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Melián Cartaya MJ, Arias Rodríguez Á, Rodríguez Pérez A, Sánchez Suárez M, Rodríguez-Novo N, Rodríguez-Novo Y, Rodríguez Pulido F. Experiences of individuals with serious mental disorders in regular employment through the Individual Placement and Support model. Front Psychiatry 2024; 15:1423742. [PMID: 39319357 PMCID: PMC11420022 DOI: 10.3389/fpsyt.2024.1423742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 08/15/2024] [Indexed: 09/26/2024] Open
Abstract
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.
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Affiliation(s)
| | - Ángeles Arias Rodríguez
- Area of Preventive Medicine and Public Health, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Armando Rodríguez Pérez
- Department of Cognitive, Social and Organizational Psychology, Faculty of Psychology, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - María Sánchez Suárez
- Individual Placement and Support (IPS) Team, Cabildo of Tenerife, Santa Cruz de Tenerife, Spain
| | - Natalia Rodríguez-Novo
- Department of Nursing, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Presidency of the Official College of Nursing of Santa Cruz de Tenerife, Santa Cruz de Tenerife, Spain
| | - Yurena Rodríguez-Novo
- Department of Nursing, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Universitary Hospital of Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Francisco Rodríguez Pulido
- Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, Santa Cruz de Tenerife, Spain
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Matousian N, Otto K. How to measure mental illness stigma at work: development and validation of the workplace mental illness stigma scale. Front Psychiatry 2023; 14:1225838. [PMID: 37502810 PMCID: PMC10369081 DOI: 10.3389/fpsyt.2023.1225838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction The study objective was to design a new theoretically driven multidimensional scale for the use in the empirical measurement of stigmatizing attitudes towards persons with mental illness within the return-to-work process as this integral part of vocational reintegration has been widely neglected by scholars so far. Methods Therefore, we developed and validated a 21-item instrument to comprehensively measure the three-factorial structure of stigmatizing attitudes (affect, cognition, behavior) across two studies (overall N = 251). Results In both studies the new scale proved to be highly internally consistent, and its proposed three-factor structure was equally supported across the two studies. Convergent and discriminant validity were demonstrated by moderate and high correlations or zero correlations with pertinent measures. Furthermore, construct validity of the new scale was supported by significant positive associations with relevant personality characteristics within stigma research. Discussion The WMISS is the first instrument to measure mental health stigma specifically within the return-to-work-process and demonstrates strong psychometric properties. Inclusion of this scale in future research can help facilitate understanding of mental illness stigma within the occupational sector and assist with targeted intervention development.
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Arena AF, Mobbs S, Sanatkar S, Williams D, Collins D, Harris M, Harvey SB, Deady M. Mental health and unemployment: A systematic review and meta-analysis of interventions to improve depression and anxiety outcomes. J Affect Disord 2023; 335:450-472. [PMID: 37201898 DOI: 10.1016/j.jad.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Unemployment is associated with substantially greater depression and anxiety, constituting a considerable public health concern. The current review provides the most comprehensive synthesis to date, and first meta-analysis, of controlled intervention trials aimed at improving depression and anxiety outcomes during unemployment. METHODS Searches were conducted within PsycInfo, Cochrane Central, PubMed and Embase from their inception to September 2022. Included studies conducted controlled trials of interventions focused on improving mental health within unemployed samples, and reported on validated measures of depression, anxiety, or distress (mixed depression and anxiety). Narrative syntheses and random effects meta-analyses were conducted among prevention- and treatment-level interventions for each outcome. RESULTS A total of 39 articles reporting on 33 studies were included for review (sample sizes ranging from 21 to 1801). Both prevention and treatment interventions tended to be effective overall, with treatment interventions producing larger effect sizes than prevention interventions. The clearest evidence for particular intervention approaches emerged for prevention-level Cognitive Therapy/CBT, followed by prevention-level work-related interventions, although neither produced entirely consistent effects. LIMITATIONS Risk of bias was generally high across studies. Low numbers of studies within subgroups precluded any comparisons between long-term and short-term unemployment, limited comparisons among treatment studies, and reduced the power of meta-analyses. CONCLUSIONS Both prevention- and treatment-level mental health-focused interventions have merit for reducing symptoms of anxiety and depression among those experiencing unemployment. Cognitive Therapy/CBT and work-related interventions hold the most robust evidence base, which can inform both prevention and treatment strategies implemented by clinicians, employment services providers, and governments.
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Affiliation(s)
- Andrew F Arena
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Sophia Mobbs
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Samineh Sanatkar
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Douglas Williams
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Daniel Collins
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Marnie Harris
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Samuel B Harvey
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mark Deady
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Zabihi Poursaadati M, Maarefvand M, Bolhari J, Hosseinzadeh S, Songhori N, Derakhshan L, Khubchandani J. Caregivers' experiences and perspectives of factors associated with relapse in Iranian people living with schizophrenia: A qualitative study. Int J Soc Psychiatry 2023; 69:86-100. [PMID: 34971526 DOI: 10.1177/00207640211068977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relapse in People Living with Schizophrenia (PLS) has several reasons and recognizing these can increase the effectiveness of treatment interventions. Formal and informal caregivers are an informed source to reduce relapse in PLS. AIM This study explores the caregivers' perspective in Iran on the factors affecting relapse in PLS. METHOD A total of 28 caregivers (16 formal caregivers and 12 informal caregivers) of PLS were enrolled in our qualitative study. A content analysis was conducted using individual and group, semi-structured in-depth interviews with informal and formal caregivers of PLS. This study was conducted in a hospital, three universities, and a non-governmental organization in Tehran, Iran. RESULTS The majority (69%) of the participants were females. About half of the informal caregivers were over 60 years old and about 40% of the formal caregivers were in the age range of 30 to 40 years. The average number of years of work for informal caregivers was 17.6 years and the average of work experience among the formal caregivers was 14.1 years. Seven key dual themes were identified from data: 'awareness-stigma', 'social support-social exclusion', 'treatment adherence-treatment discontinuation', 'holistic approach - one-dimensional approach', 'supported employment-social dysfunction', 'emotional management in family - family with high emotional expression', and 'access to treatment-treatment gap'. CONCLUSION The results of this research can help practitioners and policymakers to enable evidence-based practices to reduce relapse in PLS by emphasizing and acting on factors identified in our analyses.
