Hello and welcome. I'm Dr. Benjamin Druss, Professor and Rosalind Carter Chair in Mental Health at the Rollins School of Public Health at Emory University and Health Systems Expert for SMI Advisor. I'm pleased that you'll be joining us for today's SMI Advisor webinar, IPS supported employment for young adults with mental health conditions. 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 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 June 13th, 2022. 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. Gary Bond and Dr. Robert Drake. Dr. Bob Drake is a Vice President of the Westat Corporation and a former professor of the Dartmouth Institute on Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, and the former director of the Dartmouth Psychiatric Research Center. Dr. Gary Bond is a Senior Research Associate at Westat. He's conducted research on psychiatric rehabilitation for 40 years with academic appointments at Northwestern University, Indiana University, Purdue University, Indianapolis, and Dartmouth prior to his move to Westat in 2016. Dr. Bond and Dr. Drake's work together has focused on the benefits of individual placement and support services. Thank you both so much for leading today's webinar. So now it's down here? Okay, great. So good afternoon. My name is Bob Drake. I'm delighted to be here to talk with you about the importance of employment as a central social determinant of health for people with mental health conditions. You can see what the objectives are here for our presentation this afternoon. The main point is to try to bring you up to speed with support employment and particularly the individual placement and support or IPS model of support employment. I'm going to give you the general background on IPS support employment, which we've been working on and developing for over 30 years now. And then Gary will present the application of this intervention to young adults. Okay. So just to set the framework for this, let's go over a few basic facts. One is that most of the people with a mental health condition, whether it's a serious mental illness like schizophrenia or a common mental disorder like depression, or a variety of other disorders like PTSD, most people want to work. And what we found over the last 30 years is that the IPS model is able to help about 70% of them gain what the Department of Labor calls integrated competitive employment. And most of these people really become steady employees over time. They're very satisfied with the jobs that they have, and they benefit in many ways beyond earning a salary. Having employment really gives them structure in their lives, gives them an identity, helps with their self-esteem, and so on. And we'll talk about some of those issues. So let's see. Okay. So I want to start with the principles of IPS. And these are principles that have evolved slightly over the last 30 years, but they're all based on empirical research. In other words, every one of these principles is backed up by a number of studies showing that they're critical to providing effective employment services for people with mental health conditions. The first one is that IPS doesn't screen people out. Anyone who raises their hand and says they're ready to work is eligible for the service. And this comes out of the finding that people with these mental health conditions themselves are much more accurate predictors of whether they're ready to work and whether they're able to work than professionals. In our early studies, we were surprised to find that the people that professionals predicted would never have a chance to succeed in employment. Many of them actually did very well and became full-time employees for years. The second principle is that IPS focuses on competitive employment. Really prior to IPS, most of the models that were available were train-in-place models. And so they focused on helping people to develop skills often by working in what I think of as pretend jobs or not really competitive jobs, sheltered workshops, and so on. But most people with a mental health condition want to work a regular job, a competitive job. And so because that's their preference, that's what we focused on from the beginning in terms of trying to develop an effective intervention. The next principle is that, and this is one of the really foundational principles, IPS insists on integration of mental health services and vocational services. When we first got into this field, the so-called experts advised me that it was very important to separate vocational and mental health services because they would contaminate each other. And like most clinical wisdom of the time, this turned out to be completely wrong. Every study shows that integration is essential if you want to get good employment outcomes. The fourth principle is that we follow clients' preferences in making all decisions. That is, developing a work plan, deciding what kind of job to apply for, helping the individual to apply, helping the individual employee and the employer sometimes to provide the kinds of supports that they think are appropriate. And again, this comes from the consistent finding that clients' preferences are important. If we help people find a job that they prefer and they select and they're interested in, they like the job better and they stay in the job longer. The next principle is benefits counseling. Our benefits and insurance and other systems in this country are so complicated that the individual client and the individual clinician can't really understand them completely. And so we try to make sure that everybody gets benefits counseling before they start a job so that they really know how much they can work before it'll have an impact on their various benefits and what kind of impact and so on. People need this kind of information in order to make good decisions about what they want to do. The next principle is