Correction: A 10-year Multisite Evaluation of an Individual Placement and Support (IPS) Employment Program Based in an Australian Community Mental Health Service.

Objective Although Australia's service and policy context differs from that of the US, studies have highlighted potential for individual placement and support (IPS) to support competitive employment outcomes for people with severe and persistent mental illness. The aim of the present study was to explore why the model is not yet widely available. Methods A document analysis was conducted to discern reasons for challenges in implementation of IPS practice principles within the Australian service context. Results The document analysis illustrated that although policy acknowledges the importance of increasing employment rates for people with severe and persistent mental illness, consistent measures, change indicators, direction and time frames are lacking in policy and strategy documentation. Further, IPS principles are not consistently evident in guiding operational documentation that government-funded Disability Employment Services (DES) programs are mandated to adhere to. Conclusions For IPS to be readily implemented, it is necessary for government to offer support to agencies to partner and formal endorsement of the model as a preferred approach in tendering processes. Obligations and processes must be reviewed to ensure that model fidelity is achievable within the Australian Commonwealth policy and service context for programs to achieve competitive employment rates comparable to the most successful international programs. What is known about the topic? The IPS model has been established as the most efficacious approach to support people with severe and persistent mental ill health to gain and sustain employment internationally, yet little is known as to why this model has had very limited uptake in the Australian adult mental health service and policy context. What does this paper add? This paper provides an investigation into the achievability of IPS within DES philosophical and contractual arrangements. What are the implications for practitioners? Mental health practitioners are typically skilled in their understanding of individual or micro-level challenges faced by consumers in achieving vocational goals: working with symptoms, medication side effects, motivation and anxiety. The present study was designed to offer practitioners an increased understanding of service-level factors, because these present considerable challenges to achieving sustained employment. This paper is a call for greater advocacy towards better integration of employment and mental health service delivery in the Australian policy and practice context.

Individual Placement and Support (IPS) is a well-established evidence-based model of supported employment (Drake & Bond, 2023). This study aimed to examine program engagement and employment outcomes achieved in an IPS program based in an Australian community mental health service and identify differential employment patterns and opportunities for service development.IPS programs were in place at 9 community mental health service locations (4 rural/5 urban), with a governance model supporting program actualisation and monitoring. A multi-component evaluation comprising service-level data included: (i) routine monitoring of client-level characteristics, referral processes, caseload, and employment outcomes; (ii) quarterly reporting of referral patterns and targets.There were 1167 referrals during the 10-year evaluation period; the majority, 58% were male, the mean age was 33.9 years, and psychotic disorders were frequently reported (45.7%). Program engagement was substantial (mean = 1.5 years). Over a third, 36.3% obtained employment; retained for lengthy periods (mean = 45.5 weeks), 70.4% for 13 weeks or more (31.4% exiting as independent workers). Similar outcomes were attained regardless of age, gender, or diagnosis. Logistic regression analyses revealed the strongest predictor of employment (AOR = 3.20; p < 0.001) or vocational outcome (AOR = 2.20; p < 0.001) was associated with rural MHS-locations with fewer (1-3) employment consultants.Positive employment outcomes were demonstrated irrespective of diagnosis. Longitudinal outcomes suggest an increased likelihood of obtaining employment in rural locations and in programs with fewer employment consultants, providing insight into factors that may support IPS implementation in real-world settings.

Sustaining Individual Placement and Support (IPS) services: the IPS Learning Community.

