Individual Placement Support Research Articles

Monthly engagement with EIP keyworkers was associated with a five-fold increase in the odds of engagement with psychosocial interventions.

Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43-13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63-18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64-8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact.

Mental Health Outcomes for Young People Accessing Individual Placement Support Services: A Cohort Study.

Mental health problems and vocational disengagement are often linked for young people in a self-reinforcing cycle. Integrated Individual Placement and Support (IPS) services can help to not only overcome educational/vocational challenges but also improve mental wellbeing. In a matched cohort study, we compared improvement rates in mental health and wellbeing outcomes for young people aged 15 to 25 who had received at least two integrated IPS services with those who had received standard youth mental health services only. Data came from headspace, Australia's National Youth Mental Health Foundation. The sample comprised 2128 participants: 544 received integrated IPS services; 1584 received standard mental health services. Four out of five IPS clients (81%) achieved positive outcomes on at least one of three mental health measures, a significantly higher proportion than matched clients who received standard services (75%). Logistic regressions estimated a 22% to 36% higher likelihood of achieving significant improvement for IPS clients. Greater improvements were evident for quality of life and potentially psychosocial functioning, but not psychological distress. Integrating an IPS program within a clinical setting not only achieves positive vocational outcomes, but also supports improvements in quality of life, psychosocial functioning and psychological distress that are greater or equal to the outcomes achieved through standard clinical care.

Individual placement and support: A qualitative investigation of carers' experiences supporting someone experiencing mental illness into employment.

Unemployment rates for people living with mental illness remain persistently high. Individual Placement Support (IPS) is an evidence-based employment model that supports people with severe mental illness to gain employment. Although carers provide emotional and instrumental support for people with mental illness, there is limited research exploring carers' perspectives of IPS. To explore carers' perspectives of their experience as caregivers of individuals living with mental illness who have participated in IPS. This qualitative descriptive study gained carers' perspectives through semi-structured interviews. A convenience sample of eight carers was recruited via a community mental health service in Adelaide. Data were analysed thematically. Three main themes were identified: (1) employment benefits, (2) factors that may impact on employment, and (3) knowledge and opinions of IPS. Within each theme, four sub-themes emerged. This study addresses a gap in research and provides insights into carers' experiences of IPS. Increased communication and involvement of carers in IPS may benefit IPS participants and staff as carers provide invaluable additional insight into supporting individuals through their employment journey.

Dipendenze, empowerment, lavoro: attivazione di un'esperienza di laboratorio ispirata alla metodologia dell'Individual Placement and Support presso un Servizio delle Dipendenze

Addiction also has important consequences on the work sphere. This paper deals with a job search workshop inspired by the Individual Placement Support method. The results obtained in the nine months of experimentation on a small group of drug users appear promising, especially if one considers the proposed activity, which is a low-cost service for the Department of Drug Abuse.

Heterogeneity of quality of life in the later stages of first-episode psychosis recovery

PurposeFirst-episode psychosis (FEP) is characterised by wide heterogeneity in terms of symptom presentation and illness course. However, the heterogeneity of quality of life (QoL) in FEP is not well understood. We investigated whether subgroups can be identified using participants' responses on four QoL domains (physical health, psychological, social relationships, and environmental) 18-months into the recovery phase of FEP. We then examined the discriminant validity of these subgroups with respect to clinical, cognitive, and functioning features of FEP.MethodDemographic and clinical characteristics, QoL, cognition, and functioning were assessed in 100 people with FEP at the 18-month follow-up of a randomised controlled trial of Individual Placement Support, which aims to facilitate vocational recovery. QoL was measured using the World Health Organisation’s QoL-BRIEF. A two-stage clustering approach using Ward’s method and Squared Euclidean Distance with a k-means confirmation was conducted. Multinomial logistic regressions were used to establish external validity.ResultsThree QoL subgroups emerged: a ‘good’ subgroup with relatively high QoL across all domains (31%), an ‘intermediate’ subgroup with relatively low psychological QoL (48%) and a ‘poor’ subgroup with markedly low social relationship QoL (21%). Negative symptoms, depressive symptoms, social/occupational functioning, and social inclusion at follow-up predicted subgroup membership. Sensitivity analysis found similar results.ConclusionAlthough some individuals with FEP have QoL comparable to individuals without mental ill health, QoL can remain concerningly low despite treatment efforts. Future research on interventions that target factors associated with poor QoL, such as low social inclusion, is required to counteract prolonged poor QoL in FEP.

