Integrating the Individual Placement and Support Model of Supported Employment for Transition-Age Youth in the Texas Community Mental Health System

Background and Purpose: The purpose of this paper is to assess the feasibility of implementing an adapted transition-age youth version of the Individual Placement and Support (IPS) model of Supported Employment in the Texas community mental health system.  IPS is found to increase competitive employment among adults diagnosed with serious mental health conditions and stipulates that vocational support and mental health treatment be integrated (Bond & Drake, 2012).  IPS has implications for older youth being served in child systems of care as vocational support and mental health treatment are often separately delivered.  Also, compared to adults, transition-age youth (ages 18-25) with serious mental health conditions have low rates of adult community mental health treatment engagement (SAMHSA, 2014) and do not appear to benefit from supported employment as strongly as middle-aged and older adults do (Burke-Miller et al., 2012).  Adapting IPS to meet the unique developmental needs of transition-age youth holds promise for increasing treatment engagement as well as positively impacting transition-age youth mental health and vocational development.

Sponsored by the State Department of Health Services, funded by SAMHSA, and supported by the UT-Austin Institute for Excellence in Mental Health, the Transition-Age Youth Service Transformation Project is in the process of piloting a previously adapted version of IPS with 18-21 year olds in Illinois (Ellison et al., 2015; Klodnick et al., 2015) for 14-29 year olds.  IPS adaptations include the integration of supported education and peer support.  Research questions include: (1) what challenges do providers face in engaging transition-age youth; (2) how did providers plan to implement the adapted IPS model in their context; (3) what made the implementation process successful; and (4) what barriers did providers experience during implementation?

Methods:  The sample includes seven providers (5 child system; 2 adult system).   Data analyzed for this paper included: a) provider recruitment meeting notes, b) videos and notes from a 3-day provider orientation to best-practice in transition-age youth engagement, IPS, Supported Education, and peer support, c) logic model and implementation time lines constructed by providers at the 3-day training; and d) and monthly peer learning collaborative meeting notes.  Data was reviewed by the research team using open-coding and thematic analysis.

Results: Identified barriers to engaging youth in services include: transportation issues, aging out policies that prevent treatment continuity, and a lack of employer connections.  Adapted-IPS implementation barriers include: challenges in marketing IPS to youth, families, and colleagues; securing agency administration support for service integration; engaging families in consenting for and supporting transition-age youth engagement in adapted-IPS services, and securing funding for supported education and peer support IPS add-ons.  Adult provider sites that had pre-existing IPS teams were more efficient with integrating adapted-model elements while child system providers needed increased training and support to implement IPS and the IPS adaptations simultaneously. 

Conclusions and Implications:  The ways in which the different providers uniquely integrated the adapted-IPS model are novel and provide a framework for how providers can successfully navigate barriers to integrating transition-age youth vocational services into their pre-existing clinical services.