Individual Placement And Support Research Articles

Client Predictors of Employment Outcomes in High-Fidelity Supported Employment

Research on vocational rehabilitation for clients with severe mental illness over the past 2 decades has yielded inconsistent findings regarding client factors statistically related to employment. The present study aimed to elucidate the relationship between baseline client characteristics and competitive employment outcomes-job acquisition and total weeks worked during an 18-month follow-up-in Individual Placement and Support (IPS). Data from 4 recent randomized controlled trials of IPS were aggregated for within-group regression analyses. In the IPS sample (N = 307), work history was the only significant predictor for job acquisition, but receiving Supplemental Security Income-with or without Social Security Disability Insurance-was associated with fewer total weeks worked (2.0%-2.8% of the variance). In the comparison sample (N = 374), clients with a diagnosis of mood disorder or with less severe thought disorder symptoms were more likely to obtain competitive employment. The findings confirm that clients with severe mental illness interested in competitive work best benefit from high-fidelity supported employment regardless of their work history and sociodemographic and clinical background, and highlight the needs for changes in federal policies for disability income support and insurance regulations.

Low expectations contribute to failure of supported employment

Work represents an important goal for many people with severe mental illness, but unemployment rates often exceed 90 per cent. Several randomised controlled trials (RCTs), mainly in North America, have found that supported employment using the individual placement and support (IPS) model can increase rates of competitive employment to 30– 60 per cent.

Beyond Evidence-Based Practice: Nine Ideal Features of a Mental Health Intervention

Objectives: Recognizing the limitations of conventional frameworks for identifying evidence-based interventions, we sought to develop a comprehensive set of criteria that would have practical and policy relevance. Methods: We identify nine ideal attributes of a mental health practice (well defined, reflecting client goals, consistent with societal goals, effective, minimum side effects, positive long-term outcomes, reasonable costs, easy to implement, and adaptable to diverse communities and client subgroups). Using a case study approach, we applied these criteria to the Individual Placement and Support (IPS) model of supported employment. Findings: IPS generally satisfies all nine criteria, though the evidence is more limited in some areas. Conclusions: This framework provides a template that could be used to evaluate other social work interventions.

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.

Creation of a measure to assess knowledge of the individual placement and support model.

This article describes the development and psychometric evaluation of the IPS-Q, a quiz assessing practitioner knowledge of the Individual Placement and Support (IPS) model. Using multiple resources, including the IPS Fidelity Scale and publications about the IPS model, a 30-item multiple-choice quiz covering fundamental IPS principles and key components was developed. Ratings by eight IPS experts supported its content validity. To examine the IPS-Q's psychometric properties, 107 practitioners from high-fidelity IPS programs and 59 practitioners from non-IPS vocational programs were administered the IPS-Q via a web-based survey tool. The measure displayed good internal consistency (Cronbach's alpha = .89) and a difficulty level consistent with that of typical job knowledge tests. The IPS-Q did not correlate with demographic variables that were considered extraneous to knowledge of IPS and did correlate with self-reported supported employment familiarity. However, contrary to our hypothesis, the quiz was not significantly correlated with exposure to supported employment. The IPS-Q significantly discriminated between practitioners working in high-fidelity IPS programs and non-IPS vocational programs. Furthermore, supervisors from high-fidelity IPS programs scored significantly higher on the measure than vocational workers from high-fidelity IPS programs. The IPS-Q is a valid measure of IPS knowledge and might prove useful for assessment, research, and training purposes. Practitioners sometimes assume that they understand a program model when in fact they have misconceptions. The IPS-Q provides an objective way to gauge practitioner knowledge.