Supported employment for people with severe mental illness: a pilot study of an Italian social enterprise with a special ingredient

BackgroundPeople with mental disorders are far more likely to be unemployed than the general population. Two internationally recognized, evidence-based models of interventions for employment for people with severe mental health problems are Individual Placement Support and the Clubhouse. In Italy, a common model is the ‘social enterprise’ (SE), which is a programme run by non-profit organisations that help individuals with disabilities to be employed. Despite SEs spread and relevance in Italy, there are no studies about Italian samples. This paper reports on a pilot evaluation of psychosocial and work outcomes of a SE based in Verona, Italy. The study aims to investigate if people with SMI involved in SE job placements may achieve personal recovery and better outcomes over time, and in comparison with a comparable group of users.MethodsThis is a pilot descriptive study with three components. A longitudinal design that comprised a functioning description of 33 SE members with a psychiatric disability in two time-points (when they joined the SE—on average 5 years before the study recruitment, and at the study recruitment—year 2018); and a repeated collection of job details of the 33 members in three time points: 2 years before the recruitment,—year 2016; 1 year before the recruitment – year 2017; and at the recruitment—year 2018. An assessment at the recruitment time—year 2018, of SE users’ satisfaction with the job placement, symptoms, functioning, and quality of life (QoL). A cross-sectional study that compared the 33 SE members at the recruitment time—year 2018, with a matched group of people with the following criteria: living in local supported accommodations, being unemployed and not SE members. The two groups were compared on ratings of psychopathology, functioning, and QoL. Descriptive analyses were done.ResultsAt the recruitment time – year 2018, all SE participants showed a significant better functioning (p < 0.001) than when they joined the SE—when they had been employed for an average of 5 years. In comparison to the matched group, SE members had significantly better functioning (p = 0.001), psychopathology (p = 0.007), and QoL (p = 0.034). According to their SE membership status, participants comprised trainees (21.2%) and employee members (78.8%). Trainees compared to employees had lower autonomies, functioning, QoL and more severe psychopathology. Over the two years prior to study recruitment, trainees showed stable poor autonomies, while employee members showed a variation from average autonomies in the 2 years before the recruitment time – year 2016, to good ones at the recruitment time – year 2018. Over the two years, all SE members set increasing numbers of objectives in all three domains. All SE participants reported high levels of satisfaction with all aspects of the job placement.ConclusionsSE that provides tailored support to assist people to gain employment skills may be an effective component in helping recovery from SMI.

Cost-utility and cost-effectiveness of individual placement support and cognitive remediation in people with severe mental illness: Results from a randomized clinical trial.

Administrators and policymakers are increasingly interested in individual placement and support (IPS) as a way of helping people with severe mental illness (SMI) obtain employment or education. It is thus important to investigate the cost-effectiveness to secure that resources are being used properly. In a randomized clinical trial, 720 people diagnosed with SMI were allocated into three groups; (a) IPS, (b) IPS supplemented with cognitive remediation a social skills training (IPSE), and (c) Service as usual (SAU). Health care costs, municipal social care costs, and labor market service costs were extracted from nationwide registers and combined with data on use of IPS services. Cost-utility and cost-effectiveness analyses were conducted with two primary outcomes: quality-adjusted life years (QALY) and hours in employment. Incremental cost-effectiveness ratios (ICER) were computed for both QALY, using participant's responses to the EQ-5D questionnaire, and for hours in employment. Both IPS and IPSE were less costly, and more effective than SAU. Overall, there was a statistically significant cost difference of €9,543 when comparing IPS with SAU and €7,288 when comparing IPSE with SAU. ICER's did generally not render statistically significant results. However, there was a tendency toward the IPS and IPSE interventions being dominant, that is, cheaper with greater effect in health-related quality of life and hours in employment or education compared to usual care. Individual placement support with and without a supplement of cognitive remediation tends to be cost saving and more effective compared to SAU.

