A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Individual placement and support (IPS) is an evidence-based supported employment program designed to help people with mental health disabilities find and keep jobs. In an IPS program, employment specialists work with clients in the community mental health setting to develop job goals, find job placements, and receive on-the-job supports. IPS programs may be run by state departments of mental health or vocational rehabilitation or they may be run within community mental health centers. Despite evidence of their effectiveness, program managers and administrators may face practical challenges when trying to implement and sustain standardized programs such as IPS. As a result, agencies may discontinue these programs before they have an opportunity to be successful. In a recent NIDILRR-funded study, researchers asked IPS team leaders for their perspectives on how to sustain IPS services at their agencies. They wanted to find out what challenges the agencies faced to sustaining the IPS programs, as well as the positive factors that helped the IPS programs to persist over time.
Researchers conducting a Prospective National Study of Sustaining IPS Through Vocational Rehabilitation and Mental Health Collaboration interviewed individuals who led teams of employment specialists at 129 IPS program sites in 13 states. These team leaders were involved in a national IPS learning community, where they received ongoing training on how to implement and sustain the IPS program and shared information with one another. Teams at the 129 IPS program sites had been providing employment supports to clients with mental health disabilities for an average of 4.5 years by the time of the first interview. The researchers interviewed the team leaders twice, once in 2012 and again in 2014. In the first interview, the team leaders answered open questions about the challenges they encountered in sustaining the IPS program at their agencies, as well as factors that helped them maintain the program. In the second interview, the team leaders were again asked about challenges and success factors associated with sustaining the IPS program, and they were also asked whether or not the IPS program at their agency was still active. If it had been discontinued, they were asked to describe why.
The researchers found that the team leaders identified a number of challenges in sustaining an IPS program over time at their agencies. These challenges included:
- Reduced funding: Some team leaders described how state funding cuts or Medicaid reductions made it difficult to operate an IPS program. This was a particular problem when the program depended on only one funding source.
- Local community factors: Team leaders working in small, rural communities described how a lack of public transportation or a struggling local economy made finding jobs for clients difficult.
- Lack of agency prioritization: Some team leaders felt that their agencies did not treat the IPS program as a priority, or that agency directors did not know enough about supported employment to provide needed oversight.
The team leaders also identified positive factors that helped them sustain their IPS programs. The most commonly identified positive factors included:
- Continued funding support: Some IPS team leaders described the availability of funding from multiple sources as important for program sustainment, while others said that funding from a particular source (such as Medicaid or a state Department of Mental Health) was critical for sustaining the program.
- Agency support: Team leaders at agencies that prioritized the IPS program felt that this internal support was important for the program’s success. For example, team leaders described the value of having all agency staff, not just employment counselors, buy in to the importance of employment for their clients and refer their clients to the IPS program.
- Support from senior leadership: Involvement and advocacy from senior-level agency staff was cited as an important factor sustaining IPS programs.
- Experienced staff, internal collaboration, and well-established procedures: Skilled employment specialists and vocational rehabilitation staff were seen as instrumental for IPS program success. Programs operated best when agency staff collaborated across departments, and when procedures were set up to minimize paperwork and bureaucratic hurdles.
Nearly all of the IPS programs (122 out of 129) remained active and were operated as stand-alone programs between 2012 and 2014. Two of the programs were consolidated as their parent agencies merged, and continued to operate as one program within the new agency. The remaining five programs were discontinued. For three of these discontinued programs, team leaders identified financial pressures as a major reason for discontinuing; in addition, team leaders from two of these three programs cited challenging record-keeping requirements from Medicaid as a factor. The third of these three programs lost its agency director, a strong advocate for IPS programs, and was acquired by a behavioral health organization which chose to focus on other programs. For the two remaining IPS programs, staff shortages and institutional priorities were cited as reasons for discontinuing the IPS program.
The authors noted that IPS team leaders in this study reported a high rate of success in sustaining their programs. These team leaders were part of a national learning community, where they received a great deal of support from colleagues and professionals in the field of IPS. Program success rates may be lower in the absence of such ongoing supports. The authors also suggested that more research is needed to track the development and longevity of IPS programs beyond a two-year span.
According to the authors, evidence-based mental health programs, such as IPS, can persist over time with the right combination of supports. These include a reliable funding stream, availability of talented program staff, collaboration between agency departments, and support from agency leadership. Such factors may be especially critical for programs operating in rural or low-resource communities.
To Learn More
This project shared success stories from IPS program staff and clients in its Winter 2014 newsletter, available from the NARIC collection under Accession Number O19377.
The IPS Employment Center manages the IPS Learning Community highlighted in this article. Learn more about the Center and the Learning Community at https://www.ipsworks.org/
Learn how motivational interviewing improves outcomes for IPS clients in the research summary from the Rehabilitation Research and Training Center on Evidence Based Practice in Vocational Rehabilitation: http://research2vrpractice.org/using-motivational-interviewing-mi-to-improve-employment-outcomes-for-consumers-receiving-individual-placement-and-support-ips-services/
To Learn More About this Study
Noel, V.A. et al (2017) Barriers and facilitators to sustainment of an evidence-based supported employment program. Administration and Policy in Mental Health, 44, 331-338. This article is available from the NARIC Collection under Accession Number J74782.