Three Year Follow-Up Study of an Integrated Supported Employment for Individuals with Severe Mental Illness

The aim of the present study was to examine and compare the long-term effectiveness of the Integrated Supported Employment (ISE) programme, which consists of individual placement and support (IPS) and work-related social skills training, with the IPS programme on the vocational and non-vocational outcomes among individuals with severe mental illness (SMI) over a period of 3 years. One hundred and eighty-nine participants with SMI were recruited from two non-government organizations and three day hospitals in Hong Kong and randomly assigned into the ISE (n = 58), IPS (n = 65) and traditional vocational rehabilitation (TVR) (n = 66) groups. Vocational and non-vocational outcomes of the ISE and IPS participants were collected by a blind and independent assessor at 7 11, 15, 21, 27, 33 and 39 months after their admission, whereas the TVR groups were assessed only up to the 15th month follow up. After 39 months of service provision, ISE participants obtained higher employment rate (82.8% vs 61.5%) and longer job tenure (46.94 weeks vs 36.17 weeks) than the IPS participants. Only 6.1% of TVR participants were able to obtain employment before the 15th month follow up. Fewer interpersonal conflicts at the workplace were reported for the ISE participants. Advantages of the ISE participants over IPS participants on non-vocational outcomes were not conclusive. The long-term effectiveness of the ISE programme in enhancing employment rates and job tenures among individuals with SMI was demonstrated by this randomized controlled trial.

Implementing the individual placement and support (IPS) approach for people with mental health conditions in England

Despite the overwhelming evidence of the effectiveness of the individual placement and support (IPS) approach to vocational rehabilitation for people with mental health conditions, there is very limited evidence of implementation in the UK. Both government policy and national clinical guidelines have set out a need for the availability of this effective approach in favour of other approaches, yet implementation appears to be an exception rather than a rule. This paper sets out four key challenges to implementing the IPS approach within mental health services in England: fear on the part of professionals, individuals and their families; a culture of low expectations; a failure to provide the support that we know works, and the global ‘credit crunch’ recession. Using a framework from implementation science, this review identifies the key features of implementing IPS within routine clinical practice from the experience of two large mental health NHS trusts in England.

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.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterPatrick W. Corrigan Psy.D.Jonathon E. Larson Ed.D.Patrick W. Corrigan Psy.D.Search for more papers by this authorJonathon E. Larson Ed.D.Search for more papers by this authorPublished Online:1 Nov 2009https://doi.org/10.1176/ps.2009.60.11.1555AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Shared Decision Making: Whose Decision?To the Editor: In the August Taking Issue commentary, Drake and Deegan ( 1 ) framed shared decision making as a moral imperative for mental health services. According to this view, traditional providers must move beyond paternalistic approaches to treatment and offer decision aids and supports to help people with mental illnesses choose among service options. It levels the field of interaction, so that mental health professionals set aside authority and partner with service consumers to decide about treatment options. We believe shared decision making does not go far enough. It does not convey to the person with mental illness that his or her decision "trumps" the preferences and choice of the provider—that is, the person with mental illness has ultimate control over life choices and treatment options. Joint decision making is a relatively easy enterprise when patient and mental health professional agree on overall direction and activities. It is when they disagree that shared decision making is limiting. Consider times when the psychiatrist believes medication is needed but the individual wishes instead to stop.Leaving the ultimate choice up to the person with mental illness makes anecdotal sense, at least in terms of general medical care. Modern medicine has broadened physician roles to include those of educator and counselor, providing information patients need to decide about treatments and offering support as these treatments proceed. For example, the person treated for lymphoma is fully informed about the cancer's prognosis as well as the medical, surgical, and alternative approaches to the illness. In many cases, a single health care professional is unable to fully present the broad range of related information. The patient weighs the costs and benefits and then selects a treatment. In mental health care, self-determination is fundamental to a recovery-oriented system. Sometimes the mental health professional's role is limited to providing information and support while the person opts to move in a different direction. Professionals can be uncomfortable on the sidelines because they know that relapse and failure are not infrequent outcomes for persons with serious mental illnesses. But forestalling failure robs individuals of the dignities of risk and discovery. Our point is by no means foreign to Drake or Deegan. Patricia Deegan has been writing eloquently about personal empowerment and recovery for more than 30 years ( 2 ). Robert Drake is a leading innovator in practices that promote recovery. Individual Placement and Support (IPS), an example of supported employment developed and championed by Becker and Drake ( 3 ), is a model of leaving the ultimate choice to the person with mental illness. The IPS participant has primary authority in deciding on vocational goals and the methods to achieve these goals. For example, when Mr. Smith opts for law school but has only a high school diploma, the IPS job coach may believe that the goal exceeds Mr. Smith's capacities but nonetheless provides comprehensive support and guidance about pursuing and obtaining a law degree. Research on IPS shows that this kind of final determination is fundamental to successful vocational rehabilitation. At the core, we may be framing shared decision making and leaving the ultimate choice to the patient as categorically distinct when there is clear overlap. An additional moral imperative, therefore, is a research agenda that examines the intersection of the two constructs.The authors are on the faculty of the Institute of Psychology, Illinois Institute of Technology, Chicago.

