ICAP SHIPS IPSParticipationMeasure_SHIPS V2

SHIPS
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IPS Participation Measure
Record ID.

What is the interview period?

Data Entry Date

SHIPS Study ID

Interview Date

__________________________________

__________________________________

__________________________________

__________________________________

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Participation in IPS. The enrollee's IPS employment specialist will complete this measure
monthly.
Did the IPS specialist have a face-to-face contact
with the participant?

Yes
No

Did the IPS specialist help the participant to start a
job this month?

Yes
No

Did the IPS specialist help the participant to
maintain a job?

Yes
No

Did the IPS specialist help the participant to end a
job appropriately this month?

Yes
No

Has the participant been competitively employed for at
least 1 day in the past 30 days?

Yes
No
Unknown

Has the participant had any contact with the team (IPS
specialist, case manager, clinician, Team Leader),
including by text, phone, or in person, in the past 30
days?

Yes
No

What is the main reason that there has been no contact
with the participant?

missing/inaccurate contact info
no response to outreach
other

Please briefly describe the main reason that the
enrollee has not had any contact with the IPS team.

In the past 30 days, has the participant participated
in any IPS job development activities?

05/01/2024 12:10pm

__________________________________________
Yes
No

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In which of the following job development activities
has the enrollee participated?

What is the main reason that the enrollee has not
participated in any IPS job development activities?

Please briefly describe the main reason that the
enrollee has not participated in any IPS job
development activities.

05/01/2024 12:10pm

Job shadowing
Mock interviews(s)
Applying for job(s)
Face-to-face follow-up with employer re: job
application status
Job interviews(s)
Informational Interviews(s)
none of the above
(multiple selections possible)
Lack of interest/ambivalence
New enrollee (past 30 days)
Difficult to reach
Physical co-morbidities
Competitively employed
Other

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