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.
