Abstract
PurposeThe individual placement and support (IPS) model of supported employment is a leading evidence-based practice in community mental health services. In Japan, individualized supported employment that is highly informed by the philosophy of the IPS model has been implemented. While there is a body of evidence demonstrating the association between program fidelity and the proportion of participants gaining competitive employment, the association between fidelity and a wider set of vocational and individual outcomes has received limited investigation. This study aimed to assess whether high-fidelity individualized supported employment programs were superior to low-fidelity programs in terms of vocational outcomes, preferred job acquisition, and patient-reported outcome measures (PROMs).MethodsA prospective longitudinal study with 24-month follow-up analyzed 16 individualized supported employment programs. The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was used to assess the structural quality of supported employment programs (scores: low-fidelity program, ≤ 90; high-fidelity program, ≥ 91). Job acquisition, work tenure, work earnings, job preference matching (e.g., occupation type, salary, and illness disclosure), and PROMs such as the INSPIRE and WHO-Five Well-being index were compared between groups.ResultsThere were 75 and 127 participants in the low-fidelity group (k = 6) and high-fidelity group (k = 10), respectively. The high-fidelity group demonstrated better vocational outcomes than the low-fidelity group, i.e., higher competitive job acquisition (71.7% versus 38.7%, respectively, adjusted odds ratio (aOR) = 3.6, p = 0.002), longer work tenure (adjusted mean difference = 140.8, p < 0.001), and better match for illness disclosure preference (92.6% versus 68.0%, respectively, aOR = 5.9, p = 0.003). However, we found no differences between groups in other preference matches or PROM outcomes.ConclusionHigh-fidelity individualized supported employment programs resulted in good vocational outcomes in a real-world setting. However, enhancing service quality to increase desired job acquisition and improve PROMs will be important in the future.Clinical Trial RegistrationUMIN000025648
Highlights
Employment is as important for many people with a diagnosis of mental illness as it is for much of the general population
An analysis of only the participants who completed the patient-reported outcome measures (PROMs) showed no significant differences between groups in any baseline variables (Online Supplementary Table 2)
This study demonstrated an association between program fidelity and several vocational outcomes, confirming the results of past program-level fidelity research on the individual placement and support (IPS) and individualized supported employment models (Bond et al, 2012; de Winter et al, 2020; Lockett et al, 2016; Sasaki et al, 2018; Yamaguchi et al, 2021)
Summary
Employment is as important for many people with a diagnosis of mental illness as it is for much of the general population. The individual placement and support (IPS) model of supported employment has been a leading evidence-based practice in vocational rehabilitation and community mental health services over the past three decades (Bond et al, 2020a). IPS aims to promote competitive employment and clients’ well-being and personal recovery as they work in the community (Drake, 2020; Swanson et al, 2008). At least 20 countries have implemented IPS programs (Bond et al, 2020b). In this context, maintaining service quality and improving outcomes through fidelity assessment have become increasingly important (Bond & Drake, 2020)
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