Johnson & Johnson – Dartmouth
Community Mental Health Program
The mission of the Johnson & Johnson – Dartmouth Community Mental Health Program is to increase access to evidence-based supported employment, also known as Individual Placement and Support (IPS), for adults with serious mental illnesses who are interested in gaining employment. In the United States, this program systematically works with individual states to implement IPS supported employment following the evidence-based guidelines, initially in a small number of sites (typically three to five community mental health centers) and expanding statewide over time. The program is administered in each participating state through the collaboration between the state mental health authority and the state vocational rehabilitation administration. With support from Johnson & Johnson Corporate Contribution, the Dartmouth Psychiatric Research Center (PRC) oversees the program and provides ongoing technical assistance and consultation on IPS supported employment to the states.
The Johnson & Johnson – Dartmouth Community Mental Health Program began in 2001 with a three-site pilot in three states for one year to demonstrate the feasibility of implementing evidence-based supported employment with close collaboration between mental health and vocational rehabilitation services. Building upon the success of the pilot, the program was subsequently instituted and currently includes 13 states, the District of Columbia (federal jurisdiction), and a county from a large state.
The first four years of program participation are comprised of yearly renewable work agreements. Activities in the first year include building informed support for implementing IPS supported employment services statewide in a sustainable way, creating a state-level IPS supported employment steering committee, developing in-state technical assistance capacity, and carrying out a site selection process to select three to five sites. Years two through four are devoted to implementing IPS supported employment with good fidelity and developing plans to expand IPS supported employment services statewide in a sustainable way. Dartmouth partners with the state IPS champions from the mental health authority and state vocational rehabilitation and provides IPS trainer training and technical assistance on implementing high fidelity supported employment. In addition, Dartmouth coordinates a family advocacy project for IPS supported employment across the 15 jurisdictions. In June 2013, the program established a similar group of peers representing each of the jurisdictions. Johnson & Johnson Corporate Contributions sends a yearly gift to Dartmouth PRC to help support the program. States/jurisdictions receive a yearly sum that is matched with funding and other resources from the state departments of mental health and vocational rehabilitation during the first four years of each project. States/jurisdictions determine how funding is allocated in the yearly budget and assume greater responsibility for funding over the four years. Money is budgeted, for example, for pilot sites to offset time spent on training and start up, for employment specialist positions at the pilot sites, and the IPS state trainer position.
Yearly funding from the program ends after four years. But states/jurisdictions have continued to participate in the program through regular teleconference meetings, annual in-person meetings, sharing outcome data, training and educational materials, and accessing ongoing technical assistance and consultation from the Dartmouth supported employment team.
The program has evolved into a learning community in which the jurisdiction IPS leaders continue to meet together and identify and participate in research projects to better understand how to support people living with symptoms of mental illness in their recovery through work and school. Examples of studies in this learning collaborative are: the relationship between employment outcomes and IPS fidelity, a survey on supported education, employment benchmarks, and factors related to IPS sustainability.
After the first pilot year, six states and the District of Columbia participated in the first round of the program. Currently, there are 13 states (Connecticut, Illinois, Kentucky, Kansas, Maryland, Minnesota, Missouri, North Carolina, Ohio, Oregon, South Carolina, Vermont, Wisconsin), the District of Columbia, and 1 county-level project in Alameda County, California. North Carolina joined the project on July 1, 2013. The other 14 jurisdictions have established a minimum of three IPS supported employment sites, and some states have expanded to 20 sites that track and share outcome data. A site is defined as an agency, which may have multiple IPS teams and locations.
State liaisons collect simple program-level employment and education outcome data from each of the sites on a quarterly basis. Dartmouth summarizes the outcomes and sends graphs and tables to the state liaisons to share with their sites. In the most recent quarter (January – March 2013), 11,159 people (from 13 states and the District of Columbia) received IPS supported employment services. Forty percent of those people worked in a competitive job during the quarter.
The employment rate for the program has ranged from 38% (first quarter of data collection; 5 states and District of Columbia) to 55%. The average employment rate across 41 quarters is 43%.
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International IPS Dissemination Network
In 2012, the Johnsons & Johnson – Dartmouth Community Mental Health Program began including countries and regions outside of the United States. Italy, the Netherlands, and Catalonia, Spain have joined the international IPS dissemination network with the United States. Through the international IPS network, information will be learned about IPS implementation in different cultures and different labor markets.
Deborah R. Becker
Dartmouth Psychiatric Research Center