Implementation Of Individual Placement And Support Research Articles

Individual placement and support in mental health services: evaluation of routine clinical data using aretrospective chart review

People with severe mental illnesses are often excluded from working life and would like support to (re)enter the general labor market as part of the psychiatric treatment. Individual placement and support (IPS) is an effective method of finding and retaining work in the general labor market. The aim of the study was to determine the integration rates of IPS into the general labor market in acute and postacute psychiatric settings, identifying patient, setting and program characteristics associated with (re)entering work. A retrospective chart review (RCR) of routine clinical data between 2016 and 2021 was carried out. The IPS program adherence was rated using the IPS fidelity scale. A total of 375 patients participated in the IPS with at least 4 appointments. The (re)integration rate into the general labor market was 51.7%. A shorter time period to the last working day, diagnosis of F1, F2, F3 (vs. F4), change of treatment setting and IPS in the psychiatric institute outpatient department (PIA), IPS fidelity and the number of IPS coaching sessions were positively correlated with (re)integration into work. The implementation of IPS in clinical mental healthcare is possible and leads to high integration rates in the open labor market. An early start of IPS during the clinical treatment can promote social inclusion.

Effectiveness, cost-effectiveness and return on investment of individual placement and support compared with traditional vocational rehabilitation for individuals with severe mental illness in the Netherlands: a nationwide implementation study

ObjectivesTo assess the effectiveness, cost-effectiveness and return on investment of individual placement and support (IPS) implemented through a reimbursement strategy on a nationwide scale compared with traditional vocational rehabilitation (TVR)...

Implementing individual placement and support in Norway. From vocational rehabilitation to an employment scheme

AbstractWe explore the implementation and development of individual placement and support (IPS) in Norway. IPS is an evidence‐based practice for supporting people experiencing mental illness to obtain and maintain competitive employment. Implementation of IPS into routine practice has been challenged by different paradigms in vocational rehabilitation, health and welfare policies. Data were mainly collected through individual and joint interviews of IPS experts and key stakeholders involved in the implementation of IPS. Data were analysed using thematic analysis. Three themes were derived from the analysis, representing different phases in the implementation process: (1) seeking a way to meet unmet need in work and mental health practice, (2) gathering knowledge and national evidence, and (3) embedding IPS into routine practice. The study demonstrates how health and welfare policy gradually developed IPS from vocational rehabilitation to a mainstreamed welfare employment scheme. This development may secure the future of IPS in Norway. However, the implications for practice in the longer term are unknown. Our study provides insight into how implementation of an evidence‐based practice both influences and is influenced by national policymaking.

Implementation structures at work. Exploring implementation and de‐implementation attempts regarding Housing First and Individual Placement and Support

AbstractResearch shows that resistance to change might occur in organisations that implement new evidence‐based practices (EBP). Formal and informal structures may work to retain traditional interventions, potentially counteracting the implementation process. Little is known about the de‐implementation of traditional practices to leave room for and enhance the implementation of EBPs. This study uses implementation structures as a theoretical framework with the aim of analysing implementation and de‐implementation factors among Swedish municipalities that provide support to vulnerable clients through the Housing First (HF) or Individual Placement and Support (IPS) interventional programmes. This cross‐sectional study is based on a digital survey and collects descriptive and qualitative data from three organisational levels in each responding municipality in Sweden. The descriptive statistics and qualitative texts were analysed using content analysis. The results show the incidence of HF and IPS, if and to what extent the interventions are going to be developed further, and partially, describe the organisational settings of HF and IPS. Organisational factors shown to have a negative impact on the implementation of HF and IPS were identified. The mapping of professional experiences from the intersection between HF or IPS and organisations such as the Swedish Health Insurance Office, the social services, and other similar welfare organisations, indicates that the realisation of HF and IPS requires expanded collaboration, which raises the consideration as to whether it is necessary to de‐implement broader frameworks and guidelines in these organisations to provide the prerequisites that enable the implementation of EBPs.

Protocol: A mixed methods evaluation of an IPS program to increase employment and well-being for people with long-term experience of complex barriers in Vancouver’s downtown and DTES