Occupational Participation of Persons with Schizophrenia: Exploring Issues of Job-Termination in Supported-Employment

Occupational participation in a supported-employment is a rehabilitation strategy to improve both vocational and non-vocational domains of people with psychiatric disabilities, enabling them to access and/or re-enter employment. This study aims to identify the factors associated with unsatisfactory job-termination among the participants of supported-employment to inform future intervention. A cross-sectional survey was conducted on a group (with a diagnosis of schizophrenia) who participated in a supported-employment program in a large psychiatry institution in Malaysia. Within the first week of job termination, interviews were conducted with three subgroups independently - the participants, the employers and the hospital employment specialists, using the Job-Termination Interview. Factors linked to job-termination and job-accommodation were analysed using univariate and multivariate logistic regression.Key reasons for job termination were- poor job performance (n = 32; 47.1%), interpersonal issue (n = 31; 45.6%), medical illnesses (n = 30, 44.1%), incompatibilities between work-schedule and environment (n = 30; 44.1%), and job-dissatisfaction (n = 29, 42.6%). Key factor for sustaining job/ job-accommodation was “higher pay” (n = 4; 33.3%). Overall, an unsatisfactory trend of job terminations was observed where many (n = 53; 77.9%) quit their job without a ready job at hand. Unsatisfactory job-terminations were associated with three factors -(i). Enrolment in the Individual Placement-Support (IPS) (Adj. OR = 10.70, 95% CI 1.32-86.98, p = 0.012), (ii). Unstable medical issues (Adj. OR = 22.51, 95% CI 1.74-291.08, p = 0.003), (iii). Interpersonal issues (OR = 18.26, 95% CI: 2.24-149.15, p &lt; 0.001).Most participants terminated their jobs in an unsatisfactory manner (77.9%). A high 63.2 percent quit their job without another ready-job at hand, while 14.7 percent were fired. Unsatisfactory job-endings were correlated to, poor job-performance, interpersonal problems and medical illnesses. Occupational re-entry intervention program must be tailored to the individual levels and needs, and be fully integrated within the clinical system to ensure job-person-environment fit, in order to improve job-experience and to lower unfavourable job terminations.

Disclosure of mental illness to prospective employers: Clinical, psychosocial, and work correlates in persons receiving supported employment

Deciding whether to disclose one's psychiatric disorder to a prospective employer is a complex decision for people with severe mental illness seeking to return to work, with potential advantages and disadvantages. The present study examined the rates, patterns, and correlates of disclosure in 51 participants (74.5% schizophrenia or schizoaffective disorder) receiving high fidelity Individual Placement Support (IPS) who obtained competitive work over a two-year study period. Most participants (64.7%) disclosed their psychiatric disorder in their first job, and there was a tendency for those with multiple jobs who did not disclose initially to shift to disclosure in subsequent jobs. Participants who disclosed for their first job had worse baseline cognitive scores on the Positive and Negative Syndrome Scale (PANSS), lower self-esteem, and poorer psychosocial functioning than those who did not disclose. However, participants who disclosed to their first employer were more likely to obtain jobs that matched their interests, and worked significantly longer than those who did not disclose (32.55 vs. 12.50 weeks, respectively). The findings suggest that individuals receiving supported employment who disclose their mental illness to prospective employers may have better work outcomes.

Developing an integrated approach across various government departments’ for service users with First Episode Psychosis to achieve employment and educational goals using Individual Placement Support model

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Effectiveness of work skills programmes for offenders with mental disorders: A systematic review

