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LEAD On! Newsletter – May 2021


LEAD On! Newsletter – May 2021 Newsletter


Issue
May 12, 2021

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May is Mental Health Awareness Month and a time to raise awareness of those living with mental or behavioral health conditions. This issue of the LEAD On! Newsletter highlights evidence-based employment strategies for the one in five people who will experience a mental health condition during their lifetime. Some of these proven practices, including Individual Placement and Support (IPS) and Customized Employment (CE), are used throughout the country, as well as in other parts of the world, to help people secure and maintain employment. IPS and CE are especially helpful for people who have not found success with other employment support strategies.

In this issue, you will learn about some resources and strategies to support the employment goals of individuals with mental health conditions and other promising implementation practices and research from the field.

According to the IPS Employment Center, which is led by Westat, IPS is based on eight principles that include:

  1. Competitive Employment: IPS focuses on jobs anyone can apply for, pay at least minimum wage/same pay as coworkers with similar duties, and have no artificial time limits imposed by a social service agency.
  2. Systematic Job Development: Employment specialists systematically visit employers, who are selected based on the job seeker’s preferences, to learn about their business needs and hiring preferences.
  3. Rapid Job Search: IPS programs use a rapid job search approach to help job seekers obtain jobs rather than assessments, training, and counseling. The first face-to-face contact with the employer occurs within 30 days.
  4. Integrated Services: IPS programs are integrated with mental health treatment teams. IPS employment specialists meet at least weekly with a team of providers to discuss and coordinate their clients’ recovery-oriented services.
  5. Benefits Planning: Employment specialists help people obtain personalized, understandable, and accurate information about their Social Security, Medicaid, and other government entitlements.
  6. Zero Exclusion: People are not excluded on the basis of readiness, diagnoses, symptoms, substance use history, psychiatric hospitalizations, homelessness, level of disability, or legal system involvement.
  7. Time-Unlimited Supports: Job supports are individualized and continue for as long as each worker wants and needs the support. Employment specialists have face-to-face contact at least monthly.
  8. Worker Preferences: IPS program services are based on each job seeker’s preferences and choices rather than the employment specialist’s and supervisor’s judgments.

According to The Essential Elements of Customized Employment for Universal Application, the essential elements are organized into the following four components:

  1. Overview of Customized Employment: CE refers to competitive integrated employment for an individual with a significant disability that is based on an individualized determination of the strengths, needs, and interests of the individual. CE is designed to meet the specific abilities of the individual with a significant disability and the business needs of the employer, and is carried out through flexible strategies.
  2. Conducting Discovery and Creating Discovery Documents: The WIOA definition of customized employment requires that an individualized determination be made of the individual’s strengths, needs, and interests for the employment seeker with a significant disability and that such employment meets the needs of the individual as well as the business needs of the employer. Discovery is the first step in the CE process and results in a document that captures what an individual has to offer to an employer, their vocational interests, and their support needs.
  3. Planning for Customized Employment: An expected standard for any rehabilitation or employment service is the development of a plan that articulates the individual’s goals and charts the direction of CE services. In CE, a job is customized with the customization driven by the individual. A dedicated plan for customization is necessary to assure that job offerings reflect the wishes of the employment seeker and the needs of the business, rather than responding to job openings or existing relationships held by employment specialists.
  4. Employment Development Representation: The definition of CE within WIOA requires that an employment specialist or job developer (representative), chosen by the employment seeker, be available to assist with making the employer contacts and negotiations necessary to customize a job.

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What is IPS?

IPS is an evidence-based supported employment model for people with serious mental illness (e.g., schizophrenia spectrum disorder, bipolar, depression). IPS supported employment helps people living with behavioral health conditions work at regular jobs of their choosing. Mainstream education and technical training are included as ways to advance career paths.

What is customized employment?

Customized employment is a flexible process that involves negotiating an individualized relationship between a job seeker and an employer in ways that meet the needs of both. It is based on an individualized determination and discovery of the strengths, requirements, and interests of a person with multiple challenges, as well as on an individualized match between these factors and the identified needs.

How is IPS funded?

Most states use braided funding from two or three sources to fund IPS. These sources may include state vocational rehabilitation funds, Medicaid, or state set-aside funds. Supports through American Job Centers also are available to job seekers with mental health conditions.

How is CE funded?

Customized employment and Discovery, which is the first step in the CE process, are most often funded through vocational rehabilitation funds and/or a variety of services under Medicaid Home and Community-Based Services Waivers. Service definitions and rates vary by state. Competitive Integrated Employment (CIE) and Customized Employment are authorized under Title IV of WIOA, which applies to Vocational Rehabilitation. Successful CIE outcomes for people with disabilities are enhanced by effective VR engagement with a wide range of businesses and workforce development partners. WIOA promotes the use of CE, especially for individuals with the most significant disabilities. In addition, sometimes the state has special initiatives or settlement agreements that can fund CE for eligible individuals.

Can IPS be used with individuals with other types of disabilities or do people need to have a mental health condition?

