Individual Placement and Support: Strategies for Disseminating, Sustaining, and Replicating an Evidence-Based Practice
IPS Employment Center
Submitted by Gary R. Bond and Sarah Swanson
Individual Placement and Support (IPS) is an evidence-based model of supported employment that initially was developed for people with serious mental illness. The model focuses on helping clients find and maintain competitive employment in jobs of their choosing. This Knowledge Translation (KT) Casebook entry describes strategies that have supported the dissemination of the IPS model and the implementation, monitoring, and sustainment of IPS programs. The main elements of the project’s KT approach include a focus on rigorous research to disseminate evidence-based practices, a learning community that coordinates resources and facilitates collaboration between states and regions implementing IPS, the use of fidelity scales to monitor adherence to model standards, and training and technical assistance (TA). These strategies are being replicated in new work that adapts the IPS model to serve a young adult population.
IPS was first implemented in New Hampshire in the early 1990s. Since that time, its use has spread to at least 41 U.S. states and 19 other countries (Drake et al., 2020; Pogue et al., 2022). The IPS model has been extensively and rigorously researched. A number of systematic reviews of randomized controlled trials (RCTs) have found that IPS is effective in improving employment outcomes for adults with serious mental illness (Brinchmann et al., 2020; de Winter et al., 2022; Frederick & VanderWeele, 2019; Kinoshita et al., 2013; Marshall et al., 2014; Metcalfe et al., 2018; Suijkerbuijk et al., 2017; Weld-Blundell et al., 2021). In addition, IPS is being studied for new populations, such as people with substance use disorders or criminal justice involvement (Bond, Drake, & Pogue, 2019).
In current work funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), the project team is evaluating the effectiveness of IPS for young adults with psychiatric disabilities. State leaders in California, Kentucky, Minnesota, South Carolina, and Wisconsin and IPS team leaders for nine IPS programs in these states are participating in the project to implement the model for young adults. The project’s research team includes the original founders of the IPS model and other researchers and trainers associated with the IPS Employment Center, which defined the IPS approach to supported employment. The IPS Employment Center is located at the Research Foundation for Mental Hygiene in New York City.
As the IPS model has spread across the United States and internationally, the project team has taken an intentional approach to dissemination, seeking to ensure that IPS programs follow evidence-based practices and provide high-quality services that can be sustained for many years. Four key elements of this approach are detailed below.
Following the Evidence
Interest in the IPS model has stemmed largely from the fact that IPS is an evidence-based practice. Since the model was developed in the 1980s, researchers have studied it to assess its effectiveness in a variety of populations and to compare the IPS approach to other vocational models (Drake et al., 2012). Much of this research was made possible through funding from private foundations and federal agencies. This ever-growing research base has led many state and regional leaders to embrace the IPS model as part of the evidence-based practice movement (Drake et al., 2020). An RCT of IPS in six European countries, known as the Enhancing the Quality of Life and Independence of Persons Disabled by Severe Mental Illness through Supported Employment (EQOLISE) trial (Burns et al., 2007), was particularly influential in sparking international uptake of IPS (Bond, Lockett, & van Weeghel, 2020). Researchers associated with the IPS Employment Center actively disseminate evidence about IPS at conferences, including the International Learning Community Annual Meeting (which is celebrating its 17th year in 2023), international conferences, and national and state conferences in the United States, where researchers can engage with state leaders.
Research continues to drive adaptations of and expansions to the IPS model. The IPS Employment Center has had a long-standing interest in serving young adults and tailoring IPS to include supported education (Becker et al., 2015). Researchers associated with the project have published two systematic reviews and meta-analyses of IPS-supported employment programs for young adults with mental health conditions (Bond et al., 2015; Bond et al., 2022); a one-year follow-up study of retention, employment, and educational outcomes for young adults enrolled in IPS services (Bond et al., forthcoming); a study of program and participant characteristics of nine IPS programs that serve young adults (Al-Abdulmunem et al., 2023); a practitioner manual for providing IPS for young adults with mental health conditions (Swanson et al., 2017); an IPS fidelity scale for programs serving young adults (Bond, Swanson, et al., 2019); and findings from semistructured interviews with IPS specialists participating in the exploratory pilot (Ellison et al., 2022). These research products help establish what is already known about IPS for young adults, identify areas in which additional research is needed, and guide the development and implementation of the IPS model for young adults.
The IPS Learning Community brings together an international network of leaders—including IPS trainers, mental health leaders, vocational rehabilitation agency leaders, peer and family leaders, and employers—to disseminate, implement, sustain, and expand IPS programs. The IPS Learning Community was established in 2001 with support from Johnson & Johnson Corporate Contributions, which provided substantial funding for research and dissemination of IPS (Drake et al., 2020). Today, the learning community includes 23 states, the District of Columbia, two U.S. counties, and seven countries or regions outside of the United States (IPS Employment Center, n.d.).
The learning community has two tiers: The IPS Employment Center partners with state and regional leaders to build the infrastructure for implementing and sustaining IPS services at a high level, while those leaders set up and monitor parallel communities within their own states or regions (Bond et al., 2016; Drake et al., 2020). The learning community provides members with a set of support strategies that include training and TA, educational materials and communications (such as newsletters), tools for monitoring implementation and outcomes, and conference calls and annual meetings. Through collaboration across states and regions, the learning community facilitates problem solving around common challenges (Drake et al., 2020). In addition, for more than two decades, the learning community has generated evidence of effectiveness by regularly collecting and reporting data on employment outcomes in participating sites (Bond, Drake, & Becker, 2020).
