Frequently Asked Questions
The Workforce Innovation and Opportunities Act (federal law, Section 7(38) of the Rehabilitation Act) uses the term “supported employment” to describe the types of services, including customized employment, provided to individuals with the most significant disabilities to obtain, maintain, and advance in employment. This often includes strategies such as career exploration, job search, customizing job duties or work schedules, and designing coping mechanisms to reduce stress and anxiety as the individual transitions into the work environment.
Individual Placement and Supports (IPS) is a highly successful, evidenced-based model of supported employment that promotes a “recovery through work” philosophy whereby individuals with severe and persistent mental illness and co-occurring disabilities achieve competitive, integrated employment when assisted with ongoing support services. IPS is the most researched and best described model of supported employment. The effectiveness of IPS teams and their integration into host agencies can be assessed by a scientifically validated 25-item fidelity scale. The core principles of IPS include: A focus on competitive employment, rapid job search, eligibility based on client choice, attention to client’s preferences in employment services and supports, the integration of employment and clinical services, time-unlimited support, and systematic job and employer relationship development.
An individual’s potential for supported employment must be considered as part of the assessment to determine eligibility for the Title I Vocational Rehabilitation (VR) State Grants program. A State VR agency may support an individual’s supported employment services solely with VR State Grant funds or it may use in whole or part funds under the SE State Grants program. Most states use braided funding from two or three sources to fund IPS. These sources may include state VR funds, Medicaid, or state set aside funds.
In 2009, twelve IPS practitioners were selected to participate in a project to learn how to assist individuals with a criminal background and a mental health condition to gain competitive employment. They conducted 128 surveys with diverse types of employers within eight states and found that 63% of employers had knowingly hired at least one person with a felony. The most common reasons these employers reported that they hired these individuals is the person was qualified to do the job, presented well in their interview, someone in the job seeker’s network knew the employer, and the employer believed the person had changed their life. Employers advised that job seekers be honest and up front about their past, take responsibility for their actions, explain how they’ve changed their lives, and speak directly to a hiring manager or decision maker at the business when applying. Employers also recommended that the employment specialist think about the type of crime the person committed when helping the person identify a job goal. For example, a person with a record for theft is less likely to be hired as a cashier. You can find more information about this project at (list where on the site the report is posted).
How can we help clients develop work preferences that match individual interests, skills and abilities in a rural community where there is one large employer that pays well?
Learn about as many employers in your area as possible so that you can educate job seekers about the full range of positions available. Emphasize that the goal is to find a good job fit that contributes to the person’s overall wellness and recovery, rather than just any job that could be short lived or may exacerbate symptoms. Within a multi-state learning collaborative, programs in rural communities were as successful as those in urban areas. One employment specialist in a very rural area was extremely successful because she visited every employer in her county, whether they had one or 20 employees.
Can we serve individuals with other types of disabilities or do people need to have a mental health condition? How does the service differ for other disability groups?
With the recent federal landmark legislation to improve our nation’s public workforce system through the Workforce Innovation and Opportunities Act (WIOA), many IPS programs are beginning to serve a diverse population of individuals including those with intellectual disabilities, physical disabilities, transition aged youth, young adults, Social Security and TANF recipients. IPS has been widely researched with people with severe mental illness and the results have been consistently strong and positive. While a small number of studies for people with other conditions have occurred that have also yielded favorable results, additional research is underway. The IPS practice principles align with common sense approaches to serving a wide range of individuals, and we hope to provide a strong evidence base to prove its effectiveness as various projects unfold over the next few years.
What is the eligibility criteria for IPS? Can people with mild depression, anxiety or drug dependence be accepted? Do you need to have a severe and persistent mental illness?
IPS has been widely researched with people with severe mental illness, with consistently strong and positive results. There are a small number of studies for people with other conditions with excellent results for Post Traumatic Stress Disorder and good results for spinal cord injury and young adults experiencing early psychosis. There are projects under way to extend IPS to people with milder psychiatric disorders and other populations, but we do not have findings yet.
If your IPS program also includes people who have severe mental illness, take precautions that those people are not underserved. Ensure that mental health practitioners encourage all people to consider employment and share hopeful messages about each person’s ability to succeed in the workplace.
We do not know of research that is specific to the role of peers in IPS. Many IPS supervisors do hire peers, though their roles vary from program to program. In some programs, the peers provide supports in addition to the work done by the employment specialist. They might encourage someone to work in spite of different barriers, or they might provide additional job supports. In other areas, IPS supervisors hire employment specialists who happen to have a lived experience of mental illness and are willing to share how they have overcome difficulties and benefited from work with the people they serve. These supervisors look for people who are qualified to do the job of an employment specialist, and they view lived experience as an added qualification.