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Affiliation(s)
| | - Masoomeh Maarefvand
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Biostatistics department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nahid Songhori
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Leili Derakhshan
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jagdish Khubchandani
- Department of Public Health Sciences, New Mexico University, Las Cruces, NM, USA
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Witte I, Strandberg T, Granberg S, Gustafsson J. Intersectional perspectives on the employment rate in Supported Employment for people with psychiatric, neuropsychiatric, or intellectual disabilities: A scoping review. Work 2023; 74:435-454. [PMID: 36278382 PMCID: PMC9986703 DOI: 10.3233/wor-211155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Supported Employment (SE) has shown better results in the employment rate for persons with disabilities than other methods within vocational rehabilitation, but how SE affects the employment rate for subgroups in the interventions needs further attention. OBJECTIVE To examine previous research regarding the influence of intersecting statuses on the employment rate in SE for people with psychiatric, neuropsychiatric, or intellectual disabilities according to type of diagnosis, sex, race/ethnicity, age, level of education and previous work history. METHODS A systematic literature search was conducted in nine databases including peer-reviewed articles from 2000 to April 2021. Articles presenting the employment rate in SE interventions according to the intersecting statuses listed in the objective were included. RESULTS The searches identified 3777 unique records, of which 53 articles were included in data extraction. In most of the included articles, intersecting statuses did not affect the employment rate for people in the SE interventions with psychiatric disabilities. Few studies have examined neuropsychiatric and intellectual disabilities. A majority of the studies subjected to full-text analysis were excluded due to a lack of reporting of the effects of intersecting statuses on the employment rate. The studies that reported on the effects of intersecting statuses on the employment rate often had small samples and lacked statistical power. CONCLUSIONS Intersecting statuses do not appear to affect the employment rate for people receiving SE interventions, but systematic reviews with pooled samples need to be undertaken because of the low reporting rate and underpowered sample sizes in existing studies.
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Affiliation(s)
- Ingrid Witte
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden
| | - Thomas Strandberg
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Sarah Granberg
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,Audiological Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johanna Gustafsson
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,Audiological Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Centre for the Study of Professions, Oslo Metropolitan University, Oslo, Norway
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de Winter L, Couwenbergh C, van Weeghel J, Sanches S, Michon H, Bond GR. Who benefits from individual placement and support? A meta-analysis. Epidemiol Psychiatr Sci 2022; 31:e50. [PMID: 35815640 PMCID: PMC9281491 DOI: 10.1017/s2045796022000300] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 01/22/2023] Open
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.
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Affiliation(s)
- Lars de Winter
- Phrenos Center of Expertise for Severe Mental Illnesses, Utrecht, the Netherlands
| | - Chrisje Couwenbergh
- Phrenos Center of Expertise for Severe Mental Illnesses, Utrecht, the Netherlands
| | - Jaap van Weeghel
- Phrenos Center of Expertise for Severe Mental Illnesses, Utrecht, the Netherlands
| | - Sarita Sanches
- Phrenos Center of Expertise for Severe Mental Illnesses, Utrecht, the Netherlands
| | - Harry Michon
- Movisie Netherlands Centre for Social Development, Utrecht, the Netherlands
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Zhen-Duan J, Chary A, NeMoyer A, Fukuda M, Markle SL, Hoyos M, Zhang L, Fuentes L, Pérez G, Chambers V, Rosenthal J, Mention N, Alegría M. Key stakeholder perspectives on the use of research about supported employment for racially and ethnically diverse patients with mental illness in the United States. Health Serv Res 2022; 57 Suppl 1:95-104. [PMID: 35243630 DOI: 10.1111/1475-6773.13905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore how stakeholders responded to research evidence regarding supported employment (e.g., vocational rehabilitation), and ways evidence could be incorporated into policy and action. DATA SOURCES Qualitative data were collected from three stakeholder groups-people with lived experience of mental health challenges, community health advocates, and state health policy makers. STUDY DESIGN This study consisted of two sequential steps. First, three focus groups were conducted after presenting stakeholder groups (inclusive of 22 participants) with simulation data showing that improvement in employment status had a stronger impact on mental health than improvement in education or income for racially/ethnically diverse groups. Second, with guidance from focus group findings, researchers conducted additional in-depth interviews (n = 19) to gain a deeper understanding of the opportunities and challenges related to incorporating these findings into policy and practice. DATA COLLECTION/EXTRACTION METHODS Focus groups and in-depth interviews were conducted, audio recorded, transcribed, and analyzed using a thematic analysis approach. PRINCIPAL FINDINGS People with lived experience described the positive effect of employment in their own life while highlighting the need to increase workplace accommodations and social supports for those with mental health challenges. Across stakeholder groups, participants emphasized the need for linguistic and cultural competence to promote equity in delivery of supported employment programs. Stakeholders also underscored that centralizing existing resources and using evidence-based approaches are crucial for successful implementation. CONCLUSION Implementing effective supported employment programs should focus on meeting the specific needs of target individuals, as many of those needs are not considered in current employment-related programming. Collecting information from diverse users of research demonstrates what other aspects of supported employment are required for the likelihood of successful uptake. Implementation and dissemination efforts need to fortify collaborations and knowledge transfer between stakeholders to optimize supported employment and mental health resources.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Anita Chary
- Department of Medicine, Section of Health Services Research, Center for Innovations in Quality, Effectiveness and Safety, Baylor College of Medicine, Houston, Texas, USA.,Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Amanda NeMoyer
