1
|
Brinchmann B, Wittlund S, Lorentzen T, Moe C, McDaid D, Killackey E, Rinaldi M, Mykletun A. The societal impact of individual placement and support implementation on employment outcomes for young adults receiving temporary health-related welfare benefits: a difference-in-differences study. Psychol Med 2024; 54:1787-1795. [PMID: 38197145 DOI: 10.1017/s0033291723003744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Individual placement and support (IPS) is an evidence-based practice that helps individuals with mental illness gain and retain employment. IPS was implemented for young adults at a municipality level through a cross-sectoral collaboration between specialist mental healthcare, primary mental healthcare, and the government funded employment service (NAV). We investigated whether IPS implementation had a causal effect on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation (work assessment allowance, WAA) welfare benefit, measured at the societal level compared to municipalities that did not implement IPS. METHOD We used a difference in differences design to estimate the effects of IPS implementation on the outcome of workdays per year using longitudinal registry data. We estimate the average effect of being exposed to IPS implementation during four-years of implementation compared to ten control municipalities without IPS for all WAA recipients. RESULTS We found a significant, positive, causal effect on societal level employment outcomes of 5.6 (p = 0.001, 95% CI 2.7-8.4) increased workdays per year per individual, equivalent to 12.7 years of increased work in the municipality where IPS was implemented compared to municipalities without IPS. Three years after initial exposure to IPS implementation individuals worked, on average, 10.5 more days per year equating to 23.8 years of increased work. CONCLUSIONS Implementing IPS as a cross sectoral collaboration at a municipality level has a significant, positive, causal, societal impact on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation welfare benefit.
Collapse
Affiliation(s)
- Beate Brinchmann
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
| | - Sina Wittlund
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Institute of Sociology, University of Bergen, Bergen, Norway
- Department of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Thomas Lorentzen
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Institute of Sociology, University of Bergen, Bergen, Norway
| | - Cathrine Moe
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Faculty of Nursing and Health sciences, Nord University, Bodø, Norway
| | - David McDaid
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Eoin Killackey
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Miles Rinaldi
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- South West London and St George's Mental Health NHS Trust, London, UK
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Department of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
2
|
Drake RE, Bond GR. Individual placement and support: History, current status, and future directions. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e122. [PMID: 38867819 PMCID: PMC11114326 DOI: 10.1002/pcn5.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 06/14/2024]
Abstract
Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.
Collapse
Affiliation(s)
- Robert E. Drake
- Department of PsychiatryColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
- Westat CorporationRockvilleMarylandUSA
| | | |
Collapse
|
3
|
Bond GR, Mascayano F, Metcalfe JD, Riley J, Drake RE. Access, retention, and effectiveness of individual placement and support in the US: Are there racial or ethnic differences? JOURNAL OF VOCATIONAL REHABILITATION 2023. [DOI: 10.3233/jvr-230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND: Increased federal attention to advancing racial equity and support for underserved communities suggests the need for data on racial and ethnic differences in evidence-based employment services for people with serious mental illness. Individual Placement and Support (IPS) is an evidence-based model of supported employment for this population. OBJECTIVE: The objective was to identify differences based on race and ethnicity in IPS services. METHODS: This narrative review examined the empirical literature on IPS services in the U.S., assessing evidence of differences in access, retention, and outcomes for Black and Hispanic IPS clients, relative to non-Hispanic Whites. RESULTS: We identified 12 studies examining racial and ethnic differences in access (4 studies), retention (3 studies), and effectiveness (6 studies). The findings for access to IPS were mixed, with two studies showing no differences, one finding less access for Blacks, and another finding greater access for Blacks but less access for Hispanics. Three studies found better retention rates for clients enrolled in IPS regardless of race or ethnicity. Compared to clients receiving usual vocational services, all studies found better employment outcomes for IPS clients regardless of race or ethnicity. CONCLUSION: Unlike for most of health care, few racial and ethnic differences have been found for IPS employment services in the U.S. Access to IPS is inadequate for all groups, with conflicting evidence whether Blacks and Hispanics have even less access. Based on the available evidence, Black and Hispanic clients have comparable retention and employment outcomes in IPS as non-Hispanic White clients. State and local mental health leaders responsible for monitoring IPS outcomes should routinely report statistics on race and ethnicity. They should also give active attention to client needs and equity. Research designs should answer multifaceted questions regarding disparities for historically underserved populations.
Collapse
|
4
|
Abstract
AIMS Individual placement and support (IPS) is an evidence-based service model to support people with mental disorders in obtaining and sustaining competitive employment. IPS is increasingly offered to a broad variety of service users. In this meta-analysis we analysed the relative effectiveness of IPS for different subgroups of service users both based on the diagnosis and defined by a range of clinical, functional and personal characteristics. METHODS We included randomised controlled trials that evaluated IPS for service users diagnosed with any mental disorder. We examined effect sizes for the between-group differences at follow-up for three outcome measures (employment rate, job duration and wages), controlling for methodological confounders (type of control group, follow-up duration and geographic region). Using sensitivity analyses of subgroup differences, we analysed moderating effects of the following diagnostic, clinical, functional and personal characteristics: severe mental illness (SMI), common mental disorders (CMD), schizophrenia spectrum disorders, mood disorders, duration of illness, the severity of symptoms, level of functioning, age, comorbid alcohol and substance use, education level and employment history. RESULTS IPS is effective in improving employment outcomes compared to the control group in all subgroups, regardless of any methodological confounder. However, IPS was relatively more effective for service users with SMIs, schizophrenia spectrum disorders and a low symptom severity. Although IPS was still effective for people with CMD and with major depressive disorder, it was relatively less effective for these subgroups. IPS was equally effective after both a short and a long follow-up period. However, we found small, but clinically not meaningful, differences in effectiveness of IPS between active and passive control groups. Finally, IPS was relatively less effective in European studies compared to non-European studies, which could be explained by a potential benefits trap in high welfare countries. CONCLUSIONS IPS is effective for all different subgroups, regardless of diagnostic, clinical, functional and personal characteristics. However, there might be a risk of false-positive subgroup outcomes and results should be handled with caution. Future research should focus on whether, and if so, how the IPS model should be adapted to better meet the vocational needs of people with CMD and higher symptom severity.
Collapse
|
5
|
Probyn K, Engedahl MS, Rajendran D, Pincus T, Naeem K, Mistry D, Underwood M, Froud R. The effects of supported employment interventions in populations of people with conditions other than severe mental health: a systematic review. Prim Health Care Res Dev 2021; 22:e79. [PMID: 34879882 PMCID: PMC8724223 DOI: 10.1017/s1463423621000827] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/20/2021] [Accepted: 11/15/2021] [Indexed: 11/07/2022] Open
Abstract
AIM To assess the effectiveness of supported employment interventions for improving competitive employment in populations of people with conditions other than only severe mental illness. BACKGROUND Supported employment interventions have been extensively tested in severe mental illness populations. These approaches may be beneficial outside of these populations. METHODS We searched PubMed, Embase, CINAHL, PsycInfo, Web of Science, Scopus, JSTOR, PEDro, OTSeeker, and NIOSHTIC for trials including unemployed people with any condition and including severe mental illness if combined with other co-morbidities or other specific circumstances (e.g., homelessness). We excluded trials where inclusion was based on severe mental illness alone. Two reviewers independently assessed risk of bias (RoB v2.0) and four reviewers extracted data. We assessed rates of competitive employment as compared to traditional vocational rehabilitation or waiting list/services as usual. FINDINGS Ten randomised controlled trials (913 participants) were included. Supported employment was more effective than control interventions for improving competitive employment in seven trials: in people with affective disorders [risk ratio (RR) 10.61 (1.49, 75.38)]; mental disorders and justice involvement [RR 4.44 (1.36,14.46)]; veterans with posttraumatic stress disorder (PTSD) [RR 2.73 (1.64, 4.54)]; formerly incarcerated veterans [RR 2.17 (1.09, 4.33)]; people receiving methadone treatment [RR 11.5 (1.62, 81.8)]; veterans with spinal cord injury at 12 months [RR 2.46 (1.16, 5.22)] and at 24 months [RR 2.81 (1.98, 7.37)]; and young people not in employment, education, or training [RR 5.90 (1.91-18.19)]. Three trials did not show significant benefits from supported employment: populations of workers with musculoskeletal injuries [RR 1.38 (1.00, 1.89)]; substance abuse [RR 1.85 (0.65, 5.41)]; and formerly homeless people with mental illness [RR 1.55 (0.76, 3.15)]. Supported employment interventions may be beneficial to people from more diverse populations than those with severe mental illness alone. Defining competitive employment and increasing (and standardising) measurement of non-vocational outcomes may help to improve research in this area.
Collapse
Affiliation(s)
- Katrin Probyn
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, UK
| | | | | | - Tamar Pincus
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Khadija Naeem
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, UK
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- University Hospitals Coventry & Warwickshire, University of Warwick, Coventry, UK
| | - Robert Froud
- Department of Health Sciences, Kristiana University College, Oslo, Norway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
6
|
Metcalfe JD, Drake RE. Participation in Individual Placement and Support in the Supported Employment Demonstration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:521-529. [PMID: 34855098 DOI: 10.1007/s10488-021-01180-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
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 24 months 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.
