Assessment of a virtual disaster preparedness and response simulation compared to previous in-person iterations: successful translation of the Penndemic framework.

Collaborative learning has documented benefits. Restrictions because of the COVID-19 pandemic prevented in-person collaborative experiences, therefore creating a pathway for online ones. An inter-university team previously created and published a novel framework that fosters collaborative learning for emergency/disaster preparedness and uses scenarios that attract student participation from a spectrum of disciplines. Here, we detail the implementation and evaluation of this framework in a virtual setting. Analysis of pre- and post-surveys from the virtual event revealed similar results to the previous in-person iterations. Results for both in-person and virtual events demonstrated that students had higher confidence and interest in emergency/disaster preparedness and interprofessional teamwork after participation. Implementation of this framework in a virtual setting can facilitate a positive student learning experience and inter-university collaboration.

Measuring Fidelity to Individual Placement and Support for Transition Age Youth: Psychometric Findings.

Individual Placement and Support (IPS), an evidence-based supported employment model for working-age adults with serious mental illness, also serves transition age adults (TAY; ages 16-24). The IPS-Y is a new IPS fidelity scale tailored to this younger population. Although adopted worldwide, it lacks research on the psychometric properties of its two components (employment and education). Six IPS programs serving TAY were assessed on IPS-Y (Employment) in an initial review (Time 1) and on both components in a second review one year later (Time 2). We examined scale calibration, reliability, and validity for the IPS-Y in this sample. Fidelity reviewers use the full range of ratings, from "not IPS" to "exemplary," on both IPS-Y components. On the employment component, item calibration was excellent; internal consistency reliability was good at Time 1 (r = .81) and test-retest reliability was fair (r = .63). The IPS-Y (Employment) showed excellent sensitivity to change, with the mean scale score increasing from 88.3 to 105.5. IPS-Y (Employment) item ratings at Time 2 were similar to corresponding items in a sample of conventional IPS programs using the standard IPS fidelity scale. Predictive validity was promising for both components, with fidelity scale ratings positively correlated with site-level competitive employment rates (r = .57) and education enrollment rates (r = .69). IPS can be implemented to good fidelity for programs serving TAY. Preliminary findings regarding the psychometric properties of the IPS-Y Employment are encouraging, but replication in larger samples is needed.

COVID-19, Unemployment, and Behavioral Health Conditions: The Need for Supported Employment.

The COVID-19 pandemic has caused massive unemployment, exacerbated pre-existing behavioral health (mental health and substance use) disorders for many people, and created new disorders for others. Although policy changes have increased health care and unemployment benefits, most people want jobs and self-sufficiency rather than handouts. A robust evidence base shows that supported employment can enable unemployed people with behavioral health conditions to find competitive, integrated employment and behavioral health supports. Millions of U.S. citizens may need these services as the pandemic recedes and jobs become available. Government attention to supported employment is necessary now more than ever.

A Tale of Four States: Factors Influencing the Statewide Adoption of IPS.

Evidence-based supported employment has become a core community mental health service in much of the U.S. Although a national learning community has facilitated progress in about half of the states, other states have tried to implement evidence-based supported employment on their own. Many studies have examined site-level factors influencing implementation of supported employment, but few have focused on the role of state agency policies and actions. This study examined four states that have not joined the learning community, comparing two that have implemented with success (adopting states) and two that have faced challenges (non-adopting states). This comparative case study approach compared barriers, facilitators, and strategies in two states adopting IPS to two states that did not. The authors examined quantitative data from public records and conducted content analysis of qualitative and quantitative data from key informant interviews. The two non-adopting states lacked model clarity, funding, focus on people with serious mental illness, and collaboration between state mental health and vocational rehabilitation agencies. The two successful states experienced similar barriers but overcame them following lawsuit settlements that required implementation of evidence-based supported employment. Key strategies for successful implementation were funding, fidelity monitoring, technical assistance, and collaboration between state mental health and vocational rehabilitation agencies. With legal settlements serving as the catalyst, states facing challenges to implementing evidence-based supported employment can achieve success using standard implementation strategies to fund and ensure the quality of services.

Enhancing return to work or school after a first episode of schizophrenia: the UCLA RCT of Individual Placement and Support and Workplace Fundamentals Module training.

