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IPS Supported Employment: Impact of the COVID-19 P ...
Presentation and Q&A
Presentation and Q&A
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So, hello, everyone, and welcome. My name is Ben, and I'm the Project Coordinator for SMI Advisor, and I'm pleased that you're joining us for today's SMI Advisor webinar, IPS-Supported Employment, Impact of the COVID-19 Pandemic on Implementations and Outcomes. Ben, can you hear me now? We can hear you now. Yep. I'm so sorry. Apparently, there was an audio issue at my end, but I guess that's fixed. So I apologize to everyone. I'll start over again. I was wondering why the slides weren't advancing as I was talking. Hello and welcome. I'm Dr. Benjamin Druss, Professor and Rosalynn Carter Chair in Mental Health at the Rollins School of Public Health at Emory University and Health Systems Expert for SMI Advisor. I am pleased that you are joining us for today's SMI Advisor webinar, IPS-Supported Employment, Impact of the COVID-19 Pandemic on Implementation and Outcomes and Implications for the Post-COVID Era. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Today's webinar has been designated for 1.0 AMA PRA Category 1 credit for physicians, one continuing education credit for psychologists, and one continuing education credit for social workers. Credit for participating in today's webinar will be available until September 27, 2021. Slides from the presentation today are available in the handouts area found in the lower portion of your control panel. Select the link to download the PDF. Please feel free to submit your questions throughout the presentation by typing them into the question area found in the lower portion of your control panel. We'll reserve 10 to 15 minutes at the end of the presentation for Q&A. Now I'd like to introduce you to the faculty for today's webinar, Dr. Paul Margulies. Paul Margulies, PhD, is Associate Director for Practice Innovation and Implementation at the Center for Practice Innovations at Columbia, or CPI, located at the New York State Psychiatric Institute and Associate Professor of Clinical Medical Psychology and Psychiatry at Columbia University. At CPI, Dr. Margulies oversees implementation and training efforts for a number of initiatives that bring best treatment practices for those diagnosed with serious mental illness to the field, including IPS-supported employment. Dr. Margulies is a licensed psychologist who received his doctoral degree in clinical psychology from the State University of New York at Stony Brook. Over the course of his 40-plus year career, he has worked in community and inpatient settings in a variety of clinical, supervisory, and administrative roles. His recent publications focus on implementation and dissemination of evidence-based practices, the individual placement and support approach to supported employment, and wellness self-management. He has presented papers and workshops at regional, national, and international conferences on topics including evidence-based practices, transformational leadership, organizational change, cognitive behavioral therapy, and psychiatric rehabilitation. Dr. Margulies, it's great to have you here today. Thank you for leading today's webinar. Thank you so much, Dr. Drost, and hello, everybody. So I'm Paul Margulies, and I'm reporting no relationships or conflicts of interest related to the subject matter of this presentation. Let's talk about our learning objectives. When we complete today's activity, you will be able to describe the principles and practices of individual placement and support, otherwise known as IPS, discuss how IPS has been successfully implemented across New York State, and summarize the impact of COVID-19 realities on IPS implementation in New York State and beyond, and adaptations and innovations reported, and implications concerning its implementation in the post-pandemic era. We're going to start with a couple of polling questions to get a little bit of sense of your familiarity with IPS. So the first question is, are you familiar with the IPS approach to supported employment? Yes or no? And it looks like about two-thirds of the folks are, which is terrific. We now have a second polling question, which is, are you currently involved in providing IPS to individuals diagnosed with serious mental illness? And it looks like roughly 50-50. So for those of you who are familiar, hopefully you'll learn a little bit more, especially about what we've been doing in New York State and the impact of COVID-19 pandemic. For those of you who are not familiar, hopefully you're going to learn quite a bit today. So to move on, given our current climate and appreciation of the impact of racial injustice and disparities in access to care, let's take a look at the current context of our work. You know, we now know so much about the social determinants of health. And as this chart notes, a number of these determinants relate to employment and economic self-sufficiency. Being out of work is a problem. Being poor is a problem. Services like IPS that can address employment can make a difference. As you can see in this 2020 chart from the U.S. Bureau of Labor Statistics, unemployment rates differ across race and ethnicity, with white individuals enjoying the lowest rates of unemployment. And the same phenomenon can be found concerning the risk for COVID-19 infection, hospitalization, and death. This data was updated in June of 2021. As you see, risk rates for non-whites are generally considerably higher than whites. It's important for us to keep this context in mind, the disproportionate role of race, unemployment, poverty, and COVID-19 impact as we improve our behavioral