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1 Individualized Placement and Support (IPS) - Supported Transition-Aged Youth Community of Practice Quarterly Conference Call May 24, 2012 Technical Assistance Partnership for Child and Family Mental Health Employment

2 Welcome to Today s Call Audio Information: Dial Into: Conference ID: *All phone lines will be muted: To un-mute your phone, dial *7 To re-mute your phone, dial *6 For Technical Assistance: Dial: To Submit Questions During Presentations: Use the Q&A button at the top of your screen

3 Our Presenters Rochelle Frounfelker, Research Associate, Thresholds Psychiatric Rehabilitation Centers (Chicago, Illinois) Steven A. Reeder, Chief, Evidence-Based Practice Services and Program Evaluation, Maryland Department of Health and Mental Hygiene Administration Virginia Selleck, Adult Clinical Director, Comprehensive Psychiatric Services Division, Missouri Dept of Mental Health

4 Rochelle Frounfelker, MPH, MSSW Research Associate Thresholds-Dartmouth Research Center Thresholds Psychiatric Rehabilitation Centers Chicago, IL

5 1. The consumer determines eligibility 2. IPS is integrated with mental health treatment 3. Competitive employment is the goal 4. Searching for a job begins rapidly 5. Jobs fit individual preferences 6. Follow-along supports are time unlimited 7. Benefits counseling is a part of the employment decision-making process 8. Relationships are built with employers based upon client job interests

6 In 11 of 11 studies, IPS had significantly better competitive employment outcomes than controls (Bond, Drake & Becker, 2008) Mean across studies of consumers working competitively at some time: 61% for IPS 23% for controls

7 First-episode psychosis Integrating IPS SE & Supported Education Review of 5 RCTs (Rinaldi et al., 2010) Employment and education rate 69% vs. 35% Employment Intervention Demonstration Program (Burke-Miller et al., 2012) year olds 51% competitively employed year olds 56% competitively employed

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9 Three years of data (09-12) 53 out of 131 members competitively employed (40%) 92 jobs held Average hours worked per week Average job tenure- 90 days Average hourly pay - $8.69

10 The Transitions RTC aims to improve the supports for youth and young adults, ages 14-30, with serious mental health conditions who are trying to successfully complete their schooling and training and move into rewarding work lives. We are located at the University of Massachusetts Medical School, Worcester, MA, Dept of Psychiatry, Center for Mental Health Services Research. Visit us at: Transitions RTC

11 The specific aim of the project is to develop and evaluate a Supported Employment/Supported Education model that improves employment and educational outcomes for TAY. Aim 1. Develop a supported employment/supported education model incorporating the most promising interventions for TAY with SMI and serious emotional disturbances. Aim 2. Conduct a pilot evaluation of the supported employment/supported education model. Mixed methods pre-post feasibility study N= 40 Baseline, 12 month & 18 Month Assessments

12 Adapted IPS Supported Employment for Transition Age Youth Modeled after IPS SE for young adults with first episode psychosis Integrated IPS SE & Supported Education The Model: SE/SED + Peer Mentoring Main Program Components IPS Supported Employment Supported Education Peer Support Program Goal: to provide intensive support in finding and securing vocational and/or educational opportunities in a way that will prepare transition age youth (TAY) with serious mental health conditions for community integration and independence

13 Policy Applications Steve Reeder Maryland Department of Health and Mental Hygiene, Mental Hygiene Administration

14 Long-standing collaborative partnership with MHA and DORS which demonstrates the shared vision and central value of employment for individuals with SMI. Memorandum of Understanding (MOU) for Supported Employment (SE) between MHA and DORS for 20 years, which outlines joint funding of SE. Reeder 2

15 DORS decision to grant deemed status approval for supported employment for Mental Health Programs approved by DHMH, Office of Health Care Quality. MHA mandate of referral to DORS for SE, which leverages DORS funding for Public Mental Health System (PMHS) consumers. (COMAR ). MHA decision to direct SE funding exclusively to competitive, integrated employment and not agency-sponsored employment. Reeder 3

16 Braided funding mechanism leverages three funding sources: MA through MA Rehabilitation Option, state general funds to MHA through legislative appropriation, and DORS Vocational Rehabilitation funds from RSA. Deemed status of single SE provider to deliver discrete, and mutually exclusive services in PMHS and DORS system. Single point of entry (one authorization request; DORS application embedded in ASO system). Reeder 4

17 SE applicants are presumed eligible and to have a most significant disability for eligibility for DORS services. Guest access to ASO for DORS counselor to rehabilitation and treatment information. Seamless to provider and transparent to consumer. Appropriation of funding source is at the system level not the provider level (tied to authorization and CPT codes) Enhanced funding for EBP SE based on fidelity which is a proxy for outcomes a proxy for outcomes. Reeder 5

18 EBP SE is available and accessible to youth at age 16 or two years before graduation. Best predictor of post-school success is paid competitive employment prior to graduation from high school (mitigates against drop-out)

19 Eligibility and medical necessity criteria which span the child- and adult- mental health systems to provide continuous, uninterrupted access to transition-specific services and supports (i.e., eliminates eligibility cliff ).