rapid job search. And here again, we go back to the fact that IPS is a place and then train model rather than one of the previous train and place models. That means that once we start with somebody, we try to do an evaluation very quickly, help them figure out what kind of job they want to look for very quickly. And within a month, we should be going out in the community with them to help them find the job that they want. So it's a rapid job search approach. It's not necessarily a rapid placement approach because some people may want to look around for a while and it may take two, three months, four months before they start a first job. But we engage them by searching for a job right from the beginning. The next principle is that the IPS specialists develop jobs that are specific for the client's interest. So if a young person comes in and they want to work with animals, then we help them search for jobs at veterinary clinics and at pet shops and on farms. We don't automatically get them a job at Walmart just because there are lots of jobs available at Walmart. Most people, you know, don't want to work in fast food and so we don't look for many jobs in that domain. We look for the specific jobs that the client is interested in. And then finally, we try to provide people with long-term supports that they are wanting. So, you know, the supports are individualized and they're specific. Some clients don't want their employer to know that they have a disability and so we provide the supports off-site. Some clients don't want us to talk to the employer and so we don't do that. But some clients do want us to support the employer as well as them and so we try to do that. Some people will want supports on the job site for a brief period of time and then want us to phase out. All of this, again, goes back to client's preferences and we try to do what the client prefers. Okay. IPS is a strengths-based approach and, you know, this is a really important concept in terms of how we think about serious mental illness now compared to, you know, 50 years ago when I got into the field. Now, we want to be focused on what client's abilities are, what their interests are, what their background is, what they think they can do well rather than using a deficits-based approach where we focus on the individual's diagnosis and symptoms and problems being in the community. And this is based on just basic psychology. You know, if we reinforce people's strengths, we get a lot more change and we get a lot more improvement than if we keep hammering at their weaknesses. People have personal strengths, you know. They, you know, one client has a strong interest in working in a, you know, radio station because, you know, he listens to the radio all the time and he's really interested in how radio broadcasting works. Another client, you know, has got medical interests and really wants to work in a medical laboratory or in a hospital. So, you know, that and they've got some background perhaps, some past experiences doing these things. You know, people who have worked on a farm and liked it will want to use that competence in their job search and in their new job. People have, you know, some people have more resources and so we pay attention to a person that's got a driver's license or a person that's got a commercial driver's license or a person that has a car. You know, that's a resource that can help in finding a job that, you know, they will like and that they can do well. Or if the person doesn't have some of those resources, we try to help find them in the environment somewhere. So, you know, we've bought a lot of bicycles for people so that they can get to a job that they want to get to. Their families and friends often provide strengths also. You know, a family that really understands the benefits of working can be tremendously important to a client in terms of helping them get to a job until they can afford to have their own transportation. People often rely on friends or co-workers in the job as a strength to help them with transportation or help them with supports. Communities can also provide supports. You know, there are communities that are known for being friendly to people with disabilities and that they can be a tremendous strength in terms of finding jobs and in terms of supporting people to get to their jobs and so on. And one of the big changes in the field just in the last few years really is this focus on what's called recovery friendly workplaces. Many employers around the country are stepping forward and saying that, you know, they want to be known as a company that hires people with disabilities. And this movement has gotten a lot of traction in the last few years for people with substance use disorders, but it also, you know, should be an advantage and a strength in the community for people who have mental health conditions. Okay, so the central player on the supports or on the service side is the IPS specialist. This is an individual that, you know, goes through training, doesn't necessarily have any specific degree. You know, we've seen people with master's degrees, people with college degrees, people with high school degrees that do a great job of being IPS specialist. The specialist, you know, focuses full-time on helping people to gain competitive jobs and to do well and succeed in those jobs. An IPS specialist usually joins with one or two multidisciplinary health teams, and they can't join more than that really because they want to be part of the team meetings on some regular basis to make sure that the clinicians are participating in the job finding and the job support process. And this is a, the multidisciplinary approach is a key part of IPS. You know, we want to make sure that the social worker is involved and, you know, maybe helping the family to understand why work is important to the individual. We want to make sure that the