IPS INADDICTIONS RECOVERY

Kyriacos Colocassis – Vocational Project Manager

Agenda• Introduction to the Individual Placement & Support

(IPS) and Key Performance Indicators• IPS compared with traditional Supported Employment

methods (Pre-Vocational Training)• Effective implementation of IPS

- Associated Challenges, within Addictions- Employer Engagement- Outcomes achieved by the Addictions Team- Cost

SO WHAT IS IPS?• The Individual Placement & Support model• An evidence-based model of employment support• Originally implemented in the US to support people

with mental health problems• At the start of our project, IPS had only been used

once before in the UK with an addictions client group• CNWL is a Centre of Excellence in IPS services

Central Tenets of the IPS Model1. Eligibility is based on individual choice;

2. Supported employment is integrated with treatment;

3. Competitive employment is the goal; (Not sheltered placements or volunteering)

4. Rapid job search (within 4 weeks), minimal prevocational training

5. Job finding, and all assistance, is individualised;

6. Employers are approached with the needs of individuals in mind

7. Follow-along supports are continuous;

8. Financial planning is provided

BenefitsIPS interventions have been proven through research to provide statistically significantly better outcomes compared to other forms of employment support.

Measurable Outcomes:

• Time employed/job sustained• Earnings• Likelihood of dropping out of service/rehospitalisation• Percentage of service users entering competitive employment

Burns, Tom et al (2007), The Effectiveness of Supported Employment for People with Severe Mental Illness: A Randomised Controlled Trial, Lancet 370, 1146-52.

Sample size – 312; comprised of 156 people accessing IPS, 156 people accessing pre-vocational training

Entry criteria – Patients with severe mental illness in six European cities. All subjects had not been in competitive employment in the last year, and wanted to enter competitive work

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Results for IPS Results for pre-vocationaltraining

Number entering employment

Comparing Competitive Employment RatesIPS vs the traditional service (1996 – 2010)

96 NH 10 AL 07 IL 04 CT 08 HK 10 CA 08 AUS 06 SC 99 DC 08 CA 7EUR 6 QUE 10 HOL 2 MD0

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IPS Control 1

Control 2

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IPS v Work Choice Govt programmeJob outcomes 2011/2012

% paid job outcomes0%

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20%

30%

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60%

IPS SMI (7 sites)'Work Choice Mild to Moderate *Work Choice SMI *

Challenges • Picking up prescriptions when in employment, changing

pharmacies and arranging appointments with key worker around employment hours

• Discrimination; not covered by disability legislation. (Equality Act 2010 explicitly excludes addiction).

• Chaotic, non stable lifestyles, ESs have to work with that in mind

• Forensic history• Gaps on CV• Physical problems caused by substance use• Erratic attendance

Challenges

• Legal limitations on driving, while on replacement medication and company limitations on operating heavy machinery etc

• Zero exclusion and Key Workers• Inappropriate referrals – i.e. not seeking employment• Discharge before reaching vocational goal• Disengagement• Clients likely to miss appointments • When engaging in treatment, many find it necessary to detach

themselves from their former lives, i.e. drug using friends – leading to isolation

Employer Engagement – Addictions• Target driven – face to face employer engagement and

client interview targets as well as project targets for employment outcomes

• Working with employers around managing risk, reasonable adjustments, unlimited follow along support, mental health and drug awareness training

• All clients have return to work and relapse prevention plans• Autonomy for ESs managing their own caseload within IPS

guidelines• Support in supervision sessions around employer

engagement

Keys to successful implementation in the team:• Building a local shared vision for IPS implementation• Team presentations and training• Clear role with key performance indicators (ideally 1 ES per

team)• Being clear that the priority is paid employment not voluntary

work or training• Agreement around the role of the ES and what we mean by IPS

Fidelity• Clear supervision mechanisms in place: needs met jointly

through Vocational and Clinical Services supervision

SUCCESS SO FAR FOR IPS ADDICTIONS

TEAM

Performance:When IPS was implemented within K&C/Westminster Early Intervention 80% of those referred were inactive. Within 9 months this fell to 23%

*76 clients have entered and remain in employment at the end of the reporting period

12 Month Target

Brent H&F Hillingdon Ealing Hounslow

K&C

Clients accessing the service

35 41 31 35 36 28 41

Paid employment

15 25 16 18 16 9 18

*Sustained Employment

10 (65%)

17 5 11 8 5 7

Training / Education

10 19 7 10 7 15 13

Voluntary employment

4 8 5 3 6 1 8

• 212 clients accessed the service; with 102 employment outcomes being achieved by 84 clients. 71 education outcomes and 31 clients accessed voluntary opportunities.

• 56 of the clients accessing the service were people recovering from alcohol related problems; 152 from drug and 6 were dual diagnosis/other.

• 181(85%) of the clients accessing the service were unemployed and completely unoccupied at the time of referral; by the end of the reporting period this fell to 50 (23%).

• The average length of unemployment of clients accessing the service was 3 years and 3 months.

• Of the 84 individual clients that entered employment, 53 (63%) sustained their employment for a minimum of 13 weeks.

At the end of the reporting period:- 37 (70%) have been in employment up to 13 weeks. - 13 (25%) have been in employment between 13 weeks and 6

months.- 3 (6%) have been in employment for over 6 months

• At the beginning of the year, 5 clients disclosed illegal activity including prostitution and drug dealing. At the end of the reporting period all but 1of these clients had ceased that activity.

Skilled trades occupations

Sales & Customer Service

Professsional occupations

Process plants and machine operatives

Managers

Elementary occupants

Caring leisure & other services

Associate professional & technical

Administrative & secretarial

0 5 10 15 20 25

20

20

2

5

4

23

18

3

9

New employment starts by job type

FOR FURTHER INFORMATION:

Central and North West London NHS Foundation Trust

Kyriacos Colocassis

Tel: 020 7621 1657 Mobile: 0956 237 885

Email: gary.colocassis@nhs.net