekly team meetings Documentation of MH treatment and employment services are in a single chart Offices are co located or in close proximity ES advocate for voc services for those who have not yet been referred

NONTECHNICAL ASPECTS OF SUCCESS: PROMOTE HOPE �"Researchers are learning that a change in mind-set has the power to alter neurochemistry. ” Jerome Groopman's "The Anatomy of Hope �“Hope is the catalyst of recovery”-SAMSA Occupational Wellness Webinar �“We have to see ourselves as privileged, change our mindset. Recovery is a restoration of choice-I get to, not I have to” Herb Cobb

#3 COLLABORATION BTW ES & VOC REHAB Collaboration Btw. ES and Voc. Rehab Counselors Face-to-face TEAM contact monthly & client related contact weekly Effective, timely communication & documentation Invitation to participate in the IPS Steering Committee Quarterly meetings with expanded participation to assess progress

#4 VOCATIONAL UNIT � At least 2 full time ES and a team leader comprise unit � They meet weekly for client-based supervision and provide coverage for each other’s cases when needed

# 5 ROLE OF EMPLOYMENT SUPERVISOR � Skills are improved through outcome based � � supervision Supervisor attends each clinical treatment team meeting at least 1 x a quarter and constructively communicates with team leaders to solve programmatic issues One on one supervision occurs and INDIVIDUALIZED performance goals are set with each ES Weekly, strengths based team meetings occur Targeted mentorship is happening Community based job developmentorship occurs at least monthly for ES that are new or struggling with JD

#6 Zero Exclusion �Diagnosis �Substance Use �Symptoms �Age �Hospitalization History �Education �Gender Better Employment Outcomes

Zero Exclusion Criteria Everyone who says they want to work is a “good referral” Waiting lists are an exclusion issue-motivation wanes quickly without action

#7 Agency focus on competitive employment � Agency intake includes questions about employment � Agency includes questions about employment on all semi-annual and annual treatment plan reviews � Agency displays written postings/info about IPS in public areas � Agency supports ways for clients to share work stories with peers and staff � Agency measure rate of competitive employment for ALL clients on at least a quarterly basis and shares it with leadership and all staff

#8 Executive Team Support �Executive Director and Clinical Director demonstrate knowledge about the principles of IPS �Agency QA process includes explicit review of IPS program �A diverse IPS steering committee exists-At least one member of executive leadership is on the IPS steering committee �CEO communicates how IPS is a part of the agency mission �IPS supervisor shares info about implementation barriers with executive leadership at least 2 x a year

SERVICES 1 -14

#1: WORK INCENTIVES PLANNING �Benefits counseling for people is critical. It can help to allay an individual’s anxieties and fears about losing current benefits/income if they try work and encourages them to go ahead. �Benefits counseling may need to continue beyond initial employment, to assist the individual in coping with reporting requirements, raises, etc.

#2 DISCLOSURE �What is it? �How does it apply to me? �Will it help me? �What if I don’t want to? �What does it mean to employers? �What exactly will you say? �Who will you say it to? �Is your process different with big vs small employers? �Can I change my mind?

WHAT WE DON’T WANT TO SEE PROS OF DISCLOSURE NO CONS OF DISCLOSURE

DISLOSURE CONVERSATIONS SHOULD BE GEARED TOWARD DIVERSE LEARNERS �These conversations can and should happen several times-DATE THEM �They can include role play �The pros and cons should be written out �Clear examples of your job developing practices in disclosure and nondisclosure situations should be given

#3 VOCATIONAL ASSESSMENTS �Initial assessment occurs over 2 -3 sessions �It is COMPREHENSIVE-work, hobbies, culture, disclosure, MH �It is updated with information from new job experiences �Sources of information may include Client Treatment team Clinical records Family Previous employers Teachers

ASSESSMENTS DO NOT: emphasize office-based assessments, standardized tests, intelligence tests or work samples

FIDELITY & ASSESSMENTS �If situational assessments or paid “job try-outs’ are used on a routine basis, then the program would not rate above a 2 on the assessment item. �If a program only includes information from the client on the assessment, it could not rate above a 3. �If most people receive vocational evaluations, regardless of the reason (mandated by VR, or IPS program has a vocational evaluator), the program would receive a 1 for this item