doctor is involved in understanding that work is part of recovery for people. I've interviewed many, many clients who tell me that, well, for years, my doctor told me I couldn't work. And then when my doctor said I could work, I was more than happy to go to work. So, you know, we, the clinical people can impede the progress that people would otherwise make, but they can also be a really helpful part of the team. You know, our team often will meet with a client and decide what kind of job they want. And then everybody on the team will know somebody in the community that might help to develop that kind of job. You know, a young fellow who wants to work with animals. I can remember a guy like this, and as we went around in the team, you know, one person said, oh, well, you know, I know a veterinarian very well, and I'll talk to him right away about whether they have a job at the vet clinic. And another person says, well, you know, I rent a house on a farm, and so I'll ask the farmers if they need somebody to help with the animals. And another person says, well, you know, I go to such and such a pet store, and I know they need people, you know, there to help take care of the animals, and I'll talk to my friend who works there right away. And that's how we develop jobs that are really appropriate for the individual. The IPS specialist also works hand in hand with somebody from the vocational rehabilitation system. You know, the state federal VR system provides lots of funding and lots of support and knows lots about creating jobs. So, the closer we work with VR, the easier it is to fund these services and easier it is to fund some of the supports that people will need. For example, you know, VR often buys uniforms for people, buys tools for people, sometimes even provides transportation for people to get to their job. So, we work hand in hand with them. The IPS specialist is a generalist, And by that, we mean that the specialist does all aspects of vocational rehabilitation, you know, from the early educating the person about how the service works, to helping them develop a career goal, to helping them, you know, find, go visit employers and find out what that job would be like, helping them with their resume, helping them to prepare for the interview, helping them to keep the job and have success once they get started. The IPS specialist stays with the individual. You know, it's hard for people with a mental health condition to go back and forth and to have their providers change all the time. So having a generalist seems to work best. One IPS specialist can, you know, work pretty intensively with up to about 20 people at one time. And of course, people will rotate off of their caseload because they got a job and they no longer need supports, or they decide that they're going to go to school and they start school and they're not looking for a job any longer, or they move or whatever. So over the course of a year, one IPS specialist probably works with about 30 people, but only 20 at a time. The IPS specialist focuses specifically and importantly on the job match. You know, we believe that people like their jobs and do well in their jobs and stay in their jobs and develop a career if the job match is right. So we don't ever just throw somebody into a job because that job is available. We're always looking for a job that really matches who the individual is. And we do take advantage of some career, some educational opportunities. People will often go through a short certificate program, for example, to get a commercial driver's license, or, you know, to learn how to be a welder or something like that before or after they start a job. So IPS, and this is, I guess, part of the client choice issue. IPS will help people with education if that's their goal or help them with work if that's their goal. And we find out, we find that with young people, they often go back and forth and they often do both at the same time. Okay, so there are now 28 randomized controlled trials of IPS specifically for people with serious mental illness. And they're displayed here in this nice graph that Gary Bond put together and updates all the time. And one of the points I wanna make from this is that if you look at the eight or nine programs, studies that have been done fairly recently, well done studies in the US, we get a competitive employment rate somewhere between 60% and 80%. Some of these down in the lower range are done in other countries or they're done with specific populations like people with SMI who also have a serious criminal justice history. But in the general community mental health population of people with serious mental illness, we really should aim for getting around 70% of people employed. Okay, so there are these 28 RCTs that show 60 to 80% employment and IPS has been compared to a huge range of other interventions. Many of these studies have active control groups, but IPS always seems to come out as two or three times more effective than the controls. And IPS or once people become employed, we also see that it's not just their income that improves, but their self-esteem improves, their self-confidence improves, their relationships with people in the community expand, and they naturally start to phase out of the mental health system and use less services. Many studies show that they stop going to the emergency room and they stop getting re-hospitalized. I can tell you my own experience, this is going back 30 years or so, was that in the first couple of studies that we did, I was just shocked to see the improvements that people made once they had a competitive job and were succeeding in competitive employment. A number of clients that I knew personally and taken care of for years, really got well for all intents and purposes. Once they got a job, they started taking care of themselves, they started managing their illness without much help, they