Evaluation of an employment program for people with mental illness using the Supported Employment Fidelity Scale

The Individual Placement and Support (IPS) model aims to achieve open employment for people with mental illness. The Supported Employment Fidelity Scale (SEFS) is a 15-item instrument that evaluates the extent to which a service follows the IPS principles of best practice. This paper describes the IPS model and an evaluation of a specialist employment program for people with mental illness using the SEFS. The SEFS enabled a quantitative assessment of service provision against the criteria of evidence-based practice principles. Data were collected from multiple sources. In addition, a literature review was conducted, and personnel engaged in implementation of the IPS model at other Australian employment programs were consulted. The program achieved a score of 59 of a possible 75 on the SEFS, which is described as fair supported employment. Analysis of the 15-scale items resulted in the identification of strengths, areas for further development, and a set of recommendations. The program was operating substantially in line with evidence-based practice principles and had considerable scope for further development. Issues arising from the evaluation, areas of applicability of the SEFS and the underlying literature, and implications for occupational therapy are highlighted.

Who Benefits From Supported Employment: A Meta-analytic Study

This meta-analysis sought to identify which subgroups of clients with severe mental illness (SMI) benefited from evidence-based supported employment. We used meta-analysis to pool the samples from 4 randomized controlled trials comparing the Individual Placement and Support (IPS) model of supported employment to well-regarded vocational approaches using stepwise models and brokered services. Meta-analysis was used to determine the magnitude of effects for IPS/control group differences within specific client subgroups (defined by 2 work history, 7 sociodemographic, and 8 clinical variables) on 3 competitive employment outcomes (obtaining a job, total weeks worked, and job tenure). The findings strongly favored IPS, with large effect sizes across all outcomes: 0.96 for job acquisition, 0.79 for total weeks worked, and 0.74 for job tenure. Overall, 90 (77%) of the 117 effect sizes calculated for the 39 subgroups exceeded 0.70, and all 117 favored IPS. IPS produces better competitive employment outcomes for persons with SMI than alternative vocational programs regardless of background demographic, clinical, and employment characteristics.

Working with mental health problems: clients’ experiences of IPS, vocational rehabilitation and employment

Although the effectiveness of individual placement and support (IPS) has been well established, little is known about clients' perceptions of the model compared to usual vocational rehabilitation, nor about their experiences of searching for and returning to work with this kind of support. This qualitative study aimed to explore clients' views of the difficulties of obtaining and maintaining employment, their experiences of the support received from their IPS or Vocational Service workers and the perceived impact of work on clients' lives. Semi-structured interviews were conducted with 48 people with psychotic disorders participating in a six-centre international randomised controlled trial of IPS compared to usual vocational rehabilitation. To assess their experiences of the services and the perceived effects of working, two IPS and two Vocational Service clients at each centre who had found work during the study period were interviewed, along with two IPS and two Vocational Service clients at each centre who had not. IPS clients reported having received more help seeking and maintaining employment, whereas Vocational Service clients reported having received more help in finding sheltered employment or placements. Clients who had worked associated this with financial stability, improved social lives, increased self-esteem, integration into society and amelioration of their symptoms, as well as reduced feelings of boredom and isolation, but also reported increased levels of stress. IPS clients as well as Vocational Service ones reported not receiving enough follow-up support, despite this being proposed as a key feature of the model. Findings from the in-depth interviews reflect differences in service models that have also been tested quantitatively but further work in disaggregating the IPS model and assessing the impact of each component would be valuable.