BACKGROUND: This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling. METHODS: Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication. RESULTS: The IPS-WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS-WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS-WFM intervention (45 v. 26 weeks, p < 0.004). CONCLUSIONS: The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.

Introducing Individual Placement and Support (IPS) supported employment in Japan.

Individual Placement and Support is a standardized model of supported employment, developed initially for people with serious mental disorders and now applied to people with a range of disabilities. More than two dozen randomized controlled trials around the world show that the approach helps a majority of participants to succeed in competitive employment. Individual Placement and Support is spreading rapidly across the USA and in many other high-income countries, with facilitation by an international learning community.

Individual Placement and Support for People with Autism Spectrum Disorders: A Pilot Program.

Young adults with autism spectrum disorder (ASD) experience significant rates of unemployment and underemployment, and the field needs an inexpensive, evidence-based vocational intervention. We examined an approach developed for people with serious mental illness, IPS supported employment, for young adults with ASD. We described a pilot IPS program for young adults with ASD and evaluated the first five participants over 1 year. The first five IPS participants succeeded in competitive employment, expanded independence, and achieved broad psychosocial gains. IPS could help young adults with ASD succeed in competitive employment at a relatively low cost.

Sustaining and Expanding Evidence-Based Supported Employment: The Role of State Leaders Participating in a Learning Community.

State leaders often promote implementation of evidence-based practices but have difficulty sustaining and expanding them over time. This paper examines the activities of leaders in 13 states that have successfully implemented, sustained, and expanded evidence-based supported employment, known as Individual Placement and Support (IPS), for 4 to 12 years. We interviewed state leaders from 13 states participating in a learning community regarding the composition of their leadership team, participation in the learning community, interagency collaboration, state policy alignment, financing, training, and monitoring of fidelity and outcome. To assess state-level performance in implementing, sustaining, and expanding IPS services, we obtained measures of sustainment, expansion, program fidelity, and employment in the subsequent year and compared them to a priori benchmarks. The majority of states (between 69 % and 77 %) met benchmarks for sustainment, expansion, fidelity, and employment. States varied widely in specific actions to advance IPS, but all had established leadership teams, participated in the national learning community, and built an infrastructure supporting IPS. Leaders in 13 states participating in a learning community have adopted and maintained multiple strategies to sustain and expand evidence-based supported employment at a high level of fidelity with good employment outcomes.

Prevalence and Quality of Individual Placement and Support (IPS) Supported Employment in the United States.

The individual placement and support (IPS) model of supported employment for people with serious mental illness is an evidence-based practice. Factors including a national learning community promoting IPS and enforcement of the Supreme Court's Olmstead decision have spurred the growth of IPS nationwide. In this study we first evaluated the national prevalence and quality of IPS programs. We then evaluated the impact of learning community membership and Olmstead settlements on IPS program penetration and quality across the United States. We interviewed representatives from 48 state behavioral health agencies and 51 state vocational rehabilitation agencies. Survey questions examined the number of IPS programs in each state, the presence of an Olmstead settlement mandating employment services for people with serious mental illness, and the presence of three indicators of quality in IPS programs: collaboration between state behavioral health and vocational rehabilitation agencies, regular, independent fidelity monitoring, and technical assistance and training for IPS programs. Respondents from 38 (75%) states, including 19 states in the IPS Learning Community and 19 outside the learning community, reported a total of 523 IPS programs nationwide (M = 14, SD = 16). The state IPS program penetration rate (number of IPS programs per 1,000,000 people) ranged from 0.05 to 16.62 (M = 3.61, SD = 3.62) among states with IPS. The penetration rate was similar for learning community and non-learning community states with IPS, but learning community states were much more likely than non-learning community states with IPS to report the presence of each of three quality indicators. Eleven states reported Olmstead or other settlements that positively impacted employment services for people with serious mental illness, but among the 38 states with IPS programs, Olmstead states did not differ from non-Olmstead states in IPS program penetration or on the quality indicators. Nationally, most states provide IPS programs, but the within-state penetration rate and quality of implementation vary widely. While learning community and non-learning community states with IPS do not differ in the prevalence of IPS programs, learning community states are much more likely to report key quality indicators, which may enhance these states' potential for sustaining and expanding IPS. Olmstead settlements have not yet shown a direct impact on the penetration and quality of IPS, but as the Department of Justice continues to enforce the Supreme Court's Olmstead decision, their significance may increase.