For people who want to attend a confidence-building or crafting course but have a different job preference or no interest at all in working, can the IPS model be applied?
If a person wanted to go to school for personal enrichment, such as taking a craft course or confidence building course, we would encourage the case manager or therapist to provide support. Because IPS is almost always a limited resource, we encourage IPS supported employment programs to reserve space in the program for people who have competitive employment goals. If someone wanted to get a degree in Human Resources so that they could eventually work in that field, then the IPS supported employment program could provide education supports. Another example might be a person who wanted to take a QuickBooks class in order to get a job as a bookkeeper.
Employment specialists and mental health practitioners should talk together about the situation. When there are concerns about safety for clients or community members, supervisors and psychiatrists should be included in those conversations. One example might be someone with a drinking problem who wanted to be a bartender. In that situation you might explain that you could not help the person with bartending jobs because it could be detrimental to his health. If a person who was sober wanted to wait tables in a restaurant that served alcohol (because the tips would be higher) you might talk with him about the possible risks of working around alcohol, but help him anyhow if that is what he wanted to do. In that case, the mental health treatment team might also provide extra supports to help him maintain sobriety.
In some areas, IPS supported employment trainers are available to conduct supported employment fidelity reviews. If you do not live in an area that is part of the IPS Learning Collaborative (Colorado, Connecticut, Illinois, Kansas, Kentucky, Maryland, Minnesota, Missouri, North Carolina, Ohio, Oregon, South Carolina, Vermont, Wisconsin, District of Columbia, Alameda County in California, Italy, the Netherlands and Catalonia in Spain) then it is possible that a state fidelity reviewer is not available. In that case, your agency can still benefit by using the fidelity scale. On this website you can find Supported Employment Fidelity Kits (see Resources) that include the fidelity scale, fidelity manual, demonstration videos and sample fidelity reports. Two to three people from the agency who are not closely connected to the IPS program (for example, people who work in the quality assurance department) might spend time becoming familiar with the fidelity materials and then conduct a review for the agency.
Yes, the supported employment fidelity scale was updated in 2008 and is available on this website—see Information for Programs.
Forming a unit of at least two employment specialists provides the organizational structure for sharing information and resources. A single employment specialist at an agency has no one to help him learn skills such as employer relationship building.
Some agencies report that it is not possible to hire more than one employment specialist because the mental health program is very small. But, as mental health practitioners begin to value employment, and clients spread the word about their jobs, it is not uncommon to find that 50-70% of adults served by the mental health program are interested in getting a job. Some programs may start with one specialist and add positions over time.
Job supports vary based upon each worker’s preferences and needs. Generally, employment specialists are encouraged to provide intensive supports, including in-person contact, on a weekly basis for at least the first month of employment. Examples of supports are wake-up phone calls, meetings with employers to obtain extra feedback, help learning how to take the bus to work, family meetings to talk about the job, meetings with the worker to talk about how the job is going, on-the-job coaching to learn new duties, etc. Over time, most clients want and require fewer supports, and eventually transition off the IPS caseload. On average clients remain in the IPS program for about a year.
How can we match client preferences with employers in small, rural settings with fewer employers and resources?
We encourage employment specialists to visit and build relationships with as many employers in their area as possible to learn about the different types of opportunities available. Programs in rural communities have been as successful as those in urban areas. Getting to know each job seeker’s personality, strengths, interests and support systems is critical. Family members and other natural supports are key contributors to the process because they’ve often known the person longer than anyone else and they have their own network that can help you gain access to more employers.
With stigma being a concern, should we openly state we work for a mental health agency or should we be more general and say we work for a career center or nonprofit instead?
We believe it is best to be honest with employers from the start. As you strive to build long-term relationships with employers, you must treat those employers as your customers. Further, if you attempt to hide the fact that you work in mental health, employers may eventually find out that you work for a mental health center so you really cannot guarantee to your clients that this information will remain private.
Our suggestion is to explain to employers (without hesitation) that you work with people who have had mental health problems but have the treatment and support they need to work. You could also give some examples, “It is difficult to describe the people I work with because each person has different interests and skills. For example, one person I am working with is a bookkeeper, another is a dishwasher, and another is an aide at a childcare center. Each of these people is performing his job as well as his co-workers.”
Using data from a 13-state learning collaborative that included 8 years of program data, we determined that an IPS program with 31% employment could be considered to be meeting the minimal standard, a program with 41% employment would have achieved average performance, and a program with 50% employment would have demonstrated excellent performance. The mean average across the 8 years was 47% employment.