The contribution of IPS to recovery from serious mental illness: A case study

Individual Placement and Support (IPS) is an effective, evidence-based intervention to support transition to paid work for individuals who have a serious mental illness. Currently, there is a lack of qualitative reporting from the people receiving IPS and their support networks. A case study of a 42-year-old-man who has schizophrenia and who attends a community mental health team in a Canadian urban centre is presented. His experience and that of his mother, employer, and clinical supports are shared through semi-structured interviews. The authors of this paper include a peer researcher who has been a participant in an IPS program. The enduring and individual support of IPS is credited with being central to the study subject's successful acquisition and maintenance of paid employment. His involvement in paid work is also associated with improved health outcomes, including a significant reduction in the frequency of medical appointments to monitor his mental health. Improved social skills and self-efficacy are also reported. Provision of IPS services within a multidisciplinary mental health team can promote the acquisition of durable employment for individuals in recovery from serious mental illness. Clinicians are reminded to check their assumptions regarding which individuals could benefit from IPS, and are encouraged to take their lead from clients in determining whether to commence or continue employment services.

Service users' perceptions of the effective ingredients in supported employment

Background: The UK government is advocating the use of supported employment to help people on incapacity benefits back to work, with an emphasis on Individual Placement and Support (IPS) models. However there is little UK-based evidence on the key ingredients of effective support.Aim: To ascertain service users' views of what they found helpful about supported employment.Method: Interviews were carried out with 182 people with severe and enduring mental health problems who were actively engaged with one of the six supported employment agencies included in the study.Results: Three themes emerged: emotional support, practical assistance and a client-centred approach.Conclusion: The findings highlight the importance of the quality of support, particularly through interpersonal dynamics, which go beyond the organizational features emphasized in the IPS model.Declaration of interest: The study was financed from Higher Education European Social Fund Objective 3 resources and the six partner agencies made contributions in kind.

S47-03 Is supported employment replacing traditional vocational rehabilitation services?

The only study in Europe that compared traditional vocational rehabilitation with Individual Placement and Support (IPS) in people with psychotic and bipolar disorders clearly showed that IPS is more effective. Based on these data, this paper will review the current situation of vocational rehabilitation in Europe and analyse whether these or other research do influence the daily practice in vocational rehabilitation. Moreover, it will summarise potential for further development of Supported Employment in people with severe mental illness.

Vocational intervention in first-episode psychosis: Individual placement and support v. treatment as usual

Unemployment is a major problem for people with first-episode psychosis and schizophrenia. This has repercussions for the economy, social functioning and illness prognosis. To examine whether a vocational intervention - individual placement and support (IPS) - which has been found to be beneficial in populations with chronic schizophrenia, was a useful intervention for those with first-episode psychosis. A total of 41 people with first-episode psychosis were randomised to receive either 6 months of IPS + treatment as usual (TAU) (n=20) or TAU alone (n=21). The IPS group had significantly better outcomes on level of employment (13 v. 2, P<0.001), hours worked per week (median 38 v. 22.5, P=0.006), jobs acquired (23 v. 3) and longevity of employment (median 5 weeks v. 0, P=0.021). The IPS group also significantly reduced their reliance on welfare benefits. Individual placement and support has good potential to address the problem of vocational outcome in people with first-episode psychosis. This has economic, social and health implications.

The Impact of Supported Employment and Working on Clinical and Social Functioning: Results of an International Study of Individual Placement and Support

Concerns are frequently expressed that working might worsen the mental health of people with severe mental illness (SMI). Several studies of Individual Placement and Support (IPS), however, have found associations between working and better nonvocational outcomes. IPS has been found to double the return to work of people with SMI in 6 European countries. To explore separately associations between IPS, returning to work, and clinical and social outcomes. Patients (n = 312) in a randomized controlled trial of IPS in 6 European centers were followed up for 18 months. There were no differences in clinical and social functioning between IPS and control patients at 18 months. Those who worked had better global functioning, fewer symptoms, and less social disability at final follow-up; greater job tenure was associated with better functioning. Working was associated with concurrently better clinical and social functioning, but this contrast was stronger in the control group, suggesting that IPS was better than the control service at helping more unwell patients into work. Working was associated with having been in remission and out of hospital for the previous 6 months. It was also associated with a slight decrease in depression and with being in remission over the subsequent 6 months. Concerns among clinicians about possible detrimental effects of working and supported employment have been misplaced. Although some of the associations found may have been selection effects, there is sufficient evidence of work having beneficial effects on clinical and social functioning to merit further exploration.

