Staff Time in the Community: An Enduring Critical Component of Individual Placement and Support in the Digital Age.

OBJECTIVE: This study examined the relationship between individual placement and support (IPS) employment specialists' time spent in the community and employment outcomes in the current digital age, featuring increased technology use and online hiring practices. METHODS: The authors examined the relationship between employment outcomes and IPS employment specialists' time spent in the community at 78 sites in 2018 and 84 sites in 2019. RESULTS: The amount of time staff spent in the community was significantly and positively associated with better employment outcomes. CONCLUSIONS: These data support the continued importance of employment specialists' spending time in the community with employers and IPS recipients to achieve optimal outcomes for recipients.

Impact of the COVID-19 Pandemic on a Statewide Individual Placement and Support Employment Initiative.

The COVID-19 pandemic has had an enormous impact on the provision of behavioral health care services across the United States. This column examines this impact within the context of New York State's supported employment initiative, which involved 89 implementation sites before the start of the pandemic. The pandemic caused changes to the training and implementation supports provided, the number of sites providing these services, and the ways in which sites provided supported employment services. Although mean self-assessed implementation fidelity decreased modestly, employment outcomes that dipped early in the pandemic rebounded quickly to prepandemic levels.

Relationship Between Self-Assessed Fidelity and Self-Reported Employment in the Individual Placement and Support Model of Supported Employment.

OBJECTIVE: A growing body of literature demonstrates that high-fidelity implementation of the individual placement and support (IPS) model of supported employment increases the chances of achieving desired outcomes. This study examined the relationship between IPS fidelity, as self-reported by program sites, and employment outcomes and determined whether this relationship was maintained over time. METHODS: A total of 78 outpatient programs in New York State provided data on self-reported IPS fidelity and employment outcomes. Pearson correlations were used to determine the relationship between fidelity scores and competitive employment rates. A mixed-effects model examined the relationship between repeated fidelity and employment measures over time. RESULTS: A significant positive relationship was found between better self-reported IPS fidelity and greater employment. The relationship between IPS fidelity and employment was sustained over time (up to one year). CONCLUSIONS: Higher-fidelity implementation of the IPS model, as self-assessed by program sites, was associated with higher employment rates, which were sustained over time.

Is There a Role for Fidelity Self-Assessment in the Individual Placement and Support Model of Supported Employment?

OBJECTIVE: Fidelity assessments help ensure that evidence-based practices are implemented properly. Although assessments are typically conducted by independent raters, some programs have implemented self-assessments because of resource constraints. Self-assessments were compared with independent assessments of programs implementing individual placement and support supported employment. METHODS: Eleven community-based outpatient programs in New York State completed both self- and independent assessments. Intraclass correlation coefficients and paired t tests were used to compare scores from self- and independent assessments. RESULTS: For both assessment methods, mean scores for all programs were within the range of fair fidelity. Self- and independent assessment total scores were not significantly different; however, significant differences were found on some scale items in this small sample. CONCLUSIONS: Self-assessment may be valid for examining a program's overall functioning and useful when resource constraints prevent independent assessment. Independent assessors may be able to identify nuances, particularly on individual assessment items, that can point to areas for program improvement.

Multifamily Group Psychoeducation in New York State: Implementation and Fidelity Outcomes.

OBJECTIVE: The study examined implementation outcomes from a large state initiative to support dissemination of multifamily group (MFG) psychoeducation in outpatient mental health settings. METHODS: Thirty-one sites participated in the project. Baseline training in the MFG model was followed by monthly expert consultation delivered in either a group (16 sites) or individual format (15 sites). Research staff assessed fidelity to the MFG model by telephone at baseline and 12, 18, and 24 months and documented time to completion of three key milestones: holding a family joining session, a family educational workshop, and an MFG meeting. RESULTS: Intent-to-train analyses found that 12 sites (39%) achieved high fidelity to the MFG model, and 20 (65%) achieved moderate or high fidelity. Mean scores on the Family Psychoeducation Fidelity Assessment Scale increased over time. Twenty-five sites (81%) conducted at least one joining session, and 20 (65%) conducted at least one MFG. Mean±SD time from baseline to the first group was 11.75±4.78 months. Programs that held the first joining session within four to 12 months after training were significantly more likely than programs that did not to conduct a group (p<.05). No significant differences were found by consultation format. CONCLUSIONS: Implementation of moderate- to high-fidelity MFG programs in routine outpatient mental health settings is feasible. Sites that moved very quickly or very slowly in early implementation stages were less likely to be successful in conducting an MFG. More research on the efficiency and effectiveness of consultation formats is needed to guide future implementation efforts.

Use of learning collaboratives by the center for practice innovations to bring IPS to scale in New York State.

This column focuses on use of learning collaboratives by the Center for Practice Innovations to help programs implement the evidence-based individual placement and support model of supported employment in New York State. These learning collaboratives use fidelity and performance indicator data to drive the development of program-specific individualized quality improvement plans. As of 2014, 59 (69%) of 86 eligible programs have joined the initiative. Programs are achieving employment outcomes for consumers on par with national benchmarks, along with improved fidelity.

Public-academic partnerships: a public-academic partnership to support a state mental health authority's strategic planning and policy decisions.

Mental health authorities across the country face numerous challenges in developing effective and practical strategies to adopt and sustain research-supported and stakeholder-endorsed mental health practices. This column describes how an academic center assists a mental health authority in making policy decisions by the use of advisory panels of multiple stakeholders, including members of the research community, advocacy organizations, service providers, and consumers. An advisory panel that focused on services involving family members for adults with serious mental health problems serves as a case example.

Partnering with families: multiple family group psychoeducation for schizophrenia.

Family psychoeducation (FPE) is one of six evidence-based practices endorsed by the Center for Mental Health Services for individuals suffering from chronic mental illnesses. Multiple family group psychoeducation (MFG) has been shown to be an effective component of FPE in reducing symptom relapses and rehospitalizations for individuals with schizophrenia. It is especially effective when family members participate on a consistent basis, which allows them to increase their understanding of the biology of the disorder, learn ways to be supportive, reduce stress in the environment and in their own lives, and develop a broader social network. When used in conjunction with medication, MFG can help an individual with schizophrenia progress towards the rehabilitation phase of recovery. A case illustration describes the engagement of a chronically ill, mid-thirties male in MFG and how his family's participation for 2 years benefits all members, in spite of the longevity of his illness.

Parental influence on sibling caregiving for people with severe mental illness.

Adult siblings of people with serious mental illness are increasingly being called upon to serve as caregivers for their loved ones. The present study investigated 111 adults' reports of their relationships with their afflicted siblings and with their parents in an attempt to explain well siblings' reports of: (1) current caregiving, (2) hypothetical caregiving willingness, and (3) future intention to care for their brother or sister with mental illness. Results of hierarchical multiple regression analyses indicate that perceived sibling need, sibling affection, reciprocity with ill siblings, felt obligation toward parents, and parental requests for help with caregiving are associated with current sibling caregiving. Findings also suggest that adults' beliefs about their ill siblings' need for assistance and their parents' need for assistance are related to future sibling caregiving intentions. The implications of these findings for researchers and mental health professionals are discussed.