started wearing nice clothes, they started getting, got their own apartment. They really lived a life that's much like everybody else. And I think that's what we mean by recovery. And employment is just a central part of recovery for many, many people. These are some of the other employment outcomes that we see with IPS. And I mean, the general finding here is that, getting a job is just a proxy for succeeding in employment. And people who get a job that really matches their interests and skills and who they are, will work more time and they generally work more overtime. And most of them work more than 20 hours a week. Some people will go for working full time and will go for getting off benefits. But I think most people learn that, or figure out that it works best for them to work 20 to 25 hours or 20 to 30 hours and maintain their benefits to some degree. IPS provides a good return on investment in many ways. It's not just the dollars, although economists who have reviewed these IPS studies say that IPS is at least cost effective and probably cost savings. Often because people reduce their hospital use. And we see that it happened over the short term. But over the long term, we also see that people gradually phase out of using outpatient services. So, I followed for years, a few clients who got jobs and they would literally come in and see me once a year to get their medications renewed. Nobody else in the mental health center would have any idea who they were. And these were people who had, I met initially because they were daily hanging around in a day treatment center for several hours a day. Another thing that we have found is that all IPS seems to be effective across all client characteristics that we can measure. Disadvantaged groups like people who come from minority backgrounds, people who have been homeless, people who have had some justice system involvement, people who have other disadvantages, all improve in IPS better than in comparison conditions. We haven't yet found a characteristic that we could identify and say, oh yeah, this person should get something different from IPS. We also find consistently that IPS works across different communities. We did our first study up here in rural New Hampshire and it was criticized by the NIMH people because we used all white people and all people who lived in relatively rural, safe environments. And so we did our second study in Southeast DC and we recruited people out of homeless centers and they were nearly all African-American and they nearly all had drug comorbidities along with their serious mental illness. And to my surprise, we had exactly the same findings as we found as in New Hampshire. And that's now been repeated in many other places around the US and in many other countries. There are now 20 countries around the world that are using IPS and they range from very poor countries like Bulgaria to very wealthy countries like Norway. These are some of the trends currently in IPS research and the main one is that IPS is being extended to a variety of new populations and you can see many of them listed here. Some of these have got a good research base already and some of them are just being tried for the first time. For example, delivering IPS to people who are getting all of their healthcare in federally qualified health centers where they haven't traditionally provided much mental healthcare and haven't provided any employment services. Delivering IPS to people with young adults with autism spectrum disorder, we did one study like that and virtually, essentially all the clients got jobs that matched their specific skills as people with autism often have. The big trend I think right now and the next population that is going to be involved with IPS substantially is people with substance use disorders. The VA has just made a decision to provide IPS to people with primary substance use disorders in every one of their medical centers around the country and IPS is being studied and is expanding rapidly to substance use treatment settings around the U.S. and in other countries. And one of the really important things that we're learning in these studies is that we may need to modify the principles of IPS slightly with adjustments but the basic principles don't change. Finding a job that really matches the person's interest is still important. Trying to integrate health services with employment services is still important. Making sure that the individual is making the choices is still important and so on. Another big issue currently in the research is looking at the diversity, equity, and inclusion. So that's being studied carefully in lots of IPS studies now as far as we can tell though, across many, many IPS studies now, people from different backgrounds, especially African-Americans and people from Latinx backgrounds seem to do just as well as people who are from majority backgrounds. Excuse me. There's also a big trend to try to improve state and federal policies so that people can get access to IPS services more readily and so that people who access the services can have their services paid for completely. As you all know, we have a terribly, terribly fragmented healthcare system and disability system in this country. So IPS providers have to learn how to braid and sequence funding from many different sources, from Medicaid, from VR, from state mental health dollars, from block grants, from contracts and research projects and so on. But this is happening across the US and it's also happening in many other countries that have different insurance systems, different disability systems, different workforce regulations, and so on. And up to the present, IPS seems to be effective in these many different settings. Will you give me a clue when I have five minutes to go or I should bureaucrat? I think pretty quick because we have four. Okay, great. So there's an international