Individual placement and support: History, current status, and future directions

Borderline Personality Disorder and Loneliness: Broadening the Scope of Treatment for Social Rehabilitation

ABSTRACT

Borderline personality disorder (BPD) has been described as a condition of intolerance of aloneness. This characteristic drives distinguishing criteria, such as frantic efforts to avoid abandonment. Both BPD and loneliness are linked with elevated mortality risk and multiple negative health outcomes. Psychodynamic theories of BPD emphasize fundamental impairment in attachment and interpersonal functioning. Empirical research demonstrates an association between BPD diagnosis and increased loneliness. Individuals with BPD experience higher levels of loneliness than the general population, and their social networks are systematically smaller, less diverse, and less satisfying. Differences in the subjective experience of loneliness persist when controlling for these relevant social network features, indicating that people with BPD experience more loneliness than others in the same objective social circumstances. According to patients with BPD, increased social connection is often a primary treatment goal and marker of satisfying recovery. There are, however, few evidence-based approaches that primarily target loneliness and building life structures that support durable connections with others. Therefore, loneliness persists as an intractable problem, often failing to remit alongside other symptoms, and few resources are routinely implemented to address this problem. In this article, we argue that loneliness is central to the symptomatic oscillations and subjective experiences of many patients with BPD. We propose that treatment extend beyond the overemphasized therapeutic alliance relationship to also promote socialization and group and vocational settings to enhance patients' social networks. Building larger social networks that rely less on exclusive caregiving and/or romantic relationships and more on role-bound identity building and community relationships would more directly target long-term identity diffusion and relational instability. Such interventions can harness nonclinical community resources, such as group treatment, vocational supports, and peer supports.

Bridging the Research-to-Practice Gap: The Individual Placement and Support Model

The Research-to-Practice Gap often hinders the translation of effective healthcare interventions from clinical trials to routine care. Individual Placement and Support (IPS), an evidence-based practice designed to help individuals with mental health conditions achieve and maintain employment, has notably bridged this gap. Unlike many interventions that struggle with widespread implementation, IPS has successfully scaled to over 2,000 programs across all U.S. states and 30 other countries. This paper examines the strategies that have facilitated the rapid and extensive adoption of IPS, offering insights into best practices for integrating randomized controlled trial (RCT) findings into everyday clinical settings. Key factors contributing to the success of IPS include conducting RCTs in settings with real-world patients and clinicians, fostering collaboration through the International IPS Learning Community, developing comprehensive implementation materials and a dynamic fidelity scale, and engaging in regular, systematic meetings with stakeholders such as providers, advocates, and policymakers. These approaches have ensured that IPS remains adaptable, responsive to patient needs, and maintains fidelity to its core principles while promoting continuous improvement. The experience with IPS underscores the importance of integrating real-world evidence with clinical practice through ongoing collaboration among all stakeholders. The principles underpinning IPS-real-world application, stakeholder engagement, and adaptability-provide a model that could guide future efforts to close the research-to-practice gap across diverse healthcare settings and interventions.

Effectiveness of a three-component intervention supporting unemployed individuals with mental health issues in their job search and mental health recovery (3for1): study protocol of a non-randomized controlled study

BACKGROUND

There is a vicious cycle between unemployment and mental health issues. Unemployed individuals with mental health issues require individualized support at multiple levels in order to promote their mental health, and obtain and retain employment. The 3for1-intervention program aims to provide such support with three components (short-term psychotherapy, job coaching based on the Individual Placement and Support approach, and peer support). This study protocol outlines how the effectiveness of this three-component intervention program in terms of re-employment, mental health, and psychosocial outcomes will be evaluated.

METHODS

The 3for1-intervention program will be evaluated with a non-randomized controlled trial design in a multi-center study. 500 eligible participants aged between 18 and 60 years from six job centers in Southern Germany will be allocated to a control group or an intervention group. Allocation is time-based, with the control group being recruited first, followed by recruitment of the intervention group. The control group will receive treatment as usual, whereas the intervention group will receive treatment as usual as well as access to the three intervention components over a period of 12 months. Assessment will be conducted at baseline (t0), and 12 (t1) and 18 (t3) months later. The primary outcome will be the proportion of participants who are in employment subject to social insurance contributions at t1. Differences between control and intervention group will be tested with logistic regression analysis, controlling for relevant covariates. Analyses of secondary outcomes will relate to group differences regarding re-employment, health and well-being, social integration, help-seeking, and self-stigma at t1 and t2, applying logistic regression analysis or analysis of covariance. Additionally, usage of health services will be measured to evaluate the intervention program's cost effectiveness.