Individual Placement and Support (IPS) for Methadone Maintenance Therapy Patients: A Pilot Randomized Controlled Trial.

Individual Placement and Support (IPS) is an evidence-based employment model for people with severe mental illness, but it has not been evaluated for clients enrolled in substance abuse treatment programs. This study evaluated the effectiveness of IPS for people with opioid use disorders enrolled in an opioid treatment program. Within a randomized controlled experiment, 45 patients receiving methadone maintenance therapy were assigned to either IPS or a 6-month waitlist. The waitlist group received IPS after 6 months. The primary outcome assessed over 1 year compared the attainment of a job for the IPS condition to the waitlist comparison group. During the first 6 months after enrollment, 11 (50%) active IPS participants gained competitive employment compared to 1 (5%) waitlist participant (Χ 2 = 12.0, p < 0.001). Over 12 months of enrollment, 11 (50%) IPS participants gained competitive employment compared to 5 (22%) waitlist participants (Χ 2 = 3.92, p = 0.07). We conclude that IPS holds promise as an employment intervention for people with opioid use disorders in methadone maintenance treatment, but larger trials with longer follow-up are needed.

Barriers and Facilitators to Sustainment of an Evidence-Based Supported Employment Program.

Large-scale initiatives to expand evidence-based practices are often poorly implemented and rarely endure. The purpose of this study was to identify the perceived barriers and facilitators to sustainment of an evidence-based supported employment program, Individual Placement and Support (IPS). Within a 2-year prospective study of sustainment among 129 IPS programs in 13 states participating in a national learning community, we interviewed IPS team leaders and coded their responses to semi-structured interviews using a conceptual framework adapted from another large-scale implementation study. Leaders in 122 agencies (95%) that sustained their IPS programs identified funding, prioritization, and workforce characteristics as both key facilitators and barriers. Additional key factors were lack of local community supports as a barrier and leadership and structured workflow as facilitators. Within the IPS learning community, team leaders attributed the sustainment of their program to funding, prioritization, workforce, agency leadership, and structured workflow. The actions of the learning community's leadership, state governments, and local programs together may have contributed to the high sustainment rate.

An official American Thoracic Society/American Association of Critical-Care Nurses/American College of Chest Physicians/Society of Critical Care Medicine policy statement: the Choosing Wisely® Top 5 list in Critical Care Medicine.

RATIONALE: The high costs of health care in the United States and other developed nations are attributable, in part, to overuse of tests, treatments, and procedures that provide little to no benefit for patients. To improve the quality of care while also combating this problem of cost, the American Board of Internal Medicine Foundation developed the Choosing Wisely Campaign, tasking professional societies to develop lists of the top five medical services that patients and physicians should question. OBJECTIVES: To present the Critical Care Societies Collaborative's Top 5 list in Critical Care Medicine and describe its development. METHODS: Each professional society in the Collaborative nominated members to the Choosing Wisely task force, which established explicit criteria for evaluating candidate items, generated lists of items, performed literature reviews on each, and sought external input from content experts. Task force members narrowed the list to the Top 5 items using a standardized scoring system based on each item's likely overall impact and merits on the five explicit criteria. MEASUREMENTS AND MAIN RESULTS: From an initial list of 58 unique recommendations, the task force proposed a Top 5 list that was ultimately endorsed by each Society within the Collaborative. The five recommendations are: (1) do not order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions; (2) do not transfuse red blood cells in hemodynamically stable, nonbleeding ICU patients with an Hb concentration greater than 7 g/dl; (3) do not use parenteral nutrition in adequately nourished critically ill patients within the first 7 days of an ICU stay; (4) do not deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation; and (5) do not continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort. CONCLUSIONS: These five recommendations provide a starting point for clinicians and patients to make decisions leading to higher-quality, lower-cost care. Future work is needed to promote adherence to these recommendations and to develop additional ways for intensive care clinicians to take leadership in reining in health-care costs.

Is high fidelity to supported employment equally attainable in small and large communities?