health services in the coming years. So now we're going to give some background on what is IPS and why is it so important. So what is supported employment? Supported employment helps people diagnosed with mental illness find and keep meaningful jobs in the community. These jobs exist in the open labor market, pay at least minimum wage, and are in work settings that include people who are not disabled. In other words, these are real jobs in the real world. IPS was developed in New Hampshire by Drake, Becker, and Bond and colleagues over three decades ago, a long time ago, and you see some references here. It's the gold standard evidence-based practice for supported employment for individuals diagnosed with serious mental illness. To date, there have been 28 randomized controlled trials for IPS that have found it to be efficacious, and you have a link there that will go into a whole lot more detail. And it's important to note that Modini and his colleagues back in 2016 conducted a meta-analysis of 17 randomized controlled trials at that time and found that those receiving IPS were 2.4 times more likely to be employed than controls. And IPS has been successfully implemented across the United States and in many other countries. So we're going to spend some time talking about the foundational principles for IPS. And the first one is that competitive employment is the goal. So what does that mean? This isn't about volunteer work, this isn't about sheltered workshops, this isn't about programs that are run by agencies, all of which, you know, have happened in the course of vocational rehab over the years in our country and beyond, this is about real jobs. Second one is that eligibility is based on consumer choice, this is called zero exclusion. And I have to say, this is the one where we get the most pushback from trainees on this principle. It's contrary to the way that so many of us clinicians were trained. So basically what this means is, if somebody is highly symptomatic, if they were using substances this morning, we still connect with them and we still help them to try to find work. And there's a good reason for this. The reason is we really aren't able to predict how well a job will work out for an individual. It's just not possible. I'm a clinical psychologist, I've been trained in all sorts of testing and evaluation. And what I can tell you is that, you know, we don't have the ability to make this kind of prediction. And the reason for it is that there's no real threshold for readiness for work. It was the concept of readiness for work isn't also useful. Rather, it really depends on the goodness of fit, on the match between the person and a specific job. So I'll tell you a quick story. Back many years ago when I was in college, I was working in a very large post office in New York City. And I was working the night shift, the midnight shift, sorting mail. And basically what this consisted of was trays of mail with letters and postcards and such were brought in front of the staff member, and you'd spend your time putting each piece of mail into a particular box, depending upon zip code or depending on address or that kind of thing. In addition to the college kids there, there were many people who were clearly experiencing mental health symptoms. There were a number of people who clearly were using substances, some on the job. And the bottom line was, it didn't matter for this job. That for these folks being symptomatic or having substance use issues did not get in the way to perform this task. There were other jobs in that very same building that these issues might have become problematic. Perhaps working at the stamp window with many, many people online moving very quickly, selling people stamps and making change. Perhaps some of these folks might have struggled a bit or not with that. The point I'm trying to make here is that the only way to determine whether a person and a job are going to be a good fit is by trying the person with the job. And there really isn't a way to predict in any other way. And for me, that was a very important lesson, even at a very young age. Next principle is that consumer preferences are important. This is about maximizing motivation. And by consumer preferences, we mean we spend some time listening and talking to people to find out what their experience and history has been around work and what their preferences are and what their preferences aren't. And this is about maximizing motivation. We all work differently on jobs that we want compared to jobs that we feel we need to have. Think back over your own job history. Did you ever have a job that you kind of really didn't want, but you were there? Hopefully it's not your current job. And if we were to have a videotape of how you behaved on the job you didn't want versus how you are on the job you really are motivated around, you'd appear to be most likely a very different employee. And so this is an important issue, to really take the time to match the job to the preferences of the individual. Supporter employment is integrated with treatment. You know, what we have found over the past several decades in all of our work with evidence-based practices is that integration of the practice with the rest of treatment, with the rest of rehabilitation, seems to make all the difference in the world. Because when things are integrated, there's less opportunity for slippage, there's less opportunity for miscommunication. This is as true for employment as it is for, say, integrated treatment for tooled disorders. Personal benefits counseling is provided. One of the primary concerns people have about taking the chance on working is fear of losing benefits. And the truth of the matter