Collapse
Affiliation(s)
- Justin D Metcalfe
- Westat Inc, 85 Mechanic Street, Suite C3-1, Box4A, Lebanon, NH, 03766, USA.
| | - Robert E Drake
- Westat Inc, 85 Mechanic Street, Suite C3-1, Box4A, Lebanon, NH, 03766, USA
| |
Collapse
|
7
|
Hellström L, Pedersen P, Christensen TN, Wallstroem IG, Bojesen AB, Stenager E, Bejerholm U, van Busschbach J, Michon H, Mueser KT, Reme SE, White S, Eplov LF. Vocational Outcomes of the Individual Placement and Support Model in Subgroups of Diagnoses, Substance Abuse, and Forensic Conditions: A Systematic Review and Analysis of Pooled Original Data. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:699-710. [PMID: 33661452 DOI: 10.1007/s10926-021-09960-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To investigate the effect of Individual Placement and Support (IPS) according to diagnoses of schizophrenia, bipolar disorder, major depression, substance use disorders, or forensic psychiatric conditions. METHODS A systematic search of the literature was conducted in June 2017 and repeated in December 2020. The systematic review included 13 studies. Analyses of pooled original data were based on the six studies providing data (n = 1594). No studies on forensic psychiatric conditions were eligible. Hours and weeks worked were analyzed using linear regression. Employment, and time to employment was analyzed using logistic regression, and cox-regression, respectively. RESULTS The effects on hours and weeks in employment after 18 months were comparable for participants with schizophrenia, and bipolar disorder but only statistically significant for participants with schizophrenia compared to services as usual (SAU) (EMD 109.1 h (95% CI 60.5-157.7), 6.1 weeks (95% CI 3.9-8.4)). The effect was also significant for participants with any drug use disorder (121.2 h (95% CI 23.6-218.7), 6.8 weeks (95% CI 1.8-11.8)). Participants with schizophrenia, bipolar disorder, and any drug use disorder had higher odds of being competitively employed (OR 2.1 (95% CI 1.6-2.7); 2.4 (95% CI 1.3-4.4); 3.0 (95% CI 1.5-5.8)) and returned to work faster than SAU (HR 2.1 (95% CI 1.6-2.6); 1.8 (95% CI 1.1-3.1); 3.0 (95% CI 1.6-5.7)). No statistically significant effects were found regarding depression. CONCLUSIONS IPS was effective regarding schizophrenia, bipolar disorder, and substance use disorder; however, the effect on hours, and weeks worked was not statistically significant regarding bipolar disorder. For people with depression the impact of IPS remains inconclusive. Non-significant results may be due to lack of power. TRIAL REGISTRATION PROSPERO protocol nr. CRD42017060524.
Collapse
Affiliation(s)
- Lone Hellström
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark.
| | - Pernille Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Thomas Nordahl Christensen
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
- Institute of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Iben Gammelgaard Wallstroem
- Research Unit of Mental Health, Odense, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Bo Bojesen
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
| | - Elsebeth Stenager
- Research Unit of Mental Health, Aabenraa, Institute of Regional Health Services, University of Southern Denmark, Odense, Denmark
| | | | - Jooske van Busschbach
- University Medical Center Groningen, Groningen, Netherlands
- University Center of Psychiatry, Groningen, Netherlands
- Department of Movement and Education, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | | | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, USA
| | | | - Sarah White
- Population Health Research Institute St George's, University of London, London, UK
| | - Lene Falgaard Eplov
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
| |
Collapse
|
8
|
Wallstroem IG, Pedersen P, Christensen TN, Hellström L, Bojesen AB, Stenager E, White S, Mueser KT, Bejerholm U, van Busschbach JT, Michon H, Eplov LF. A Systematic Review of Individual Placement and Support, Employment, and Personal and Clinical Recovery. Psychiatr Serv 2021; 72:1040-1047. [PMID: 33940948 DOI: 10.1176/appi.ps.202000070] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this review was to assess associations between Individual Placement and Support (IPS), employment, and personal and clinical recovery among persons with severe mental illness at 18-month follow-up. METHODS A systematic literature search identified randomized controlled trials (RCTs) comparing IPS with services as usual. Outcomes were self-esteem, empowerment, quality of life, symptoms of depression, negative or psychotic symptoms, anxiety, and level of functioning. A total of six RCTs reported data suitable for meta-analyses, and pooled original data from five studies were also analyzed. RESULTS Meta-analyses and analyses of pooled original data indicated that receipt of the IPS intervention alone did not improve any of the recovery outcomes. Participants who worked during the study period, whether or not they were IPS participants, experienced improved negative symptoms, compared with those who did not work (standardized mean difference [SMD]=-0.41, 95% confidence interval [CI]=-0.56, -0.26). For participants who worked, whether or not they were IPS participants, improvements were also found in level of functioning and quality of life (SMD=0.59, 95% CI=0.42, 0.77 and SMD=0.34, 95% CI=0.14, 0.54, respectively). CONCLUSIONS Employment was associated with improvements in negative symptoms, level of functioning, and quality of life.
Collapse
Affiliation(s)
- Iben Gammelgaard Wallstroem
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Pernille Pedersen
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Thomas Nordahl Christensen
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Lone Hellström
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Anders Bo Bojesen
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Elsebeth Stenager
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Sarah White
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Kim T Mueser
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Ulrika Bejerholm
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Jooske Tanna van Busschbach
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Harry Michon
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Lene Falgaard Eplov
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| |
Collapse
|
9
|
Abidin MZRZ, Yunus FW, Rasdi HFM, Kadar M. Employment programmes for schizophrenia and other severe mental illness in psychosocial rehabilitation: a systematic review. Br J Occup Ther 2021. [DOI: 10.1177/0308022620980683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Employment programmes for people with mental illness vary widely in range, but nonetheless all share the same objectives of restoring or initiating vocational roles to promote recovery in psychosocial rehabilitation. The current interventions available usually focus on the specific vocational outcomes of the intervention rather than focusing holistically on the client’s needs. Method This review aimed to examine the effectiveness of intervention programmes and determine the best intervention for schizophrenia and other severe mental illness, considering both vocational and non-vocational outcomes. Searching five databases – CINAHL, Medline via Ovid, Scopus, OT Seeker and Web of Science – a total of 3108 studies was identified; 24 met the selection criteria and were reviewed. Interventions were categorised into five major programmes of supported employment, integrated supported employment, vocational rehabilitation, cognitive intervention and virtual reality-based vocational training. Results Integrated supported employment was found to be the most effective approach for a vocational outcome. However, evidence concerning non-vocational outcomes of employment programmes and the use of cognitive training remains unclear. Conclusion Clinicians are advised to consider the needs and preferences of the client before selecting the best intervention programme. More research is needed to determine the applicability and the efficacy of intervention programmes.
Collapse
Affiliation(s)
- Muhammad Zairul Rezal Zainol Abidin
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Farahiyah Wan Yunus
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hanif Farhan Mohd Rasdi
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Masne Kadar
- Centre for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Occupational Therapy Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
10
|
Rössler W, Kawohl W, Nordt C, Haker H, Rüsch N, Hengartner MP. 'Placement budgets' for supported employment: impact on employment rates in a multicentre randomised controlled trial. Br J Psychiatry 2020; 216:308-313. [PMID: 31256765 DOI: 10.1192/bjp.2019.154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The most effective rehabilitation model for job (re-)entry of people with mental illness is supported employment. A barrier to introducing supported employment into standard care is its temporally unlimited provision, which conflicts with health and social legislation in many European countries. AIMS To test the impact of different 'placement budgets', i.e. a predefined maximum time budget for job seeking until take-up of competitive employment. METHOD Participants (116) were randomly assigned to 25 h, 40 h or 55 h placement budgets in an intent-to-treat analysis. We applied the individual placement and support model over 24 months, following participants for 36 months. Primary outcome was employment in the labour market for at least 3 months. RESULTS The proportion of participants obtaining competitive employment was 55.1% in the 25 h group, 37.8% in the 40 h group and 35.8% in the 55 h group. In a Cox regression analysis, time to employment was slightly lower in the 25 h group relative to the 40 h (hazard ratio 1.78, 95% CI 0.88-3.57, P = 0.107) and 55 h groups (hazard ratio 1.74, 95% CI 0.86-3.49, P = 0.122), but this was not statistically significant. The vast majority of all participants who found a job did so within the first 12 months (80.4%). CONCLUSION A restricted time budget for job finding and placement does not affect the rate of successful employment. In accordance with legislation, a restriction of care provision seems justified and enhances the chances of supported employment being introduced in statutory services.
Collapse
Affiliation(s)
- Wulf Rössler
- Professor, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil; and Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Wolfram Kawohl
- Senior Consultant, Psychiatrische Dienste Aargau AG, Klinik für Psychiatrie und Psychotherapie, Switzerland
| | - Carlos Nordt
- Senior Researcher, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Switzerland
| | - Helene Haker
- Senior Researcher, Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland
| | - Nicolas Rüsch
- Professor, Section of Public Mental Health, University of Ulm, Germany
| | - Michael P Hengartner
- Senior Lecturer, Department of Applied Psychology, Zurich University of Applied Sciences, Switzerland
| |
Collapse
|
11
|
Brinchmann B, Widding-Havneraas T, Modini M, Rinaldi M, Moe CF, McDaid D, Park AL, Killackey E, Harvey SB, Mykletun A. A meta-regression of the impact of policy on the efficacy of individual placement and support. Acta Psychiatr Scand 2020; 141:206-220. [PMID: 31733146 DOI: 10.1111/acps.13129] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS The evidence for efficacy of IPS is very strong. The efficacy of IPS can be generalized between countries.
Collapse
Affiliation(s)
- B Brinchmann
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,UiT - The Arctic University of Norway, Tromsø, Norway
| | - T Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital, Bergen, Norway
| | - M Modini
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Concord Centre for Mental Health, NSW Health, Sydney, NSW, Australia
| | - M Rinaldi
- South West London & St George's Mental Health NHS Trust, London, UK
| | - C F Moe
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - D McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-L Park
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic, Australia
| | - S B Harvey
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - A Mykletun
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,UiT - The Arctic University of Norway, Tromsø, Norway.,Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital, Bergen, Norway.,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
12
|
Nuechterlein KH, Subotnik KL, Ventura J, Turner LR, Gitlin MJ, Gretchen-Doorly D, Becker DR, Drake RE, Wallace CJ, Liberman RP. Enhancing return to work or school after a first episode of schizophrenia: the UCLA RCT of Individual Placement and Support and Workplace Fundamentals Module training. Psychol Med 2020; 50:20-28. [PMID: 30606273 PMCID: PMC6620168 DOI: 10.1017/s0033291718003860] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling. METHODS Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication. RESULTS The IPS-WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS-WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS-WFM intervention (45 v. 26 weeks, p < 0.004). CONCLUSIONS The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.