Having a job with poor working conditions can be just as bad for a person’s mental health as being unemployed �Mental health benefits of work are restricted to good quality jobs. �The poorest quality work is comparable to unemployment as a risk factor for poor mental health. �Poor psychosocial job quality is measured by factors such as: high job demands low job control poor job security low job esteem

ASSESSMENT TIPS �It should be dated-start, completion & updates �It can involve community based employer exploration-informational interviews, observation �Use open-ended questions and visualization �Work Experience section should not say “see resume” This section should explore the negative and positive elements of each position in addition to the job title, employer info, tasks and dates

#4: Rapid Job Search �The research shows that participation in extensive pre-vocational assessment, work adjustment and job skills training programs does NOT improve employment success (Becker & Drake, 2003) �Assessments are limited to community career exploration as REQUESTED by a consumer �IPS encourages RAPID JOB SEARCH - The first employer contact occurs within a few weeks (30 days) or so of entering the IPS program.

Rapid Job Search Cont. �Reviewers determine the MEDIAN time to first employer contact. �IN ORDER TO RATE A 5 ON THIS ITEM, THE SUPERVISOR MUST TRACK THE # OF DAYS FROM 1 ST ES MEETING TO FACE EMPLOYER CONTACT FOR EACH CLIENT.

#5: INDIVIDUALIZED JOB SEARCH �Type of job �Workplace environment �Number of hours �Work shift �Disclosure (or no disclosure) �Location…

# 6 JD Frequent Employer Contacts �At least 6 face to face employer contacts per week �Must be made with a “decision maker” �“Follow-up” or relationship building contacts count

JOB DEVELOPMENT LOG EXAMPLE/CRITIQUE Date Employer Contact Outcome Follow-Up Plan 6/12/ Mariano’s Fresh Market Sam Targar, 2014 Lawrence & deli manager Ravenswood Contact HR, Chris Atwood at corp head *346 Print app, bring in w/ clnt & resume, meet Chris on Mondays aftr 2 pm 6/12/ Sparkle 2014 Broadway & Buena Delilah, store clerk Owner not in, Go back come back, left brochure 6/12/ Beck’s Bookstore 2014 1546 N. Sheridan manager Maybe in fall, low hrs Go back in fall 6/15/ C. S 2014 Todd@bns. glo bal. ney Not now Check back

POSSIBLE ADJUSTMENTS �Variations Add client the contact is intended for Add mileage log Note observations Rate/code level of urgency or openness to services Add purpose of contact �Improve Get last names Exact address Specific follow up plan

JOB DEVELOPMENT TRACKING �What is important when logging contacts? Who What Where When Follow-up plan, maintenance

#7 JD QUALITY �What do you consider quality job development? 1. ________ 2. ________ 3. ________ 4. ________ 5. ________

DO SOME RESEARCH BEFORE YOU WALK THROUGH THE DOOR. � HISTORY OF EMPLOYER � CURRENT EMPLOYMENT OPPORTUNITIES & STANDARD QUALIFICATIONS FOR THEM � REVIEWS OF SERVICES AND PRODUCTS � MISSION STATEMENT � ORGANIZATIONAL STRUCTURE

BUILD TRUST �Follow up and do what you promise �Create opportunities to build trust �Establish that the relationship you hope to build is mutually beneficial � Demonstrate that you appreciate and want to help the employer with their bottom line Saving money Building a diverse work force productivity

EXPAND NOTION OF WHAT WE CAN OFFER EMPLOYERS �INTER AGENCY ADVERTISING �DISABILITY AWARENESS TRAINING �REFERRAL TO OTHER BUSINESSES �ACCURATE TAX CREDIT INFORMATION �CONSISTENT, INFORMED, ON-SITE SUPPORT – (IF DESIRED)

#8 DIVERSITY OF JOBS & #9 EMPLOYERS �Reviewers take a list of at least 10 placements �Employers and job types are assessed to determine if individual preferences are being followed Agencies can have 2 of the same job type and two of the same employer without penalty 3 of the same may cause a point drop on this item If an employer is a chain, each franchise/location is counted as a separate employer

#10: Competitive Employment Is the Goal �Competitive employment is a job that is owned by the person. The person receives a paycheck directly from the employer. The job is not set aside for consumers through a work slot agreement. �Consumers interested in employment are not steered into day treatment or sheltered work. �Volunteer work should be used ONLY in response to individual preferences. It should not be sought out by the ES.