China multicenter study of sentinel node biopsy substituting axillary node dissection: CBCSG-01 trial

To determine the effects of a 24-month program of Individual Placement and Support (IPS) supported employment (SE) on employment outcomes for veterans with spinal cord injury (SCI).Longitudinal, observational multisite study of a single-arm, nonrandomized cohort.SCI centers in the Veterans Health Administration (n=7).Veterans with SCI (N=213) enrolled during an episode of either inpatient hospital care (24.4%) or outpatient care (75.6%). More than half the sample (59.2%) had a history of traumatic brain injury (TBI).IPS SE for 24 months.Competitive employment.Over the 24-month period, 92 of 213 IPS participants obtained competitive jobs for an overall employment rate of 43.2%. For the subsample of participants without TBI enrolled as outpatients (n=69), 36 obtained competitive jobs for an overall employment rate of 52.2%. Overall, employed participants averaged 38.2±29.7 weeks of employment, with an average time to first employment of 348.3±220.0 days. Nearly 25% of first jobs occurred within 4 to 6 months of beginning the program. Similar employment characteristics were observed in the subsample without TBI history enrolled as outpatients.Almost half of the veterans with SCI participating in the 24-month IPS program as part of their ongoing SCI care achieved competitive employment, consistent with their expressed preferences at the start of the study. Among a subsample of veterans without TBI history enrolled as outpatients, employment rates were >50%. Time to first employment was highly variable, but quite long in many instances. These findings support offering continued IPS services as part of ongoing SCI care to achieve positive employment outcomes.

Predictors of employment for people with severe mental illness: results of an international six-centre randomised controlled trial

An international six-centre randomised controlled trial comparing individual placement and support (IPS) with usual vocational rehabilitation for people with serious mental illness found IPS to be more effective for all vocational outcomes. To determine which patients with severe mental illness do well in vocational services and which process and service factors are associated with better outcomes. Patient characteristics and early process variables were tested as predictors of employment outcomes. Service characteristics were explored as predictors of the effectiveness of IPS. Patients with previous work history, fewer met social needs and better relationships with their vocational workers were more likely to obtain employment and work for longer. Remission and swifter service uptake were associated with working more. Having an IPS service closer to the original IPS model was the only service characteristic associated with greater effectiveness. The IPS service was found to be more effective for all vocational outcomes. In addition, maintaining high IPS fidelity and targeting relational skills would be a valuable focus for all vocational interventions, leading to improved employment outcomes. Motivation to find work may be decreased by satisfaction with current life circumstances.

VR closure rates for two vocational models.

The Individual Placement and Support (IPS) model of supported employment is an evidence-based practice for individuals with psychiatric disabilities. To be financially viable, IPS programs require funding from the state-federal vocational rehabilitation (VR) system. However, some observers have questioned the compatibility of IPS and the VR system. Using a randomized controlled trial comparing IPS to a well-established vocational program called the Diversified Placement Approach (DPA), we examined rates of VR sponsorship and successful VR closures. We also describe the establishment of an active collaboration between a psychiatric rehabilitation agency and the state VR system to facilitate rapid VR sponsorship for IPS clients. Both IPS and DPA achieved a 44% rate of VR Status 26 closure when considering all clients entering the study. IPS and DPA averaged similar amount of time to achieve VR sponsorship. Time from vocational program entry to Status 26 was 51 days longer on average for IPS. Even though several IPS principles seem to run counter to VR practices, such as zero exclusion and rapid job search, we found IPS closure rates comparable to those for DPA, a vocational model that screens for readiness, provides prevocational preparation, and extensively uses agency-run businesses.