Introduction We aimed to identify the barriers and facilitators to the implementation of a high fidelity individual placement and support service in a community forensic mental health setting. Method In-depth interviews were conducted with clinical staff ( n = 11), patients ( n = 3), and employers ( n = 5) to examine barriers and facilitators to implementation of a high fidelity individual placement and support service. Data was analysed using thematic analysis, and themes were mapped onto individual placement and support fidelity criteria. Results Barriers cited included competing interests between employment support and psychological therapies, perceptions of patients’ readiness for work, and concerns about the impact of returning to work on welfare benefits. Facilitators of implementation included clear communication of the benefits of individual placement and support, inter-disciplinary collaboration, and positive attitudes towards the support offered by the individual placement and support programme among stakeholders. Offences, rather than mental health history, were seen as a key issue from employers’ perspectives. Employers regarded disclosure of offending or mental health history as important to developing trust and to gauging their own capacity to offer support. Conclusions Implementation of individual placement and support in a community mental health forensic setting is complex and requires robust planning. Future studies should address the barriers identified, and adaptations to the individual placement and support model are needed to address difficulties encountered in forensic settings.

Background Individuals with severe mental illness (SMI) are under-represented in the workforce. The Individual Placement and Support (IPS) programme is an evidence-based intervention that co-locates an Employment Specialist in a community mental health team to support individuals with a SMI with their goal of finding work. Previous research predominantly explored IPS programme outcomes rather than stakeholder experiences. Aim To explore programme stakeholder perspectives and experiences during the early stages of IPS programme implementation. Methods Qualitative descriptive methodology explored consumers (n = 11), health professionals and employment specialist (n = 11) perceptions and experiences of the IPS programme. Semi-structured interviews were conducted and thematically analysed. Results Three main themes emerged: enacting core care philosophies, IPS programme process and catalyst for supportive environments and relationships. The combination of IPS programme relationships, enactment of core care philosophies, and programme process promoted development of supportive environments and relationships for consumers participating in the programme. Conclusion Findings suggest IPS processes promoted the enactment of person-centred and recovery-oriented care approaches and positively influenced care planning practices and service culture. Significance IPS directly tackles the compounding disadvantage resulting from unemployment for people with a SMI. At a service level, IPS can foster positive changes to care practices and service culture.

Adults with a serious persistent mental illness (SPMI) express a strong desire to work. However, they continue to experience higher levels of unemployment, barriers, and occupational exclusion that impact their vocational outcomes and choice of work. The aim of this study was to investigate the impact of co‐location partnerships between adult mental health and disability employment services (DES) on employment outcomes and consumer choice of work for adults with a SPMI. Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methodology, a systematic literature review was conducted by searching four databases. The relationship between mental health, employment, and DES was examined. Inclusion criteria were adults with a SPMI; employment services and outcomes; and job retention and sustainability. Twelve studies met inclusion criteria. All studies were peer‐reviewed, Australian‐based, and published between 01 January 2017 and 30 August 2021. Individual placement and support (IPS); DES practice, funding, policy, and reform within the Australian mental health system; and barriers to participation in DES were the three main themes that emerged. Findings highlight the importance of joint, co‐location partnerships between mental health and employment services, including a collaborative approach to policy reform between both services, to assist adults with a SPMI to gain and sustain competitive employment. Vocational, non‐vocational, systemic, and structural barriers still exist; hence, adults with a SPMI continue to face challenges with gaining and sustaining long‐term employment. Hence, it is important for these partnerships to be systematically set up to support the complexity of the employment journey for adults with a SPMI.

