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Individual Placement and Support-Supported Employment in a Medication Assisted Treatment Setting

Grant to a North Carolina Nonprofit or For-Profit Substance
Abuse Provider to Provide Employment Services to Patients

Agency Type:

State

Funding Source:

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North Carolina Department of Health and Human Services (DHHS) - Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMHDDSAS)

Deadline Date:

12/01/18 5:00 pm

Description:

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Grant to a North Carolina nonprofit or for-profit substance abuse provider to develop an employment and continuing education program for individuals receiving medical treatment for opioid abuse. Funding is intended to assist substance treatment providers in integrating an Individual Placement Support‐Supported Employment (IPS) team into their services.

The purpose of the Invitation to Apply‐Request for Applications (RFA) is for NC DMH/DD/SAS to partner with a Medication Assisted Treatment (MAT) provided by an Opioid Treatment Program (OTP), a Local Management Entity‐ Managed Care Organization (LME‐MCO) and the Division of Vocational Rehabilitation (DVR) to procure an Individual Placement Support‐Supported Employment (IPS) team to provide services to individuals receiving medication assisted treatment in an opioid treatment program.

IPS is a behavioral health service that focuses on engaging individuals with severe and persistent mental illness and co‐occurring substance use disorders in competitive employment and/or continuing their education for the purpose of obtaining competitive employment. Recent research has begun to explore if IPS is effective with other populations, including individuals receiving MAT services. IPS views employment and education as critical tools to support individuals in recovery, and something that should be included at the start of treatment. Employment and education engagement should not depend on whether an individual is deemed ‘ready’ by their treatment team. Instead, when the individual expresses some interest in work or education, IPS should be offered to the individual to explore one’s employment or educational goals.

Background

North Carolina is experiencing an opioid epidemic. In June 2017, NC DHHS and Governor Roy Cooper released North Carolina’s Opioid Action Plan. This plan identified seven focus areas to reduce opioid addiction and overdose death, two of which are the focus of this Invitation to Apply: (1) Expand treatment and recovery‐oriented systems of care, and (2) measure the impact and revise strategies based on results.

A strategy identified under expanding recovery supports focuses on employment, specifically reducing barriers to employment for those with criminal history. DMH/DD/SAS is confident that the implementation and integration of IPS in an OTP is the most efficient and effective practice to support individuals receiving services in finding and maintaining employment. Finding and maintaining employment can have a positive impact on all the Substance Abuse Mental Health Services Administration’s (SAMHSA’s) Eight Dimensions of Wellness. It can link individuals to new peers and community, improve their housing options, and improve treatment participation.

Stanford University completed a twelve‐month randomized clinical trial, where 22 individuals received IPS and treatment as usual (TAU), and 23 individuals were placed on an IPS waitlist while they received TAU. At 6 months, 50% of individuals in the IPS and TAU group were employed, compared to 5% of individuals in the TAU group. At twelve months, 50% of individuals in the IPS and TAU group were employed, compared to 22% of individuals in the TAU group. The study noted that “IPS holds promise as an employment intervention for people with opioid use disorders in methadone maintenance treatment, but larger trials with longer follow‐up are needed.” DMH/DD/SAS has staff that can both train and support implementation and data collection to measure the impact IPS‐SE has on employment rates, treatment retention, and treatment outcomes. This data can then be added to the Metrics for North Carolina’s Opioid Action Plan.

SAMHSA’s TIP 38‐ Integrating Substance Abuse Treatment and Vocational Services indicates that the three best predictors of success in substance use treatment are: gainful employment, adequate family support, and lack of co‐ existing mental illness. It further states that there is a need for integrated, wrap‐around services that include a vocational focus. Federal law requires individuals in OTPs to have access to medical, counseling, vocational, educational, and other assessment and treatment services in addition to medication. Yet many OTPs struggle to offer adequate vocational supports to individuals receiving services. SAMHSA’s TIP 43‐ Medication‐Assisted Treatment for Opioid Addiction in Opioid Treatment Programs cites a study that found between 50‐80% of individuals attending a MAT clinic were unemployed, yet only 5% receive services supporting their employment goals.

Scope of Services/Service Model

IPS is an evidence‐based practice originally developed for adults with severe mental illness/severe and persistent mental illness (SMI/SPMI) and co‐occurring substance use that focuses on supporting and helping individuals find and maintain competitive employment or pursue educational goals that improve their ability to find and maintain competitive employment. It was developed to address the significant barriers adults with SMI/SPMI face when pursuing employment, and to address the staggering unemployment rates this specific population faces (the national unemployment rate for individuals with a mental illness is 80%, in North Carolina, as of 2014, it was 85%.) In comparison, IPS‐SE has been proven to be an effective intervention to begin to address this disparity. Teams in North Carolina that implement with Good to Exemplary fidelity to the model have on average between a 40‐44% employment rate for individuals receiving services.

The eight practice principles of IPS address many of the barriers that individuals with mental illness and substance use face when considering employment, and are as follows:

1. Competitive employment is the goal
2. Zero exclusion
3. Attention to personal preferences
4. Access to benefits counseling
5. Rapid job search
6. Systematic and targeted job development
7. Time unlimited support
8. Integration with behavioral health

The team/agency selected through this Invitation to Apply will be expected to provide services that align with these practice principles, as well as ensure that staff have access to training and resources that support them in working with individuals that have criminal justice records. The team/agency will be expected to adhere to the NC DMH/DD/SAS IPS for AMH/ASU service definition, and to apply to become a vendor with the Division of Vocational Rehabilitation within 90 days of start‐up.

Implementing IPS in an OTP in NC will allow us to measure the efficacy of the service and identify any implementation considerations when merging these two best practices.

GrantWatch ID#:

GrantWatch ID#: 184500

Estimated Total Program Funding:

$380,000

Number of Grants:

NC DMH/DD/SAS anticipates awarding one contract as a result of this Invitation to Apply.

Estimated Size of Grant:

The maximum award will be up to $380,000

Term of Contract:

The grant will be for the period starting the date of the award through June 30, 2019, with the awardee having access to the funds upon the date of the award being made.

Funding is for one year only, and not recurring.

Additional Eligibility Criteria:

The award recipient will be a substance use provider (nonprofit or for-profit) that operates an Opioid Treatment Program (OTP) providing medication assisted treatment, is willing to integrate an IPS team in the OTP and is willing to apply for a DVR contract.

Pre-Application Information:

Applications are only accepted submitted via email as official submissions. They must be received prior to 5:00 p.m., December 1, 2018.

All prospective applicants are ENCOURAGED to submit questions to Brenda T. Smith by 5:00 pm on October 31, 2018 for them to be answered.

Successful applicants will be notified by January 1, 2019.

Contact Information:

Before starting your grant application, please review the funding source's website listed below for updates/changes/addendums/conferences/LOIs.

Direct all inquiries concerning this RFA to:

Brenda T. Smith
Brenda.t.smith@dhhs.nc.gov
Subject: RFA # 30‐IPS‐MAT‐19

Funding or Pin Number:

RFA # 30‐IPS‐MAT‐19

URL for Full Text (RFP):

Geographic Focus:

USA: North Carolina