Cleveland, OH—An analysis of employment data from 23 behavioral healthcare organizations in Ohio shows that 36 percent of people with serious mental illness who received evidence-based Supported Employment/Individual Placement and Support (SE/IPS) services were competitively employed in full-time or part-time jobs in September 2011. The number is significant, because the national average was 37 percent in that same month for similar services delivered at multiple organizations in 12 states as part of the Johnson & Johnson-Dartmouth Community Mental Health Program. The evaluation of Ohio services also shows that some organizations are consistently achieving job-placement rates of 50 to 60 percent.
The analysis of Ohio outcomes was conducted by Debra R. Hrouda, MSSA, LISW-S, director of quality improvement at the Center for Evidence-Based Practices at Case Western Reserve University. The data was submitted to the Center by the 23 organizations, which collected the following data on a quarterly basis from July to December 2011:
- Number of people receiving employment services from each organization’s SE/IPS team
- Number of people receiving SE/IPS services who were employed
- Average number of people receiving SE/IPS services from each employment specialist
Hrouda reported the results of her analysis to program managers this past summer. A summary is included in Figure 1 below. Nicole Clevenger, BFA, consultant and trainer at the Center, assisted with the data analysis.
The Center for Evidence-Based Practices analyzed this jobs data because it is the parent organization for the Ohio Supported Employment Coordinating Center of Excellence (SE CCOE), which provides technical-assistance services—consultation, training, and evaluation—to help organizations implement SE/IPS, an evidence-based practice endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA). The SE CCOE is part of the Coordinating Center of Excellence initiative supported by the Ohio Department of Mental Health.
GOOD NEWS FOR OHIO
According to Patrick E. Boyle, MSSA, LISW-S, director of implementation services at the Center for Evidence-Based Practices, the 36-percent employment rate is very good news, because it is significantly higher than employment rates reported in other studies of community services conducted in other states. He cites researcher Gary R. Bond, PhD, professor of psychiatry at the Dartmouth Psychiatric Research Center, who has noted that surveys of people receiving community treatment have found that only 10 to 15 percent are competitively employed. In addition, follow-up surveys of people discharged from psychiatric hospitals have found employment rates of less than 5 percent (see Bond (2011) in Resources below).
Boyle explains that employment among people with mental illness tends to be higher when they receive evidence-based SE/IPS, because the model encourages organizations to be systematic about the way they help people identify and pursue their employment dreams.
"This evidence-based practice teaches us that getting a job is not the result of treatment and recovery," Boyle says. "Instead, employment is integral to recovery. The job search must begin as soon as someone expresses an interest in considering and pursuing a part-time or full-time job in the community, even after hospitalization."
Boyle adds that the employment rates of 50 to 60 percent being achieved by several organizations in Ohio affirms that SE/IPS can produce outcomes similar to those achieved in controlled clinical trials, such as those conducted by the Dartmouth Psychiatric Research Center in the late 1990s (see Bond (2004) and Becker & Drake (2003) in Resources below). Ohio’s SE/IPS services are responding positively to the needs of residents in local communities. In the late 1990s and early 2000s, the Ohio Mental Health Commission reported that people with mental illness identified employment as a top recovery goal (see OMHC in Resources below).
| July to Sept 2011 | Oct to Dec 2011 | ||
|---|---|---|---|
| Team size | Average number of people receiving SE/IPS services from each service team in 23 Ohio organizations | 55 (range of 1 to 141) |
55 (range of 4 to 163) |
| Employment rate | Percentage of people receiving SE/IPS services who found jobs and were employed | 36 (7 to 100 percent) |
28 (7 to 75 percent) |
| Caseload size | Average number of people receiving SE/IPS services from each FTE employment specialist | 24 (range of 3 to 50) |
21 (range of 4 to 46) |
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ABOUT THE DATA
Several factors may influence Ohio’s employment data and the results of current and future analyses, according to Hrouda. For example, employment rates may be influenced by the size of the SE/IPS service team and the caseload size of employment specialists (see Figure 1), as well as by each organization’s definition of when a person is active—that is, when he or she officially begins to receive SE/IPS services. In addition, outcomes may be influenced by organizational policies, leadership, and staffing, as well as by systemic issues such as changes in state policy and available funding.
FUTURE ANALYSES
The Center for Evidence-Based Practices will continue to evaluate employment data from organizations in Ohio that are implementing SE/IPS. The Center is working to expand the analyses to include data about employment tenure (duration), the range of hours worked per month, and hourly wages. The Center also plans to compare such data from Ohio teams with those in the national J&J-Dartmouth program.
RESOURCES
Gary R. Bond (2011). Employment of People with Mental Disabilities, Written Testimony. US Equal Employment Opportunity Commission, March 15, 2011.
http://www.eeoc.gov//eeoc/meetings/3-15-11/bond.cfm
Gary R. Bond & Kukla, M (2011). Is Job Tenure Brief in Individual Placement and Support (IPS) Employment Programs? Psychiatric Services, Aug, v62, n8, p953.
Gary R. Bond and Amanda Jones (2005). Supported Employment. Evidence-Based Mental Health Practice: A Textbook. New York: W. W. Norton & Company, Inc., p367-394.
Gary R. Bond (2004). Supported Employment: Evidence for an Evidence-Based Practice. Psychiatric Rehabilitation Journal, v27, n4, p345-359.
Deborah R. Becker & Robert E. Drake (2003). A Working Life for People with Severe Mental Illness. New York: Oxford University Press.
OMHC (Ohio’s Mental Health Commission) (2001). Access Issues Impacting Adults. Changing Lives: Ohio’s Action Agenda for Mental Health (Report). Columbus, Ohio: Ohio Department of Mental Health, p21-22.
Robert E. Drake, Guest Editor (1998). Supported Employment: A Special Issue of Psychiatric Rehabilitation Journal. Psychiatric Rehabilitation Journal. Summer, v22, n1.
ES Rogers, D Walsh, L Masotta, et al (1991). Massachusetts Survey of Client Preferences for Community Support Services (Final Report). Boston: Boston University, Center for Psychiatric Rehabilitation.
EVIDENCE-BASED SE/IPS
Supported Employment/Individual Placement and Support (SE/IPS) is an evidence-based practice that helps people with mental illness and other disabilities identify and acquire part-time or full-time jobs of their choice in the community with rapid job-search and placement services. SE/IPS is different from traditional vocational rehabilitation (voc rehab) because it emphasizes that work is not the result of treatment and recovery but integral to both.
For more information about SE/IPS, consult the Practices section of our website.
NATIONAL CONNECTION
The SE/IPS model was developed by researchers at the Dartmouth Psychiatric Research Center, which continues to study the effectiveness of this evidence-based practice through the Johnson & Johnson-Dartmouth Community Mental Health Program. Multiple organizations in 13 states, including eight organizations in Ohio, are implementing evidence-based Supported Employment as part of the J&J-Dartmouth Program.