Academic literature and government initiatives have emphasised the importance of work as a means of improving health and reducing reoffending among offenders with mental disorders. Whilst a number of work skills programmes have shown promise for offenders more generally, evaluation of evidence for their effectiveness for those with a mental disorder is lacking, particularly in relation to improving employment outcomes. To assess the evidence on the effectiveness of work skills programmes for mentally disordered offenders. A systematic review of the literature was conducted by searching the following databases: PsycINFO, CINAHL, Cochrane Library (Trials Register), Embase and Medline, using search terms which included Work Skills Programme*, Offend* and Mental*. Any empirical comparison study of work skills programmes was included in this review. The primary outcome was employment. Secondary outcomes included employment outcomes, reoffending, education, mental state, substance misuse, global functioning, quality of life, acceptability, leaving the study early and cost effectiveness or other economic outcomes. Six articles met the inclusion criteria. Collectively they provided limited evidence that work skills programmes increase the likelihood of people with mental disorder who are offenders obtaining employment in the short term, but there are insufficient studies to determine the long-term impact of work skills programmes. There is modest evidence to support inclusion of specific work skills programmes in the treatment of offenders with mental disorder. Future studies should be of theoretically driven programmes, such as Individual Placement Support (IPS), and use a standard set of relevant outcome measures and long enough follow-up for testing the effectiveness of any programme on engagement in competitive, paid employment as, even if skilled, offenders with mental disorder must constitute a hard to place group. Copyright © 2015 John Wiley & Sons, Ltd.

Recommendations for a “Recovery” orientated apprenticeships scheme in mental health: a literature review

Purpose – Recovery principles have been central to debates in both the government and the mental health field, when thinking about the best way to support people who have experienced mental health distress into employment and education. The purpose of this paper is to review how this principle has been employed within the most effective approaches. This information will contribute to the development of the South London and Maudsley (SLaM) NHS Foundation Trust apprenticeship/return-to-work scheme for people who have experienced mental health distress. Design/methodology/approach – NHS evidence was used to undertake searches journals on CINAHL, EMBASE, PsycINFO, MEDLINE, HMIC, AMED, BNI, HEALTH BUSINESS ELITE and the Cochrane Library. Common search terms used were as follows: apprentice*; mental illness*; mental disorder*; psychiatric; psychosis; chronic mental disorder*; patient*; service user*; client*; return to work schemes; work; employment; unemployment; peer worker*; supported employment; vocational rehabilitation; peer training*; outcome measure*; recovery. Findings – Although the available literature writing about these employment schemes were not explicit in using Recovery as its guiding principle (i.e. Hope, Control and Opportunity), many of the participants in studies about a particular type of supported employment called Individual Placement Support (IPS) referred to recovery concepts in their narrative accounts, i.e. doing work that is meaningful, building self-esteem. This particular type of employment scheme was shown to have better outcomes for people who have experienced mental health difficulties then others schemes. The importance of employers having systems in place to support people’s control/self-management of their mental health condition was a key factor in helping them retain jobs once they have got them. Originality/value – The SLaM education and training service plans to develop a return to work programme for people who have had lived experience of mental health distress, through a workforce skills apprenticeships scheme. This is first apprenticeship scheme of this type in London. Therefore, this paper will review the literature on previous and current employment programmes for people who have experienced mental health distress, specifically highlighting what has worked well and what could be improved. This paper will also draw on the literature presented in this review and conclude on key points, which will contribute to the development of SLaM’s apprenticeships scheme. This literature review will form the basis of further research about the outcome/evaluation of the actual apprenticeship scheme after the first year.

Effects of integrated supported employment plus cognitive remediation training for people with schizophrenia and schizoaffective disorders

ObjectivesThe present study aims to investigate the synergistic effects of cognitive remediation training (CRT) on Integrated Supported Employment (ISE). ISE blends individual placement support service with work-related social skills training for Chinese people suffering from schizophrenia or schizoaffective disorder. MethodNinety participants with schizophrenia or schizoaffective disorders were recruited from two psychiatric outpatient services in Hong Kong. They were randomly assigned into the ISE+CRT (n=45) and ISE (n=45) conditions. Blinded assessments on vocational, clinical, psychological, and neurocognitive outcomes were conducted by independent assessors. The two groups were followed up at 7 and 11months. ResultsBoth groups yielded similar improvements across several outcome domains assessed immediately after the interventions and at 7 and 11month follow-ups, but no significant group differences were found. Significant positive trends over time in vocational, clinical and cognitive outcomes consistently favored the ISE+CRT condition. ConclusionWhile both the ISE+CRT and ISE groups demonstrated improvement in vocational, clinical, psychological, and neurocognitive outcomes, there was no evidence to show that cognitive remediation facilitated further improvement in these domains beyond gains associated with ISE alone. Further investigation is needed to fully exploit the synergistic potential of ISE combined with CRT, and to better understand which individuals experience a maximal benefit from the specific rehabilitation program components.