is that there are many safeguards in place to make it a lot less risky than many individuals and many staff members realize. So to the extent that personalized benefits counseling is provided to people, what we have discovered over many years is that, you know, it really, really takes away a lot of that fear and results in people being a whole lot more motivated to find work. Next principle is employment staff develop relationships with employers based upon the consumer's job preferences. So this is just, once again, about being person-centered and connecting with employers that have something to offer that's consistent with what people are looking for. Rapid job search, which means that as soon as an individual says, hey, I'm interested in work, we begin the process. This doesn't necessarily mean that the person's going to find a job real quickly, although it might. But it does mean that we really capitalize on that motivation and don't delay. Another very quick story. There was a time decades ago that I ran a clinic. And as part of the intake process, if an individual coming into the clinic told us that they wanted to work, our reaction and our response was, please, let's wait for six months. We need to get to know you better. We need to get a sense of what you can handle. And we need to see whether you can handle the stresses of work. And at the time, that made sense. Back then, we were very concerned that work could be too stressful, could be toxic for people. And we're really trying to do the right thing. Turns out we weren't doing the right thing. And so for those who were motivated to work, what do you think happened? Some never came back after that intake. And that might have actually been a good decision. Because within that six months, we managed to erase whatever motivation they had for work, sadly. I'm not at all proud about that. At the time, we were doing the right thing. We now know better. And that's the point of this principle. Finally, follow-along supports are provided. That's a very important principle. So what does this mean? It means that choosing and getting a job are not the same thing as keeping a job. And different services need to be provided once a person is working. Okay, there are a number of practitioner skills. And from the poll, we know that about half of you are doing IPS. And therefore, I'm sure I know quite a bit about these skills. But just very quickly, and our center trains our participating sites on these skills. Engagement around work is important. And we have created a resource that I'll describe to you in a little while that helps with engagement. Around assessment, IPS is not about overwhelming people with assessments that don't predict a whole lot. But our colleagues, Drake and Becker and Bond, have developed something they call the vocational profile, which is a nice way to assess a person's background and interests. Planning, of course, the benefits counselor we've talked about. Job development is a skill set that people develop. And we spend a fair amount of time teaching people these skills. And we actually have an online module I'll describe later that also teaches these skills. In many states, there's a state vocational rehabilitation department, part of the state government, that funds training and provides opportunities for people around work. So one of the skills for an IPS practitioner is working with that state voc rehab department. And finally, as we mentioned, the skills related to follow along supports. So let's talk about IPS implementation in New York State. Our center, the Center for Practice Innovations, is what's known as an intermediary organization. And what that means is that we provide training and support to help implementation sites implement evidence-based practices. And so, we work with the New York State Office of Mental Health to promote the widespread availability of evidence-based practices to improve mental health services, ensure accountability, and promote recovery-oriented outcomes for recipients and families. We work with providers to implement a number of evidence-based practices, IPS being one of them, and with the Office of Mental Health to disseminate these practices across New York State. Currently, this year, we have over 80 implementation sites, and they're really two different kinds of sites. One set consists of community psychosocial rehabilitation programs. These are programs that people attend to develop skills and knowledge and support to accomplish their rehabilitation goals, work being one of those. The other are the clinics that are attached to the state hospital system, and we work with many sites in that system as well. What did we provide pre-COVID? Well, pre-COVID, we provided learning collaboratives. And for those of you who aren't familiar with learning collaboratives, learning collaboratives are an opportunity for sites that are all working towards the same implementation outcome to work together so that they can learn from one another as well as learn from experts, and they get an opportunity to share their experiences and truly work together to solve challenges. Pre-pandemic, we offered three online training modules. These are courses that are accessed through our learning management system. One is an intro to IPS. One is job development, and one is using the employment resource book. I'll talk about the employment resource book in a while. We have an extensive online IPS library that provides PowerPoints and videos of all sorts of presentations we've done in the past, as well as implementation guides and other resources. We have this employment resource book. We have monthly activities, webinars, regional face-to-face workshops where we pull teams