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mercedes Hoyos
- Department of Political Science, Boston College, Chestnut Hill, Massachusetts, USA
| | - Liao Zhang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Larimar Fuentes
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gilberto Pérez
- Bienvenido Community Solutions, LLC, Goshen, Indiana, USA
| | | | - Jill Rosenthal
- National Academy for State Health Policy, Portland, Maine, USA.,Center for American Progress, Washington, District of Columbia, USA
| | - Najeia Mention
- National Academy for State Health Policy, Portland, Maine, USA.,Counseling & Psychological Services (CAPS), University of Hartford, Hartford, Connecticut, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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McDonagh MS, Dana T, Kopelovich SL, Monroe-DeVita M, Blazina I, Bougatsos C, Grusing S, Selph SS. Psychosocial Interventions for Adults With Schizophrenia: An Overview and Update of Systematic Reviews. Psychiatr Serv 2022; 73:299-312. [PMID: 34384230 DOI: 10.1176/appi.ps.202000649] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors of this systematic review (SR) sought to provide evidence for effects of commonly used psychosocial interventions on several outcomes among adults with schizophrenia. METHODS MEDLINE, the Cochrane Library, and PsycINFO databases were searched through July 2020. Eligible studies were SRs and trials of at least 12 weeks duration and with ≥50 participants that compared psychosocial interventions with treatment as usual among adults with schizophrenia. Study design, year, setting, country, sample size, eligibility criteria, population, clinical and intervention characteristics, results, and funding source were extracted, along with quality criteria. The evidence was evaluated on quality and strength of evidence stratified by intervention area and outcome, according to the Evidence-Based Practice Centers Methods Guide of the Agency for Healthcare Research and Quality. RESULTS Nine SRs and 30 trials (N=23,921 patients) in 11 intervention areas were included. Trials were mostly of fair quality and had low-to-moderate strength of evidence. Compared with treatment as usual, most psychosocial interventions were more effective in improving intervention-targeted outcomes, including core illness symptoms. Compared with treatment as usual, assertive community treatment, cognitive-behavioral therapy (CBT), family interventions, psychoeducation, social skills training, supported employment, and early interventions for first-episode psychosis (FEP) improved various functional outcomes. CBT and early interventions for FEP improved quality of life. Family interventions, psychoeducation, illness self-management, and early interventions for FEP reduced relapse. CONCLUSIONS Compared with treatment as usual, most psychosocial interventions improved functional outcomes, quality of life, and core illness symptoms, and several reduced relapse frequency among adults with schizophrenia.
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Affiliation(s)
- Marian S McDonagh
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Tracy Dana
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Sarah L Kopelovich
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Maria Monroe-DeVita
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Ian Blazina
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Christina Bougatsos
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Sara Grusing
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Shelley S Selph
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
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9
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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.
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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
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10
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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.
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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
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11
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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.
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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)
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12
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Metcalfe JD, Pogue JA, Drake RE. A brief assessment of race and ethnicity in individual placement and support studies in the United States. Psychiatry Res 2021; 301:113981. [PMID: 33971563 DOI: 10.1016/j.psychres.2021.113981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/25/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Justin D Metcalfe
- Westat Inc., 85 Mechanic Street, Suite C3-1, Box4A, Lebanon, NH 03766, United States.
| | - Jackie A Pogue
- Westat Inc., 85 Mechanic Street, Suite C3-1, Box4A, Lebanon, NH 03766, United States.
| | - Robert E Drake
- Westat Inc., 85 Mechanic Street, Suite C3-1, Box4A, Lebanon, NH 03766, United States.
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13
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Hellström L, Kruse M, Christensen TN, Trap Wolf R, Eplov LF. Cost-effectiveness analysis of a supported employment intervention for people with mood and anxiety disorders in Denmark - the IPS-MA intervention. Nord J Psychiatry 2021; 75:389-396. [PMID: 33559510 DOI: 10.1080/08039488.2021.1877348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We aimed to investigate the cost-utility and cost-effectiveness of a modified Individual Placement and Support intervention for people with mood and anxiety disorders (IPS-MA). METHODS Costs were assessed from a societal perspective. Health care costs were derived from registers and combined with data on use of IPS-MA services, municipal social care, and labour market services. EQ-5D was used to compute QALY. Missing data were imputed in a sensitivity analysis. We also computed the cost per gain in hours worked. Incremental cost-effectiveness ratios (ICER) were computed and bootstrapped to obtain confidence intervals for QALY and gain in hours worked. RESULTS We found no difference in overall costs between groups. A significant saving was found in use of labour market services in the IPS-MA group. But the IPS-MA group had significantly lower wage earnings compared to the control group. The intervention group had a higher, though statistically in-significant, increase in QALYs than the control group. The ICER did not show statistically significant results, but there was a tendency, that IPS-MA could have a positive effect on health-related quality of life without any additional costs. However, participants in the IPS-MA group had a significantly lower gain in hours worked compared to the control group. CONCLUSIONS Despite a significant saving in use of labour market services, IPS-MA was not cost-effective. Participants in the IPS-MA group worked significantly fewer hours and earned significantly less than participants in the control group at 1-year follow-up.
