IPS Research UpdateIPS Research Update
Bob DrakeBob Drake
Dartmouth Medical SchoolDartmouth Medical School
20112011
Dilemma in 1990Dilemma in 1990
3-5% population disabled by mental illness People with severe mental illness identify work as
their top goal– More than 70% want to work
Less than 10% working No effective interventions
• Bond, 1992
The President’s New Freedom The President’s New Freedom Commission Report (2003)Commission Report (2003)
““The main goal of the mental health system is to help people to The main goal of the mental health system is to help people to live, learn, work, and participate fully in their communities”live, learn, work, and participate fully in their communities”
Mike Hogan (2006): “Work is the most direct step to recovery”Mike Hogan (2006): “Work is the most direct step to recovery”
Current Status of IPSCurrent Status of IPS
IPS model is simple and effectiveIPS model is simple and effective Other benefits accrue with consistent workOther benefits accrue with consistent work Work outcomes improve over timeWork outcomes improve over time IPS is relatively easy to implementIPS is relatively easy to implement
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
96 NH
10 AL
07 IL
04 CT
08 HK
10 CA
08 AUST
06 SC
99 DC
11SWITZ
08 CA
07 EUR
06 QUE
10 HOL
02 MD
11 UK
IPS Control Control 2
Competitive Employment Rates Competitive Employment Rates in 16 Randomized Controlled Trials in 16 Randomized Controlled Trials of Individual Placement and Supportof Individual Placement and Support
Percent Competitively Employed in 24 month period
0
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Study Time
Percent competitively employed
Standard
IPS
Chrysalis Center
CT Supported Employment StudyCT Supported Employment Study(Mueser, 2004)(Mueser, 2004)
Impact on Impact on Other OutcomesOther Outcomes
Improved self-esteem, symptom control, quality Improved self-esteem, symptom control, quality of lifeof life
Related to sustained competitive employmentRelated to sustained competitive employment No changes with sustained sheltered employmentNo changes with sustained sheltered employment
(Bond, 2001)(Bond, 2001)
Long-Term OutcomesLong-Term Outcomes
4 studies with 10-year follow-ups4 studies with 10-year follow-ups(Test, 1989; Salyers, 2004; Becker, 2006; Bush,2009)(Test, 1989; Salyers, 2004; Becker, 2006; Bush,2009)
Work outcomes improve over timeWork outcomes improve over time Costs decrease dramatically for consistent Costs decrease dramatically for consistent
workers workers (Bush, 2009)(Bush, 2009)
8-12 Year Follow-up: 8-12 Year Follow-up: Day Treatment to IPSDay Treatment to IPS
71% working at follow-up71% working at follow-up85% in competitive jobs85% in competitive jobs71% worked more than 50% of FU71% worked more than 50% of FU90% still receiving benefits90% still receiving benefits
(Becker, 2006)(Becker, 2006)
Cost SavingsCost Savings
Each person with a SMI who becomes employed achieves an average savings in health costs of $5,000 per year (Bush et al. 2009)
Figure 1. Cost Outpatient Services and Institution Days
8000
13000
18000
23000
28000
33000
38000
43000
48000
0 1 2 3 4 5 6 7 8 9 10
Years
Mean Cost
Minimum Work
Steady Work
People with Severe Mental Illness in Treatment
Already Employed
10%
Not Interested in Employment
25%
Evidence-Based
Supported Employement
2%
No Employment
services40%
Ineffective Employment
Services23%
Johnson & Johnson-Johnson & Johnson-Dartmouth ProjectDartmouth Project Mental health-vocational rehabilitation collaboration Mental health-vocational rehabilitation collaboration implement evidence-based SE = IPSimplement evidence-based SE = IPS Local programs selected by statesLocal programs selected by states Dartmouth provides training, consultation, evaluationDartmouth provides training, consultation, evaluation National Learning CollaborativeNational Learning Collaborative States: CT, DC, KS, MD, OR, SC, VT, IL, MN, MO, OH, KY, WIStates: CT, DC, KS, MD, OR, SC, VT, IL, MN, MO, OH, KY, WI Special Projects: NJ, OH, ILSpecial Projects: NJ, OH, IL International CollaborativeInternational Collaborative
• (Becker, 2011)(Becker, 2011)
J&J-Dartmouth Program: Real J&J-Dartmouth Program: Real World AgenciesWorld Agencies
Early InterventionEarly Intervention
First episode psychosis First episode psychosis (Nuechterlein, 2005; Rinaldi, (Nuechterlein, 2005; Rinaldi,
2009; Killackey, 2009)2009; Killackey, 2009)
IPS Supported Employment for Clients with First-episode Schizophrenia
0
20
40
60
80
100
Baseline 6 Months 12 Months 18 Months% of Employment or
school
IPS
SAU
Early Intervention Early Intervention (Nuechterlein, 2005)(Nuechterlein, 2005)
Addressing CognitionAddressing Cognition
Concentration, memory, reaction speed, Concentration, memory, reaction speed, and problem-solvingand problem-solving
Job match Job match Improve cognitive function Improve cognitive function Compensatory strategiesCompensatory strategies
(McGurk, 2008)(McGurk, 2008)
Cognitive TrainingCognitive Training
Practicing cognitive tasks may create Practicing cognitive tasks may create new neuronal connectionsnew neuronal connections
Tasks directly relevant to work tasksTasks directly relevant to work tasksNew capacity may translate to workNew capacity may translate to work
(McGurk, 2005)(McGurk, 2005)
Computer Training and Memory
30
35
40
45
50
Baseline 3 Months
Total Number Correct
Computer Training and Work
0
5
10
15
20
25
30
Baseline 3 MonthsHours worked per Month
Benefits ReformBenefits Reform
People are socialized into disabilityPeople are socialized into disabilityChanging benefits structure essentialChanging benefits structure essential
Policy ChangesPolicy Changes
People with disabilities need cash, health insurance, and a job
They do not need to be assigned to a lifetime of unemployment and poverty in order to get health insurance
Legislative change is critical
Carl Suter, CSAVR (2006)
Federal Funding ReformFederal Funding Reform
We need simple payment systemFederal committeesAdvocacy
ConclusionsConclusions IPS has created hope for for people with IPS has created hope for for people with
psychiatric disabilities, their families, and psychiatric disabilities, their families, and MH/VR practitionersMH/VR practitioners
Outcomes can be enhanced furtherOutcomes can be enhanced further New researchNew research Policy changesPolicy changes
Financial SupportFinancial Support
Grants from NIDA, NIDRR, NIMH, RWJF, SAMHSA
Contracts from Guilford Press, Hazelden Press, MacArthur Foundation, Oxford Press, New York Office of Mental Health, Research Foundation for Mental Health
Gifts from Johnson & Johnson Corporate Contributions, Segal Foundation, Thomson Foundation, Vail Foundation, West Foundation
Many ThanksMany Thanks Deborah Becker Gary Bond Greg McHugo Haiyi Xie Jon Skinner Phil Bush Will Torrey Kim Mueser Rob Whitley Susan McGurk Eric Latimer Elizabeth Carpenter-Song
Matt Merrens Paul Gorman Sarah Swanson David Lynde Howard Goldman Sandy Reese Kikuko Campbell Will Haslett Saira Nawaz Crystal Glover
Information: books, Information: books, videos, research articlesvideos, research articles
Patti O’BrienPatti.O’[email protected]://dms.dartmouth.edu/prc