together. Our trainers will go on site to do training and technical assistance. There'll be consultation calls whenever the need arises. Data collection and analysis, we'll talk about that in a moment. And many of these sites have been working with us for about a decade or so. Others have joined more recently, and because of that, different sites are in different places concerning IPS implementation. Concerning implementation, and because of that, we're able to tailor what we do for each site based upon their fidelity and performance indicator data. So what's expected of these sites? Participation and training and the implementation support activities, a willingness to share experiences and challenges with others. And this is important, and what this really requires is establishing a setting, an environment where people can be honest with one another and talk about their challenges and what they struggle with, as well as their accomplishments. And we put a fair amount of time and effort into that. There are monthly performance indicator data that they submit. I'll talk a bit more about that, as well as annual fidelity self-assessments. This is a complicated slide, and I'm just going to spend a few minutes walking through it. We use the growing literature on implementation science to guide our center's work. On this slide and the next one, we're going to show you how the concepts of outer and inner settings, which are derived from Dan Schroeder and colleagues' CFER, which is the Consolidated Framework for Implementation Research, how this has really helped to guide our efforts. On this slide, you'll see the outer setting. What is it? It's all the factors that impact upon the implementation site from outside. So it's policies, regulations, money, and all those need to be aligned. It's the state mental health authority and the message they give. And as you can see in the outer setting, there are things that we've done even prior to implementation, other things that we've done during the early stages of implementation, and finally, things that we've done around maintenance and evolution. So for pre-implementation, we needed to understand how IPS fits into the community psych rehab programs, regulations, and billing structure, because without that, it's not going to happen. We needed to understand how the state facility clinic operations supported IPS. We needed to understand how other kinds of initiatives connected. Key mental health leadership set an expectation related to this. To help with implementation, state did extra funding. Deficit funds were used. Governing bodies oversee the state facilities. We have clarification documents. And reports around uptake and participation are shared with the state mental health authority. And around maintenance and evolution, ongoing discussions with the Office of Mental Health Leadership to advise them around challenges and incentives that are needed. Inner setting consists of the site itself, the agency itself. And the intervention must address the felt need in these programs. Leadership needs to be on board with the changes. And the program must support a culture of change. Pre-implementation, we asked leadership to commit to the implementation activities, which is really important. We did needs assessments with state facility leaders. Many discussions. Implementation itself are these learning collaboratives and activities for supervisors. Maintenance and evolution, reaching out to programs that haven't yet adopted and encouraging their participation. And adapting and refining our training materials. So I want you to have a sense of the amount of focus and work that goes into making this kind of thing happen. That goes way beyond simply training. Okay. I want to spend a moment talking about this resource we developed called the Employment Resource Book. And to do that, I'm going to give you a little sense of how it's set up. And so, there are over 30 topics that are involved, and 10 appendices, and the topics are organized prior to the job search, during the job search, and after getting a job. And so, an example of prior to the job search is thinking through my decision to work. We're talking with family and supports about work, or my hopes and concerns about working. During the job search, developing my specific work goal, developing a plan of finding a job, applying for a job, disclosing and deciding what to say about my background, preparing for the job interview. Prior to getting a job, topics include dealing with my concerns when I'm starting a new job, transportation to and from work, talking with people on my first days of the job. I think you get a feel for this. This is not a curriculum at all. It's not something that people need to complete in order to be considered ready to be looking for a job. But as a topic matches a person's particular situation or need, the person gets a chance to kind of think these things through. A recipient can use the book on their own. They could use it with their employment staff. They can use it with other members of their team. There are also, as I mentioned, 10 appendices that have everything from interview tips to sample resumes, or tips around starting the new job and preparing for the first day of work, how to use supports, et cetera, et cetera. This resource book, the electronic version, is available actually to you at no cost at our center's website. And paper copies we sell basically at cost to us. So I just want to make you aware of this very important resource that can be helpful to you in your efforts. Okay, moving ahead. Here's another resource that we won't have time to play for you, but it's a five-minute video that we created that's designed for recipients to