IPS Research Update Bob Drake Dartmouth Medical School

IPS Research Update Bob Drake Dartmouth Medical School 2011

Dilemma in 1990 3 -5% population disabled by mental illness l People with severe mental illness identify work as their top goal l – More than 70% want to work Less than 10% working l No effective interventions l • Bond, 1992

The President’s New Freedom Commission Report (2003) l “The main goal of the mental health system is to help people to live, learn, work, and participate fully in their communities” l Mike Hogan (2006): “Work is the most direct step to recovery”

Current Status of IPS l l IPS model is simple and effective Other benefits accrue with consistent work Work outcomes improve over time IPS is relatively easy to implement

Competitive Employment Rates in 16 Randomized Controlled Trials of Individual Placement and Support

CT Supported Employment Study (Mueser, 2004)

Impact on Other Outcomes l l l Improved self-esteem, symptom control, quality of life Related to sustained competitive employment No changes with sustained sheltered employment (Bond, 2001)

Long-Term Outcomes l 4 studies with 10 -year follow-ups (Test, 1989; Salyers, 2004; Becker, 2006; Bush, 2009) Work outcomes improve over time l Costs decrease dramatically for consistent workers (Bush, 2009) l

8 -12 Year Follow-up: Day Treatment to IPS l 71% working at follow-up l 85% in competitive jobs l 71% worked more than 50% of FU l 90% still receiving benefits (Becker, 2006)

Cost Savings Ø Each person with a SMI who becomes employed achieves an average savings in health costs of $5, 000 per year (Bush et al. 2009)

Johnson & Johnson. Dartmouth Project l l l l Mental health-vocational rehabilitation collaboration implement evidence-based SE = IPS Local programs selected by states Dartmouth provides training, consultation, evaluation National Learning Collaborative States: CT, DC, KS, MD, OR, SC, VT, IL, MN, MO, OH, KY, WI Special Projects: NJ, OH, IL International Collaborative

J&J-Dartmouth Program: Real World Agencies

Early Intervention l First episode psychosis (Nuechterlein, 2005; Rinaldi, 2009; Killackey, 2009)

Early Intervention (Nuechterlein, 2005)

Addressing Cognition l Concentration, memory, reaction speed, and problem-solving l Job match l Improve cognitive function l Compensatory strategies (Mc. Gurk, 2008)

Cognitive Training l Practicing cognitive tasks may create new neuronal connections l Tasks directly relevant to work tasks l New capacity may translate to work (Mc. Gurk, 2005)

Benefits Reform l People are socialized into disability l Changing benefits structure essential

Policy Changes People with disabilities need cash, health insurance, and a job l They do not need to be assigned to a lifetime of unemployment and poverty in order to get health insurance l Legislative change is critical l Carl Suter, CSAVR (2006)

Federal Funding Reform l We need simple payment system l Federal committees l Advocacy

Conclusions l l IPS has created hope for people with psychiatric disabilities, their families, and MH/VR practitioners Outcomes can be enhanced further New research Policy changes

Financial Support Grants from NIDA, NIDRR, NIMH, RWJF, SAMHSA l Contracts from Guilford Press, Hazelden Press, Mac. Arthur Foundation, Oxford Press, New York Office of Mental Health, Research Foundation for Mental Health l Gifts from Johnson & Johnson Corporate Contributions, Segal Foundation, Thomson Foundation, Vail Foundation, West Foundation l

Many Thanks l l l Deborah Becker l Gary Bond l Greg Mc. Hugo l Haiyi Xie l Jon Skinner l Phil Bush l Will Torrey l Kim Mueser l Rob Whitley l Susan Mc. Gurk l Eric Latimer Elizabeth Carpenter-Song Matt Merrens Paul Gorman Sarah Swanson David Lynde Howard Goldman Sandy Reese Kikuko Campbell Will Haslett Saira Nawaz Crystal Glover

Information: books, videos, research articles l Patti O’Brien l Patti. O’Brien@Dartmouth. edu l 603 -448 -0263 l http: //dms. dartmouth. edu/prc