Collapse
Affiliation(s)
- Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Luana R. Turner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Michael J. Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Denise Gretchen-Doorly
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Deborah R. Becker
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Robert E. Drake
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Charles J. Wallace
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Robert P. Liberman
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| |
Collapse
|
13
|
Terry R, Townley G. Exploring the Role of Social Support in Promoting Community Integration: An Integrated Literature Review. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:509-527. [PMID: 31116874 DOI: 10.1002/ajcp.12336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Community integration has emerged as a priority area among mental health advocates, policy makers, and researchers (Townley, Miller, & Kloos, 2013; Ware, Hopper, Tugenberg, Dickey, & Fisher, 2007). Past research suggests that social support influences community integration for individuals with serious mental illnesses (Davidson, Haglund, Stayner, Rakfeldt, Chinman, & Tebes, 2001; Davidson, Stayner, Nickou, Styron, Rowe, & Chinman, 2001; Wong & Solomon, 2002), but there has not yet been a systematic review on this topic. Therefore, the purpose of this paper was to explore the influence of social support on community integration through a review of the existing literature. An extensive literature search was conducted, resulting in 32 articles that met the search criteria. These articles were organized into three categories: defining community integration, supportive relationships, and mental health services. The search results are analyzed according to the types of support being provided. Article strengths, limitations, implications, and future directions are also addressed. Overall, the findings of this review suggest that social support, which may be provided by a variety of individuals and services, plays an important role in promoting community integration for individuals with serious mental illnesses. Therefore, as community mental health research and practice continues to promote community integration for individuals with serious mental illnesses, the mental health field should emphasize the importance of social support as a key factor influencing community integration.
Collapse
Affiliation(s)
- Rachel Terry
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Greg Townley
- Department of Psychology, Portland State University, Portland, OR, USA
| |
Collapse
|
14
|
Vukadin M, Schaafsma FG, Vlaar SJ, van Busschbach JT, van de Ven PM, Michon HWC, Anema JR. Work Motivation and Employment Outcomes in People with Severe Mental Illness. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:803-809. [PMID: 31154594 PMCID: PMC6838012 DOI: 10.1007/s10926-019-09839-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose To study associations between the level of self-reported work motivation and employment outcomes in people with severe mental illness (SMI) enrolled in a vocational rehabilitation program. Methods Data of 151 study participants, collected from a randomised controlled trial with a 30-month follow-up period, were used for a secondary data analysis. Multiple logistic regression, linear regression and cox regression analyses were performed to analyse the association between the level of work motivation at baseline and job obtainment, duration of job, and time until job obtainment during the 30-month follow-up period. Results No statistically significant associations were found between the level of work motivation and job obtainment (OR 1.83, 95% CI 0.55-6.06, p = 0.32), job duration (B = - 0.74, 95% CI - 2.37 to 0.89, p = 0.37, R-squared = 0.03), or time until job obtainment (HR = 1.53, 95% CI 0.64-3.68, p = 0.34). Conclusions The results of this study show no statistically significant associations between the level of work motivation and employment outcomes in people with SMI enrolled in a vocational rehabilitation program. These associations may be underestimated due to range restriction of the work motivation's level. Further research is recommended to increase knowledge on the associations between work motivation and employment outcomes, as it could be relevant for further understanding success in vocational rehabilitation.
Collapse
Affiliation(s)
- Miljana Vukadin
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands.
- Research Center for Insurance Medicine: collaboration between AMC- UMCG - UWV - VUmc, Amsterdam, The Netherlands.
| | - Frederieke G Schaafsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands
- Research Center for Insurance Medicine: collaboration between AMC- UMCG - UWV - VUmc, Amsterdam, The Netherlands
| | - Sandra J Vlaar
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands
| | - Jooske T van Busschbach
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Windesheim University of Applied Sciences, Campus 2, 8000 GB, Zwolle, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands
| | - Harry W C Michon
- Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, The Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands
- Research Center for Insurance Medicine: collaboration between AMC- UMCG - UWV - VUmc, Amsterdam, The Netherlands
| |
Collapse
|
15
|
DeTore NR, Hintz K, Khare C, Mueser KT. Disclosure of mental illness to prospective employers: Clinical, psychosocial, and work correlates in persons receiving supported employment. Psychiatry Res 2019; 273:312-317. [PMID: 30677720 DOI: 10.1016/j.psychres.2019.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
Abstract
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.
Collapse
Affiliation(s)
- Nicole R DeTore
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
| | - Kathryn Hintz
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
| | - Chitra Khare
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychological and Brain Sciences, and Psychiatry, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA.
| |
Collapse
|
16
|
Frederick DE, VanderWeele TJ. Supported employment: Meta-analysis and review of randomized controlled trials of individual placement and support. PLoS One 2019; 14:e0212208. [PMID: 30785954 PMCID: PMC6382127 DOI: 10.1371/journal.pone.0212208] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/29/2019] [Indexed: 11/17/2022] Open
Abstract
Supported employment is a treatment whereby those with severe mental illness (or other disabilities) receive aid searching for competitive employment and mental health (or other) treatments concurrently. The most popular implementation of supported employment is individual placement and support (IPS). We conducted meta-analytic analyses of the randomized controlled trials of IPS. We found that subjects in IPS, compared to usual treatment conditions, had better vocational outcomes (obtained any competitive employment: RR = 1.63, 95%CI = [1.46, 1.82]; job tenure: d = 0.55, 95%CI = [0.33, 0.79]; job length: d = 0.46, 95%CI = [0.35, 0.57]; income: d = 0.48, 95%CI = [0.36, 0.59]) Non-vocational outcomes estimates, while favoring IPS, included the null (quality of life: d = 0.30, 95%CI = [-0.07, 0.67]; global functioning: d = 0.09, 95%CI = [-0.09, 0.27]; mental health: d = 0.03, 95%CI = [-0.15, 0.21]). Analysis of the expected proportion of studies with a true effect on non-vocational outcomes with d>0.2 showed some reason to expect a possible improvement for quality of life for at least some settings (Prop = 0.57, 95%CI = [0.30, 0.84]).
Collapse
Affiliation(s)
- Donald E. Frederick
- Human Flourishing Program, The Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States of America
| | - Tyler J. VanderWeele
- Human Flourishing Program, The Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| |
Collapse
|
17
|
Drake RE, Becker DR, Bond GR. Introducing Individual Placement and Support (IPS) supported employment in Japan. Psychiatry Clin Neurosci 2019; 73:47-49. [PMID: 30370626 DOI: 10.1111/pcn.12792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/05/2018] [Accepted: 10/12/2018] [Indexed: 11/30/2022]
Abstract
Individual Placement and Support is a standardized model of supported employment, developed initially for people with serious mental disorders and now applied to people with a range of disabilities. More than two dozen randomized controlled trials around the world show that the approach helps a majority of participants to succeed in competitive employment. Individual Placement and Support is spreading rapidly across the USA and in many other high-income countries, with facilitation by an international learning community.
Collapse
|
18
|
Rodríguez Pulido F, Caballero Estebaranz N, Tallo Aldana E, Méndez Abad ME, Hernández Álvarez-Sotomayor MC, López Reig S, Vílchez de León PI, González-Dávila E. Efectividad de una estrategia de apoyo individualizado al empleo para personas con trastornos mentales graves. GACETA SANITARIA 2018; 32:513-518. [DOI: 10.1016/j.gaceta.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
|
19
|
Petrakis M, Stirling Y, Higgins K. Vocational support in mental health service delivery in Australia. Scand J Occup Ther 2018; 26:535-545. [PMID: 30301392 DOI: 10.1080/11038128.2018.1498918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Individuals experiencing severe and persistent mental illness report a desire to gain and sustain work. Individual Placement and Support (IPS) is an evidence-based approach to vocational rehabilitation to support competitive employment outcomes. AIM/OBJECTIVE This study aimed to evaluate whether a joint-governance management partnership, between a clinical adult mental health and an employment service, could deliver a sustained IPS program in Australia. MATERIALS AND METHOD The methodology entailed a Clinical Data Mining approach, to examine records from seven years of implementation of IPS in one setting within an Australian public mental health service context. RESULTS/FINDINGS Despite the prevalence of schizophrenia spectrum diagnoses and an older mean age (39 years), indicating that a large proportion of the cohort had experienced serious mental illness for over twenty years, findings were that 46.3% of participants achieved employment. CONCLUSIONS This is an excellent result and is comparable to the only randomised control trial, with adult services, in the Australian context, which found a 42.5% employment rate possible under IPS compared with just 23.5% with referral to external employment services. SIGNIFICANCE More extensive trialling of IPS across clinical services is required, in Australia and internationally, including fidelity protocols, for knowledge translation to be achieved.
Collapse
Affiliation(s)
- Melissa Petrakis
- a Mental Health Service , St Vincent's Hospital (Melbourne) , Melbourne , Australia.,b Department of Social Work, Faculty of Medicine, Nursing and Health Sciences , Monash University , Melbourne , Australia
| | - Yolande Stirling
- a Mental Health Service , St Vincent's Hospital (Melbourne) , Melbourne , Australia.,b Department of Social Work, Faculty of Medicine, Nursing and Health Sciences , Monash University , Melbourne , Australia
| | - Kate Higgins
- c Quality & Service Development , Wellways Australia , Melbourne , Australia
| |
Collapse
|
20
|
Porter S, Bejerholm U. The effect of individual enabling and support on empowerment and depression severity in persons with affective disorders: outcome of a randomized control trial. Nord J Psychiatry 2018; 72:259-267. [PMID: 29382250 DOI: 10.1080/08039488.2018.1432685] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effect of Individual Enabling and Support (IES) on empowerment and depression severity as compared to Traditional Vocational Rehabilitation (TVR) in people with affective disorders at 12 months follow-up. Additionally, longitudinal changes within the intervention groups and the correlation over time between empowerment and depression severity were evaluated. METHOD A single-blind randomized controlled trial of two intervention groups, IES (n = 33) and TVR (n = 28), was performed with measurement points at baseline, 6, and 12 months. Individuals with affective disorders, including depression and bipolar disorder diagnoses were included. The Empowerment Scale and Montgomery-Åsberg Depression Self-Rating Scale were administered, and Intention-To-Treat analysis was applied. The study was registered with the trial number ISRCTN93470551. RESULT There was a statistically significant difference between the intervention groups on empowerment and depression severity at 12 months. Within-group analysis showed that IES-participants increased their perceived empowerment and decreased their depression severity between measurement points, this was not seen among TVR-participants. A moderate, inverse relationship was detected between empowerment and depression. CONCLUSION IES is more effective in increasing empowerment and decreasing depression severity after a 12-month intervention than is TVR. This study was limited by a small sample size and larger trials in different contexts are needed.
