TheMHS 2015 Integration not just Colocation
- 1. Integration: not just Colocation! Full integration between mental health and disability employment services to achieve greater employment outcomes for consumers with mental illness Dhiraj Kishnani Senior Occupational Therapist Catherine Skate Vocational Consultant
- 2. Integration : not just Colocation! Extent of the problem In the beginning……Nov 2010-Feb 2011 ● No systematic approach to collection of data: referrals, participation and outcomes of employment programs ● No systematic documentation of education and employment status or goals ● No integrated system approach between Mental Health and Disability Employment Services ● Limited dedicated vocational resources in mental health: 0.4 FTE limited to one cluster of the Area
- 3. Integration : not JUST Colocation! Proposed solutions Why IPS? Evidence based with Systematic Reviews and RCTs consistently showing employment outcomes of 60% or above worldwide Developed in 1996 by Deborah Becker and Robert Drake, Dartmouth University, USA Target group is people with serious, persistent, mental illness “Employment Specialist” spends 4 days a week colocated with the mental health team
- 4. Integration : not just Colocation! Measuring Fidelity Supported Employment Fidelity Scale Measured using 25 Item Supported Employment Fidelity Scale (SEFS) adapted for ANZ by Geoffrey Waghorn Fidelity correlates positively with employment outcomes……higher score, more jobs!! Audit schedule: Steering Group (monthly) ES Self Audit (3 monthly) External (6,12 monthly)
- 5. Integration : not just Colocation! aims ● To implement Integrated Employment Program with high fidelity to Individual Placement & Support Model ● To increase the number of consumers in employment ● To incorporate consumers’ employment goals, progress and outcomes into clinical documentation
- 6. Integration : not just Colocation! outcomes To implement IPS with high fidelity to the Model Monthly and Quarterly self reviews External reviews: Nov 2012, Oct 2013 and May 2015
- 7. Integration : not just Colocation! outcomes To increase the number of consumers in employment
- 8. Integration : not just Colocation! outcomes Additional information: measuring employment sustainability
- 9. Integration : not just Colocation! outcomes To incorporate consumers’ employment goals, progress and outcomes into clinical documentation Completion of care plans has risen from 18.6 % to 46% Where a Care Plan has been completed, 100% have a documented Vocational Goal Total Evidentiary Indicators of Vocational Activity (referral documentation on file, note in care plan, progress notes, note in Management Plan in file notes, outcome of Vocational Activity) has risen from to 8 (18.6%) to 70(300%)
- 10. Integration : not just Colocation! challenges Referral sources and fidelity to IPS Model Referral information and documentation Staffing issues and organisational issues: DES and Mental Health Resources for governance: External reviews, VETE services, IPS Practitioners Group, IPS Reference Group, National Reference Body
- 11. Integration : not just Colocation! Case study Bob is a 35 year old gentleman who, prior to relapse of Schizophrenia and admission to the hospital last year, had worked full time in a technical position. He lost his employment during this period, and upon discharge was referred to the community mental health team for case management services. The Case Manager addressed Bob’s vocational history and goals in the first session after discharge from the hospital, and information about the employment program was also provided. Bob was referred to WISE Employment but was ineligible as his current casual 12 hour a week job as a sports coach was not in jeopardy, nor did he want to increase his hours. He remained ambivalent about his job, as it wasn’t really what he wanted to do. The Employment Specialist and Case Manager developed a plan with the consumer that he would work on his vocational goal and maintain his current job with the support of the VETE Clinician. This enabled him to work on his individual employment goal in his own time. If the current job became in jeopardy or he did decide to increase his hours, the Employment Specialist would be able to become involved quickly. Over a number of months the consumer worked with the VETE Clinician to develop a clear goal and plan while maintaining his job. During this time he remained ambivalent about increasing his hours and changed his mind almost weekly. Once he decided upon an employment goal (significantly different to his current job and full time), he was eligible for the employment program and got a job 4 weeks after registering with WISE Employment. He now works full time in a professional technical position which he has maintained for more than 26 weeks.
- 12. Integration : not just colocation! Thank you!