learning community that encompasses many of these other states and that includes 26 states in the US and states collaborate in helping each other and to improve their services. The states follow a pathway in terms of developing their system and gradually increasing sites and consulting with each other. The IPS learning community helps them in all phases of development. This is a list of the states that are currently involved in the learning community although there are many other states that are providing IPS and just haven't joined the learning community yet. But we know the states that are in the learning community are having more success in terms of sustaining services and expanding their services over time and so on. And that's true in the international settings as well. The learning community provides regular calls with the different stakeholder groups that support IPS services in their state. And I'm sure you know states and professionals like to learn from each other rather than from so-called experts. And so the learning community takes advantage of that preference. For states that are in the learning community, we follow competitive employment outcomes each quarter and the quarterly integrated competitive employment has stayed over 40% for 16 years now since we started the learning community. I think it's currently at about 46%. We saw a slight dip in the Great Recession and a slight dip at the beginning of COVID. But generally the learning community states have done very well and they've done better than other states in all of these areas that I mentioned and listed here. Lots of research studies also go on within the learning community. And here's a list of some of the studies that have been done. IPS has survived pretty well throughout the COVID pandemic, but all the teams now are returning to more face-to-face contact with clients and also with employers. We're looking, everybody's looking forward to that being more face-to-face. Just to summarize quickly, IPS seems to benefit people in lots of ways. And I think that all of the wealthy countries in the world, the high income countries have accepted the idea that employment is good treatment now. I know for me as a researcher, I think employment is the best treatment that we have. And I hope all of you will look into the literature, try this with your patients and feel the same way. We also know that unemployment carries a variety of risks and I'll skip over that and let Gary have the floor to talk about young adults. Thank you, Bob. Well, I'm Gary Bond and we're now turning to the question of whether this IPS model would work or whether it does work for young adults with mental health conditions. Bob has painted a very vivid picture of what the IPS model is and shared a bit of the research on its effectiveness. And as he said, it's now being extended to other groups. And one group that IPS has been used with for many years but hasn't been studied so much has been young adults. So to set the stage, we know that in the US we're seeing an increase in mental health problems in high schools and colleges. We're seeing increase in suicide rates and increasing depression in this population. We're also seeing growing numbers of young adults who are not in employment, education or training. The acronym there is NEET. It's something that the European countries and Australia have given a lot of attention to. The worry that disaffected young adults are dropping out of the workforce or never joining actually. And what are the implications for later in life? We know that young adulthood is a very pivotal developmental stage that when young adults don't have a good foundation it influences their later development. So let's see. We also know that I wanted to say about the different populations of young adults. So it's not just a single group but there are a number of different groups that have been of attention to mental health providers including high school students. There's been some interest in helping foster care children to say transition from the child welfare system and that very difficult period of transition. We know in general, young adults leaving the kid system and going to the adult system that transition doesn't work so well. There are also homeless young adults who are another population who could benefit from employment services. The juvenile justice system. And certainly young adults with the first episode of psychosis. We know in the US over the last several years there've been development of hundreds of coordinated specialty care programs for young adults with early psychosis. And the model that the National Institute of Mental Health has advanced for the community coordinated specialty care program includes supported employment and education as one of the critical ingredients. And there have always been young adults who are enrolled in community mental health services as well. So the issue of the long-term outcomes for young adults who don't get off to a good start in terms of employment and education, I think is exemplified by this graph that shows employment rates after a first episode of psychosis in a series of longitudinal studies. So one to two years after their first episode, the employment rate in 15 studies was over 40%. And you can see over time, the employment rate declines down to 27% after six years. So what this says to me is that without any assistance in helping people get jobs, we are likely to see a decline in employment rate over the adult later life in adulthood. So the idea here is that employment services for young adults can play a critical role in their long-term recovery. So IPS has been used for young adults in a number of studies. We undertook a randomized, excuse me, a systematic review of the literature and found maybe 20 studies that have looked at IPS for young adults. And what we zeroed in on were the seven high quality