Many IPS programs are beginning to serve a diverse population of individuals including those with intellectual disabilities, physical disabilities, transition-aged youth, young adults, and Social Security and Temporary Assistance for Needy Families recipients.

Who benefits most from CE?

Customized employment provides an avenue to employment for job seekers who find that traditional job search methods do not meet their needs. CE is a universal strategy that benefits many people, including people with disabilities and others with multiple challenges to employment – including those with and without disabilities. It also benefits employers by specifically targeting and filling unmet needs in their businesses.

What types of job supports do employment specialists provide within IPS?

Job supports vary based upon each worker’s preferences and needs. Generally, employment specialists are encouraged to provide intensive supports, including in-person contact on a weekly basis for at least the first month of employment. Examples of supports are wake-up phone calls, meetings with employers to obtain extra feedback, help learning how to take a bus to work, family meetings to talk about the job, meetings with the worker to discuss how the job is going, on-the-job coaching to learn new duties, etc. Over time, most clients want and require fewer supports and eventually transition off the IPS caseload. On average, clients remain in the IPS program for about a year.

Visit the IPS Employment Center’s Frequently Asked Questions page to learn more about how IPS can support your workforce disability and inclusion needs. Learn more about how to promote CE as a universal design approach within the workforce development system to enable youth and adults with disabilities to secure and maintain employment.

Sources: The IPS Employment Center and the Essential Elements of Customized Employment.

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Missouri

The Missouri Departments of Mental Health (DMH) and Vocational Rehabilitation (VR) oversee the implementation and expansion of Individual Placement and Support (IPS) throughout the state. Their community IPS providers contributed to the expansion of Missouri's IPS program. In 2009, Missouri began with six IPS sites in the state, which grew to 13 sites by 2015. Today, 31 IPS sites serve Missourians with mental health conditions across the state. The employment team consists of VR and DMH staff with team members from both agencies conducting IPS reviews together. Several VR counselors received IPS Ambassadors training and educate others on the importance of IPS as a supported employment evidence-based practice. A Missouri State IPS trainer tracks and coordinates all IPS reviews and provides employment trainings to providers. Regional DMH staff, located throughout the state, provide training and technical assistance to their providers. Staff from both agencies are trained as lead reviewers. Providers coordinate trainings provided by AJCs, in which job center staff come onsite to explain services and provide general trainings on job seeking and job retention. VR and DMH promote and recognize these partnerships with the workforce system.

Collaboration is key. The IPS employment team holds quarterly IPS collaborative meetings between VR, DMH, and the IPS supervisors. These meetings provide opportunities for guest speakers from American Job Centers, housing authorities, benefits specialists, and other service providers. During these meetings, the team reviews the supported employment training schedule and providers share success stories, promising strategies, and challenges in their regions. They also provide updates on upcoming fidelity reviews. IPS programs use standardized fidelity reviews that measure the level of implementation of the evidence-based IPS practices. These collaborative meetings host breakout sessions that focus on specific IPS principles and serve as a forum to discuss the challenges and successes regarding each principle. Established IPS teams partner with newer teams to discuss challenges and successes related to each fidelity component. They also provide opportunities for teams to learn from each other.

Finally, these meetings help DMH and VR get a sense of areas where they can work with IPS providers to develop and implement employment trainings to improve fidelity and outcomes.

Illinois

In 2005, the Illinois Division of Mental Health (DMH), Department of Human Services and Vocational Rehabilitation (DRS) began the implementation of Individual Placement and Support (IPS). At that time, Illinois had only six IPS teams that served about 80 people. Now, 16 years later, they serve more than 3,500 people per year and have over 50 IPS teams across the state, including seven IPS trainers that make up the IPS review team.

Illinois partners emphasize the essential role of normalizing employment and interagency collaboration in their work. They also consider employment as a social determinant of health, which can lead to other gains that help people feel connected, integrated in their communities, and fulfilled in life.

The Illinois agencies also moved from a medical model to a recovery model. This shift reinforces that recovery is possible. DMH and DRS continue to expand their partnership. They work with the Division of Developmental Disabilities and their Employment First community. The Employment First community works with more than 15 different collaborative partners, including the Department of Commerce and Economic Opportunity, which oversees the Workforce Innovation and Opportunity Act (WIOA).

Messaging is critically important to the cross-agency collaboration. DMH and DRS engage their WIOA partners and the Department of Commerce and Economic Opportunity to help others understand that people with disabilities can and want to work. DMH and DRS emphasize the business case for hiring individuals who have disabilities to their partners. For example, they engaged with Cornell's Diversity Partners, American Job Centers, DMH, DRS, and community rehabilitation providers to discuss their collective shared mission. As a group, they created mutual talking points that made the business case to support IPS clients and other job seekers who have disabilities.

The Office of Disability Employment Policy, Veterans' Employment and Training Service, and the U.S. Department of Veterans Affairs released two videos featuring businesses that met their hiring needs by using Customized Employment to hire Veterans with disabilities. The U.S. Department of Labor premiered the "Customized Employment Works for Veterans" videos on February 23. Experts on employing veterans with disabilities and leaders from the U.S. Departments of Labor and Veterans Affairs joined the presentation.

