Individuals with a mental health or substance abuse diagnosis often struggle to obtain and maintain employment. Florida, like most states, has a high unemployment rate for people with mental illness. State agencies in Florida are working together to address this problem through state and local-level agency partnerships. The Broward Behavioral Health Coalition (BBHC) is working with state and local partners at the Division of Vocational Rehabilitation (VR) under the Department of Education, and the Department of Children and Families (DCF) Substance Abuse and Mental Health (SAMH) office. DCF contracts for behavioral health services through regional systems of care called managing entities (MEs). MEs do not provide direct services. Instead, they allow the department’s funding to be tailored to the specific behavioral health needs in the various regions of the state. BBHC is the state-contracted ME for services in Broward County, the second-most populous county in Florida, and manages appropriated funding, contracting with 31 network providers. As a nonprofit organization, BBHC is committed to the development of a recovery-focused, integrated, and comprehensive behavioral health system of care for providing treatment and support services to individuals with mental health challenges and their families. To carry out this commitment, BBHC blends state, federal, and grant funds to implement evidence-based practices that address the various needs of people recovering from the effects of mental health and substance use challenges. BBHC started to implement the individual placement and support (IPS) model through the combination of state funding and a system of care grant for transition-age youth from the Substance Abuse and Mental Health Services Administration. BBHC chose the IPS model because it focuses on employment as a means of treatment, recovery, and reintegration into the wider community. Extensive international research on IPS also supports the effectiveness of this model. At sites where it is implemented with fidelity, the employment rate for people served ranges from 53% to 79%. Thus, IPS is a model with a strong evidence base.

Other benefits of implementing the IPS model are:

  • If a person is receiving IPS services, a VR counselor and employment specialist participate regularly on the person’s clinical team. The result is seamless collaboration between VR and SAMH and a shared understanding that employment is an important part of successful treatment and recovery.
  • The model supports people to become employed, and then to receive training on the job as long as they need it. This is in contrast to more traditional employment services which focus just on providing training and other services to prepare individuals for employment.
  • If a person wants to work, the treatment team works with them to create a career profile coordinated with the individualized plan for employment they have through VR. The goal is achieving employment no matter what.
  • The model takes a recovery-focused approach through psychiatric rehabilitation, motivational interviewing, and harm reduction approaches. Services and supports are not time limited.
  • The job search is focused on finding competitive employment and is based on the person’s preferences and environments where they would be a good fit.
  • The job search and job development processes are conducted quickly, using the 30-day rapid job search model. The person can receive supports for job placement, follow-along, supported education, and career changes. The job seeker also receives personal counseling about benefits and potential earnings to increase economic empowerment.
Lessons learned: Since BBHC introduced IPS in 2015, three local providers now use it. While IPS has only been used for a few years in Broward County, outcomes are positive.
  • In one year, FootPrint Clubhouse went from serving 0 to 80 people with primary mental health and co-occurring substance use challenges in employment services.
  • The Susan B. Anthony Recovery Center went from serving 35 people with substance use challenges only to serving 69 people with both mental health and substance use challenges in employment services.
  • A third more recent provider is working to secure funding for an additional staff person dedicated to employment.
  • All three providers now have a contract with VR. VR and BBHC are continuing to work together to align VR’s operating policies with the IPS approach across the state.
Emery Cowan at BBHC says that the success of the IPS model is being driven at the local level through education. For example, the area VR office is working with a psychiatrist who supports the IPS model to create a letter to VR vendors that explains to mental health practitioners in their own terms why IPS benefits people with mental health challenges. Ms. Cowan also shared that explaining the nuts and bolts of the process to stakeholders makes all the difference to people’s acceptance of the model. For example, some providers offer peer support in conjunction with IPS, mentoring people served and their families and modeling successful employment retention. This helps to reduce work stress and fears of losing benefits. Once stakeholders know about the employment team, the effect of employment on benefits and employment earnings, the support they will have on the job, and the employment outcomes people achieve, they are more encouraged to pursue employment. Ms. Cowan cites the importance of counselors who are knowledgeable about benefits planning, one of the major concerns keeping people from wanting to work. The use of the IPS model has also had a significant positive effect on employment staff, who previously worked without much job development training. Employment staff contracted through BBHC have shared that they are much happier using IPS because it includes a number of tools such as career profiles, job development logs, job start/stop sheets, follow-along plans, and educational tools about mental health and substance use. For more information on the Broward Behavioral Health Coalition, contact: Emery Cowan, LMHC, LPC, CESP Director of Clinical Services, Project Director: OCP2