Supported Emloyment / Individual Placement and Support SE/IPS

Supported Employment/Individual Placement and Support (SE/IPS) is an evidence-based practice that helps people with mental illness and other disabilities identify and acquire part-time or full-time jobs of their choice in the community with rapid job-search and placement services. It emphasizes that work is not the result of treatment and recovery but integral to both.

SE/IPS is very different from traditional vocational rehabilitation (voc rehab). It also emphasizes consumer choice as well as time-unlimited and individualized follow-along services, among other components that are described below.

MAKING THE CASE

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.

For more information, see Bond (2004), Becker & Drake (2003), and Drake (1999) in Resources below.

WORK IS RECOVERY

SE Increases

• Employment in competitive jobs
• Number of hours worked
• Amount of income earned in competitive jobs

SE Decreases

• Unemployment
• Dependence upon public systems of care
• Symptoms of mental illness
• Hospitalizations
• Stigma in the community about mental illness

Competitive Employment Improves

• Self-esteem
• Self-management of mental health symptoms
• Independent living
• Autonomy

CORE PRINCIPLES

1.) Zero-Exclusion Policy

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 SE/IPS
• Are still experiencing symptoms of mental illness
• Experience cognitive impairments (e.g., memory, problem-solving difficulties)
• *Are still using alcohol or other drugs
• 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

* 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.

2.) Integrated Employment & Treatment

SE/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)

3.) Competitive Jobs

Competitive employment is the goal of SE/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:

• Consumers like them more than sheltered work.
• 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.

4.) Rapid Job-Search

As soon as people express an interest in employment, service team members connect them with employment specialists. In two to three weeks, 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.

5.) Systematic Job Development

Getting to know employers helps people find jobs that meet their strengths, needs, abilities, and preferences. Employment specialists build relationships with employers through planned 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.

6.) Time-Unlimited Support

Follow-along services help people through their work and recovery journeys for as long as they want or need them. These supports are provided by employment specialists, case managers, other service providers, and by natural supports, including family members, friends, co-workers, and other peers. Examples of follow-along services include

• On-the-job supports (e.g., job coaching)
• Job transitions (e.g., to new roles within a business, to new jobs at different businesses).

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

7.) Consumer Preferences

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

8.) Benefits Planning

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
  

FIDELITY & OUTCOMEs

There are treatment characteristics (components) and organizational characteristics of the SE/IPS model that are called fidelity domains. These domains encourage service systems and organizations to develop holistic integrated program structures and treatments. These domains also provide a structure for a continuous quality-improvement process that addresses multiple outcomes. SE/IPS facilitates systems change, organizational change, and clinical change when it is implemented with fidelity.

SOURCES

• Gary R. Bond (2004). Supported Employment: Evidence for an Evidence-Based Practice. Psychiatric Rehabilitation Journal, v27, n4, p345-359.

• Deborah R. Becker and Robert E. Drake, MD (2003). A Working Life for People with Severe Mental Illness. New York: Oxford University Press, Inc.

• Robert E. Drake, Guest Editor. (1998). Supported Employment: A Special Issue of Psychiatric Rehabilitation Journal. Psychiatric Rehabilitation Journal. Summer, v22, n1.