inspire them around the world of work. And it has some video clips of people who are currently working. And I think you'll find it to be a useful resource. I see in the chat box that this link has been pasted. So feel free to take advantage of this resource. So what does our data tell us? We have a number of performance indicators, and each of the sites is asked on a monthly basis to submit data on these indicators. And we spent a fair amount of time helping the sites with continuous quality improvement. So they use this data to get a sense of what they're doing well and maybe where there's opportunities for improvement, and they use the data in that way. It allows us to get a sense across the entire system how things are going. We provide a link every month, and each site has a person who's responsible for doing this. And I can't say we get 100% of the data every month, but we get a fair amount. You'll see a chart in a little while that shows you that. I would say most months, three quarters or more of the sites are due to submit data. What are the performance indicators? Total FTE employment staff with a caseload, an IPS caseload, aggregated across all of your program's employment staff, the percentage that time in the community last month, because being in the community is an important part of this model. Aggregated across all of your program's employment staff, the total number of in-person employer contacts last month, the total number of people on your IPS caseload any time last month, and for the community rehab programs we also asked for the past three months. Of those people, the total number working at least one day or more last month for the last three months, and finally, the total number of unique individuals on your IPS caseload since January 1st of this year. This one gives us a sense of flow so that we get a sense that whether there are new people coming on the caseload or whether the caseload is very static. Now, I don't know if these numbers are very visible to you, but I will walk you through the important points. These are employment outcomes for the past two and a half years, starting in 2019. What you'll see is that most months in 2019, the number of sites that were reporting varied from the high 60s to the mid-70s, which really isn't bad, with roughly 80 sites total. The mean monthly employment rates ranged from the mid-40s to the low 50s, so roughly half the people receiving these services each month are working, which are very good numbers. 2020, for the most part, these numbers begin the year in the same place, but by April, and we're going to circle back to this, this is now the time of COVID, the numbers drop for a month to the mid-30s, but then bounce up pretty quickly, and we'll talk more about this in a few minutes. In fact, now in 2021, the number of sites reporting is in the 70s, and the outcomes themselves are in the 40% range, low to high 40% range. That gives you a sense of what's happening in terms of employment outcomes, and we'll zoom in in a little while on the COVID impact. There's also a fidelity scale, and it defines the critical ingredients at IPS. It can be used, and we use it as a continuous quality improvement tool, but it also gives us a good snapshot of how the system is doing, and demonstrated through research. There are many studies about this. High fidelity programs generally do better, 25 items on the scale, each item is rated on a one to five scale, and you can see how things can be sorted out here. Non-fidelity is above 115 total, good is 100 to 114, fair is 74 to 99, and below 73 is it just isn't really being implemented well. This is our fidelity over recent years. Once again, I don't know if the numbers are clear on your end, but I'll tell you what we have here, and I'm just going to look at the all sites for now. 2018, 2019, this is pre-COVID. We tend to average across our sites in the low to mid to high 90s, which is the high end of fair fidelity. What's interesting is despite that the outcomes themselves are quite good in terms of, as you saw, the employment outcomes, 2020 is the year of the COVID pandemic, and we'll cycle back to this in a little while, but you can see we have the traditional scale, which dropped a bit, and we also developed an adjusted scale where there were seven items that traditionally you get credit or higher levels of credit for the amount of time, face-to-face, and community. We adjusted those items to include remote contact, and the numbers bounced up. I will return to this in a little while in more detail, but you get a sense here of fidelity. I should say that these are self-report fidelity, and we did a study a few years ago demonstrating that in our situation, the differences between self-report and independent reported fidelity at about a dozen sites were minimal. There just weren't differences there, and we think there are many reasons for that. We don't think that automatically would happen everywhere, but we think there are a number of reasons for that, including the tone we set in terms of people's willingness to be honest in sharing their data. So now let's talk about the impact of COVID-19 on training, support, and implementation. So what changed and what are centers doing? Well, you probably could have guessed. We took everything we were doing on-site, both regionally and at each site, and we moved it remote. Everything else is still available. Everything else is exactly as it was. We can still tailor. Everything else is there, but we moved our regional meetings remote, and what had been site visits are now remote site visits. But some of what we focused on began to change. So, for example, sites were sharing their innovations, telling us about what they were