Collapse
Affiliation(s)
- Susann Porter
- a Department of Health Sciences, Mental Health Activity and Participation Medical Faculty , Lund University , Lund , Sweden
| | - Ulrika Bejerholm
- a Department of Health Sciences, Mental Health Activity and Participation Medical Faculty , Lund University , Lund , Sweden
| |
Collapse
|
21
|
Davis LL, Kyriakides TC, Suris AM, Ottomanelli LA, Mueller L, Parker PE, Resnick SG, Toscano R, Scrymgeour AA, Drake RE. Effect of Evidence-Based Supported Employment vs Transitional Work on Achieving Steady Work Among Veterans With Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2018; 75:316-324. [PMID: 29490371 PMCID: PMC5875356 DOI: 10.1001/jamapsychiatry.2017.4472] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) often interferes with a person's ability to obtain or sustain employment, which leads to premature exit from the labor force and reduced income. OBJECTIVE To determine whether individual placement and support (IPS)-supported employment is more effective than stepwise vocational rehabilitation involving transitional work assignments at helping veterans with PTSD attain steady, competitive employment. DESIGN, SETTING, AND PARTICIPANTS The Veterans Individual Placement and Support Toward Advancing Recovery (VIP-STAR) study was a prospective, multisite, randomized clinical trial that included 541 unemployed veterans with PTSD at 12 Veterans Affairs medical centers. Data were collected from December 23, 2013, to May 3, 2017. Intent-to-treat analysis was performed. INTERVENTIONS Individual placement and support is a supported employment intervention that rapidly engages people with disabilities in community job development to obtain work based on their individual job preferences. Transitional work is a stepwise vocational rehabilitation intervention that assigns people temporarily to noncompetitive jobs as preparation for competitive employment in the community. MAIN OUTCOMES AND MEASURES A priori hypotheses were that, compared with those in transitional work, more participants in the IPS group would become steady workers (primary) and earn more income from competitive jobs (secondary) over 18 months. Steady worker was defined as holding a competitive job for at least 50% of the 18-month follow-up period. RESULTS A total of 541 participants (n = 271 IPS; n = 270 transitional work) were randomized. Mean (SD) age was 42.2 (11) years; 99 (18.3%) were women, 274 (50.6%) were white, 225 (41.6%) were African American, and 90 (16.6%) were of Hispanic, Spanish, or Latino ethnicity. More participants in the IPS group achieved steady employment than in the transitional work group (105 [38.7%] vs 63 [23.3%]; odds ratio, 2.14; 95% CI, 1.46-3.14). A higher proportion of IPS participants attained any competitive job (186 [68.6%] vs 154 [57.0%]; P = .005) and had higher cumulative earnings from competitive jobs (median [interquartile range] $7290 [$23 174] in IPS vs $1886 [$17 167] in transitional work; P = .004). CONCLUSIONS AND RELEVANCE This multisite trial demonstrated significantly greater effectiveness of IPS-supported employment over stepwise transitional work vocational rehabilitation for veterans living with chronic PTSD. The results provide supporting evidence for increasing access to IPS for veterans living with PTSD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01817712.
Collapse
Affiliation(s)
- Lori L. Davis
- Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama,Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa
| | - Tassos C. Kyriakides
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Alina M. Suris
- Department of Psychiatry, VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas
| | - Lisa A. Ottomanelli
- Health Services Research and Development, Center of Innovation for Disability and Rehabilitation Research, University of South Florida, Tampa,Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa
| | - Lisa Mueller
- Department of Psychology, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts,Veterans Integrated Service Network (VISN) 1 Mental Illness Research Education and Clinical Center, Bedford, Massachusetts
| | - Pamela E. Parker
- Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa
| | - Sandra G. Resnick
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut,VISN 1 Mental Illness Research Education and Clinical Center, West Haven, Connecticut
| | - Richard Toscano
- Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama
| | - Alexandra A. Scrymgeour
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico Healthcare System, Albuquerque
| | - Robert E. Drake
- Individual Placement and Support Employment Center, Rockville Institute, Westat, Rockville, Maryland
| | | |
Collapse
|
22
|
Iorfino F, Hermens DF, Cross SPM, Zmicerevska N, Nichles A, Badcock CA, Groot J, Scott EM, Hickie IB. Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study. BMJ Open 2018; 8:e020678. [PMID: 29588325 PMCID: PMC5875606 DOI: 10.1136/bmjopen-2017-020678] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/06/2018] [Accepted: 02/16/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Mental disorders typically emerge during adolescence and young adulthood and put young people at risk for prolonged socioeconomic difficulties. This study describes the longitudinal course of social and occupational functioning of young people attending primary care-based, early intervention services. DESIGN A longitudinal study of young people receiving mental healthcare. SETTING Data were collected between January 2005 and August 2017 from a designated primary care-based mental health service. PARTICIPANTS 554 young people (54% women) aged 12-32 years. MEASURES A systematic medical file audit collected clinical and functional information at predetermined time intervals (ie, 3 months to 5+ years) using a clinical pro forma. Group-based trajectory modelling (GBTM) was used to identify distinct trajectories of social and occupational functioning over time (median number of observations per person=4; median follow-up time=23 months). RESULTS Between first clinical contact and time last seen, 15% of young people had reliably deteriorated, 23% improved and 62% did not demonstrate substantive change in function. Of the whole cohort, 69% had functional scores less than 70 at time last seen, indicative of ongoing and substantive impairment. GBTM identified six distinct functional trajectories whereby over 60% had moderate-to-serious functional impairment at entry and remained chronically impaired over time; 7% entered with serious impairment and deteriorated further; a quarter were mildly impaired at entry and functionally recovered and only a small minority (4%) presented with serious impairments and functionally improved over time. Not being in education, employment or training, previous hospitalisation and a younger age at baseline emerged as significant predictors of these functional trajectories. CONCLUSION Young people with emerging mental disorders have significant functional impairment at presentation for care, and for the majority, it persists over the course of clinical care. In addition to providing clinical care earlier in the course of illness, these data suggest that more sophisticated and more intensive individual-level and organisational strategies may be required to achieve significant and sustained functional improvements.
Collapse
Affiliation(s)
- Frank Iorfino
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel F Hermens
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Shane, PM Cross
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Natalia Zmicerevska
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alissa Nichles
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caro-Anne Badcock
- Statistical Consulting, The University of Sydney, Sydney, New South Wales, Australia
| | - Josine Groot
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth M Scott
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
23
|
Linnemørken LTB, Sveinsdottir V, Knutzen T, Rødevand L, Hernæs KH, Reme SE. Protocol for the Individual Placement and Support (IPS) in Pain Trial: A randomized controlled trial investigating the effectiveness of IPS for patients with chronic pain. BMC Musculoskelet Disord 2018; 19:47. [PMID: 29433493 PMCID: PMC5809966 DOI: 10.1186/s12891-018-1962-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Work disability involves large costs to the society as well as to the individual. Work disability is common among people with chronic pain conditions, yet few effective interventions exist. Individual Placement and Support (IPS) is an evidence-based work rehabilitation model originally developed to help people with severe mental illness obtain and maintain employment. The effectiveness of IPS for patients with severe mental illness is well documented, but the model has never before been tested for patients with chronic pain. Methods/design The aim of the IPS in Pain trial is to investigate the effectiveness of IPS as an integrated part of the interdisciplinary treatment for patients with chronic pain in a hospital outpatient clinic. The study is a randomized controlled trial comparing pain treatment with integrated IPS to treatment as usual in unemployed patients suffering from various chronic pain conditions. The primary outcome of the study is labor market participation during 12 months after enrollment, and secondary outcomes include physical and mental health and well-being, collected at baseline, 6, and 12 months. Finally, there will be an additional long-term follow-up for the primary outcome, which will be collected through a brief phone interview at 24 months. Discussion The IPS in Pain trial will be the first report of the effectiveness of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. It will thus provide important information about the effectiveness of repurposing IPS to a new patient group in great need of job support. Trial registration Clinicaltrials.gov: NCT02697656. Registered January 15th, 2016.
Collapse
Affiliation(s)
| | | | - Thomas Knutzen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Linn Rødevand
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Silje Endresen Reme
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
| |
Collapse
|
24
|
Llerena K, Reddy LF, Kern RS. The role of experiential and expressive negative symptoms on job obtainment and work outcome in individuals with schizophrenia. Schizophr Res 2018; 192:148-153. [PMID: 28599750 DOI: 10.1016/j.schres.2017.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/08/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
Unemployment rates for schizophrenia are high across all age groups compared to the general population. Past studies have focused on neurocognition as a key determinant of unemployment and poor work outcome in schizophrenia. However, several recent studies suggest that clinical symptoms may be equally or more important than cognitive dysfunction for understanding employment difficulties. An enhanced understanding of the domains of negative symptoms that hinder job obtainment and work outcomes in people with schizophrenia is vital for developing treatments that translate into better employment outcomes. The purpose of this study was to determine whether 112 participants with schizophrenia or schizoaffective disorder receiving supported employment services differed on experiential and expressive negative symptoms based on whether they obtained a job or remained unemployed. Further, in a subset of workers, this study examined the relationship of experiential "motivational" negative symptoms with work outcomes (weeks worked, hours worked, wages earned). Neurocognition was assessed using the MATRICS Consensus Cognitive Battery and clinical symptoms were assessed using the Scale for the Assessment of Negative Symptoms and the Brief Psychiatric Rating Scale. Experiential, but not expressive, negative symptoms were related to job obtainment, hours worked, and wages earned. However, these findings were attenuated and non-significant after controlling for age. These results suggest that experiential negative symptoms are potentially key to better understanding employment outcomes of individuals with schizophrenia receiving supported employment services, but further work is needed to untangle its significance vis-à-vis other individual, environmental, and program factors.