# 11 INDIVIDUALIZED FOLLOW ALONG SUPPORTS �JOB RETENTION PLANS

THE DEVIL’S IN THE DETAILS � Who is going to walk the dog? � When will I see my therapist? � What if something happens? � What am I going to wear and how am I going to keep it clean? � What if nobody likes me? � What if I get fired? � How am I going to get there? � What will I do for lunch?

TAKE THE BUS? IN THIS RAIN? !

BUT, CHI-BERIA, SNOWPOCALYPSE…

BUT, I’M TIRED

NOT SO EFFECTIVE JD/JR PLAN STATEMENTS �IMPLEMENT TREATMENT PLAN AS WRITTEN �MEET WITH ES �GO TO WORK �WORK ON TREATMENT PLAN GOALS �MANAGE SYMPTOMS �“YES” OR “NO” TO OPEN ENDED QUESTIONS �VISIT EMPLOYERS IN THE COMMUNITY

EIGHT DIMENSIONS OF WELLNESS

REASONS TO CALL OFF GOOD/ACCEPTABLE BAD �You are legitimately ill �You are a little tired �There was a death in �You had an argument the family �_______________ �You can’t find your shoes �It’s a nice day �It’s raining

#12 Time Unlimited Follow-Along Supports ES has face to face contact within: � 1 week before starting a job � 3 days after starting a job � Weekly for the first month � At least monthly for a year or more, on average, after working steadily and desired by clients � Clients are transitioned to step down supports following steady employment

#13 COMMUNITY BASED SERVICES �The goal for ES is to spend at least 65% of their time in natural community settings. �Library for job search activities with client �Meeting at a café before work shifts to talk about job retention supports �Conducting informational interviews with employers �Teaching self-advocacy skills at a job fair �________

#14 ASSERTIVE ENGAGEMENT & OUTREACH BY INTEGRATED TREATMENT TEAM 1. 2. 3. 4. 5. 6. Service termination is not based on missed appts or fixed time limits Systematic documentation of outreach attempts exists Engagement & outreach attempts are made by integrated team members Multiple community/home visits are made Coordinated visits by ES with integrated team member Connect with family when applicable

RULE OF THUMB �When writing plans, completing assessments and other documentation, be specific and gather information from diverse sources A reader should be able to tell who you are talking about without reading the name

USE PAST EXPERIENCES TO PLAN FOR THE FUTURE �JOB DEVELOPMENT PLAN �JOB RETENTION Not necessarily at job start. Can begin at assessment and job search planning stage

PEOPLE OFTEN FEAR THE UNKNOWN Normalize Anxiety �Provide examples of success �Work through fears and concerns �Bring in the treatment team �Provide peer mentor connections, peer supports �Explore resources-child care, carpool, flex schedule

EIGHT DIMENSIONS OF WELLNESS

SUPPORT APPROPRIATE EMPLOYMENT SITE SOCIALIZATION & CULTURAL ADAPTATION �Dress and hygiene �What are ways to take part in company sponsored activities? Jeans day, sportswear day, picnics? �Break room norms-food, cleanliness, shared space �What are good topics of conversation? Give examples, role play

PEER SUPPORT & WRAP INVALUABLE SUPPORTS FOR IPS PARTICIPANTS �THESE SUPPORTS CAN BE USEFUL AT ALL STAGES OF THE IPS PROCESS �SAMHSA, THE DEPT. OF VETERANS AFFAIRS & OVER 40 STATES CONSIDER PEER &FAMILY SUPPORTS AN EVIDENCE BASED PRACTICE

FACETS: WHO ARE WE REALLY DEVELOPING FOR? �People with a MH diagnosis �Members of Ethnic/Cultural Communities �Women �Vets �Animal lovers �Alumni �LGBT Community

DOCUMENT! UPDATE FORMS! DATE! �Possible Reasons for Adjustments/Updates Hire Assessment/job development plan: Change and REASONS FOR CHANGE in vocational interest Change in disclosure preference, reintroduction of disclosure topic Benefits consultation prior to JD, at hire, after job leaving Job development: New interests, triggers, obstacles, resources, natural supports Job retention plan-newly identified triggers, goals, natural supports or coping strategies

POSSIBLE REASONS FOR UPDATE �Commute Issues: bus stops running, car breaks down �Med change/new side effects �Issues with new supervisor or coworker �New natural support-girlfriend/boyfriend, coworker �Goal change-advancement/promotion �Change in job function or schedule, new tasks or productivity goals �Increased stress