Individual Placement and Support (IPS) is an evidence-based model to help people with serious mental illness achieve employment. This study examined variation in model adherence in small and large communities. We compared program-level ratings on a standardized 25-item IPS fidelity scale (range = 25-125) for 79 sites in eight states categorized by local community size. Programs in large and small communities achieved comparable fidelity scores (mean = 100 and 104, respectively). Fidelity-outcome correlations within the two groups were both of moderate size. As a practical guide, the IPS fidelity scale is suitable for use in both small and large communities.

Individual placement and support for young adults: One-year outcomes.

OBJECTIVE: Many young adults who are unemployed and not in school need support achieving employment goals. Individual Placement and Support (IPS) is an evidence-based employment practice for adults with serious mental illness, but its applicability to young adults with mental health conditions has not been well-researched. The present study prospectively assessed IPS effectiveness in a national sample of young adults enrolled in routine practice settings in the U.S. public mental health system. METHOD: Nine community agencies in five states participated in a 1-year follow-up study of young adults (aged 16-24) enrolled in IPS services. The study examined three outcomes: retention in services, employment, and education. State fidelity reviewers examined IPS fidelity using a new fidelity scale, the IPS-Y. RESULTS: In a sample of 111 participants, the mean age was 19.2, 72 (64.9%) had never worked, and 76 (68.5%) had a diagnosis of depressive and/or anxiety disorder. Participants averaged 8 months of enrollment before terminating from IPS services. During follow-up, 51 (45.9%) participants obtained a competitive job (N = 50) or paid internship (N = 1); 14 (12.6%) achieved a new education outcome. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: IPS has promising outcomes for helping young adults with mental health conditions achieve positive employment outcomes, but its effectiveness in helping young adults achieve education goals has not been demonstrated. IPS should be offered to young adults with employment goals. Targeted funding for supported education and training for IPS specialists in delivering educational supports may be necessary to ensure optimal education outcomes in IPS. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A test of the occupational matching hypothesis for rehabilitation clients with severe mental illness.

PURPOSE: This study compared job matching rates for clients with severe mental illness enrolled in two types of employment programs. Also examined was the occupational matching hypothesis that job matching is associated with better employment outcomes. METHODS: The study involved a secondary analysis of a randomized controlled trial comparing evidence-based supported employment to a diversified placement approach. The study sample consisted of 187 participants, of whom 147 obtained a paid job during the 2-year follow-up. Jobs were coded using the Dictionary of Occupational Titles classification system. Match between initial job preferences and type of job obtained was the predictor variable. Outcomes included time to job start, job satisfaction, and job tenure on first job. RESULTS: Most occupational preferences were for clerical and service jobs, and most participants obtained employment in these two occupational domains. In most cases, the first job obtained matched a participant's occupational preference. The occupational matching hypothesis was not supported for any employment outcome. The occupational matching rate was similar in this study to previous studies. CONCLUSIONS: Most clients who obtain employment with the help of evidence-based supported employment or diversified placement services find jobs matching their occupational preference, and most often it is a rough match. Occupational matching is but one aspect of job matching; it may be time to discard actuarial classification systems such as the Dictionary of Occupational Titles as a basis for assessing job match.

Individual placement and support programmes for young adults: Where are they and whom do they serve?

AIM: Individual Placement and Support (IPS), an evidence-based supported employment model developed for adults with serious mental illness, has been recently targeted to young adults with mental health conditions, but little is known about its adoption in this age group in the United States. METHODS: We recruited a volunteer sample of nine IPS programmes in five states serving young adults with mental health conditions aged 16 to 24. IPS team leaders reported programme and participant characteristics and rated barriers to employment and education. RESULTS: Most IPS programmes were located in community mental health centres, served a small number of young adults, and received most referrals from external sources. The study sample of 111 participants included 53% female, 47% under 21 years old, 60% diagnosed with a depressive disorder; 92% had an employment goal, and 40% had an education goal. IPS specialists reported that managing mental health symptoms was the most common barrier to achieving employment and education goals. CONCLUSION: Future research should examine how IPS programmes could best provide services to young adults.

Update on funding IPS supported employment services in the IPS learning community.