Wouldn’t it be better to have someone on the team who does job placement, rather than to ask each employment specialist to do job development?
In IPS programs, each employment specialist provides the full-range of employment services to the people on his or her caseload. This helps in several ways. The job seeker is able to establish a relationship with one worker who helps him throughout the return to work. In research trials, when people were asked to work with one person for job development and another for job supports, clients often dropped out of employment services when they were asked to switch to a new worker. In addition, the employment specialist and worker learn together as the person tries employment. For example, they may discover that the person is most successful when the supervisor is promoted to give frequent feedback. If the client is switching back and forth between workers as she tries different jobs, those lessons could be lost. Finally, it helps to have one employment specialist so that the person returning to work does not hear conflicting messages from different people.
Most employment specialists are able to become effective job developers by practicing over time with a coach, such as a supervisor or colleague who accompanies them as they meet with employers. Information about job development skills can be found in “IPS Supported Employment: A Practical Guide.” Information about ordering this guide is available on this website under Resources.
IPS supported employment does not use skill assessments or vocational evaluations because these have not been demonstrated to predict employment for people with severe mental illnesses. Further, testing and other assessments can be discouraging to people who want to work right away.
Instead, employment specialists attempt to help people make good job matches by learning as much as possible about each individual. The employment specialist talks to the person’s mental health workers, and with permission, family members. The specialist also has a series of conversations with the job seeker about his work history (jobs he liked, strategies that worked, etc.), his job preferences, work skills, interests, current symptoms and coping strategies, etc.
Employment specialists also talk to employers about the types of jobs that they have available, job requirements, and hiring preferences. The information about local jobs is invaluable as the specialist can combine this with client preferences to suggest jobs to the job seeker.
If a person has not had much work experience, or is not sure what he would like to do, the employment specialist might take him out to look at different worksites and observe people working for an hour or so. They might also prepare some questions to ask the manager, such as “What qualities make a person a good assembler?”
Of course, not every job works out, but this is also true for workers without disabilities. If a job doesn’t go well, the employment specialist, client, Vocational Rehabilitation counselor, mental health practitioners, and with permission, family members, talk about the things that went well, as well as those things that did not go well. Practitioners look for lessons learned and help the person develop a new job plan. They offer to help with a new job search without delay.
Employment specialists learn about each employer’s needs before introducing a job seeker, and this helps to ensure a good job match. Further, specialists stay in close contact with employers after their clients start work. If someone does not work out, employers are often willing to collaborate with the specialist again because they feel that the employment specialist was there to provide support for the duration of the job. Also, employers have hired many people who did not work out in the past, so they understand that it is not always possible to predict who will be a good match for a job.
Since many employers require drug testing, how do you help people with substance use disorders find jobs?
Let your client know that an employer may screen for drug use. If the person is not offered employment because of the drug test, then the person has more information about how drugs are affecting his goals. Some people will decide to cut down on substance use while looking for work, and others may decide to look into treatment options. Still others will decide to try to find employers who do not require drug tests for employment.
How do we work with an individual who repeatedly does not show up or will not engage with us? How much time should we spend trying to reach out to him?
Rather than focusing on the length of time spent on providing outreach, focus on learning the reason that the person is not engaged. If you find out that the person has changed his mind about employment, then go ahead and close the person’s case. If the person has encountered other obstacles, such as trouble remembering the appointments or conflicting family commitments, talk with the mental health team to devise strategies to support the person’s involvement in IPS. Remember that many people miss appointments because they do not feel hopeful about finding a job that they would like. Explain how others have become workers in spite of multiple barriers to employment and ask mental health practitioners to point out the person’s strengths related to working.
We recommend that you avoid internships and focus on regular jobs instead. IPS focuses on a rapid job search. Rather than asking people to adjust to different work environments and supervisors before getting the job of their choice, IPS programs offer to help people directly with competitive employment. Helping people to prepare for the workforce in a stepwise approach is not effective. Research demonstrates that people are most likely to be successful at work if they are not asked to engage in short-term job tryouts or sheltered employment. Perhaps this is because people have higher levels of motivation to succeed in regular jobs or because when we help people find competitive work we are demonstrating our confidence in their skills.
What are some ways that we can increase our time spent in the community to meet the fidelity standard of 65% or more?
Explain the rationale for spending time in the community. Time in the community is correlated with better client outcomes. Also, people are more likely to stay engaged in the program if they do not have to come to the office for appointments. And employment specialists learn more about their clients’ preferences by meeting them in the community, visiting different workplaces, and seeing them at home. You could point out that people are more likely to find jobs if employment specialists are out in the community talking to employers, helping their clients apply for jobs, and helping their clients follow up on job applications in person.