Introduction: Individual Placement and Support (IPS) is an integrated social, labor and mental health intervention with an important component of evidence for its effectiveness in helping people with severe mental disorders. Its objective is to obtain and maintain competitive jobs, increase social inclusion and quality of life, and while consuming fewer resources. In Europe, IPS model (which began 14 year ago) is currently implemented in four countries which share background with Dartmouth College. This work aims to describe achievements and challenges of IPS implementation in Catalonia, Spain. Back in 2013, the project started with an agreement among three Regional Government Departments (Ministry of Health, Ministry of Business and Labor, and Ministry of Social Wellbeing and Family), “la Caixa” Banking Foundation, Government of Province of Barcelona, and the Dartmouth Psychiatric Research Center. The goal of the project is to improve labor and social inclusion of people with mental disorders, with a pilot project of the integrated plan of care for people with mental illness and addictions (2014-2016), as one of the strategies to promote ordinary labor inclusion for people with severe mental disorders. Practice change implemented: The project aims to integrate efforts and workflow from three areas (health care, social services and labor) both at community and policy levels to develop supported employment. It is based on IPS principles, such as: zero exclusion criteria; personalized benefits counseling; competitive jobs; IPS and mental health services integration; rapid job search; IPS professionals building relationships with employers; continuous supports and follow-up’s; and respect clients’ preferences. The innovative challenge involves implementing a new community perspective to support people with severe mental disorders finding a job and keeping it. Changes implemented are based on a specific patient management system including integration of Employment Programs with mental health treatment teams, interventions at community level and in the workplace including local employers. They are measured through a “fidelity scale” validated by Dartmouth College. Facing stigma and social barriers for inclusion are also included. Actions taken include: 1) professional training, as specific competencies are needed to be developed in different professionals’ roles to work in multidisciplinary teams; 2) improving workflow integration between mental Health and Employment Services including periodic meetings, patient plans and training on benefits planning and coordination among main administrators; 3) on-site support and monitoring achievements through an ICT platform that allows on-time review of results; 4) quarterly follow-up meetings among regional leaders, Mental Health teams and Employment Services to identify opportunities for improvement and support and encourage local development. In addition, an individualized action plan is developed to improve practices in each Employment Service. Key findings: Since October 2013, 7 sites have adapted their own programs to implement IPS methodology in Catalonia. Up to June 2015, an average of 350 people with severe mental illness has participated in these programs quarterly. Although severe economic crisis, percentage of working people have increased 17.7% from the beginning of the program. The number of jobs found by people during this period is 344. Although first fidelity reviews (which measure adherence of work process proposed by IPS methodology) were poor, now they have increased 18.8% as average. Highlights: Main barriers found in implementation process are related to economic crisis background and stigma for people with mental illness; adoption of innovation, current funding for programs development, different reported indicators for different funding sources, and the need of further integration among Employment Services and Mental Health Agencies, including the lack of shared electronic records with confidentiality implications Facilitators involve strong government support for the pilot project, periodic follow up and facilitator support approach, friendly professionals’ network created, as well as their commitment to increase patients’ quality of life. Improving communication among services is a key practice to increase access to multidisciplinary resources, with a strong senior leadership that supports the integration of different services in a variety of levels. Conclusions: A strong local leadership and commitment is fostering the project with a territorial approach, and raising IPS as an important intervention to obtain and maintain competitive employment and recovery for people with a mental health condition. To achieve this goal, payment systems will probably need to be aligned. The possibility of a European Collaborative Network to share these practices and knowledge may improve sustainability and implementation in a European context, and allow testing its effectiveness in other patients groups.

PurposeIndividual Placement and Support (IPS) is a recovery-based approach to support people with mental health difficulties back into employment. Embedding of IPS within the mental health Multi-Disciplinary Team (MDT) is a key component of IPS fidelity; however, few studies have examined how those involved with IPS implementation navigate this process. This article explores how IPS Employment Specialists (ES) and Occupational Therapist (OT) Managers integrated and embedded IPS within traditionally-oriented MDTs as part of a national reform program in the Republic of Ireland.MethodsThe study design was qualitative, descriptive with data collected through three focus groups with 17 IPS ESs and 11 OT Managers. Data were analyzed using thematic synthesis.ResultsThree key themes emerged from analysis. The first characterizes the context into which IPS landed, described as one marked by clinical resistance, doubt, and fear of risk. The second explores the strategies and factors that helped with the introduction of IPS into Irish mental health services. These included strategies, such as providing education and information about IPS and reassuring the MDT about IPS governance and IPS ES’ competencies. The evidenced-based nature of IPS and its attached accountabilities through IPS fidelity measures were perceived to be an important factor in its acceptance. The final theme encapsulates perceptions of how IPS impacted on the MDTs’ views of people with mental health difficulties. Findings suggest a shift in the ways in which MDTs view their clients. Initial fears about work capacity and risk shifted towards seeing people beyond the label of ‘service user’ and their diagnosis.ConclusionsIt is contended that IPS is an approach that allows practitioners to engage with real recovery-practice and may be one key to unlocking how a recovery approach can truly trickle down and embed itself within mental health service provision and support mental health system reform.