The videos on "Customized Employment Works for Veterans: A Job that I Love" and "Customized Employment Works for Veterans: A Win-Win Strategy" are available for viewing.

Under the Advancing State Policy Integration for Recovery and Employment (ASPIRE) initiative, the Office of Disability Employment Policy (ODEP), working with Westat, awarded seven states technical assistance to align state policy, program, and funding infrastructures to support and expand competitive integrated employment (CIE) for persons with mental health conditions. Through ASPIRE, ODEP will help these states create and implement strategic plans that encompass multiple state systems and entities (including Mental/Behavioral Health, Medicaid, employment agencies, and other relevant systems and supports) in order to support CIE for persons with mental health conditions. To learn more, read the ODEP news release.

The LEAD Center’s February 4th webinar offered an introduction to IPS and explored the role of the workforce system in its implementation. The webinar focused on the benefits of IPS for all stakeholders, including, but not limited to job seekers, employers, and workforce programs and partners. Subject matter experts highlighted promising implementation practices from the field, including the involvement of the workforce development system in securing IPS supports for some job seekers. Speakers included international IPS expert Robert Drake and experienced practitioners from Illinois and Missouri.

This webinar, sponsored by the Office of Disability Employment Policy, discussed the IPS model and shared research on its effectiveness for people with serious mental illness and/or substance use disorders. To further highlight the importance of IPS, an individual with co-occurring disorders shared his story on how IPS helped him find employment and be successful at work. The webinar highlighted approaches that can be used during the three stages of employment (interview and application, post-offer and pre-employment, and during employment). The webinar featured speakers Barry Whaley and Pam Williamson from the Southeast ADA Center and Jackie Pogue from the IPS Employment Center.

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Many Veterans experience mental health conditions as a result of post-traumatic stress and other experiences they may have had during their service. The following four resources were developed to support Veterans in getting, keeping, and thriving in their post-service career.

  • LEAD Center created and field-tested Guided Group Discovery (GGD) for Veterans, and released a Guided Group Discovery - Veterans Edition Facilitator Guide. GGD trains people to facilitate Guided Group Discovery sessions with Veterans, people with disabilities, and/or others who experience barriers to employment. LEAD Center has supported pilot projects implementing Guided Group Discovery in American Job Centers in collaboration with a variety of partners, including Veterans services, vocational rehabilitation, developmental disabilities, behavioral health, Centers for Independent Living, homeless services providers, and others. By facilitating groups with partners, job seekers can get support from multiple systems and the agencies can leverage each other’s resources. The Facilitator Guide is available for download.
  • The Customized Employment Works for Veterans brief features the stories of five wounded warriors who obtained employment by using discovery and Customized Employment.
  • ODEP also created two videos that highlight ways that Customized Employment has enabled Veterans to achieve and retain employment. Customized Employment: A Job That I Love and Customized Employment Works for Veterans: A Win-Win Strategy.

State data related to mental health can be found on the DRIVE website, as well as access to state-level WIOA profiles that demonstrate how each state addresses mental health.

  • State-level Disability & Employment Data: Click on State Profiles to access a state or territory and find up-to-date State-level data in the areas of mental health, education, vocational rehabilitation, and more.
  • State-level WIOA Profiles: Click on WIOA Profile tab for your state to find 16 elements (including Behavioral / Mental Health) from your WIOA State Plan and State Plan Modification from a disability perspective.
  • Advanced Search: Click the Advanced Search function to discover Mental Health policy by state.

Related Research

Research shows a high prevalence of mental health conditions in special populations (Mental Health Disparities: Diverse Populations, American Psychiatric Association, 2017). Recognizing that mental health issues may need to be addressed with a unique lens when working with individuals whose backgrounds vary by race, ethnicity, religion, and language, Mental Health America (MHA) has created a BIPOC (Black, Indigenous, and People of Color) Mental Health Hub to promote and be effective in addressing mental health for all. MHA uses a racial equity and intersectionality lens to highlight, better understand, and effectively respond to the range of experiences of individuals and families with diverse values, beliefs, and sexual orientations.

Upcoming webinars:

Rate Reimbursement Restructuring Webinar Series

  • Part I:  Value, Outcome and Performance-Based Payment Methodologies to Advance Competitive Integrated Employment in State Medicaid Long-Term Services and Supports (LTSS) Systems and Managed Care LTSS Systems
    May 5, 2021
    Archive 

  • Part II: Supporting Employment Service Providers to Succeed and Prosper by Partnering to Advance Competitive Integrated Employment: Applying Value, Outcome and Performance-Based Payment Methodologies
    Archive

  • Part III: Advancing Competitive Integrated Employment: Value, Outcome and Performance-Based Payment Methodologies in State Vocational Rehabilitation and Behavioral Health Systems
    May 19, 2021
    3:00 - 4:30 p.m. ET
    Register

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