In 2020, the IPS Employment Center launched the IPS Young Adult Learning Community, a smaller learning community that focuses on IPS for young adults. The COVID 19 pandemic made it difficult for many members to participate fully in the young adult learning community during the first year of the study. Since 2021, the IPS Young Adult Learning Community has facilitated the collection of fidelity and outcome data in participating sites and shared ideas among members of the learning community.
The project works to help IPS sites adhere to the model’s core principles—or implement the model with fidelity—to reliably achieve the benefits of IPS. Research has demonstrated that high-fidelity IPS programs tend to have better client outcomes than low-fidelity programs, where fidelity is measured using a standardized IPS fidelity scale (Bond et al., 2012). A fidelity scale is a tool for measuring the level of implementation of an evidence-based practice. Members of the IPS Learning Community are required to collect fidelity data and to conduct regular fidelity reviews using the IPS Supported Employment Fidelity Scale.
The current version of the IPS fidelity scale, also known as the IPS 25, defines 25 key components of the IPS model (Becker et al., 2019). Fidelity reviewers use the IPS 25 to provide feedback to program leaders, who can then develop strategies to target program components that are not yet fully implemented. The project team recently adapted the IPS 25 for a young adult context. The IPS Fidelity Scale for Young Adults, or IPS Y, is a 35 item scale that includes both an employment component and an education component (Bond et al., 2019)Bond, Swanson, et al., 2019; Swanson et al., 2020). To support the uptake and use of the IPS 25 and the IPS Y, the IPS Employment Center provides manuals and training courses in conducting fidelity reviews using these scales.
Training and Technical Assistance
The IPS Employment Center offers online training courses, in-person training and TA, and toolkits to support the implementation of IPS programs. The project sends trainers around the world to deliver tailored, in-person assistance to state and government officials responsible for employment services in their jurisdiction and occasionally to sites implementing IPS. State and local IPS trainers provide most in-person training to local programs, as discussed below. Much of this training and TA is delivered through the learning community, which provides an organized structure in which trainers can identify and respond to the needs of participating sites. For example, a key lesson to emerge from the Young Adult Learning Community was that IPS teams need additional training related to supported education interventions, which are often incorporated into IPS programs that serve young adults.
Members of the learning community also provide training and TA within their own states or regions. The IPS Employment Center uses a train-the-trainer model to help states, regions, and countries build their own expertise and training infrastructure. Many state trainers, as well as trainers from other countries, have received training from IPS Employment Center national trainers through hands-on training in their local communities and through IPS Employment Center leadership trainings offered four to six times annually. Thousands of IPS specialists have enrolled in an online course for practitioners. Additionally, several countries have established TA centers to provide training, fidelity reviews, and national coordination of IPS programs outside of the United States. (Bond, Lockett, & van Weeghel 2020).
Studies of the IPS Learning Community and related approaches have found that these KT strategies are effective in spreading and sustaining high-quality IPS services. The number of IPS programs in the United States has grown steadily over the last two decades, from 11 in 2002 to 486 in 2020 (Pogue et al., 2022). One study found that between 2016 and 2019 the growth of IPS services was more rapid in U.S. states and counties that participated in the IPS Learning Community than outside of the Learning Community (Pogue et al., 2022). The same study found that states and counties in the Learning Community provided greater implementation support for IPS and accessed more funding sources for IPS than other states. Other research has shown that within the learning community, nearly all IPS programs sustain services for at least 2 years, and the quality of these services improved over time (Bond et al., 2016).
NIDILRR Project Name: Helping Young Adults Succeed at Work and School Through IPS Supported Employment
Parent Organization: Westat (in collaboration with the IPS Employment Center)
Physical Address: Rivermill Commercial Center, 85 Mechanic Street, Lebanon, NH 03766
Key Contact: Gary R. Bond, PhD, email@example.com
- Al-Abdulmunem, M., Bond, G. R., Ressler, D. R., Becker, D. R., Swanson, S. J., & Marbacher, J. (2023). Individual Placement and Support programs for young adults: Where are they and whom do they serve? Early Intervention in Psychiatry. https://onlinelibrary.wiley.com/doi/abs/10.1111/eip.13440
- Becker, D. R., Swanson, S. J., Drake, R. E., & Bond, G. R. (2015). Supported education for persons experiencing a first episode of psychosis. Issue brief. National Association of State Mental Health Program Directors (Technical Assistance Material Developed for SAMHSA/CMHS). https://ipsworks.org/wp-content/uploads/2018/02/15-becker-IssueBrief-SED-6.24.pdf
- Becker, D. R., Swanson, S. J., Reese, S. L., Bond, G. R., & McLeman, B. M. (2019). Supported employment fidelity review manual: A companion guide to the evidence-based IPS Supported Employment Fidelity Scale (4th ed.). The IPS Employment Center at the Rockville Institute, Westat.
- Bond, G. R. (2022). Evidence for the effectiveness of individual placement and support model of supported employment [PowerPoint slides]. IPS Employment Center. https://docs.google.com/presentation/d/1RFqFrzidP_EwUEb_tgZ57LUJGpodbCM-7oQIQDda1P8/edit#slide=id.p1
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- Weld-Blundell, I., Shields, M., Devine, A., Dickinson, H., Kavanagh, A., & Marck, C. (2021). Vocational interventions to improve employment participation of people with psychosocial disability, autism and/or intellectual disability: A systematic review. International Journal of Environmental Research and Public Health, 18(22), 12083. https://doi.org/10.3390/ijerph182212083
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