Center for Practice Innovations Brings
Best Practices to NYS:
IPS Model of Supported Employment and
Wellness Self-Management (WSM)
NYAPRS Conference
September 23, 2010
Carlos Jackson, Ph.D.
Paul Margolies, Ph.D.
Raymond Gregory
Anthony Salerno, Ph.D.
Who we are?
Public-Academic Partnership
Tony Salerno, Ph.D.
Project Director,
Wellness Self-Management
Susan Essock, Ph.D.
Director
Paul Margolies, Ph.D.
Associate Director
Implementation
Raymond Gregory
IPS Trainer
Carlos Jackson, Ph.D.
Associate Director
Operations
What we do?
On-line
training
Distance
Learning
www.practiceinnovations.org
Web-based
Collaborations
Building best practices with you.
Individual Placement and
Support
Why Focus on Employment?
• Viewed by many as an essential part of
recovery
• Most consumers want to work
• A typical role for adults in our society
Competitive Employment for
People with Severe Mental
Illness
Say they want to work: 70%
Are currently working: <15%
Current access to supported
employment: <5%
What is Supported
Employment?
• Supported Employment helps people with mental
illnesses find and keep meaningful jobs in the
community.
• The jobs exist in the open labor market, pay at
least minimum wage, and are in work settings
that include people who are not disabled.
SAMHSA Supported Employment Tool Kit
Evidence-Based Principles
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Eligibility is based on consumer choice
Supported employment is integrated with treatment
Competitive employment is the goal
Personalized benefits planning is provided
Job search starts soon after a consumer expresses interest
in working
• Follow-along supports are continuous
• Consumer preferences are important
Eligibility Is Based on Consumer
Choice
• All consumers who want to work are
eligible for Supported Employment.
• Consumers are not excluded because
they are not “ready” or because of prior
work history, hospitalization history,
substance use, symptoms, or other
characteristics.
Supported Employment Is
Integrated with Mental Health
Treatment
• Employment specialists are
treatment team members and
coordinate their efforts with all
team members
Competitive Employment Is the
Goal
• Employment specialists help consumers find jobs in
the open labor market and that pay at least minimum
wage, including part-time and full-time jobs.
• Consumers interested in employment are not steered
into day treatment or sheltered work.
• The agency devotes sufficient resources to supported
employment to permit full access to all consumers who
seek competitive employment.
Personalized Benefits Planning
Is Provided
• Employment specialists help consumers
understand how benefits (such as Social
Security or Medicaid) are affected by working so
that they can make informed decisions about
starting or changing jobs.
• Most consumers are able to work and receive
some benefits.
Job Search Starts Soon After A
Consumer Expresses an Interest
in Working
• Pre-employment assessment, training,
and counseling are not required and are
kept to a minimum.
Follow-Along Supports Are
Continuous
• Supported employment staff
continue to stay in regular contact
with consumer and (when
appropriate) the employer without
arbitrary time limits.
Consumer Preferences Are
Important
• Job finding is based on consumers’
preferences, strengths, and work
experiences, not on a pool of jobs that are
available.
Myths and Misconceptions about
IPS
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“Supported Employment? Oh, we do that!”
We have too much to do as it is…
Results aren’t real, they are exaggerated
This can’t be done with such a poor economy.
There just aren’t any jobs out there.
• No exclusion criteria???
• Rapid Placement???
• How can IPS fit into a Pros program???
Center for Practice Innovation’s
Statewide IPS Initiative:
Focus on PROS
Plan
To bring IPS to PROS programs:
• Many PROS programs will receive
significant technical assistance through
learning collaboratives and distance
learning approaches
• Some PROS programs will receive
significant on-site consultation, coaching
and training
Goals
 Clear understanding of priority placed on employment
outcomes
 Clear understanding of essential role of leadership in
making and sustaining this change
 Clear understanding of IPS fidelity and the need for
adaptation to PROS environment
 Implementation of IPS, adapted to PROS environment
 Fully competent employment specialist(s)
 Supervisory structure for IPS in place and functioning
Anticipated Outcomes
• Employment outcomes for participating
PROS programs are improved,
• IPS practice is implemented in a manner
that allows for successful adaptation to
PROS environment
Learning Collaboratives/Distance
Learning
Methods
• Regional forums – learning collaborative meetings for PROS
program directors and employment specialists
• Guidance and support for implementation
• Employment specialists receive training and coaching in critical
skills
• Consultation phone calls
• For PROS program directors
• Some regional, some program-specific
• Online discussion threads including “Ask the Expert” threads
• Webinars/videoconferences
• Implementation guidelines, engagement guides, and other
implementation supports
Significant on-site consultation,
coaching and training
Methods
Hands-on work with program and agency
leadership, supervisor(s), and team
members with special emphasis on
employment specialists(s)
Significant on-site consultation,
coaching and training
Programs Now Involved
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HALI
Clubhouse of Suffolk
FEGS
Federation of Organizations
Putnam Family and Community Services
Occupations, Inc.
IPS
Some illustrations from our work with PROS
programs….
Wellness Self-Management
Agenda
• What is Wellness Self-Management
(WSM) and why is it important?