doing differently. They're talking about their accomplishments and their challenges. Trainees spent a lot of time, and this is the beauty of this learning collaborative approach. The trainees spent a lot of time supporting one another. They did a lot of brainstorming, so one site would have a challenge. Other sites would jump in and say how they've approached it and did a lot of brainstorming and a lot of sharing. There were new challenges to address concerning how to address finances and benefits. Remember, people started receiving additional monies, and people were thinking through how that impacted their finances, their benefits, the stimulus payments, unemployment, and all of that. The other part of it is there was ambivalence, and you'd imagine, and I would imagine you've seen this, those of you doing IPS in your own work as well this past year. There is ambivalence, a concern expressed by some recipients about the health risks of working, either continuing to work or finding new work. So we introduced a shared decision-making perspective where the employment staff helped recipients to think through their options, their choices, and their personal decisions. We use Elwynn's three-talk model, and there's a whole literature on that, but this wasn't something that we wanted to take for granted. We wanted to make sure that individuals had the opportunity to really think through this decision, and we really trained our employment staff to not be advocating one way or the other. This is a very personal decision. We did a survey spring, summer of last year, 2020, asking the sites, so what's going on? And at that time, there were 89 implementation sites, 88 responded, and three-quarters were continuing to provide services. The sites that weren't, for the most part, were attached to hospitals, and their staff was redeployed to inpatient and residential sites. But much to our surprise, three quarters of these sites were continuing. The grand majority of these sites are now providing IPS once again, 81 as of June 2021. Then we asked, what if any changes or additions to your role or job duties have occurred since the crisis started? Representative responses included working from home and providing services remotely, more benefits counseling, including unemployment and stimulus payments, providing more general emotional support, including concerns about COVID and mental health symptoms, and helping individuals more generally maintain their wellness. We then asked, what challenges do the current realities present for implementation? A lot of this was about technology, both staff as well as recipients being unfamiliar with the technology. It was a bit more difficult to do job development. Individuals were losing jobs and the whole issue around fear of COVID and motivation, not having access to computers, and engaging and connecting with individuals newly referred to IPS. You know, it's one thing to continue a relationship that you started face-to-face and now moving it remotely. It's something else to connect brand new with somebody who is coming to you for the first time remotely. What new strategies and innovations are you now using for IPS? Representative responses, use of technology, helping individuals to become comfortable with and knowledgeable in using technology, providing support more frequently, teaching tele-interviewing skills, and focusing more on reaching out to essential businesses. So how is it going? How are the recipients reacting? And what you see here from these quotes, and I won't read them all, is it varied. Lots of people did well. Some struggled a bit. Some learned over time. The issue was use of technology and access to technology was a major part of all of this. Which specific new strategies and innovations do you recommend? Representative responses, and this is assuming that they can be funded and paid for, use of remote technology, online interviews, providing ongoing support remotely. And we've heard this a lot. And providing more frequent support remotely. And as we move into the post-pandemic era, it will be important to monitor which of these services will continue to be reimbursable and thus maintain those options. New jobs, and I'd be curious. I know many of you have been doing this work this past year. So some of these are brand new kinds of jobs. Some became more available. Warehouse positions, grocery stores, being a shopper and deliverer, janitorial and cleaning, remote COVID tracing, telemarketing, retail sales, and home health aides and nursing assistants. All of these are jobs that people were taking. Impact on our outcomes. This is the same chart I showed you before, the same table, but you can see April of 2020, which is now highlighted in red, the number of sites reporting dips significantly. And of those reporting, their mean monthly employment rate dropped now into the mid-30%. Not surprising. What was surprising is they bounced back up pretty quickly. So beginning in May, the numbers of sites began to rise again, and the mean monthly employment rates began to rise again. We did not expect that. And this basically says statistically what we found is there was a significant drop from March to April, and a significant increase from April to May. So it was very much short-lived, the impact. The fidelity, similar kind of picture here. The traditional scale dropped because of the inability to get out there face-to-face, but with this adjusted scale that I described before, it's pretty much consistent with what we've been seeing over the years. And that's basically what we're saying here statistically. I'm gonna shift gears now and talk about the findings that Drake and Bond and Becker and their team have found nationally and