Collapse
Affiliation(s)
- Katiah Llerena
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, 11301 Wilshire Blvd., Bldg. 210, Los Angeles, CA 90073, USA; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - L Felice Reddy
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, 11301 Wilshire Blvd., Bldg. 210, Los Angeles, CA 90073, USA; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Robert S Kern
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, 11301 Wilshire Blvd., Bldg. 210, Los Angeles, CA 90073, USA; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA 90095, USA
| |
Collapse
|
25
|
Metcalfe JD, Drake RE, Bond GR. Economic, Labor, and Regulatory Moderators of the Effect of Individual Placement and Support Among People With Severe Mental Illness: A Systematic Review and Meta-analysis. Schizophr Bull 2018; 44:22-31. [PMID: 29036727 PMCID: PMC5768052 DOI: 10.1093/schbul/sbx132] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
As Individual Placement and Support (IPS) has become the international standard for vocational rehabilitation of adults with serious mental illness, researchers must consider the relationship between IPS and local environments. This meta-analysis used mixed-effects meta-regressions to assess the impact of site-level moderators on the likelihood that IPS recipients, compared with recipients of alternative vocational services, achieved competitive employment. Potential moderators included change in gross domestic product (GDP), local unemployment and unionization rates, and indices describing employment protection regulations, level of disability benefits compensation, and efforts to integrate people with disabilities into the workforce. Regulatory moderators represent facilitators and barriers to employment that may reinforce or detract from the effectiveness of IPS. Across 30 sites drawn from 21 randomized controlled trials in 12 countries (33% in the United States), IPS recipients were 2.31 (95% CI 1.99-2.69) times more likely to find competitive employment than recipients of alternative vocational rehabilitation services. The significant competitive-employment rate advantage of IPS over control services increased in the presence of weaker employment protection legislation and integration efforts, and less generous disability benefits. Policy makers should recognize and account for the fact that labor and disability regulations can create an arrangement of incentives that reduces the relative efficacy of supported employment.
Collapse
Affiliation(s)
- Justin D Metcalfe
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Robert E Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.,IPS Employment Center, Westat Inc., Lebanon, NH
| | - Gary R Bond
- IPS Employment Center, Westat Inc., Lebanon, NH
| |
Collapse
|
26
|
Bertram M, Howard L. Employment status and occupational care planning for people using mental health services. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.30.2.48] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodThe aim of the study was to identify the employment rates of people using local mental health services and examine any evidence in care plans for vocational or occupational interventions. We investigated case notes retrospectively.ResultsA total of 297 case notes were examined: 88% of the patients were unemployed, but there was evidence of documentation relating to vocational needs in only 18% of out-patients; 8% in patients of community mental health teams; and 39% in acute wards; 8% of patients were engaged in work schemes; 10% of patients were in education; and 9% were engaged in vocational interventions with their care coordinator; the latter was less likely if the patient was from a Black or minority ethnic group (OR=2.44, 95% CI 0.18–1.05).Clinical ImplicationsDespite high rates of unemployment, patients with psychiatric disorders are not referred for vocational interventions. Growing professional awareness of vocational possibilities for patients with severe mental illness should mean that many patients could return to competitive employment and return to mainstream society.
Collapse
|
27
|
Rinaldi M, Perkins R, Glynn E, Montibeller T, Clenaghan M, Rutherford J. Individual placement and support: from research to
practice. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.003509] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Vocational rehabilitation for people with severe mental health problems is
poorly developed in the UK. Although there is a clear evidence base
indicating the effectiveness of approaches to helping people with severe
mental health problems gain and retain employment there is generally a lack
of awareness of this evidence. As a result there has been a lack of
implementation within routine clinical practice of the most effective
approaches to improving employment outcomes for such individuals.
Collapse
|
28
|
Rødevand L, Ljosaa TM, Granan LP, Knutzen T, Jacobsen HB, Reme SE. A pilot study of the individual placement and support model for patients with chronic pain. BMC Musculoskelet Disord 2017; 18:550. [PMID: 29282028 PMCID: PMC5746000 DOI: 10.1186/s12891-017-1908-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background Individual Placement and Support (IPS) is an evidence-based work rehabilitation model with well-documented effects for people with mental illness. The model has, however, never been tested out for people with chronic pain. This pilot study aimed to investigate chronic pain patients’ experiences with the IPS job support model. Methods We recruited eight consecutive patients referred for various chronic pain conditions at a hospital outpatient pain clinic. They were offered IPS job support as an integrated part of their interdisciplinary pain rehabilitation. The patients’ experiences were investigated through semi-structured interviews 3 months after inclusion in the study. Results The participants reported mostly positive experiences with IPS. One participant dropped out of the study after deterioration of symptoms, while the remaining participants were satisfied with the intervention. Particular helpful aspects of the IPS intervention were the follow-up from the employment specialist, focus on competitive employment, focus on work despite pain complaints, reframing work into something positive, administrative support, and practice in writing applications. No participants reported adverse experiences from the IPS intervention. Within a 12-months time frame, 3 of the 8 participants gained competitive employment. Conclusions This is the first report of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. The results suggest that IPS can be successfully integrated with interdisciplinary pain rehabilitation, and warrants large-scale testing in a randomized controlled trial.
Collapse
Affiliation(s)
- L Rødevand
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - T M Ljosaa
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - L P Granan
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - T Knutzen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - H B Jacobsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - S E Reme
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Postboks 1094 Blindern, 0317, Oslo, Norway.
| |
Collapse
|
29
|
Suijkerbuijk YB, Schaafsma FG, van Mechelen JC, Ojajärvi A, Corbière M, Anema JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 2017; 9:CD011867. [PMID: 28898402 PMCID: PMC6483771 DOI: 10.1002/14651858.cd011867.pub2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions. OBJECTIVES To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness. SEARCH METHODS In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only. DATA COLLECTION AND ANALYSIS Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE. MAIN RESULTS We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions. AUTHORS' CONCLUSIONS Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.
Collapse
Affiliation(s)
- Yvonne B Suijkerbuijk
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Frederieke G Schaafsma
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Joost C van Mechelen
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
| | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Marc Corbière
- Université du Québec à Montréal (UQAM)Department of Education and Pedagogy ‐ Career CounselingMontrealQCCanada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR‐IUSMM)MontrealCanada
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | | |
Collapse
|
30
|
Bejerholm U, Larsson ME, Johanson S. Supported employment adapted for people with affective disorders-A randomized controlled trial. J Affect Disord 2017; 207:212-220. [PMID: 27723546 DOI: 10.1016/j.jad.2016.08.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/18/2016] [Accepted: 08/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND While effective vocational methods for gaining employment exist for people with schizophrenia and similar conditions, no evidence exists with regard to people with affective disorders. We aimed to study the effectiveness of a newly developed Individual Enabling and Support (IES) model adapted for the target group and compared to traditional vocational rehabilitation (TVR). METHODS An assessor-blinded randomized controlled trial (RCT) with a parallel design was performed. Sixty-one participants received IES or TVR. The primary outcome was employment rate at 12-month follow-up. Secondary vocational outcomes, depression severity, and quality of life were also studied. Trial register number is ISRCTN93470551. RESULTS IES was more effective for employment compared to TVR (42.4% vs. 4%; difference 38%, 95% CI 0.12-0.55). Significant group differences were present in secondary vocational outcomes (hours and weeks employed, time to employment), and depression severity. The IES-group had significantly lowering in depression scores and increased quality of life scores during the intervention period. LIMITATIONS This RCT was limited by the small sample size due to restriction of recruitment to middle-sized cities within geographically diverse sites in southern Sweden. Larger trials are needed, also in primary health care and employment services settings. CONCLUSIONS IES is more effective than TVR for attaining employment and improving depressive symptoms. On a societal level, IES closes the time and service gap between treatment and employment, and thus lowers sick-leave costs.
Collapse
Affiliation(s)
- Ulrika Bejerholm
- Department of Health Sciences/Work and Mental Health, Medical Faculty, Lund University, Lund, Sweden.
| | - Maria E Larsson
- Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Suzanne Johanson
- Department of Health Sciences/Work and Mental Health, Medical Faculty, Lund University, Lund, Sweden
| |
Collapse
|
31
|
Kirsh B. Client, Contextual and Program Elements Influencing Supported Employment: A Literature Review. Community Ment Health J 2016; 52:809-20. [PMID: 27055809 DOI: 10.1007/s10597-015-9936-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/02/2015] [Indexed: 11/29/2022]
Abstract
Supported employment is an evidence-based practice with a well-established research base. Most studies track such outcomes as employment rates, time to employment and wages earned. Few studies address client and contextual factors that impact outcomes or consider program elements beyond those that comprise the individual placement and support model. This paper reviews existing literature to shed light on the following questions: (1) What impact do labour market trends have on the effectiveness of SE? (2) How lasting are the effects of SE and what factors influence longevity of SE effects? (3) What levels and types of employment are targeted by SE? (4) What are the characteristics of people who benefit from SE? (5) What is the role of peer support in SE? and (6) What are the barriers to effective SE implementation? Research findings are synthesized and suggestions for service enhancements are offered so that the model can continue to evolve.
Collapse
Affiliation(s)
- Bonnie Kirsh
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, Canada. .,Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, Canada.
| |
Collapse
|
32
|
Bond GR, Drake RE, Campbell K. Effectiveness of individual placement and support supported employment for young adults. Early Interv Psychiatry 2016; 10:300-7. [PMID: 25138195 PMCID: PMC4417652 DOI: 10.1111/eip.12175] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 06/22/2014] [Indexed: 11/29/2022]
Abstract
AIM The individual placement and support (IPS) model of supported employment was first developed in community mental health centres for adults with severe mental illness. While IPS is an established evidence-based practice in this broad population, evidence on its effectiveness focused specifically on young adults has been limited. The current study aimed to address this gap. METHODS To investigate the effects of IPS on young adults, the authors conducted a secondary analysis on a pooled sample of 109 unemployed young adults (under age 30) from four randomized controlled trials employing a common research protocol that included a standardized measurement battery and rigorous fidelity monitoring. Researchers assessed these participants over 18 months on nine competitive employment outcome measures. RESULTS On all measures, the IPS group had significantly better employment outcomes. Overall, 40 (82%) of IPS participants obtained employment during follow-up compared with 25 (42%) of control participants, χ(2) = 17.9, P < .001. IPS participants averaged 25.0 weeks of employment, compared with 7.0 weeks for control participants, t = 4.50, P < .001. CONCLUSIONS The current analysis supports a small number of previous studies in showing that IPS is highly effective in helping young adults with severe mental illness to attain competitive employment. When young adults acquire competitive jobs and initiate a path towards normal adult roles, they may avoid the cycle of disability and psychiatric patient roles that are demeaning and demoralizing.
Collapse
Affiliation(s)
- Gary R. Bond
- Department of Psychiatry, Geisel Medical School at Dartmouth, Lebanon, NH, USA
| | - Robert E. Drake
- Department of Psychiatry, Geisel Medical School at Dartmouth, Lebanon, NH, USA
| | | |
Collapse
|
33
|
Abstract
Despite substantial progress in developing empirically validated psychotherapeutic treatments for specific mental health problems, most current efforts are based largely on treatment with drugs, which may not produce permanent recovery. The result has been an almost nihilistic attitude that assumes that little can be done to rehabilitate persons with mental health problems. Empirical evidence gleaned from innovative treatment programs and ethnocultural studies indicates clearly that healthy environments that provide meaningful work and a variety of nonmedical interventions offer more lasting health results than medical treatment alone. The supportive and curative influence of the environment has been greatly neglected, in part because of medical dominance in the treatment of emotional problems. More effective is the removal of the social, economic, and professional barriers to mental health and the strengthening of rehabilitative efforts that promote activity and purpose.