studies, seven randomized controlled trials that are listed here. They include four studies for young adults experiencing early psychosis and three other subgroups of young adults, two in mental health centers. And the last one, this Feinfelder study was done with, it's a Norwegian study done with young adults who were at risk for entering the disability system. And this slide shows you a bit of the study characteristics. The samples are relatively small on these studies. The length of follow-up is six to 18 months. We are interested of course, in looking at long-term outcomes in some of the IPS studies and the general population, the 28 studies that Bob mentioned do have a follow-up of a longer time period of five or more years. We, in this review, looked at studies that followed the IPS model, followed the eight principles of IPS because of the research that shows that programs that are implemented according to the IPS principles have better outcomes. So the findings from the seven studies include the employment outcomes and the education outcomes, because as Bob mentioned, many young adults have an interest in education in addition to employment. So in this graph, we're looking at employment during the follow-up period. And the blue bar is the employment rate for IPS. And the red bar is the control group, which was in most cases, services as usual, whatever employment services were available in the community, a referral to voc rehab, for example. And the first two studies were done by Coletti and these were Australian studies. The first study you can see was a, although there were only 41 participants, the differences were very strong, 65% employed for IPS versus 10% for the control group. The second study found an advantage for IPS. The control group in that study did better than in the original Coletti study. The third study was done by Keys Nectarline. This was a study in Los Angeles. Again, you see large differences between the employment rate for IPS and the control group. Recently a study in Vancouver by Erickson, also a first episode psychosis study. Again, significant advantage for IPS. And then the study that we did in 2016, that combined results from four of the randomized controlled trials, looking at the young adult subgroup. And there the differences were very strong, over 80% of the young adults gained employment, who were enrolled in IPS compared to half that many for the control group. And in that particular study, we were able to compare the young adults to the older adults. And the young adults actually had better outcomes, employment outcomes in the older adults in that sample. The second to last study was done in Denmark by Christensen. And there are the differences. Again, as with all seven of these studies, the employment rate favored IPS over the control group. And then finally, the Norwegian studies, Feindhilder, found very strong differences for IPS. So all seven of these studies had significant improvements in employment rates, comparing IPS to controls. And the employment rate is one of the measures of outcome for employment. And it tends to be correlated with other outcomes, including job duration. So six of these studies evaluated job duration, either the number of weeks worked, or the days worked, or the hours worked. And in all six of these studies, there was an advantage to IPS over the control group. The seventh study did not find any difference to the CLECI study. When we turn to education for the studies, the four, three of them that were for first episode psychosis and the Christensen study looked at education, measured education in their study. And again, you see that the IPS group had better education outcomes than the control group, but the differences aren't as strong. And in fact, none of these four studies found a significant difference between education and between IPS and control. So a couple comments about measuring education. First of all, unlike employment, going to a job and working even a few days, that I would consider a success. And in most cases, once started on the path to gaining employment, IPS clients continue down that path, they may change jobs, but usually the employment is sustained over time. In terms of education, it's not quite the milestone to start in an education program as it is to get a job. It's not quite the challenge of getting through the interview or being hired as is true for applying and enrolling in education program. So the point I'm making is that measuring education outcomes turns out to be a complicated issue. Now comparing across these seven studies and combining the results in a meta analysis, here are a few comparisons here. As overall, the employment rate for people in IPS is about 25% higher than the control group. And then the test of overall significance is very strong. For education, the overall significance is also significant. It's P less than 0.01. The difference is quite a bit less in terms of education rate than it is for employment rate. So to summarize here, then the employment rate for IPS is 25% more than for controls, the job duration is longer, education rate is slightly higher than control for IPS. And when you compare it within studies to people of different ages, young adults often have better outcomes in older adults. So one of the directions we're going in studies of IPS for young adults is to further develop the supported education component. In the original fidelity scale, which is called the IPS fidelity scale, we don't have measures of interventions for helping people get education. So we recently sought to rectify this. And so we developed a new fidelity scale that has two components. One is the original employment component. And the second one is a component measuring education that has 10 items. The employment services are just the same for young adults as for older adults. There really don't need to make modifications for