Bridging the science-to-service gap in schizophrenia care in the Netherlands: the Schizophrenia Quality Improvement Collaborative

Many patients with schizophrenia are not treated in line with evidence-based guidelines. This study examines the large-scale implementation of the National Multidisciplinary Guideline for schizophrenia in the Netherlands. /st> Observational, prospective study, with repeated measurement. Thirty mental healthcare teams in different regions of the Netherlands. Three hundred and fifty-nine clinicians with different professional backgrounds and 1489 patients suffering from schizophrenia. Six evidence-based interventions for schizophrenia were implemented, in the context of a quality improvement collaborative: assertive community treatment (ACT) or its adapted version functional assertive community treatment (FACT), cognitive behavioural therapy, psycho-education, family interventions, individual placement support and pharmacotherapy. Professional performance, social functioning and relapse rates. Improved professional performance, in line with guidelines. Availability of (F)ACT improved from 23 to 60%. Individual Placement Support improved from 20 to 53%. Complete care plans were composed for 38% of the patients and routine outcome monitoring was introduced in most teams. Social functioning improved slightly (HoNOS mean: from 6.2 to 5.6). Relapse rates did not improve during the course of the study. An intensive implementation programme can result in an improved delivery of evidence-based care, increased continuity of care and slightly improved outcomes for individuals with schizophrenia. More rigorous research designs have to confirm these findings.

Die ressourcenorientierte Integration chronisch psychisch Kranker in den Arbeitsmarkt über Ein-Euro-Jobs – erste Erfahrungen eines Modellprojekts

Until recently the vocational rehabilitation of chronic mentally ill often resulted in employment in the framework of sheltered workshops. There are an increased number of workshops and day clinics but in this context the patient does not come in contact with the everyday working environment. However, several multicenter studies demonstrated that "Individual Placement Support" (IPS) is more effective than vocational services. The aim of our project is to show that this concept is applicable even to patients with chronic and severe psychiatric diseases. We created "One-Euro-Jobs" for patients with chronic mental illnesses within regular employments in the confinements of our clinic. The choice of workplace was carried out according to the individual experience and knowledge and included the library, central buying and post office. Until now 15 mentally ill patients with an average disease duration of 11 years were included in the project. 1 patient discontinued within the first 3 weeks. The others were occupied on average for 9 months. Our project shows that integration of chronically mental ill patients in regular employment environments is possible. Concerns that the pressure and stress would be too extreme were proved to be unfounded.

Nonvocational outcomes for clients with~severe mental illness

This study focuses primarily on the non-vocational outcomes and the changes in psychosocial functioning of individuals with severe mental illness through competitive employment. Thirteen out of 56 participants in the Individual Placement & Support (IPS) group who were competitively employed were recruited from two community based mental health settings for the first interview. Eight of them who met the selection criteria for the second interview were interviewed again for comparison. Data were collected through a tailor-made interview guide during their third and sixth months of employment and were analyzed through an inductive process. Data analyses indicated that the employed participants in the IPS group showed positive outcomes in both personal well-being and self-efficacy after three months of employment, while positive and negative impacts were obtained after six months of employment. A dynamic model was suggested based on the findings to explain the job tenure of participants. Further integration of this model to the existing supported employment model is explored.

Vocational outcomes of an integrated supported employment program for individuals with persistent and severe mental illness

We examined the effectiveness of an integrated supported employment (ISE) program, which augments Individual Placement & Support (IPS) with social skills training (SST) in helping individuals with SMI achieve and maintain employment. A total of 163 participants were randomly assigned to three vocational rehabilitation programs: ISE, IPS, and traditional vocational rehabilitation (TVR). After fifteen months of services, ISE participants had significantly higher employment rates (78.8%) and longer job tenures (23.84 weeks) when compared with IPS and TVR participants. IPS participants demonstrated better vocational outcomes than TVR participants. The findings suggested that ISE enhances the outcomes of supported employment, endorsing the value of SST in vocational rehabilitation.

From caterpillars to butterflies

Modernising a sheltered workshop into a new, vocational service providing individual placement support was a painful but ultimately rewarding and worthwhile experience for Hilary Hawkes and the service users with whom she works.