Individual placement and support (IPS), an evidence-based supported employment practice, is a core service in community mental health in the United States. Several factors promote the growth of IPS, including a network of 24 states participating in a learning community devoted to expanding IPS services. This study examined growth of IPS in the United States from 2016 to 2019, comparing growth rates for states within and outside the learning community. This national survey included telephone interviews with 70 representatives from state mental health and vocational rehabilitation agencies in 50 states and the District of Columbia, replicating methods of a 2016 survey. The primary outcomes were the number of IPS programs and clients served. The survey inquired about four indicators of state-level support for IPS implementation and sustainment: collaboration between state agencies, independent fidelity reviews, technical assistance and training, and funding. In 2019, 41 (80%) of 50 states and the District of Columbia had IPS services, with 857 IPS programs serving an estimated 43,209 clients. Between 2016 and 2019, the number of programs increased from 272 to 486 in 22 learning-community states and two learning-community counties, and from 251 to 371 in 18 states outside the learning community. State-level support for IPS was significantly greater in learning-community states, compared with non-learning-community states. IPS services expanded substantially in the United States between 2016 and 2019. Learning-community states had more rapid growth and provided greater implementation support, facilitating implementation, expansion, and sustainment of high-fidelity IPS. Nevertheless, access to IPS remains limited.

Long-Term Employment Trajectories Among Participants With Severe Mental Illness in Supported Employment

The long-term trajectories of participants in supported employment have not been clear. This exploratory study presents eight- to 12-year employment trajectories among adults with psychiatric disabilities who participated in supported employment. We reinterviewed 38 of 78 participants (49%) with severe mental illness eight to 12 years after they enrolled in supported employment studies in a small urban mental health center in New England. Data were analyzed by using quantitative and qualitative methods. All 38 participants worked during the follow-up period, a great majority (82%) in competitive jobs, and 71% worked for more than half of the follow-up years. Participants reported numerous benefits related to employment, including enhancements to self-esteem, relationships, and illness management. Psychiatric illness was the major barrier to work; part-time employment and long-term supports were the major facilitators. Three overlapping themes emerged from the qualitative analysis as significant perceived influences on participants' work-related behavior. First, the successful management of symptoms and the deployment of appropriate coping skills appeared to play an important role in finding and maintaining work. Second, participants generally preferred to work part-time because of the lesser demands of this type of job and because it was perceived to allow for the maintenance of Social Security and health care entitlements. Third, participants saw the importance of ongoing individual placement and support services. Participants stated that this was imperative in making successful transitions between jobs or from unemployment to employment and in helping negotiate pay raises or changes in conditions. The long-term trajectories of participants in supported employment programs, both vocational and nonvocational, appear to be positive.

Superiority and cost-effectiveness of Individual Placement and Support versus standard employment support for people with alcohol and drug dependence: a pragmatic, parallel-group, open-label, multicentre, randomised, controlled, phase 3 trial

One of the main challenges in supporting people with mental health problems in gaining employment is the mismatch between their needs and the services provided. Often, the mental health and the employment sector operate independently of one another, with different objectives and approaches, and under different government authorities. Individual Placement and Support (IPS) is an evidence-based approach to helping people with severe mental illness achieve competitive employment. A central principle in IPS is the integration of IPS with mental health services. This paper examines the challenges of integrating IPS and mental health services (MH) in a cross-sectoral setting in Denmark. Four IPS units and collaborating MH services were studied over a period of four years. The paper focuses on the MH managers’ experiences of cooperation with IPS employment specialists. Semi-structured interviews with 12 managers from MH services were conducted and analysed using a combined ‘pattern matching and pattern inducing’ technique. Findings were interpreted using an institutional logic approach, focusing on the material and symbolic aspects of the cooperation. The institutional logic approach conceives of IPS as a logic that organizes the time and space of daily activities, and motivates and legitimizes these practices as evidence-based. MH managers regarded IPS as a parallel service that supplemented treatment, and they valued the work of the IPS specialists as meaningful for the client’s recovery. They emphasized the informality in the cooperation with IPS specialists, while IPS was expected to fit into the existing organization of the treatment service.

