TheMHS 2015 Integration not just Colocation

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

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

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


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)


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


outcomes

To implement IPS with high fidelity to the Model

Monthly and Quarterly self reviews

External reviews: Nov 2012, Oct 2013 and May 2015


outcomes

To increase the number of consumers in employment


outcomes

Additional information: measuring employment

sustainability


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%)


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


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.

Integration : not just colocation!

Thank you!

Documents

TheMHS 2015 Integration not just Colocation