young adults with mental health conditions. But what you need to do is add the education component that include helping people assess what their educational goals are, helping to apply for colleges or technical schools, and so forth and so on. Working with families is another piece that's new with young adults that we think should be emphasized. And for many young adults who have never worked ever, career exploration is a highlighted component that might include information interviews. So in summary, what Bob and I have tried to explain here is that IPS is an evidence based practice that has truly transformed the lives of many, many people all over the world. And its effectiveness has been shown not only for older adults, but now promising results for young adults. And that research is continuing to look at how we can best serve this young adult population. So with that, I will end and turn it over back over to Ben. Thanks so much to both of you for a really wonderful presentation. So before we shift into Q&A, I just want to take a moment and let you know that SMI Advisor is accessible from your mobile device. You can use the SMI Advisor app to 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 So we have time maybe for a couple of questions. I'd like to just briefly start off with one. You know, many clinicians, I mean, IPS is a wonderful intervention, as I think you made a great case for. I'm wondering how you kind of respond to clinicians who might be working in a setting that doesn't have a formal IPS program about ways, perhaps, of incorporating any of the IPS principles in a setting where they may not have all of, you know, the infrastructure to support the full intervention. They should advocate with the administrators in their setting to do that. You know, there's a central problem in our health care system that we focus so much on treatment and so little on social determinants. And all of the research shows we get better outcomes if we spread that out a little bit and pay more attention to social determinants. And that's what we find in all the European countries. But it also helps, I think, just for any clinician should be talking with their patient or client about what's important in their life. And for most people, having a job, having a role, having an income, having something to do every day that's out in the real world rather than in the mental health center is an important goal. Great. Thanks so much. And then maybe just one more question we have from a listener. Are there any statistics? And I gather what they mean here is statistics on the use of IPS for persons who are coming out of prison. Oh, that's a good question. You know, about half of the people who are in mental health centers now have a justice system and history of one kind or another. But I think that we, our system doesn't enable people to get access to good services immediately when they come out. We've been trying to work with the justice system and work with mental health systems to meld these together more. You know, as soon as people are released from jail or prison, they really should have access to reinstatement of their benefits. And they should have access to a mental health team and they should have help getting housing and employment, which are the two things we know are most correlated with staying out of prison. But our system doesn't allow that to happen very easily. I should mention that there's a study that's going on right now called the Next Gen Study in five states that is evaluating IPS for people that are being released from correctional facility. That's going on in five states right now. Great. Thank you both. Maybe just one more question. I know we're almost at time, but one more person squeezed one in under the wire, which is about making sure that there's no disruption in benefits for clients when they're getting employment. How you guys think about that? Well, it's really important. That's why we insist that everybody get benefits counseling before they start working, because we don't want to have happen that people are surprised that they suddenly lose their SSI and lose their food stamps and so on. That's a terrible outcome. And that did happen in the past before we really insisted on benefits counseling as part of the model. Great. Okay. Well, I think that's all we have time for with regards to questions. I do want to let you know that if you have follow-up questions about this or any topic related to evidence-based care for SMI, our clinical experts are now available for online consultations. Mental health clinicians can submit a question and receive a response from one of our SMI experts. Consultations are free and confidential. Finally, on behalf of SMI Advisor, I'd like to invite you to learn more about the APA's 2022 annual meeting. The in-person conference takes place May 21st to May 25th in New Orleans, and the virtual meeting takes place June 7th to 10th. During the live conference, clinical experts from SMI Advisor are leading a variety of sessions on how to improve care for individuals who have SMI. Topics for these sessions include the basics on how to use Clozapine, digital navigators, making technology work, how to improve physical health in patients who have SMI, and more. I encourage you to take a moment right now and browse the agenda at psychiatry.org forward slash annual meeting. 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 on April 22nd, 2022, as Dr. Craig Bryan presents Lethal Means Counseling for Suicide Prevention. This free webinar, again, will be April 22nd, 2022, from 12 to 1 p.m. Eastern Standard Time. Thank you again for joining us. Until next time, take care.

IPS

supported employment

young adults

mental health conditions

competitive employment

integration of mental health and vocational services

positive outcomes

job duration

early psychosis

social determinants of health