Individual placement and support (IPS) was the primary intervention in the United States Social Security Administration's supported employment demonstration (SED), a large randomized trial that sought to increase employment and reduce disability among those whose first application for disability benefits was denied. Researchers developed a measure of participation in IPS services to quantify participation among enrollees assigned to receive IPS. The IPS participation measure, which IPS teams completed monthly for individual clients, recorded clients assigned to IPS as being either out of contact with their IPS treatment teams or, if in contact, according to their employment status (employed or not employed) and receipt of IPS job search services (participating or not participating). The measure also recorded types of IPS activities and reasons for non-participation. IPS teams completed the IPS participation measure at a rate of approximately 95% each month. Between 27 and 35% of enrollees assigned to a treatment condition participated in IPS services each month during the first 24months of measurement. The most common activities were applying for jobs and attending job interviews. Most of those out of contact were not responding to outreach efforts (58-72%). Those in contact but not participating despite being unemployed were typically either uninterested in employment (20-44%) or difficult to reach (10-16%). As IPS expands to serve new populations, it will be important to document and understand the links between individual characteristics, variance in participation patterns, and employment outcomes. Subsequent analyses of SED data will investigate these relationships among enrollees.

Individual Placement and Support (IPS) has been shown to effectively help people with serious mental illness obtain competitive employment, and IPS programs have been established in over 40 U.S. states and at least 20 other countries. As this expansion continues, the field needs data describing IPS implementation, clients, fidelity, and outcomes in real-world, non-research settings, specifically regarding racial and ethnic disparities and young adults. The goal of this study was to observe the initial three years of IPS implementation, measuring fidelity, client characteristics, and employment outcomes in three mental health agencies in one California county.In 2018, officials in one California county contracted with the IPS Center to provide training and measure IPS program fidelity at three mental health agencies in a large urban area. The goal was to establish and maintain IPS programs with good fidelity and effectiveness. After an initial year of preparation, three mental health programs recruited unemployed clients with interest in employment and implemented IPS. An IPS trainer provided initial training, ongoing consultation, and measured program fidelity. The program clinicians documented client characteristics, IPS service use, and quarterly employment throughout 13 quarters.The project followed 351 mental health clients as they participated in three new supported employment programs over a three-year period. The average client age was 36 years, including 107 (31%) young adults (ages 18-25) and 244 older adults (ages 26+); 177 (50%) identified their gender as female, 173 as male, and 1 as other or declined to answer; 119 (36%) identified as Hispanic, 116 (35%) as non-Hispanic White, 42 (13%) as non-Hispanic Asian, 35 (11%) as non-Hispanic Black, and 20 (6%) as other non-Hispanic. Most clients (78%) had diagnoses of non-psychotic conditions such as anxiety or depression, and 22% had diagnoses of schizophrenia, schizoaffective, or other psychotic disorder. During the project, 312 (87%) engaged in supported employment services, 206 (58%) attained competitive employment, and 177 (50%) found their first job within nine months of enrolling. Hispanics (64%), Asians (57%), and non-Hispanic Blacks (77%) achieved higher employment rates than non-Hispanic Whites (49%). Young adults (73%) achieved higher employment rates than older adults (51%).Engaging in new IPS supported employment programs over several months led to high rates of competitive employment across all groups in real-world, non-research settings, typically within nine months. Hispanics, Asians, and non-Hispanic Blacks achieved higher rates of competitive employment than non-Hispanic Whites, and young adults achieved higher rates than older adults. Further research may explain these differences.