An effective strategy is for supervisors to model spending time in the community by going with staff to meet with employers, to meet with clients, etc. Working side-by-side will show specialists how to work in different locations and will also demonstrate that you think community-based services are important.
During individual supervision, review schedules with the employment specialists who are spending the most time in the office. Ask, “What are you scheduled to do tomorrow? And where are you meeting Tim? Why are you meeting him in the office instead of taking him out to look at jobs?…”
A list of questions, along with other information about how to build employer relationships is in the practitioner manual, IPS Supported Employment: A Practical Guide (see our Resource page if you do not own a manual). Another resource is videos of employer meetings. To find those videos, go to Information for Programs.
We encourage employment specialists to prepare for meetings with employers by learning a little bit about the company and selecting questions to start the conversation with an employer. Be sure to avoid asking about job openings or talking at length about your program. The purpose of this conversation is to learn more about the employer. Instead, focus on understanding the type of job applicant the employer would like to meet. Sample questions might be, “What type of person tends to be successful here?” “When you are interviewing candidates, how do you know if someone is a good fit for your business?” “What positions do you have that I might not know about?” “What do people enjoy about the ___ position?” “What have been challenges for people in the ___ position?” “What is a typical day like for a worker in the ___ position?” Employment specialists can return a day or two later to say, “I have had time to consider your need for workers who have good customer service skills and who are available to work on Sundays. I think I do know someone who matches that description. Would you like to hear a little bit about her?”
Many employment specialists use time at the beginning or end of the day to return emails, document their services, and make phone calls. They report that they block out time in their schedules for job development—usually four to six hours total during the week. Employment specialists attend a vocational unit meeting each week, as well as one to two mental health team meetings. And they spend about two-thirds of their time in the community meeting with clients and employers. Below is the schedule for an employment specialist for one day.
8:30 – 9:10 / Office / Emails and phone calls
9:30 – Client home / Met with client to talk about his job
10:45 / Cafe / Met a new client at a local cafe
Noon / Lunch
1:00 / Office / Mental health treatment team meeting
2:30 / Businesses / Job development
4:00 / Business / Took bus tickets to client at her workplace
4:15 – 5:00 / Office / Document services and return messages.
Competitive jobs are those that any person can apply for regardless of disability status. Workers earn minimum wage or higher (or their wages are commensurate with co-workers who have similar training and experience). Seasonal jobs may be considered competitive, but jobs that are designed to be short term as a way to ease someone back into the working world are not competitive. Likewise, jobs that have limited duration because they are designed to be assessments or to teach good work skills are not competitive. The number of hours worked each week does not affect whether a job is competitive, for example, a job working two hours a week could be competitive. Peer specialist positions are competitive because only a person with a lived experience of mental illness is qualified for those positions. Self-employment is considered to be competitive employment.
How can we diversify the types of employers clients want to work for, especially in a rural community?
The first step is to support and assist individuals with identifying specific work preferences. Use motivational interviewing to open up dialogue about hopes, dreams, wants and needs to guide the job search towards specific industries and positions. Get out together in the community to visit employers to assess the environment, job tasks and cultural aspects of businesses. Next, build good relationships with as many employers as possible within your community. Utilize local chambers of commerce, business alliances, rotary clubs and other networking groups to maximize knowledge about and access to a wide range of employers. In small towns, relationships are everything and information is often shared by word of mouth, so involvement in community events can be helpful as well.
How can employment specialists keep up with all of their duties when one of their clients needs intensive job coaching (20 or more hours per week) because of a co-occurring cognitive disorder?
Some programs in this situation have contracted with people to provide job coaching when it looks like a client might need those services for more than a week or two. For example, they would contract for someone to provide a short-term service (coaching). You might find a retired teacher or other person who is interested in working periodically. The employment specialist should work closely with the coach and continue to make some visits to the worksite to talk to the employer and ensure that the coaching is effective. Another solution is for other employment specialists on the team to help out with coaching.
Can we offer a job support club or job finding group and still meet fidelity standards for individualized services?
We would not recommend groups because each person likely has different job search skills to learn. One person may need help completing a job application that he can copy when applying for jobs. Another may need help describing his justice system involvement and efforts to move his life forward. Further, people learn best by working alongside of an employment specialist rather than talking about how to do things. Rather than discussing how to complete job applications, an employment specialist and job seeker would work on job applications together until the job seeker knew how to do that on his own.