BackgroundEmployment improves mental health and well-being by providing financial security, daily structure, a sense of identity and purpose, and social engagement. However, securing and sustaining employment is exceptionally challenging for vulnerable populations who experience persistent and multiple barriers, such as mental illness, homelessness, food and housing insecurity, and marginalization. Evidence-based supported employment programs, most notably individual placement and support (IPS) are becoming a more common approach for addressing the needs of these high-risk individuals. The aim of this paper is to outline the protocol for evaluating an IPS program in Vancouver’s downtown and Downtown Eastside (DTES).Methods and designThis prospective quasi-experimental study of persons with persistent and multiple barriers to employment will use a mixed-methods approach for evaluating a novel IPS program. The evaluation will consist of survey packages and interviews that will capture outcomes related to employment and well-being, as well as the experiential process of receiving individualized and integrated supports through the IPS program. A mixed-methods approach is appropriate for this study as quantitative data will provide an objective assessment of program impacts on employment and well-being outcomes over time, while qualitative data will provide an in-depth understanding of continued barriers and experiences.DiscussionThe results from this evaluation will contribute evidence within a local British Columbian (BC) context that may increase access to meaningful employment for those with long-term experience of complex barriers to employment. Further, the findings will support continued improvements, and guide decision-making around practices and policy for future implementation of IPS and employment supports across BC.

Growth of IPS Supported Employment Programs in the United States: An Update.

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.

A meta-regression of the impact of policy on the efficacy of individual placement and support.

Individual placement and support (IPS) has shown consistently better outcomes on competitive employment for patients with severe mental illness than traditional vocational rehabilitation. The evidence for efficacy originates from few countries, and generalization to different countries has been questioned. This has delayed implementation of IPS and led to requests for country-specific RCTs. This meta-analysis examines if evidence for IPS efficacy can be generalized between rather different countries. A systematic search was conducted according to PRISMA guidelines to identify RCTs. Overall efficacy was established by meta-analysis. The generalizability of IPS efficacy between countries was analysed by random-effects meta-regression, employing country- and date-specific contextual data obtained from the OECD and the World Bank. The systematic review identified 27 RCTs. Employment rates are more than doubled in IPS compared with standard vocational rehabilitation (RR 2.07 95% CI 1.82-2.35). The efficacy of IPS was marginally moderated by strong legal protection against dismissals. It was not moderated by regulation of temporary employment, generosity of disability benefits, type of integration policies, GDP, unemployment rate or employment rate for those with low education. The evidence for efficacy of IPS is very strong. The efficacy of IPS can be generalized between countries.

Evidence for Occupational Therapy Intervention With Employment and Education for Adults With Serious Mental Illness: A Systematic Review.

Many of the estimated 9.8 million American adults with serious mental illness (SMI) want to engage in employment and education, yet the majority report a need for more skills training. This review presents evidence for the effectiveness of interventions that occupational therapy practitioners can provide to help people with SMI improve and maintain performance and participation in employment and education. Citations, abstracts, and full-text articles in databases including MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were reviewed for inclusion and analysis. Fifty-seven articles met criteria for inclusion. For employment, strong evidence was found for the Individual Placement and Support (IPS) model and cognitive interventions. For education, moderate evidence was found for supported education interventions. This systematic review supports the role of occupational therapy practitioners in promoting the implementation of IPS, cognitive-based, and social skills programs to improve vocational and educational outcomes for adults with SMI.

Implementing Supported Employment. Lessons from the Making IPS Work Project.

Individual Placement and Support (IPS) is an internationally accepted and effective form of supported employment for people with severe mental health conditions. Despite its strong evidence base, the implementation of IPS has been slow and inconsistent. In England, a demonstration project, Making IPS Work, was developed to offer support for the implementation of IPS in six local sites National Health Service Mental Health trusts. The project aimed to: Establish Individual Placement and Support services within clinical teams; develop high fidelity practice and leave a sustainable IPS service beyond the project. The number of people gaining open employment in each site was monitored. Fidelity checks were carried out at three sites by independent assessors. Stakeholders were interviewed over the 18-month lifetime of the implementation period to examine the experience of developing the services in the six sites. A total of 421 jobs were found for people with mental health conditions over 18 months with a large variation between the highest and lowest performing sites. The sites assessed for fidelity all attained the threshold for a ‘Good Fidelity’ service. The new services were readily accepted by mental health service users, clinical staff and managers across the trust sites. Maintaining the funding for the Individual Placement and Support services beyond the project period proved to be problematic for many sites. Placing the services within a broader strategy of improving psychosocial services and bringing together decision making at the corporate, commissioning and clinical management level were helpful in achieving success. The growth and maintenance of these services is difficult to achieve whilst the current cost pressures on the NHS continue.

Mental health occupational therapy and supported employment

Purpose The individual placement and support (IPS) model is an evidence-based approach to employment support for people with severe mental illness that functions by co-locating an employment consultant from the local disability employment service within a community mental health team to assist service users to find work. This paper aims to examine the unintended impacts of implementing IPS on occupational therapy practice and offer some suggestions. Design/methodology/approach The authors performed a narrative literature review on the IPS model, employment and occupational therapy. Authors then analysed and discussed impact on occupational therapy practice and concluded by making suggestions based on current evidence and practice. Findings The authors concluded that implementation of IPS has resulted in some unintended changes of practice in mental health with occupational therapists taking a less active role in enabling employment outcomes than previously. This paper concludes by calling upon occupational therapists to re-establish their role of enabling employment. Originality/value This paper offers an original viewpoint on employment and occupational therapy based on current evidence and authors’ expertise.

Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury

Purpose: In a 5-year study, individual placement and support (IPS) significantly increased employment rate of United States Veterans with spinal cord injury (SCI), a historically underemployed population. In a follow-up study, data on barriers and facilitators to IPS implementation were identified.Methods: Over 24 months of implementation, 82 key medical and vocational staff underwent semi-structured interviews (n = 130). Interviews were digitally recorded and qualitatively analyzed (ATLAS.ti v0.7) using a constant comparative method to generate themes.Results: Some barriers to implementation occurred throughout the study, such as Veterans’ lack of motivation and providers’ difficulty integrating vocational and medical rehabilitation. Other barriers emerged at specific stages, for example, early barriers included a large geographic service area and a large patient caseload, and late barriers included need for staff education. Facilitators were mostly constant throughout implementation and included leadership support and successful integration of vocational staff into the medical care team.Conclusions: Implementation strategies need to be adjusted as implementation progresses and matures. The strategies that succeeded in this setting, which were situated in a real-world context of providing IPS as a part of SCI medical care, may inform implementation of IPS for other populations with physical disabilities.Implications for RehabilitationKey facilitators to IPS in SCI implementation are integrating vocational staff with expertise in IPS and SCI on clinical rehabilitation teams and providing leadership support.Ongoing barriers to IPS in SCI include patient specific and program administration factors such as caseload size and staffing patterns.Varying implementation strategies are needed to address barriers as they arise and facilitate successful implementation.

The IPS Learning Community: A Longitudinal Study of Sustainment, Quality, and Outcome.

Implementations of evidence-based mental health practices often disappear quickly, and few studies have examined sustainment. Since 2001, the Individual Placement and Support (IPS) learning community has promoted dissemination, implementation, sustainment, and expansion of IPS by using multiple strategies: online training, in-person training and technical assistance, technical assistance teleconferences, annual meetings, stakeholder conference calls, fidelity assessments, and transparency of outcomes. This study examined sustainment of IPS over a two-year period among programs in the learning community in the United States. The authors interviewed IPS team leaders in 129 programs actively participating in the learning community in 2012 and 2014. The structured interview addressed questions about program status, funding, and quality improvement activities. Simultaneously, the learning community tracked program-level data on IPS fidelity and employment rates. The study examined two-year program sustainment and changes in employment rates, fidelity, funding, and quality improvement activities. In 2012, 129 participating sites had been active for an average of 4.5 years. At two-year follow-up, 124 (96%) sites were sustained. The sustaining sites maintained quality improvement activities, expanded funding sources, and increased employment rates (41% to 43%; p=.04) and fidelity scores (103.8 to 108.4; p=.002). Nearly all programs participating in a learning community in 2012 continued to provide IPS services over the next two years, exceeding sustainment rates for evidence-based practices reported in the literature. Quality indicators also improved, suggesting that learning community activities fostered sustainment and quality. Controlled studies must compare specific learning community approaches with usual methods of sustainment.

Effectiveness of individual placement and support for people with severe mental illness in The Netherlands: a 30-month randomized controlled trial.

Whereas in the U.S. and Canada the Individual Placement and Support (IPS) model has proven to be highly effective in enhancing employment perspectives for persons with severe mental illnesses, the evidence base is less abundant in countries with a different socioeconomic climate. The aim of this study was to examine the effectiveness of IPS in the Dutch socioeconomic context. A multisite randomized controlled trial was performed following 151 persons with severe mental illnesses expressing an explicit wish for regular employment, comparing IPS with traditional vocational rehabilitation (TVR). Primary outcome was the proportion of persons who were competitively employed over a period of 30 months. Secondary outcomes were self-reported quality of life, self-esteem and mental health. Additionally, the impact of being engaged in competitive employment on these secondary outcomes was examined. In 30 months, 44% of IPS participants found competitive work, compared with 25% of participants supported by TVR. No direct effect of IPS on mental health, self-esteem or quality of life was found. Being competitively employed before follow-up measurements was significantly associated with an increase in mental health, self-esteem and quality of life. This study strongly confirms that IPS is an effective method in helping people with severe mental illnesses find competitive work also in countries characterized by a relatively protective socioeconomic climate putting up unintended barriers to employment. The implementation of IPS on a larger scale seems warranted, and new studies are needed on the mechanisms through which IPS works.