DISCUSSION

The 3for1-intervention aims to improve employability and mental health outcomes of a vulnerable population with high need for assistance. Improvements for this population would benefit the German welfare state as well. This study could provide valuable insights into the feasibility, implementation, and sustainability of this individualized, multi-level support program within German job centers.

TRIAL REGISTRATION

This trial is registered with the German Clinical Trials Register: DRKS00029002 (registered on 11 May 2022).

Supported employment as a global mental health intervention

The global health community has recognized that social determinants of health account for most of the inequities of health outcomes, including mental health outcomes, across and within countries. Strategies to overcome such inequities must focus on modifiable social factors. In this viewpoint, we argue for the preeminence of employment among social determinants of mental health for several reasons. People with mental health disabilities want to work, and a well-validated model of supported employment that is effective and cost-effective now exists. Employment leads to improvements in income, daily structure, self-esteem, social support, community integration and illness management, and people who are employed experience fewer emergencies and hospitalizations. Employment is empowering because people can use added income to activate their own choices regarding other social determinants. Supported employment actualizes the recovery paradigm: People who are employed in competitive jobs of their choice develop a meaningful functional life, increased self-esteem and new social supports. We provide examples of supported employment developments in diverse settings and discuss the implications of scaling up these services worldwide.

Measuring Fidelity to Individual Placement and Support for Transition Age Youth: Psychometric Findings

Individual Placement and Support (IPS), an evidence-based supported employment model for working-age adults with serious mental illness, also serves transition age adults (TAY; ages 16-24). The IPS-Y is a new IPS fidelity scale tailored to this younger population. Although adopted worldwide, it lacks research on the psychometric properties of its two components (employment and education). Six IPS programs serving TAY were assessed on IPS-Y (Employment) in an initial review (Time 1) and on both components in a second review one year later (Time 2). We examined scale calibration, reliability, and validity for the IPS-Y in this sample. Fidelity reviewers use the full range of ratings, from "not IPS" to "exemplary," on both IPS-Y components. On the employment component, item calibration was excellent; internal consistency reliability was good at Time 1 (r = .81) and test-retest reliability was fair (r = .63). The IPS-Y (Employment) showed excellent sensitivity to change, with the mean scale score increasing from 88.3 to 105.5. IPS-Y (Employment) item ratings at Time 2 were similar to corresponding items in a sample of conventional IPS programs using the standard IPS fidelity scale. Predictive validity was promising for both components, with fidelity scale ratings positively correlated with site-level competitive employment rates (r = .57) and education enrollment rates (r = .69). IPS can be implemented to good fidelity for programs serving TAY. Preliminary findings regarding the psychometric properties of the IPS-Y Employment are encouraging, but replication in larger samples is needed.

Second Look at Reported Racial-Ethnic Employment Differences in the Supported Employment Demonstration

OBJECTIVE

The Supported Employment Demonstration (SED) trial, which studied the effects of individual placement and support (IPS) among individuals initially denied Social Security Administration disability benefits for mental illness, reported racial-ethnic differences in IPS' effect on employment. Because of high rates of attrition in the SED, this finding warranted further study. The current reanalysis used a subsample with a directly observed measure of competitive employment and less attrition to try to corroborate the reported racial-ethnic differences.

METHODS

The authors compared self-reported employment (collected via telephone interviews) with observed employment (reported monthly by multidisciplinary teams) among a representative subsample (N=614) of the SED, stratified by race and ethnicity.

RESULTS

The observed competitive employment outcomes showed no significant racial-ethnic differences among those assigned to participate in IPS.

CONCLUSIONS

Congruent with previous research, reanalysis based on more complete data and more rigorous outcome measurements implied an absence of racial-ethnic differences in IPS' effect on observed employment outcomes.