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Affiliation(s)
- Lone Hellström
- CORE: Copenhagen Research Center for Mental Health, Mental health Centre Copenhagen, Hellerup, Denmark
| | - Marie Kruse
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | | | - Rasmus Trap Wolf
- CORE: Copenhagen Research Center for Mental Health, Mental health Centre Copenhagen, Hellerup, Denmark.,Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Lene Falgaard Eplov
- CORE: Copenhagen Research Center for Mental Health, Mental health Centre Copenhagen, Hellerup, Denmark
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14
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Khare C, Mueser KT, Bahaley M, Vax S, McGurk SR. Employment in people with severe mental illnesses receiving public sector psychiatric services in India. Psychiatry Res 2021; 296:113673. [PMID: 33418456 DOI: 10.1016/j.psychres.2020.113673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
The limited literature on employment in people with severe mental illnesses (SMI) in developing countries suggests higher rates than in developed countries. The present study explored rates and associated characteristics of work in people receiving public psychiatric services. Semi-structured interviews were conducted with 150 individuals with SMI (90% schizophrenia-spectrum) receiving public outpatient psychiatric services in an urban district in western India to evaluate employment. Forty percent of participants were employed, most for independent employers (86.7%), and were working an average of 53 hours/week. Earning money was reported as the primary motivation to work. A high proportion (92.2%) of unemployed participants wanted to work. Common barriers to work for unemployed participants who were interested in working were psychological (e.g., stress), mental illness (e.g., symptoms), and work-related factors (e.g., difficulty finding a job). Help finding a job and managing mental illness were the primary desired supports. Rates of employment in people with SMI living in urban areas in India are higher than in developed countries, but much lower than the general population. The high interest in work coupled with specific barriers and desired supports point to the need for vocational rehabilitation for improving the employment functioning of people with SMI in India.
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Affiliation(s)
- Chitra Khare
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave. Boston, MA 02215, USA; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA.
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA; Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA.
| | | | - Sigal Vax
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave. Boston, MA 02215, USA; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA.
| | - Susan R McGurk
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA; Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA.
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15
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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.
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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
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16
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Pichler EM, Stulz N, Wyder L, Heim S, Watzke B, Kawohl W. Long-Term Effects of the Individual Placement and Support Intervention on Employment Status: 6-Year Follow-Up of a Randomized Controlled Trial. Front Psychiatry 2021; 12:709732. [PMID: 34712153 PMCID: PMC8546221 DOI: 10.3389/fpsyt.2021.709732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
People with mental illness often experience difficulties with reintegration into the workplace, although employment is known to assist these individuals in their recovery process. Traditional approaches of "first train, then place" have been recently replaced by supported employment (SE) methods that carry strategy of "first place, then train." Individual placement and support (IPS) is one of the best-studied methods of SE, which core principles are individualized assistance in rapid job search with consequent placement in a paid employment position. A considerable amount of high-quality evidence supported the superiority of IPS over conventional methods in providing improved employment rates, longer job tenure, as well as higher salaries in competitive job markets. Nonetheless, our knowledge about the IPS-mediated long-term effects is limited. This non-interventional follow-up study of a previously published randomized controlled trial (RCT) called ZhEPP aimed to understand the long-term impact of IPS after 6 years since the initial intervention. Participants from the ZhEPP trial, where 250 disability pensioners with mental illnesses were randomized into either IPS intervention group or treatment as usual group (TAU), were invited to face-to-face interviews, during which employment status, job tenure, workload, and salaries were assessed. One hundred and fourteen individuals agreed to participate in this follow-up study. Although during the first 2 years post-intervention, the IPS group had higher employment rates (40% (IPS) vs. 28% (TAU), p < 0.05 at 24 months), these differences disappeared by the time of follow-up assessments (72 months). The results indicated no substantial differences in primary outcome measures between IPS and TAU groups: employment rate (36 vs. 33%), workload (10.57 vs. 10.07 h per week), job tenure (29 vs. 28 months), and salary (20.21CHF vs. 25.02 CHF). These findings provide important insights regarding the long-term effects of IPS among individuals with mental health illnesses. Further research is required to advance the current knowledge about IPS intervention and its years-long impact.
