by Paul Margolies, Ph.D.

Columbia University and New York State Psychiatric Institute

Individual Placement and Support (IPS)

Individual Placement and Support (IPS) is the gold-standard evidence-based practice helping people diagnosed with serious mental illness find and keep personally meaningful jobs (https://ipsworks.org). Developed over three decades ago and increasingly in use today throughout the United States and indeed around the world, IPS has a very strong research base and impressive success in real-world settings.  Over 30 research studies have supported its efficacy and data collected through the IPS Employment Center, looking at hundreds of sites across the country, consistently shows its effectiveness with between 40% and 50% of those receiving IPS services working.  This is an amazing finding.  So many people’s recovery journeys have been enhanced with meaningful employment due to IPS.

There was a time when mental health professionals and others believed that people diagnosed with serious mental illness couldn’t work because of their symptoms, or didn’t want to work, or that work would be too stressful and lead to increased symptoms and even the need for hospitalization.  Some believed that by working, people would jeopardize their benefits.  Many of these myths persist today.  Experience with IPS has demonstrated, beyond any doubt, that this simply isn’t true.  Every day, people with schizophrenia, bipolar disorder, co-occurring mental health and substance use problems, and other diagnoses are working productively and experiencing success and satisfaction through their efforts.

New York State’s Experience

In New York State (NYS), the Center for Practice Innovations (CPI) (https://practiceinnovations.org) has been working with behavioral healthcare agencies to support their implementation of IPS since 2009.  From the beginning, we viewed training employment staff members as important, but far from all that was needed.  We recognized the need to go beyond training by guiding supervisors and managers with the implementation of IPS at their sites and working with large numbers of agencies and state mental health officials to disseminate IPS across NYS.  Training, implementation, and dissemination are the initiative’s three components.

We began with a handful of community psychosocial rehabilitation programs, which in NYS are called Personalized Recovery-Oriented Services (PROS).  Over time, we expanded to include all PROS programs across the state, many outpatient clinics run by our state hospitals, first episode psychosis programs which in NYS are called OnTrackNY, and most recently added Assertive Community Treatment (ACT) teams as well as other psychosocial rehabilitation sites.  This year, we will be adding Certified Community Behavioral Health Clinics (CCBHCs).  By the end of 2026, we will likely be supporting the efforts of over 300 sites.

How Do We Do This?

There is a growing field known as implementation science that provides empirically derived guidance concerning how to make innovation happen in the real world.  We use specific strategies to guide our efforts, including the use of a fidelity scale, data that tells us about employment staff’s activities and employment outcomes, important tasks for agency leaders, managers and supervisors, and many other considerations.

One important focus is on continuous quality improvement (CQI).  Sites use their data to identify areas of implementation strength and opportunities for improvement, and work with us to develop CQI plans that are designed to improve their efforts and ultimately their employment outcomes.

Participating sites are involved in many training and support activities, all organized within learning collaboratives.  Learning collaboratives bring sites together so that they can share and learn from each other in addition to learning from IPS and implementation experts.  Sites are tremendously generous and helpful to one another, and we strongly encourage the sharing of experiences, strategies, and ideas.  This really makes a difference.

We provide the sites with online learning modules that can be accessed 24/7, webinars focusing on a variety of training and implementation issues, a guide book called the Employment Resource Book, implementation guides, site-specific zoom meetings, site-specific in-person visits, regional in-person sharing sessions, special interest group meetings (focusing on issues such as implementing IPS in rural settings), and consultation at any time requested.  We even provide a short video designed to help people consider employment (https://player.vimeo.com/video/149332459). We tailor what we offer to the needs of sites, so that different sites participate in different activities depending upon their needs. It’s a lot! And it makes a difference.

What About Outcomes?

In 2024, state facility clinics and PROS programs reported a one-month mean employment rate of 51.3% for those receiving IPS and a three-month mean employment rate of 50.1%.

In 2025 (January – November), the results were similar:  a one-month mean employment rate of 50.9% for those receiving IPS and a mean reported three-month employment rate of 50.0%.

Within OnTrackNY first episode psychosis programs, within six months after admission, two-thirds of individuals are working or in school.

In Summary

CPI has been providing IPS training and implementation support to increasing numbers of behavioral healthcare sites across NYS for over 15 years.  IPS works, as evidenced by the numbers of people each month whose recovery experiences include employment.

References – IPS in NYS

1. Margolies PJ, Patel SR, Covell NH, Broadway-Wilson K, Gregory R, Jewell TC, Scannevin G, Dixon LB. Successful Implementation Isn’t Enough: One Intermediary Organization’s Focus on Sustainment.  Global Implementation Research and Applications. 2023; published online December 2023.
2.  Margolies PJ, Chiang IC, Covell NH, Jewell TC, Broadway-Wilson K, Gregory R, Scannevin G, Dixon LB. Staff Time in the Community: An Enduring Critical Component of Individual Placement and Support in the Digital Age.  Psychiatric Services. 2023; 74: 197-20.
3. Margolies PJ, Chiang IC, Jewell T, Broadway-Wilson K, Gregory R, Scannevin G, Dixon LB. Impact of the COVID-19 Pandemic on a Statewide Individual Placement and Support (IPS) Employment Initiative.  Psychiatric Services. 2022; 73: 705-708.
4. Margolies PJ, Covell NH, Patel SR. Applying Implementation Drivers to Scale-up Evidence-Based Practices in New York State. Global Implementation Research and Applications. 2021 1: 53-64.
5. Margolies PJ, Broadway-Wilson K, Gregory R, Jewell TC, Scannevin G, Myers RW, Fernandez HA, Ruderman D, McNabb L, Chiang I, Marino L, Dixon LB.  Use of learning collaboratives by the Center for Practice Innovations to bring IPS to scale in New York State.  Psychiatric Services.  2015; 66: 4-6.