internationally with their sites. This is a link that will take you to more details. I'll walk you through this relatively quickly. And the long and the short of it is it's very similar to our findings in New York State. So first, the programs were providing services remotely, phone, video chat, text message, email. Second, continuing to deliver VOC services, including intake assessment, job, and all the other services. Several staff shared that they successfully reconnected with clients who were disengaged. And they were also offering important emotional support to people by checking in frequently, sharing encouragement, promoting wellness. It's exactly what we're hearing in New York State as well. Teams are helping clients with financial changes. Very similar. Programs are responding to a rapidly shifting labor market by continuing to help people find jobs and build employer partnerships, rather than contacting employers in person, connecting with employers remotely. Staff are looking at their contact logs and reaching back to existing employer connections. Job offers still coming, people still working. IPS specialists staying connected to their team remotely. And finally, leaders in the learning community communicating frequently with their providers, offering more online training too. So this is all very similar to what we reported in New York State, which really tells us New York is not an anomaly in this way. Finally, I wanna show you data. This is once again from Bob Drake and Debbie Becker and Gary Bond and their team. This was reported recently in their newsletter, taking a look at the impact across the year. So this is the year 2020. And what you see is the first quarter. If we can use that as a baseline for the moment. Second quarter, which is where COVID hit really. Slight dip by third and fourth quarter, bouncing back up again. Very similar to what we found in New York State. Very, very similar. Okay. We can use the chat box to ask you, have you adapted your own implementation of IPS to COVID-19 realities? What you would like to continue in the post-pandemic era? I know a number of you have been doing this. Now, unfortunately right now, I can't access the chat box. For some reason, my mouse is not behaving well for that. So if people are typing up, if the other folks on our team can read some responses, that would be great. Taking a moment or so, see if any folks are responding. Okay. Let me ask, are we having any responses at all? And if so? None yet. Okay, let's give folks just another minute or so. And if not, we'll just move on. Well, if there's nothing else, we'll move on. Here's a bibliography. We've got a bunch of references for you. Both the work nationally with Bonda, Becker, and Drake, and our work in New York State. And I believe I'm now turning control back over to the team. Thanks so much, Dr. Margolis for a really timely and helpful presentation. It was really interesting. So I would encourage everyone now, we're gonna have about 10 minutes for question and answer. So I would encourage you to add any questions that you may have. To the Q&A portion of the GoToWebinar page. But before we shift into Q&A, I wanna take a moment and let you know that SMI Advisor is accessible from your mobile device. Use the SMI Advisor app to access resources, education, and upcoming events. And if you're not already using it, you can access resources, education, and upcoming events, complete mental health rating scales, and even submit questions directly to our team of SMI experts. Download the app now at smiadvisor.org forward slash app. Okay, so now we are gonna move on to Q&A. We have one from Elaine Hagley, who's asking about how peer specialists or peer coaches are involved in your work in supported employment. That is such an important and timely question. Thank you for the question. There are a number of our sites that do use peer specialists, that peer specialists are involved. And clearly, we all can understand that the ability to really inspire and connect can make all the difference. And peer specialists do such an extraordinary job with that. I don't have data to say what percentage of our sites are using peer specialists, but there are some that are. And clearly, it can make a big difference. Okay. Thanks so much. I'm also wondering if you can say a little bit more about kind of some of the ethical issues. I mean, you talked about kind of helping patients make decisions, but how do you think about some of the ethical trade-offs that are now facing patients? With COVID and perhaps also where vaccination fits into that picture as they think about some of these kind of essential jobs that they're often employed in? You know, that's a great question. Our sense of it is that individuals have the ability and have the right and responsibility to make these kinds of decisions for themselves. Our ethical responsibility is to make sure that they're well thought through and that people can weigh the pros and cons and know what the pros and cons are. And then we are there to support them in whatever way could be most helpful. Great. Thank you so much. We have another question about a documentation that people often need to get employment such as identification, social security card, and how you think about that as a step towards the job search process. This comes up a lot in our training learning collaborative sessions, a lot. And what we find is that there are many people who struggle with getting documentation. This is where the sites help one another and are able to come up with just extraordinarily good ideas around how to approach that. And for the most part, I think more good ideas around this have come from our sites and have come from our quote