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Affiliation(s)
- Eva-Maria Pichler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland
| | - Niklaus Stulz
- Psychiatric Services Aargau, Windisch, Switzerland.,Integrated Psychiatric Services Winterthur-Zurcher Unterland (IPW), Winterthur, Switzerland
| | - Lea Wyder
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland
| | - Simone Heim
- Psychiatric Services Aargau, Windisch, Switzerland.,Praxis Dr. Pramstaller, Uetikon am See, Switzerland
| | - Birgit Watzke
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland.,Clienia Schlössli AG, Oetwil am See, Switzerland
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17
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Khare C, Mueser KT, Fulford D, Watve VG, Karandikar NJ, Khare S, Karandikar DN, McGurk SR. Employment functioning in people with severe mental illnesses living in urban vs. rural areas in India. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1593-1606. [PMID: 32564092 DOI: 10.1007/s00127-020-01901-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/09/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE Research on employment in people with severe mental illnesses (SMI) in developing countries is sparse and largely limited to employment rates. We conducted a comprehensive study of work, interest in work, and perceived benefits and barriers to work in people with SMI in India. METHODS Semi-structured interviews were conducted with 550 individuals with SMI receiving private psychiatric outpatient services in two districts in western India, one urban (Pune) and the other rural (Ahmednagar). RESULTS More than half of the participants were employed, with significantly more men working (79.4%) than women (35.9%). Higher rates of work were found in rural areas (77.8%), where most work was in family agricultural businesses, than in urban areas (48.9%), where most work was for independent employers. Participants in rural areas worked fewer hours and earned less money, and reported fewer benefits and fewer problems related to work than urban participants. Over 45% of participants working for independent employers found jobs with help from families and extended social networks. Most unemployed participants wanted to work, and desired a variety of supports, including assistance with job finding and illness management. CONCLUSIONS Gender-specific social role expectations and families play an important role in work in people with SMI in India. Despite higher rates of work in this sample than most studies from developed countries, a significant subgroup was unemployed but wanted to work. Persons with SMI in developing countries may benefit from the adaptation of validated vocational rehabilitation approaches in developed countries to their cultural context.
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Affiliation(s)
- Chitra Khare
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA.,Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA, 02215, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA, 02215, USA. .,Department of Occupational Therapy, Boston University, Boston, MA, 02215, USA. .,Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Daniel Fulford
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA.,Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Vidyadhar G Watve
- Department of Psychiatry, Poona Hospital and Research Centre, Sadashiv Peth, Pune, Maharashtra, 411030, India
| | - Neeraj J Karandikar
- Manasdeep Psychiatric and De-Addiction Center, Dr. Karandikar Hospital, Laltaki, Siddharthnagar, Ahmednagar, Maharashtra, 414001, India
| | - Sailee Khare
- KEM Hospital and Research Centre (KEMHRC), Sardar Moodliar Road, Rasta Peth, Pune, Maharashtra, 411011, India
| | - Dipti N Karandikar
- Manasdeep Psychiatric and De-Addiction Center, Dr. Karandikar Hospital, Laltaki, Siddharthnagar, Ahmednagar, Maharashtra, 414001, India
| | - Susan R McGurk
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA, 02215, USA.,Department of Occupational Therapy, Boston University, Boston, MA, 02215, USA.,Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Prior S, Maciver D, Aas RW, Kirsh B, Lexen A, van Niekerk L, Irvine Fitzpatrick L, Forsyth K. An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study. BMC Psychiatry 2020; 20:361. [PMID: 32641009 PMCID: PMC7346406 DOI: 10.1186/s12888-020-02745-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes. METHODS This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education). RESULTS Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(7) = 41.38 p < .001. CONCLUSION An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment. TRIAL REGISTRATION NCT04083404 Registered 05 September 2019 (retrospectively registered).
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Affiliation(s)
- Susan Prior
- Queen Margaret University, Edinburgh, EH21 6UU, UK.
| | - Donald Maciver
- grid.104846.fQueen Margaret University, Edinburgh, EH21 6UU UK
| | - Randi W. Aas
- Faculty of Health Sciences, University of Stavanger & Oslo Metropolitan University, Oslo, Norway
| | - Bonnie Kirsh
- grid.17063.330000 0001 2157 2938Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Annika Lexen
- grid.4514.40000 0001 0930 2361Department of Health Sciences/Mental Health Activity and Participation (MAP), Lund University, Lund, Sweden
| | - Lana van Niekerk
- grid.11956.3a0000 0001 2214 904XDivision of Occupational Therapy, University Stellenbosch, Stellenbosch, South Africa
| | - Linda Irvine Fitzpatrick
- Mental Health and Wellbeing, City of Edinburgh Health and Social Care Partnership, Waverley Court, Edinburgh, EH8 8BG UK
| | - Kirsty Forsyth
- grid.104846.fQueen Margaret University, Edinburgh, EH21 6UU UK
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How do recovery-oriented interventions contribute to personal mental health recovery? A systematic review and logic model. Clin Psychol Rev 2020; 76:101815. [DOI: 10.1016/j.cpr.2020.101815] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/14/2019] [Accepted: 01/03/2020] [Indexed: 01/16/2023]
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20
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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.
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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
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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.
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Affiliation(s)
- Rachel Terry
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Greg Townley
- Department of Psychology, Portland State University, Portland, OR, USA
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22
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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.
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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.
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23
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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]).
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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
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Abstract
In many European countries, deinstitutionalisation has been an ongoing process over the last few decades. Mental health organisations were transformed to provide support in a more integrated and comprehensive manner, preferably in their own homes in the community. Yet, despite the welcome aspiration of community integration for all, people with complex mental health problems (also termed severe mental illness) have continued to require high levels of support, in inpatient settings and in the community. This group's needs make them highly dependent on their caregivers. The attitudes, knowledge and skills of the staff providing treatment and support is crucial to their recovery. Rehabilitation programmes provide a much-needed framework to guide practitioners and help them organise and focus their recovery-oriented approach. In this editorial, we will provide a non-exhaustive overview of such rehabilitation programmes and interventions to illuminate the wide scope and practical usability of these interventions for this group of people with complex mental health problems.