Collapse
|
34
|
Sveinsdottir V, Tveito TH, Bond GR, Grasdal AL, Lie SA, Reme SE. Protocol for the SEED-trial: Supported Employment and preventing Early Disability. BMC Public Health 2016; 16:579. [PMID: 27422271 PMCID: PMC4947309 DOI: 10.1186/s12889-016-3280-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early withdrawal or exclusion from the labor market leads to significant personal and societal costs. In Norway, the increasing numbers of young adults receiving disability pension is a growing problem. While a large body of research demonstrates positive effects of Supported Employment (SE) in patients with severe mental illness, no studies have yet investigated the effectiveness of SE in young adults with a range of social and health conditions who are receiving benefits. METHODS/DESIGN The SEED-trial is a randomized controlled trial (RCT) comparing traditional vocational rehabilitation (TVR) to SE in 124 unemployed individuals between the ages of 18-29 who are receiving benefits due to various social- or health-related problems. The primary outcome is labor market participation during the first year after enrollment. Secondary outcomes include physical and mental health, health behaviors, and well-being, collected at baseline, 6, and 12 months. A cost-benefit analysis will also be conducted. DISCUSSION The SEED-trial is the first RCT to compare SE to TVR in this important and vulnerable group, at risk of being excluded from working life at an early age. TRIAL REGISTRATION Clinicaltrials.gov, registration number NCT02375074 . Registered on December 3rd 2014.
Collapse
Affiliation(s)
| | | | - Gary R. Bond
- />Dartmouth Psychiatric Research Center, Rivermill Commercial Center, 85 Mechanic St., Suite B4-1, Lebanon, NH 03766 USA
| | | | - Stein Atle Lie
- />Department of Clinical Dentistry, University of Bergen, POB 7804, 5020 Bergen, Norway
| | - Silje Endresen Reme
- />Uni Research Health, Uni Research, POB 7810, 5020 Bergen, Norway
- />Department of Psychology, University of Oslo, POB 1094, 0317 Oslo, Norway
| |
Collapse
|
35
|
Modini M, Tan L, Brinchmann B, Wang MJ, Killackey E, Glozier N, Mykletun A, Harvey SB. Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence. Br J Psychiatry 2016; 209:14-22. [PMID: 27103678 DOI: 10.1192/bjp.bp.115.165092] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Individual placement and support (IPS) is a vocational rehabilitation programme that was developed in the USA to improve employment outcomes for people with severe mental illness. Its ability to be generalised to other countries and its effectiveness in varying economic conditions remains to be ascertained. AIMS To investigate whether IPS is effective across international settings and in different economic conditions. METHOD A systematic review and meta-analysis of randomised controlled trials comparing IPS with traditional vocational services was undertaken; 17 studies, as well as 2 follow-up studies, were included. Meta-regressions were carried out to examine whether IPS effectiveness varied according to geographic location, unemployment rates or gross domestic product (GDP) growth. RESULTS The overall pooled risk ratio for competitive employment using IPS compared with traditional vocational rehabilitation was 2.40 (95% CI 1.99-2.90). Meta-regressions indicated that neither geographic area nor unemployment rates affected the overall effectiveness of IPS. Even when a country's GDP growth was less than 2% IPS was significantly more effective than traditional vocational training, and its benefits remained evident over 2 years. CONCLUSIONS Individual placement and support is an effective intervention across a variety of settings and economic conditions and is more than twice as likely to lead to competitive employment when compared with traditional vocational rehabilitation.
Collapse
Affiliation(s)
- Matthew Modini
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Leona Tan
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Beate Brinchmann
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Min-Jung Wang
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Eoin Killackey
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Nicholas Glozier
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Arnstein Mykletun
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Samuel B Harvey
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| |
Collapse
|
36
|
van Rijn RM, Carlier BE, Schuring M, Burdorf A. Work as treatment? The effectiveness of re-employment programmes for unemployed persons with severe mental health problems on health and quality of life: a systematic review and meta-analysis. Occup Environ Med 2016; 73:275-9. [PMID: 26740687 DOI: 10.1136/oemed-2015-103121] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/30/2015] [Indexed: 01/07/2023]
Abstract
Given the importance of unemployment in health inequalities, re-employment of unemployed persons into paid employment may be a powerful intervention to increase population health. It is suggested that integrated programmes of vocational reintegration with health promotion may improve the likelihood of entering paid employment of long-term unemployed persons with severe mental health problems. However, the current evidence regarding whether entering paid employment of this population will contribute to a reduction in health problems remains unambiguous. This systematic review and meta-analysis aimed to assess the effects of re-employment programmes with regard to health and quality of life. Three electronic databases were searched (up to March 2015). Two reviewers independently selected articles and assessed the risk of bias on prespecified criteria. Measures of effects were pooled and random effect meta-analysis of randomised controlled trials was conducted, where possible. Sixteen studies were included. Nine studies described functioning as an outcome measure. Five studies with six comparisons provided enough information to calculate a pooled effect size of -0.01 (95% CI -0.13 to 0.11). Fifteen studies presented mental health as an outcome measure of which six with comparable psychiatric symptoms resulted in a pooled effect size of 0.20 (95% CI -0.23 to 0.62). Thirteen studies described quality of life as an outcome measure. Seven of these studies, describing eight comparisons, provided enough information to calculate a pooled effect size of 0.28 (95% CI 0.04 to 0.52). Re-employment programmes have a modest positive effect on the quality of life. No evidence was found for any effect of these re-employment programmes on functioning and mental health.
Collapse
Affiliation(s)
- Rogier M van Rijn
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bouwine E Carlier
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Merel Schuring
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
37
|
Skarpaas LS, Ramvi E, Løvereide L, Aas RW. Maximizing work integration in job placement of individuals facing mental health problems: Supervisor experiences. Work 2015; 53:87-98. [DOI: 10.3233/wor-152218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lisebet Skeie Skarpaas
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
- Presenter, Stavanger, Norway
| | - Ellen Ramvi
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Lise Løvereide
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Randi Wågø Aas
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
- Presenter, Stavanger, Norway
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
38
|
Fioritti A, Burns T, Rubatta P, Rucci P. Impact of the Community on Intensive Community Care. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2015. [DOI: 10.1080/00207411.2002.11449572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
39
|
Individual Placement and Support supplemented with cognitive remediation and work-related social skills training in Denmark: study protocol for a randomized controlled trial. Trials 2015; 16:280. [PMID: 26093636 PMCID: PMC4479316 DOI: 10.1186/s13063-015-0792-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individual Placement and Support (IPS) appears to be an effective vocational intervention for obtaining competitive employment for people with severe mental illness. However, no IPS studies or trials have been conducted in Denmark, a country characterized by a specialized labor market with a higher minimum wage and fewer entry-level jobs in comparison with other countries such as the US. Furthermore, long-term job retention and economic self-sufficiency have not been clearly demonstrated. Integrating methods such as cognitive remediation and work-related social skills training may be ways to address these issues. METHODS/DESIGN The trial design is an investigator-initiated, randomized, assessor-blinded, multi-center trial. A total of 750 patients with severe mental illness will be randomly assigned into three groups: (1) IPS, (2) IPS enhanced with cognitive remediation and work-related social skills training, and (3) service as usual. The primary outcome is number of hours in competitive employment or education at 18-month follow-up. Secondary and exploratory outcomes are money earned, days to first employment, symptoms, functional level, self-esteem, and self-efficacy at 18-month follow-up. Thirty- and 60-month follow-ups will be register-based. DISCUSSION This will be one of the largest randomized trials investigating IPS to date. The trial will be conducted with high methodological quality in order to reduce the risk of bias. If the results of this trial show that IPS, or IPS enhanced with cognitive remediation and work-related social skills training, is superior to service as usual, this will support preliminary evidence. Furthermore, it will show that the method is generalizable to a variety of labor markets and welfare systems and provide important knowledge about the effect of adding cognitive remediation and social skills training to the IPS intervention. TRIAL REGISTRATION ClinicalTrials registration number: NCT01722344 (registered 2 Nov. 2012).
Collapse
|
40
|
Abstract
BACKGROUND Supportive therapy is often used in everyday clinical care and in evaluative studies of other treatments. OBJECTIVES To review the effects of supportive therapy compared with standard care, or other treatments in addition to standard care for people with schizophrenia. SEARCH METHODS For this update, we searched the Cochrane Schizophrenia Group's register of trials (November 2012). SELECTION CRITERIA All randomised trials involving people with schizophrenia and comparing supportive therapy with any other treatment or standard care. DATA COLLECTION AND ANALYSIS We reliably selected studies, quality rated these and extracted data. For dichotomous data, we estimated the risk ratio (RR) using a fixed-effect model with 95% confidence intervals (CIs). Where possible, we undertook intention-to-treat analyses. For continuous data, we estimated the mean difference (MD) fixed-effect with 95% CIs. We estimated heterogeneity (I(2) technique) and publication bias. We used GRADE to rate quality of evidence. MAIN RESULTS Four new trials were added after the 2012 search. The review now includes 24 relevant studies, with 2126 participants. Overall, the evidence was very low quality.We found no significant differences in the primary outcomes of relapse, hospitalisation and general functioning between supportive therapy and standard care.There were, however, significant differences favouring other psychological or psychosocial treatments over supportive therapy. These included hospitalisation rates (4 RCTs, n = 306, RR 1.82 CI 1.11 to 2.99, very low quality of evidence), clinical improvement in mental state (3 RCTs, n = 194, RR 1.27 CI 1.04 to 1.54, very low quality of evidence) and satisfaction of treatment for the recipient of care (1 RCT, n = 45, RR 3.19 CI 1.01 to 10.7, very low quality of evidence). For this comparison, we found no evidence of significant differences for rate of relapse, leaving the study early and quality of life.When we compared supportive therapy to cognitive behavioural therapy CBT), we again found no significant differences in primary outcomes. There were very limited data to compare supportive therapy with family therapy and psychoeducation, and no studies provided data regarding clinically important change in general functioning, one of our primary outcomes of interest. AUTHORS' CONCLUSIONS There are insufficient data to identify a difference in outcome between supportive therapy and standard care. There are several outcomes, including hospitalisation and general mental state, indicating advantages for other psychological therapies over supportive therapy but these findings are based on a few small studies where we graded the evidence as very low quality. Future research would benefit from larger trials that use supportive therapy as the main treatment arm rather than the comparator.