• WSM Personal Workbook – one key
resource
• Statewide initiative and update
• Center for Practice Innovations: A
resource for consumers, practitioners and
agencies
What is Wellness SelfManagement?
• Curriculum based practice designed to assist adults to
effectively self -manage serious mental health and
related problems
• The topics covered include a number of research
informed approaches that are organized into a
comprehensive and coordinated set of practices
• Integrates 3 key areas:
• Recovery
• Mental health wellness and relapse prevention
• Physical health
What is Wellness SelfManagement? Continued
Based upon several sources:
• Dartmouth/SAMHSA Illness Management and
Recovery materials and implementation resource kits
• OMH Bureau of Recipient Affairs revision of
Dartmouth materials
• Eli Lilly NTTP materials
• Feedback from focus groups involving consumers,
practitioners, and experts on cultural competency
Eight Goals of the Program
• Learning about recovery and what it can mean
for you
• Making the best use of your mental and physical
health services
• Learning how mental health and physical
wellness will help you to achieve your goals and
support your personal recovery
• Staying well by decreasing symptoms of a
mental health problem
Goals of the Program
(continued)
• Learning how to manage day-to-day stress
and prevent relapse
• Staying well by connecting with others
• Staying well by living a healthy lifestyle
• Recognizing and building on your cultural
values and experiences to support your
personal recovery
WSM:
The Personal Workbook
• 57 lesson curriculum
• Integrates concepts of Recovery-Mental health
Wellness and Physical health
• Structured lesson format
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Important information
Discussion points
Personalized worksheet
Action step planning
• Non-prescriptive language
WSM: Logistics
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Group or individual format
Meets at least once a week for 45+ minutes
Group meets around a table
Optimally closed group with 8-10 members
• Successfully employed in open groups
• Optimally co-led with a peer counselor
• May be customized to setting and population
(Selected chapters and lessons)
Details about the WSM Program
in the NYS Initiative
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Group Format
Meets at least once weekly
Lasts approximately 1 year
Ideally, closed group where possible
Encourage peer co-facilitation (e.g., peer
specialists)
• Reinforced in individual meetings (consistency
and continuity across services)
Going Statewide
Participating Agencies
105 programs participated in the statewide
initiative (Nov 2007-Nov 2009)
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22 Clinics
11 Inpatient programs
3 IPRT
8 Psychosocial Clubs
14 Residential programs (various types)
33 CDT’s
2 Adult home case management
2 PROS
2 ACT
1 COD program (VA of Northport, Long Island)
9 Forensic programs (1 inpatient and 8 outpatient programs
located in prisons)
** 3 VA systems 12 State Operated
Statewide Initiative update
• Over 4500 participants and growing
• A recent survey based on the responses of 87 of the
original 100 participating agencies indicate that 85%
currently provide WSM groups; 13 % have plans to offer
WSM starting in the fall and 2 % won’t be offering WSM.
• WSM spinoffs in field testing
• WSM+ (integrates mental health and substance use)
• KEY (Knowledge Empowers You) for youth
• WSM for individuals treated in prison mental health units
Goals Identified by Consumers at the Beginning of the WSM Program
(n = 409)
Being confident I can handle my mental health problems
Improving my physical health
Enjoying hobbies, leisure and recreational activities
Being hopeful about my future
Using medication in a way works for me
Working at a paid job
Living in a place that I like and can manage
Engaging in creative activities
Stopping or reducing my use of alcohol, drugs or cigarettes
Working towards an academic degree
Contributing to my community in a useful way
Add your own goal
Having a good relationship with family members
Socializing with friends
Improving my spiritual/religious side
0
10
20
30
40
50
60
70
Percent of Consumers
80
90 100
Personal Assessment of Progress at the End of the Program
Achieved Goal
Improvement
No Improvement
Stopping or reducing my use of alcohol, drugs or cigarettes (n = 259)
Using medication in a way works for me (n = 309)
Having a good relationship with family members (n = 110)
Socializing with friends (n = 110)
Enjoying hobbies, leisure and recreational activities (n = 330)
Living in a place that I like and can manage (n = 289)
Engaging in creative activities (n = 292)
Being confident I can handle my mental health problems (n = 339)
Improving my physical health (n = 339)
Improving my spiritual/religious side (n = 99)
Contributing to my community in a useful way (n = 233)
Being hopeful about my future (n = 322)
Working at a paid job ( n = 296)
Add your own goal (n = 129)
Working towards an academic degree (n = 243)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90% 100%
Sustainability of WSM: CPI Resources and Tool Development
WWW.PRACTICEINNOVATIONS.ORG
Informational/promotional materials
• Brochure
• Sample workbooks
• DVD with program description and participant testimonials
Training materials
• Group skills DVD
• Full day comprehensive training DVD
• Group leaders quick guide
• Online course (1 ½ to 2 hours) 224 have registered; 127 (57%) have
completed the course, 83 (37%) are in progress, and 14 (6%) have registered but not
yet started the training.
Program materials
• Workbooks (electronic and bound copies) English, Spanish, Korean
and Chinese. Also, large print for visually impaired