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25
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Fleming C, Curtis R, Davis Martin E, Kraska M, Shippen M, Varda K. Perceptions and practices of mental health professionals regarding the employment of people with serious mental illness. JOURNAL OF VOCATIONAL REHABILITATION 2019. [DOI: 10.3233/jvr-180986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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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]
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Pinto AD, Hassen N, Craig-Neil A. Employment Interventions in Health Settings: A Systematic Review and Synthesis. Ann Fam Med 2018; 16:447-460. [PMID: 30201643 PMCID: PMC6130994 DOI: 10.1370/afm.2286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/30/2018] [Accepted: 05/10/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Employment is a key social determinant of health. People who are unemployed typically have worse health than those employed. Illness and disability can result in unemployment and be a barrier to regaining employment. We combined a systematic review and knowledge synthesis to identify both studies of employment interventions in health care settings and common characteristics of successful interventions. METHODS We searched the peer-reviewed literature (1995-2017), and titles and abstracts were screened for inclusion and exclusion criteria by 2 independent reviewers. We extracted data on the study setting, participants, intervention, methods, and findings. We also conducted a narrative synthesis and iteratively developed a conceptual model to inform future primary care interventions. RESULTS Of 6,729 unique citations, 88 articles met our criteria. Most articles (89%) focused on people with mental illness. The majority of articles (74%) tested interventions that succeeded in helping participants gain employment. We identified 5 key features of successful interventions: (1) a multidisciplinary team that communicates regularly and collaborates, (2) a comprehensive package of services, (3) one-on-one and tailored components, (4) a holistic view of health and social needs, and (5) prospective engagement with employers. CONCLUSIONS Our findings can inform new interventions that focus on employment as a social determinant of health. Although hiring a dedicated employment specialist may not be feasible for most primary care organizations, pathways using existing resources with links to external agencies can be created. As precarious work becomes more common, helping patients engage in safe and productive employment could improve health, access to health care, and well-being.
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Affiliation(s)
- Andrew D Pinto
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada .,Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nadha Hassen
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Amy Craig-Neil
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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28
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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.
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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
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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.
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Abstract
Aims and MethodWe evaluated the impact of implementing the individual placement and support (IPS) approach within eight community mental health teams (CMHTs) in two London boroughs. Demographic, clinical and vocational data were collected enabling a comparison of the number of people supported in work/education and individual client outcomes at 6 and 12 months.ResultsFollowing the integration of employment specialists there were significant increases in the number and proportion of clients engaged in mainstream work or educational activity at 6 months and 12 months. The employment specialists supported 38% in open employment at 6 months and 39% at 12 months.Clinical ImplicationsThe results support the use of IPS in clinical practice in CMHTs.
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McKay C, Nugent KL, Johnsen M, Eaton WW, Lidz CW. A Systematic Review of Evidence for the Clubhouse Model of Psychosocial Rehabilitation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:28-47. [PMID: 27580614 PMCID: PMC5756274 DOI: 10.1007/s10488-016-0760-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Clubhouse Model has been in existence for over sixty-five years; however, a review that synthesizes the literature on the model is needed. The current study makes use of the existing research to conduct a systematic review of articles providing a comprehensive understanding of what is known about the Clubhouse Model, to identify the best evidence available, as well as areas that would benefit from further study. Findings are summarized and evidence is classified by outcome domains. Fifty-two articles met the selection criteria of Randomized Clinical Trials (RCT's), quasi-experimental studies, or observational studies for domains of employment (N = 29); quality of life/satisfaction (N = 10); reductions in psychiatric hospitalization(s) (N = 10); social relationships (N = 10); education (N = 3); and health promotion activities (N = 2). RCT results support the efficacy of the Clubhouse Model in promoting employment, reducing hospitalization(s), and improving quality of life. Quasi-experimental and observational studies offer support in education and social domains. The findings from this review indicate that Clubhouses are a promising practice but additional studies using rigorous methods that report the strength of the outcomes are needed to evaluate Clubhouse programs with fidelity to the Clubhouse Model.
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Affiliation(s)
- Colleen McKay
- Department of Psychiatry, Program for Clubhouse Research, Systems and Psychosocial Advances Research Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Katie L Nugent
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD, 21228, USA
| | - Matthew Johnsen
- Department of Sociology, Worcester State University, 486 Chandler Street, Worcester, MA, 01602, USA
| | - William W Eaton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Room 880B, 624 North Broadway, Baltimore, MD, 21205, USA
| | - Charles W Lidz
- Department of Psychiatry, Systems and Psychosocial Advances Research Center, University of Massachusetts Medical School, Worcester, MA, 01655, USA
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Stirling Y, Higgins K, Petrakis M. Challenges in implementing individual placement and support in the Australian mental health service and policy context. AUST HEALTH REV 2018; 42:82-88. [DOI: 10.1071/ah16093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 12/09/2016] [Indexed: 11/23/2022]
Abstract
Objective
Although Australia’s service and policy context differs from that of the US, studies have highlighted potential for individual placement and support (IPS) to support competitive employment outcomes for people with severe and persistent mental illness. The aim of the present study was to explore why the model is not yet widely available.
Methods
A document analysis was conducted to discern reasons for challenges in implementation of IPS practice principles within the Australian service context.
Results
The document analysis illustrated that although policy acknowledges the importance of increasing employment rates for people with severe and persistent mental illness, consistent measures, change indicators, direction and time frames are lacking in policy and strategy documentation. Further, IPS principles are not consistently evident in guiding operational documentation that government-funded Disability Employment Services (DES) programs are mandated to adhere to.
Conclusions
For IPS to be readily implemented, it is necessary for government to offer support to agencies to partner and formal endorsement of the model as a preferred approach in tendering processes. Obligations and processes must be reviewed to ensure that model fidelity is achievable within the Australian Commonwealth policy and service context for programs to achieve competitive employment rates comparable to the most successful international programs.