Collapse
Affiliation(s)
- Lucy A Buckley
- Northumberland, Tyne and Wear NHS Foundation TrustSunderland Psychotherapy ServiceCherry Knowle HospitalUpper Poplars, RyhopeSunderlandTyne and WearUKSR2 0NB
| | - Nicola Maayan
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Karla Soares‐Weiser
- CochraneCochrane Editorial UnitSt Albans House, 57 ‐ 59 HaymarketLondonUKSW1Y 4QX
| | - Clive E Adams
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthInnovation Park, Triumph Road,NottinghamUKNG7 2TU
| | | |
Collapse
|
41
|
Bejerholm U, Areberg C, Hofgren C, Sandlund M, Rinaldi M. Individual placement and support in Sweden - a randomized controlled trial. Nord J Psychiatry 2015; 69:57-66. [PMID: 24983382 DOI: 10.3109/08039488.2014.929739] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden. AIMS To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect. METHODS A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024. RESULTS One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18-54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this. CONCLUSIONS IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.
Collapse
Affiliation(s)
- Ulrika Bejerholm
- Ulrika Bejerholm, Ph.D., Associate Professor, Department of Health Sciences/Work and Mental Health, Medical Faculty, Lund University , Sweden
| | | | | | | | | |
Collapse
|
42
|
Shankar J, Collyer F. Vocational rehabilitation of people with mental illness: The need for a broader approach. ACTA ACUST UNITED AC 2014. [DOI: 10.5172/jamh.2.2.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Janki Shankar
- School of Humanities and Social Sciences, Charles Sturt University, NSW, Australia
| | - Fran Collyer
- Department of Sociology and Social Policy, University of Sydney, NSW, Australia
| |
Collapse
|
43
|
McCabe OL. Evidence-Based Practice in Mental Health Accessing, Appraising, and Adopting Research Data. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411350204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
44
|
Sveinsdottir V, Løvvik C, Fyhn T, Monstad K, Ludvigsen K, Øverland S, Reme SE. Protocol for the effect evaluation of Individual Placement and Support (IPS): a randomized controlled multicenter trial of IPS versus treatment as usual for patients with moderate to severe mental illness in Norway. BMC Psychiatry 2014; 14:307. [PMID: 25403470 PMCID: PMC4244061 DOI: 10.1186/s12888-014-0307-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/20/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Roughly one third of disability pensions in Norway are issued for mental and behavioral disorders, and vocational rehabilitation offered to this group has traditionally been dominated by train-and-place approaches with assisted or sheltered employment. Based on a more innovative place-and-train approach, Individual Placement and Support (IPS) involves supported employment in real-life competitive work settings, and has shown great promise for patients with severe mental illness. METHODS/DESIGN The study is a multicenter Randomized Controlled Trial (RCT) of IPS in a Norwegian context, involving an effect evaluation, a process evaluation, and a cost/benefit analysis. IPS will be compared to high quality treatment as usual (TAU), with labor market participation and educational activity at 12 months post inclusion as the primary outcome. The primary outcome will be measured using register data, and the project will also include complete follow-up up to 4 years after inclusion for long-term outcome data. Secondary outcomes include mental health status, disability and quality of life, collected through survey questionnaires at baseline, and after 6 and 12 months. Participants will include patients undergoing treatment for moderate to severe mental illness who are either unemployed or on sickness or social benefits. The estimated total sample size of 400-500 will be randomly assigned to the interventions. To be eligible, participants must have an expressed desire to work, and sufficient Norwegian reading and writing skills to fill out the questionnaires. DISCUSSION The Effect Evaluation of Individual Placement and Support (IPS) will be one of the largest randomized controlled trials to date investigating the effectiveness of IPS on competitive employment, and the first study to evaluate the effectiveness of IPS for patients with moderate to severe mental illness within a Norwegian context. TRIAL REGISTRATION Clinicaltrials.gov: NCT01964092 . Registered October 16th, 2013.
Collapse
Affiliation(s)
| | - Camilla Løvvik
- Uni Research Health, Uni Research, POB 7810, Bergen, NO-5020, Norway.
- Department of Psychosocial Science, University of Bergen, POB 7807, Bergen, NO-5020, Norway.
| | - Tonje Fyhn
- Uni Research Health, Uni Research, POB 7810, Bergen, NO-5020, Norway.
| | - Karin Monstad
- Uni Rokkan Centre, Uni Research, Nygårdsgaten 5, Bergen, NO-5015, Norway.
| | - Kari Ludvigsen
- Uni Rokkan Centre, Uni Research, Nygårdsgaten 5, Bergen, NO-5015, Norway.
| | - Simon Øverland
- Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Nydalen, POB 4404, Oslo, NO-0403, Norway.
- Department of Psychosocial Science, University of Bergen, POB 7807, Bergen, NO-5020, Norway.
| | | |
Collapse
|
45
|
Luciano A, Bond GR, Drake RE. Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research. Schizophr Res 2014; 159:312-21. [PMID: 25278105 DOI: 10.1016/j.schres.2014.09.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/29/2014] [Accepted: 09/04/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This review synthesized prospective evidence to assess whether achieving employment alters the course of schizophrenia-spectrum disorder. METHOD Researchers identified relevant analyses for review via PubMed, expert referral, and reference review and systematically applied two levels of screening to 1484 citations using seven a priori criteria. RESULTS A total of 12 analyses representing eight cohorts, or 6844 participants, compared illness course over time by employment status in majority schizophrenia-spectrum samples. Employment was consistently associated with reductions in outpatient psychiatric treatment (2 of 2 studies) as well as improved self-esteem (2 of 2 studies). Employment was inconsistently associated with positive outcomes in several other areas, including symptom severity, psychiatric hospitalization, life satisfaction, and global wellbeing. Employment was consistently unrelated to worsening outcomes. DISCUSSION Achieving employment does not cause harm among people with schizophrenia-spectrum disorder and other severe mental illnesses. Further detailed mechanistic analyses of adequately powered long-term follow-up studies using granular descriptions of employment are needed to clarify the nature of associations between employment and hypothesized benefit.
Collapse
Affiliation(s)
- Alison Luciano
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, United States.
| | - Gary R Bond
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, United States.
| | - Robert E Drake
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, United States.
| |
Collapse
|
46
|
Hacioglu Yildirim M, Alantar Z, Yildirim EA. The relationship between working status and symptoms, quality of life and self-esteem in patients with schizophrenia in Turkey. Int J Soc Psychiatry 2014; 60:646-55. [PMID: 24319053 DOI: 10.1177/0020764013511791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Schizophrenia is a severe mental disorder with substantial socioeconomic burden associated with poorer psychosocial functioning during the course of illness. In schizophrenia patients, multiple factors play a role in occupational functioning. AIM It was aimed to investigate the relationship between different working conditions and quality of life and self-esteem on patients with schizophrenia in Turkey. METHODS A total of 100 patients diagnosed as schizophrenic were divided into three groups: competitive working, supported working and unemployed. RESULTS The groups did not differ significantly with regard to psychotic symptoms, self-esteem and illness history. Working was associated with higher scores on quality of life subscales especially in supported working group, whereas unemployed patients had more depressive symptoms and autonomic drug side effects. CONCLUSION Structured working programs which may improve social life of patients with schizophrenia in many aspects is warranted in Turkey.
Collapse
Affiliation(s)
- Munevver Hacioglu Yildirim
- Department of Psychiatry, Psychotic Disorders Inpatient Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Zeynep Alantar
- Department of Psychiatry, Psychotic Disorders Inpatient Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ejder A Yildirim
- Department of Psychiatry, Psychotherapy Outpatient Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| |
Collapse
|
47
|
Reddy LF, Kern RS. Supported employment among veterans with serious mental illness: the role of cognition and social cognition on work outcome. SCHIZOPHRENIA RESEARCH-COGNITION 2014; 1:144-148. [PMID: 29379747 PMCID: PMC5779091 DOI: 10.1016/j.scog.2014.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/01/2014] [Accepted: 09/05/2014] [Indexed: 11/17/2022]
Abstract
Unemployment is a primary functional deficit for the majority of adults with schizophrenia. Research indicates that over two-thirds of adults living in the community with schizophrenia are unemployed. Despite effective programs to assist with job identification and placement, the ability to attain and maintain employment remains a pressing concern. Neurocognitive functioning is widely acknowledged to be a determinant of work outcome; however, effect sizes tend to be in the small to medium range. The present study sought to further understand the determinants of work outcome among a sample of 104 veterans with schizophrenia enrolled in a supported employment program. A small percentage of veterans in the study got competitive jobs; 53% who secured jobs maintained employment for longer than 6 months. Cognition, social cognition, and symptoms were unrelated to job attainment. However, speed of processing and social cognition were significant predictors of work outcomes such as wages and tenure. These findings suggest that cognitive abilities including processing speed and the ability to accurately interpret and respond to social cues are significant determinants of whether individuals with schizophrenia remain employed. The results are discussed in light of current available treatment options and domains to target in synergy with work rehabilitation efforts.