OBJECTIVE: Individual placement and support (IPS) is the evidence-based supported employment approach for people with serious mental illness. Because funding is the major barrier for states to implement IPS and increase access, the IPS Learning Community collected information about sources of IPS funding from 24 member states. METHODS: In early 2020, IPS employment leaders from the public mental health authority and the state vocational rehabilitation (VR) authority completed a questionnaire identifying sources of funding for IPS in their states. RESULTS: The main sources of funding were Medicaid, Substance Abuse and Mental Health Services Administration (SAMHSA) block grants, state and county government, the Ticket to Work program, and the federal-state VR programs. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Funding IPS services requires braided funding from multiple sources. This complicated method limits scaling up services statewide. Solving this funding problem would require coordinated action from federal and state agencies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Growth of IPS Supported Employment Programs in the United States: An Update.

OBJECTIVE: Individual placement and support (IPS), an evidence-based supported employment practice, is a core service in community mental health in the United States. Several factors promote the growth of IPS, including a network of 24 states participating in a learning community devoted to expanding IPS services. This study examined growth of IPS in the United States from 2016 to 2019, comparing growth rates for states within and outside the learning community. METHODS: This national survey included telephone interviews with 70 representatives from state mental health and vocational rehabilitation agencies in 50 states and the District of Columbia, replicating methods of a 2016 survey. The primary outcomes were the number of IPS programs and clients served. The survey inquired about four indicators of state-level support for IPS implementation and sustainment: collaboration between state agencies, independent fidelity reviews, technical assistance and training, and funding. RESULTS: In 2019, 41 (80%) of 50 states and the District of Columbia had IPS services, with 857 IPS programs serving an estimated 43,209 clients. Between 2016 and 2019, the number of programs increased from 272 to 486 in 22 learning-community states and two learning-community counties, and from 251 to 371 in 18 states outside the learning community. State-level support for IPS was significantly greater in learning-community states, compared with non-learning-community states. CONCLUSIONS: IPS services expanded substantially in the United States between 2016 and 2019. Learning-community states had more rapid growth and provided greater implementation support, facilitating implementation, expansion, and sustainment of high-fidelity IPS. Nevertheless, access to IPS remains limited.

PennDemic Simulation Framework: An Innovative Approach to Increase Student Interest and Confidence in Disasters Preparedness/Response and Interdisciplinary Teamwork.

An interdisciplinary group from two higher-education institutions in Philadelphia developed a novel framework for interprofessional education. This framework was applied to two different scenarios disease outbreak and natural disaster, which were used in simulations in 2018 and 2020. By design, these simulations included students from a broad range of disciplines, beyond the typical healthcare fields. Students were first grouped by discipline and were then placed in interdisciplinary teams for the rest of the scenario. Students were administered four surveys throughout which included 10 point-Likert scale and free response items. A statistically significant post-simulation increase in student interest and confidence was found. Survey analysis also revealed higher scores of positive group behaviors among interdisciplinary teams when compared to discipline groups. Importantly, students realized the importance of broad representation of disciplines for disaster preparedness. The PennDemic framework may be helpful for teams looking to develop simulations to build interest and confidence in disaster preparedness/response and interdisciplinary teamwork.

Helping People Denied Disability Benefits for a Mental Health Impairment: The Supported Employment Demonstration.

Social Security Administration demonstration projects that are intended to help people receiving disability benefits have increased employment but not the number of exits from disability programs. The Supported Employment Demonstration (SED) is a randomized controlled trial (RCT) of services for individuals with mental health problems before they enter disability programs. The SED aims to provide health, employment, and other support services that help them become self-sufficient and avoid entering disability programs. The target population is people who have been denied Social Security disability benefits for a presumed psychiatric impairment. Thirty community-based programs across the United States serve as treatment sites; inclusion in the SED was based on the existence of high-fidelity employment programs that use the individual placement and support model, the ability to implement team-based care, and the willingness to participate in a three-armed RCT. In the SED trial, one-third of 2,960 participants receive services as usual, one-third receive services from a multidisciplinary team that includes integrated supported employment, and one-third receive services from a similar team that also includes a nurse care coordinator for medication management support and medical care. The goals of the study are to help people find employment, attain better health, and delay or avoid disability program entry. This article introduces the SED.