What is known about the topic?
The IPS model has been established as the most efficacious approach to support people with severe and persistent mental ill health to gain and sustain employment internationally, yet little is known as to why this model has had very limited uptake in the Australian adult mental health service and policy context.
What does this paper add?
This paper provides an investigation into the achievability of IPS within DES philosophical and contractual arrangements.
What are the implications for practitioners?
Mental health practitioners are typically skilled in their understanding of individual or micro-level challenges faced by consumers in achieving vocational goals: working with symptoms, medication side effects, motivation and anxiety. The present study was designed to offer practitioners an increased understanding of service-level factors, because these present considerable challenges to achieving sustained employment. This paper is a call for greater advocacy towards better integration of employment and mental health service delivery in the Australian policy and practice context.
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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: 88] [Impact Index Per Article: 12.6] [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.
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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
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Lövgren V, Markström U, Sauer L. Towards Employment: What Research Says About Support-to-Work in Relation to Psychiatric and Intellectual Disabilities. JOURNAL OF SOCIAL WORK IN DISABILITY & REHABILITATION 2017; 16:14-37. [PMID: 28187697 DOI: 10.1080/1536710x.2017.1260516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article presents an overview of research about support-to-work in relation to psychiatric and intellectual disabilities. The overview shows that support-to-work services are multifaceted, and that work can be seen as a tool for individual rehabilitation or as a set of goals to achieve. Providers are presented with specific components, which are characterized by systematic, targeted, and individualized interventions. The overview illustrates a need for long-term engagement and cooperation of and between welfare services and agents within the labor market to dissolve the Gordian knot that the transition from welfare interventions to employment seems to be.
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Affiliation(s)
| | - Urban Markström
- a Department of Social Work , Umeå University , Umeå , Sweden
| | - Lennart Sauer
- a Department of Social Work , Umeå University , Umeå , Sweden
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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.
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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.
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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.
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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
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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.
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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
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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.
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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
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Gold PB, Macias C, Rodican CF. Does Competitive Work Improve Quality of Life for Adults with Severe Mental Illness? Evidence from a Randomized Trial of Supported Employment. J Behav Health Serv Res 2016; 43:155-71. [PMID: 24504832 PMCID: PMC4636477 DOI: 10.1007/s11414-014-9392-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A randomized trial comparing a facility-based Clubhouse (N = 83) to a mobile Program of Assertive Community Treatment (PACT; N = 84) tested the widely held belief that competitive employment improves global quality of life for adults with severe mental illness. Random regression analyses showed that, over 24 months of study participation, competitively employed Clubhouse participants reported greater global quality of life improvement, particularly with the social and financial aspects of their lives, as well as greater self-esteem and service satisfaction, compared to competitively employed PACT participants. However, there was no overall association between global quality of life and competitive work, or work duration. Future research will determine whether these findings generalize to other certified Clubhouses or to other types of supported employment. Multi-site studies are needed to identify key mechanisms for quality of life improvement in certified Clubhouses, including the possibly essential role of Clubhouse employer consortiums for providing high-wage, socially integrated jobs.
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Affiliation(s)
- Paul B Gold
- Department of Counseling, Higher Education, and Special Education, University of Maryland at College Park, College Park, MD, 20742, USA.
| | - Cathaleene Macias
- Community Intervention Research, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Charles F Rodican
- Community Intervention Research, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
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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).
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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.
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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.
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Mental health services for individuals with high functioning autism spectrum disorder. AUTISM RESEARCH AND TREATMENT 2014; 2014:502420. [PMID: 25276425 PMCID: PMC4168143 DOI: 10.1155/2014/502420] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/09/2014] [Indexed: 11/17/2022]
Abstract
Adolescents and adults with an autism spectrum disorder (ASD) who do not have an intellectual impairment or disability (ID), described here as individuals with high-functioning autism spectrum disorder (HFASD), represent a complex and underserved psychiatric population. While there is an emerging literature on the mental health needs of children with ASD with normal intelligence, we know less about these issues in adults. Of the few studies of adolescents and adults with HFASD completed to date, findings suggest that they face a multitude of cooccurring psychiatric (e.g., anxiety, depression), psychosocial, and functional issues, all of which occur in addition to their ASD symptomatology. Despite this, traditional mental health services and supports are falling short of meeting the needs of these adults. This review highlights the service needs and the corresponding gaps in care for this population. It also provides an overview of the literature on psychiatric risk factors, identifies areas requiring further study, and makes recommendations for how existing mental health services could include adults with HFASD.
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Education and employment needs and receipt of services in community and inpatient mental health settings. Community Ment Health J 2014; 50:637-45. [PMID: 24468798 DOI: 10.1007/s10597-014-9694-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
The interRAI Education and Employment Clinical Assessment Protocol (EdEmp CAP) identifies three groups of individuals in community and inpatient mental health settings: those who are at risk of losing their employment or disrupting their education; those who require support in employment or educational participation; or those for whom interventions related to education and employment are not triggered. The EdEmp CAP was effective in identifying subpopulations who were at risk, but who did not receive any vocational rehabilitation or counseling. The EdEmp CAP can be used in clinical practice to identify individuals who might benefit from specific interventions in these areas.
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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.
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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
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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.