Experiences of individuals with serious mental disorders in regular employment through the Individual Placement and Support model

Introduction

This study shows the perspective, meaning and satisfaction perceived by people with Serious Mental Disorders during their experiences in regular employment.

Methods

A mixed qualitative-quantitative methodology was used, applying semi-structured interview as qualitative information collection tool and the Indiana Job Satisfaction Scale as quantitative tool. The study period was from January 2021 to December 2022. A purposive sampling was performed with a sample of 24 people with Serious Mental Disorders who had obtained a job through an Individual Placement and Support (IPS) program during the study period. Semi-structured interview and the Indiana Job Satisfaction Scale were applied to this Serious Mental Disorder workers' sample. The Indiana Job Satisfaction Scale was also applied to a group of 24 workers without mental disorders in the same working conditions who served as control group.

Results

The results of the analyses of the Serious Mental Disorder workers' narratives show that perception of work experience is conditioned by individual, environmental and social predictors, as well as external factors as determining variables. Quantitative results obtained by the Indiana Job Satisfaction Scale reveal levels of job satisfaction resembling those of the rest of workers without Serious Mental Disorder.

Discussion

These findings reinforce the significance of employment in the recovery process for individuals with Serious Mental Disorders and emphasize the importance of understanding the subjective meaning individuals attribute to their work experiences.

Employers' perceptions of supports provided to their employees with disabilities

The employment of individuals with disabilities is significantly low. Many factors are associated with this issue; however, support and accommodations that can be provided to such individuals can improve their employment rate and outcomes. This study aimed to examine the support provided to employees with disabilities in Saudi Arabia. The descriptive approach was utilized, and a survey was used to collect the data. The sample consisted of 86 employer participants to examine the support of their employees with disabilities. Findings revealed that the support provided was high, and the participants reported that such support facilitates finding and maintaining a job. In addition, the variables were all found to have no significant differences. Providing needed and necessary support is an effective strategy that leads to competitive employment for individuals with disabilities, especially for the long term. Implications and recommendations are also discussed.

Struggling with Fitting in: Clients Mixed Experiences of Receiving Job Support and Getting a Job When Participating in Individual Placement and Support in Norway

PURPOSE

To explore clients' experiences of receiving job support from employment specialists (ESs) working with individual placement and support (IPS) in Norway. IPS is developed to help people with severe mental illness (SMI) into competitive employment as an integral component of mental health services.

METHODS

Using a hermeneutic phenomenological methodology, this study comprises individual semi-structured interviews with ten participants engaged in IPS at two districts psychiatric centers. Data analysis was conducted according to systematic text condensation.

RESULTS

Three themes emerged: (1) ES-a door opener? (2) Striving to sidestep a "spider web" of triggers at and away from work; and (3) Calling for a safer route.

CONCLUSION

This study highlights the importance of ESs offering IPS clients' opportunities to try out diverse jobs and focusing more on assessing the work environment in the jobs they place people into. Our findings imply that ESs should spend more time on building a good working alliance with both clients and employers, and pay more attention on understanding individuals' vocational capacities and support needs at the worksite. The ES training should focus not simply on the technical processes of job development and placement, but more directly on empowering clients to stay focused on their vocational ambitions and prospects. The salutogenic model of health can help ESs to analyze whether clients experience workplaces as meaningful, manageable, and comprehensible.

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

BACKGROUND

Unemployment rates for people living with mental illness remain persistently high. Individual Placement Support (IPS) is an evidence-based employment model that supports people with severe mental illness to gain employment. Although carers provide emotional and instrumental support for people with mental illness, there is limited research exploring carers' perspectives of IPS.

AIMS

To explore carers' perspectives of their experience as caregivers of individuals living with mental illness who have participated in IPS.

METHODS

This qualitative descriptive study gained carers' perspectives through semi-structured interviews. A convenience sample of eight carers was recruited via a community mental health service in Adelaide. Data were analysed thematically.

FINDINGS

Three main themes were identified: (1) employment benefits, (2) factors that may impact on employment, and (3) knowledge and opinions of IPS. Within each theme, four sub-themes emerged.

CONCLUSIONS

This study addresses a gap in research and provides insights into carers' experiences of IPS. Increased communication and involvement of carers in IPS may benefit IPS participants and staff as carers provide invaluable additional insight into supporting individuals through their employment journey.