unquote experts. But it comes up a lot. There is no one easy answer. But the more minds in our learning collaboratives that come together to think it through, the more likely they come up with some answers that can make sense. Great. Thank you. I have another question. Sorry, just a minute. Just reading through them. So many, about half of people, I believe, in one of your initial polls are familiar with IPS, but aren't working for formal IPS programs. So how do you think about that group of clinicians and how they can think about incorporating employment focus into their clinical work? Well, I think it happens on a couple of levels. I think one level is with the individuals with whom they're working. At the very least, to begin conversations around work and to see and understand the individual's interest, potential interest in work. This employment resource book that I mentioned a little while ago has many topics that can help a practitioner, a clinician, start those conversations. So one level, it's really engaging, starting the conversation. And if the ability to offer IPS isn't available on your site, to have some sense of where to refer. On another level, it's working with the team and the organization so that they can become more supportive, let's say, of the idea that employment can make a difference in people's lives and is not something to be avoided necessarily. So there can be a role in advocating and discussing these issues with other team members. Great, and I think probably we have time for just one more question, which is kind of a zoom-out, more broadly, to other social determinants of health. So how do you think about some of the other social determinants of health as predicting successful engagement of people in this person-centered program? Good question. I don't know if I'd approach it as predicting so much as these are issues we need to take into account in our conversation. Become aware of how these determinants impact upon the person's experience in so many ways. And I think to the extent that we can have these conversations comfortably and respectfully, it helps for engagement and ultimately can help for outcomes. Great. Thank you. I, there may be, if there are other questions, perhaps there'll be ways of following up with Dr. Moghulis afterwards. But thanks so much again for the presentation, as well as the questions. So if you have followers on Twitter, so if you have follow-up questions about this or any other topic related to evidence-based care for serious mental illness, our clinical experts are now available for online consultations. Any mental health clinicians can submit a question and receive a response from one of our SMI experts. Consultations are free and confidential. SMI Advisor is proud to partner with the American Psychiatric Association and the Mental Health Services Conference, which takes place on October 14th to 15th. The keynote address at this conference features Dr. Miriam Delphin-Rittman, the newly appointed Assistant Secretary of Mental Health and Substance Use for HHS and the Administrator of SAMHSA. The conference agenda features high-level questions and answers on mental health issues, and the conference agenda features topics such as climate change in mental health, sociopolitical determinants, structural racism, mental health in rural and indigenous populations, and much more. I encourage you to learn more and register right now at psychiatry.org forward slash MHSC. To claim credit for participating in today's webinar, you'll need to have met the requisite attendance threshold for your profession. Verification of attendance may take up to five minutes. You'll then be able to select Next to advance and complete the program evaluation before claiming your credit. Please join us next week on September 1st, 2021 as Angela Kimball and Hannah Wesolowski with NAMI present Reimagining Crisis Response, 988 and a Crisis Standard of Care. Again, this free...
Video Summary
The video summarized in the transcript is a webinar presented by Dr. Paul Margulies on the topic of IPS-Supported Employment and the impact of the COVID-19 pandemic on implementations and outcomes. The webinar is part of the SMI Advisor initiative, which aims to help clinicians implement evidence-based care for individuals with serious mental illness. Dr. Margulies discusses the principles and practices of individual placement and support (IPS) and how it has been successfully implemented across New York State. He emphasizes the goal of competitive employment, eligibility based on consumer choice, the importance of consumer preferences, and the integration of employment support with treatment. He also highlights the use of personalized benefits counseling and the development of relationships with employers. Dr. Margulies discusses the challenges and innovations that arise from the COVID-19 pandemic, including the shift to remote services and the increased need for emotional support and financial guidance. He shares data on employment outcomes during the pandemic, which initially dipped but quickly recovered. The webinar concludes with a discussion of ethical considerations and recommendations for adapting IPS implementation to post-pandemic realities. Overall, the webinar provides valuable insights into the impact of the COVID-19 pandemic on IPS implementation and the importance of supported employment for individuals with serious mental illness.
Keywords
IPS-Supported Employment
COVID-19 pandemic
implementations
outcomes
SMI Advisor initiative
serious mental illness
individual placement and support
competitive employment
consumer choice
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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