An update on supported employment for people with severe mental illness

Individual Placement and Support (IPS) is an effective intervention for helping people with severe mental illness obtain competitive employment, yet it has not been widely implemented. This review will examine and summarize the latest research on IPS. As the effectiveness of IPS has been well established in the literature, newer research is exploring nonvocational outcomes, such as quality of life and mental health services utilization and expanding the reach of IPS to include different countries and different population groups. There is also a growing literature exploring the cost-effectiveness of IPS compared with traditional vocational services, which has favored IPS. By far, the area of research that has expanded the most is aimed at enhancing IPS outcomes, at both the intervention level and the client level. Researchers are exploring the variance in IPS outcomes as a means of increasing competitive employment rates with IPS. Although the field of research continues to expand, it is clear that many barriers remain to broad implementation of IPS. The solution goes beyond further research and involves policies and practices that support a recovery oriented mental healthcare system.

Randomized controlled trial of supported employment in England: 2 year follow‐up of the Supported Work and Needs (SWAN) study

Studies from North America have concluded that supported employment using the Individual Placement and Support (IPS) model is effective in helping individuals with severe and persistent mental illness gain competitive employment. The aim of this study was to investigate the effectiveness and cost-effectiveness of IPS in England in patients followed up for 2 years. Patients with severe mental illness were randomised to IPS or local vocational services (treatment as usual). Service use and costs were measured. Two hundred-nineteen participants were randomised, and 86% re-assessed 2 years later. In the multivariate analysis, relatively low rates of competitive employment were found in both the intervention group and the treatment as usual group, although significantly more patients obtained competitive employment in the treatment arm (22% vs. 11%, p=0.041). There were no significant differences in costs. The employment rate among participants receiving IPS was lower than in previously published reports, and the number needed to treat to obtain the benefit of IPS was relatively high. This may reflect difficulties in the implementation of IPS where it is not structurally integrated within mental health teams, as well as economic disincentives which lead to lower levels of motivation for patients and mental health professionals.

Individual placement and support illustrated in the Swedish welfare system: A case study

Individual Placement and Support (IPS) results in more people with severe mental illness obtaining employment in comparison to traditional vocational rehabilitation approaches. The implementation challenges of IPS vary across countries and contexts. However, the implications for IPS delivery and thus the IPS principles have not been studied in Sweden, which this embedded case study aims to investigate. The study was bounded by a single case, which was equivalent to the implementation of IPS in a Swedish city over 18 months. Data was collected from multiple units of information and consisted of interviews, documents and audio materials. A content analysis was used. The results showed that the first four IPS principles were challenged by the welfare system. Work capacity, in terms of amount of working hours per week, was evaluated differently in IPS and in the welfare system's prevocational services. In addition, the type of welfare benefit was decisive for IPS delivery and could be withdrawn if the IPS participant did not enter the prevocational rehabilitation situated within the welfare service. The differences of vocational approaches as experienced by professionals led to frustration, but also positive statements regarding how to increase integration between the welfare services and IPS. The authors discuss the tangible result and suggestive recommendations are made.

Supported employment: randomised controlled trial

BackgroundThere is evidence from North American trials that supported employment using the individual placement and support (IPS) model is effective in helping individuals with severe mental illness gain competitive employment. There have been few trials in other parts of the world.AimsTo investigate the effectiveness and cost-effectiveness of IPS in the UK.MethodIndividuals with severe mental illness in South London were randomised to IPS or local traditional vocational services (treatment as usual) (ISRCTN96677673).ResultsTwo hundred and nineteen participants were randomised, and 90% assessed 1 year later. There were no significant differences between the treatment as usual and intervention groups in obtaining competitive employment (13% in the intervention group and 7% in controls; risk ratio 1.35, 95% CI 0.95–1.93, P = 0.15), nor in secondary outcomes.ConclusionsThere was no evidence that IPS was of significant benefit in achieving competitive employment for individuals in South London at 1-year follow-up, which may reflect suboptimal implementation. Implementation of IPS can be challenging in the UK context where IPS is not structurally integrated with mental health services, and economic disincentives may lead to lower levels of motivation in individuals with severe mental illness and psychiatric professionals.

Supporting mental health service users back to work

Evidence accumulated over many years illustrates the benefits of work for mental health, including that of mental health service users. Despite strong evidence of the effectiveness of the individual placement and support (IPS) approach in enabling this group to find and keep paid employment, employment rates among mental health service users remain low, and IPS is not widely implemented in the UK. This paper reviews recent evidence for IPS, describes the key features of the approach and compares these with service users' accounts of the kind of support that they find helpful. The current situation regarding implementation of IPS is then considered, together with the barriers hindering implementation. It is clear that the barriers are multifaceted, and action will be required at a number of levels if mental health service users are to be enabled to achieve their employment goals.