Collapse
Affiliation(s)
- L. Felice Reddy
- Corresponding author at: VA Greater Los Angeles Healthcare System, MIRECC 210A, 11301 Wilshire Blvd., Los Angeles, CA 90073. Tel.: + 1 310 478 3711x42941; fax: + 1 310 268 4056.
| | | |
Collapse
|
48
|
Whiteford H, McKeon G, Harris M, Diminic S, Siskind D, Scheurer R. System-level intersectoral linkages between the mental health and non-clinical support sectors: a qualitative systematic review. Aust N Z J Psychiatry 2014; 48:895-906. [PMID: 25002710 DOI: 10.1177/0004867414541683] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Concerns about fragmented mental health service delivery persist, particularly for people with severe and persistent mental illness. The objective was to review evidence regarding outcomes attributed to system-level intersectoral linkages involving mental health services and non-clinical support services, and to identify barriers and facilitators to the intersectoral linkage process. METHODS A systematic, qualitative review of studies describing attempts to coordinate the activities of multiple service agencies at the policy, program or organisational level was conducted. Electronic databases Medline, PsycINFO and EMBASE were searched via OVID from inception to July 2012. RESULTS Of 1593 studies identified, 40 were included in the review - 26 in adult and 14 in vulnerable youth populations. Identified mechanisms to promote positive system-level outcomes included: interagency coordinating committees or intersectoral/interface workers engaged in joint service planning; formalised interagency collaborative agreements; a single care plan in which the responsibilities of all agencies are described; cross-training of staff to ensure staff culture, attitudes, knowledge and skills are complementary; service co-location; and blended funding initiatives to ensure funding aligns with program integration. Identified barriers included: adequacy of funding and technology; ensuring realistic workloads; overcoming 'turf issues' between service providers and disagreements regarding areas of responsibility; ensuring integration strategies are implemented as planned; and maintaining stakeholder enthusiasm. CONCLUSIONS System-level intersectoral linkages can be achieved in various ways and are associated with positive clinical and non-clinical outcomes for services and clients. Some linkage mechanisms present greater implementation challenges than others (e.g. major technology upgrades or co-location in geographically remote areas). In some instances (e.g. co-location) alternative options may achieve equivalent benefits. Publication bias could not be discounted, and studies using high-quality research designs are scarce. The limited information base applicable to system-level integration argues strongly for the evaluation of the models that evolve in the rollout of the national Partners in Recovery initiative.
Collapse
Affiliation(s)
- Harvey Whiteford
- School of Population Health, The University of Queensland, Herston QLD, Australia Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol QLD, Australia
| | - Gemma McKeon
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol QLD, Australia
| | - Meredith Harris
- School of Population Health, The University of Queensland, Herston QLD, Australia Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol QLD, Australia
| | - Sandra Diminic
- School of Population Health, The University of Queensland, Herston QLD, Australia Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol QLD, Australia
| | - Dan Siskind
- School of Population Health, The University of Queensland, Herston QLD, Australia Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol QLD, Australia Metro South Addiction and Mental Health Service, Brisbane QLD, Australia
| | - Roman Scheurer
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol QLD, Australia
| |
Collapse
|
49
|
Craig T, Shepherd G, Rinaldi M, Smith J, Carr S, Preston F, Singh S. Vocational rehabilitation in early psychosis: cluster randomised trial. Br J Psychiatry 2014; 205:145-50. [PMID: 24855129 DOI: 10.1192/bjp.bp.113.136283] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Individual placement and support (IPS) is effective in helping patients return to work but is poorly implemented because of clinical ambivalence and fears of relapse. AIMS To assess whether a motivational intervention (motivational interviewing) directed at clinical staff to address ambivalence about employment improved patients' occupational outcomes. METHOD Two of four early intervention teams that already provided IPS were randomised to receive motivational interviewing training for clinicians, focused on attitudinal barriers to employment. The trial was registered with the International Standard Randomised Controlled Trial Register (ISRCTN71943786). RESULTS Of 300 eligible participants, 159 consented to the research. Occupational outcomes were obtained for 134 patients (85%) at 12-month follow-up. More patients in the intervention teams than in the IPS-only teams achieved employment by 12 months (29/68 v. 12/66). A random effects logistic regression accounting for clustering by care coordinator, and adjusted for participants' gender, ethnicity, educational and employment history and clinical status scores, confirmed superiority of the intervention (odds ratio = 4.3, 95% CI 1.5-16.6). CONCLUSIONS Employment outcomes were enhanced by addressing clinicians' ambivalence about their patients returning to work.
Collapse
Affiliation(s)
- Tom Craig
- Tom Craig, MBBS, PhD, FRPsych, Health Services and Population Research Department (HSPRD), Institute of Psychiatry, King's College London; Geoff Shepherd, BSc, MPhil, PhD, Centre for Mental Health, London; Miles Rinaldi, South West London and St George's Mental Health National Health Service (NHS) Trust, London; Jo Smith, BSc, MSc, PhD, Worcestershire Early Intervention Service, Worcestershire Health and Care NHS Trust and University of Worcester; Sarah Carr, BSc, MSc, Institute of Psychiatry, King's College London; Fay Preston, BSc, Swaran Singh, MBBS, PhD, FRCPsych, Warwick Medical School, University of Warwick, UK
| | - Geoff Shepherd
- Tom Craig, MBBS, PhD, FRPsych, Health Services and Population Research Department (HSPRD), Institute of Psychiatry, King's College London; Geoff Shepherd, BSc, MPhil, PhD, Centre for Mental Health, London; Miles Rinaldi, South West London and St George's Mental Health National Health Service (NHS) Trust, London; Jo Smith, BSc, MSc, PhD, Worcestershire Early Intervention Service, Worcestershire Health and Care NHS Trust and University of Worcester; Sarah Carr, BSc, MSc, Institute of Psychiatry, King's College London; Fay Preston, BSc, Swaran Singh, MBBS, PhD, FRCPsych, Warwick Medical School, University of Warwick, UK
| | - Miles Rinaldi
- Tom Craig, MBBS, PhD, FRPsych, Health Services and Population Research Department (HSPRD), Institute of Psychiatry, King's College London; Geoff Shepherd, BSc, MPhil, PhD, Centre for Mental Health, London; Miles Rinaldi, South West London and St George's Mental Health National Health Service (NHS) Trust, London; Jo Smith, BSc, MSc, PhD, Worcestershire Early Intervention Service, Worcestershire Health and Care NHS Trust and University of Worcester; Sarah Carr, BSc, MSc, Institute of Psychiatry, King's College London; Fay Preston, BSc, Swaran Singh, MBBS, PhD, FRCPsych, Warwick Medical School, University of Warwick, UK
| | - Jo Smith
- Tom Craig, MBBS, PhD, FRPsych, Health Services and Population Research Department (HSPRD), Institute of Psychiatry, King's College London; Geoff Shepherd, BSc, MPhil, PhD, Centre for Mental Health, London; Miles Rinaldi, South West London and St George's Mental Health National Health Service (NHS) Trust, London; Jo Smith, BSc, MSc, PhD, Worcestershire Early Intervention Service, Worcestershire Health and Care NHS Trust and University of Worcester; Sarah Carr, BSc, MSc, Institute of Psychiatry, King's College London; Fay Preston, BSc, Swaran Singh, MBBS, PhD, FRCPsych, Warwick Medical School, University of Warwick, UK
| | - Sarah Carr
- Tom Craig, MBBS, PhD, FRPsych, Health Services and Population Research Department (HSPRD), Institute of Psychiatry, King's College London; Geoff Shepherd, BSc, MPhil, PhD, Centre for Mental Health, London; Miles Rinaldi, South West London and St George's Mental Health National Health Service (NHS) Trust, London; Jo Smith, BSc, MSc, PhD, Worcestershire Early Intervention Service, Worcestershire Health and Care NHS Trust and University of Worcester; Sarah Carr, BSc, MSc, Institute of Psychiatry, King's College London; Fay Preston, BSc, Swaran Singh, MBBS, PhD, FRCPsych, Warwick Medical School, University of Warwick, UK
| | - Fay Preston
- Tom Craig, MBBS, PhD, FRPsych, Health Services and Population Research Department (HSPRD), Institute of Psychiatry, King's College London; Geoff Shepherd, BSc, MPhil, PhD, Centre for Mental Health, London; Miles Rinaldi, South West London and St George's Mental Health National Health Service (NHS) Trust, London; Jo Smith, BSc, MSc, PhD, Worcestershire Early Intervention Service, Worcestershire Health and Care NHS Trust and University of Worcester; Sarah Carr, BSc, MSc, Institute of Psychiatry, King's College London; Fay Preston, BSc, Swaran Singh, MBBS, PhD, FRCPsych, Warwick Medical School, University of Warwick, UK
| | - Swaran Singh
- Tom Craig, MBBS, PhD, FRPsych, Health Services and Population Research Department (HSPRD), Institute of Psychiatry, King's College London; Geoff Shepherd, BSc, MPhil, PhD, Centre for Mental Health, London; Miles Rinaldi, South West London and St George's Mental Health National Health Service (NHS) Trust, London; Jo Smith, BSc, MSc, PhD, Worcestershire Early Intervention Service, Worcestershire Health and Care NHS Trust and University of Worcester; Sarah Carr, BSc, MSc, Institute of Psychiatry, King's College London; Fay Preston, BSc, Swaran Singh, MBBS, PhD, FRCPsych, Warwick Medical School, University of Warwick, UK
| |
Collapse
|
50
|
Mueser KT, McGurk SR. Supported employment for persons with serious mental illness: current status and future directions. Encephale 2014; 40 Suppl 2:S45-56. [PMID: 24929974 DOI: 10.1016/j.encep.2014.04.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/29/2014] [Indexed: 11/27/2022]
Abstract
The individual placement and supported (IPS) model of supported employment is the most empirically validated model of vocational rehabilitation for persons with schizophrenia or another serious mental illness. Over 18 randomized controlled trials have been conducted throughout the world demonstrating the effectiveness of supported employment at improving competitive work compared to other vocational programs: IPS supported employment is defined by the following principles: 1) inclusion of all clients who want to work; 2) integration of vocational and clinical services; 3) focus on competitive employment; 4) rapid job search and no required prevocational skills training; 5) job development by the employment specialist; 6) attention to client preferences about desired work and disclosure of mental illness to prospective employers; 7) benefits counseling; and 8) follow-along supports after a job is obtained. Supported employment has been successfully implemented in a wide range of cultural and clinical populations, although challenges to implementation are also encountered. Common challenges are related to problems such as the failure to access technical assistance, system issues, negative beliefs and attitudes of providers, funding restrictions, and poor leadership. These challenges can be overcome by tapping expertise in IPS supported employment, including standardized and tested models of training and consultation. Efforts are underway to increase the efficiency of training methods for supported employment and the overall program, and to improve its effectiveness for those clients who do not benefit. Progress in IPS supported employment offers people with a serious mental illness realistic hope for achieving their work goals, and taking greater control over their lives.
Collapse
Affiliation(s)
- K T Mueser
- Departments of Occupational Therapy, Psychology, and Psychiatry; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, United States.
| | - S R McGurk
- Departments of Occupational Therapy, Psychology, and Psychiatry; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, United States
| |
Collapse
|