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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
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Leddy M, Stefanovics E, Rosenheck R. Health and well-being of homeless veterans participating in transitional and supported employment: Six-month outcomes. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2014; 51:161-75. [PMID: 24805902 DOI: 10.1682/jrrd.2013.01.0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 07/22/2013] [Indexed: 11/05/2022]
Abstract
Supported employment, specifically individual placement and support (IPS), improves competitive employment (CE) rates for individuals with serious mental illness, but has not shown greater improvement in non-vocational outcomes than other rehabilitation approaches. The Department of Veterans Affairs offers two types of vocational services, IPS and transitional work experience (TWE), but no study has compared the effectiveness of these approaches. This secondary analysis of data from a study of homeless veterans compared 6 mo improvement in diverse outcomes for five employment patterns: never worked, worked only in TWE, worked in TWE followed by CE, worked in CE without IPS, and worked in CE with IPS referral. Veterans referred to IPS were more likely to be competitively employed. Those who worked in CE (whether following TWE or with or without IPS referral) showed the greatest increase in days worked, employment income, and total income and the greatest decrease in public support income when compared with those who worked only in TWE or not at all. Veterans in TWE showed the greatest increase in residential treatment days, but there were no other differences in non-vocational outcomes between groups. There are multiple paths to CE, but few differences in non-vocational outcomes across employment experiences.
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Affiliation(s)
- Meaghan Leddy
- Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave, Bldg 15, Rm 127, West Haven, CT 06516.
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Beck C, Wernham C. Improving access to competitive employment for service users in forensic psychiatric units. BMJ QUALITY IMPROVEMENT REPORTS 2014; 3:bmjquality_uu204182.w1821. [PMID: 26734271 PMCID: PMC4645814 DOI: 10.1136/bmjquality.u204182.w1821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/24/2014] [Indexed: 11/06/2022]
Abstract
Employment has been proven to be an effective recovery tool and therapeutic intervention for those with severe and enduring mental health conditions. Aside from monetary reward, employment is a means of structuring time and provides a sense of worth and achievement, which enhances self-esteem and confidence. A social identity is developed through employment, encouraging social support and increasing social networks. Securing employment can bring about improved quality of life and positive change in one's social circumstances; therefore it can reduce symptoms associated with mental illness and potentially prevent re-offending, as the individual develops a sense of independence, self-efficacy, and value. Barriers to employment exist for forensic mental health service users and therefore it is imperative that employment needs are addressed at the earliest possible stage in recovery. An evaluation of employment activities across two forensic mental health units revealed a lack of appropriate employment opportunities for service users, and those roles available were not implemented in line with recommended best practice. In response to this issue several enterprises were established to offer opportunities for service users to engage in meaningful employment and develop skills that a future employer would value. Each enterprise responds to a business need within the units to ensure sustainability of services. The enterprises are essentially micro-businesses with social objectives whose surpluses are reinvested for the purpose of increasing opportunities for service users. The enterprises are underpinned by the philosophy of the Individual Placement and Support (IPS) model; empirical evidence suggests that the IPS model is the most effective intervention, based on the ‘place then train’ philosophy. The model recommends a focus upon rapid job search to achieve competitive employment for those who want to work; opportunities sourced should be consistent with individual preference and benefits counselling offered. Support should be time unlimited and integrated with mental health treatment. A person-centred and strengths-based approach is also adopted to support people to build on their strengths, establish goals, and encourage motivation.
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Hellström L, Bech P, Nordentoft M, Lindschou J, Eplov LF. The effect of IPS-modified, an early intervention for people with mood and anxiety disorders: study protocol for a randomised clinical superiority trial. Trials 2013; 14:442. [PMID: 24368060 PMCID: PMC3879652 DOI: 10.1186/1745-6215-14-442] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety and affective disorders can be disabling and have a major impact on the ability to work. In Denmark, people with a mental disorder, and mainly non-psychotic disorders, represent a substantial and increasing part of those receiving disability pensions. Previous studies have indicated that Individual Placement and Support (IPS) has a positive effect on employment when provided to people with severe mental illness. This modified IPS intervention is aimed at supporting people with recently diagnosed anxiety or affective disorders in regaining their ability to work and facilitate their return to work or education. AIM To investigate whether an early modified IPS intervention has an effect on employment and education when provided to people with recently diagnosed anxiety or affective disorders in a Danish context. METHODS/DESIGN The trial is a randomised, assessor-blinded, clinical superiority trial of an early modified IPS intervention in addition to treatment-as-usual compared to treatment-as-usual alone for 324 participants diagnosed with an affective disorder or anxiety disorder living in the Capital Region of Denmark. The primary outcome is competitive employment or education at 24 months. Secondary outcomes are days of competitive employment or education, illness symptoms and level of functioning including quality of life at follow-up 12 and 24 months after baseline. DISCUSSION If the modified IPS intervention is shown to be superior to treatment-as-usual, a larger number of disability pensions can probably be avoided and long-term sickness absences reduced, with major benefits to society and patients. This trial will add to the evidence of how best to support people's return to employment or education after a psychiatric disorder. TRIAL REGISTRATION NCT01721824.
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Affiliation(s)
- Lone Hellström
- Copenhagen University Hospital, Research Unit, Mental Health Centre Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
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Kinoshita Y, Furukawa TA, Kinoshita K, Honyashiki M, Omori IM, Marshall M, Bond GR, Huxley P, Amano N, Kingdon D. Supported employment for adults with severe mental illness. Cochrane Database Syst Rev 2013; 2013:CD008297. [PMID: 24030739 PMCID: PMC7433300 DOI: 10.1002/14651858.cd008297.pub2] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND People who suffer from severe mental disorder experience high rates of unemployment. Supported employment is an approach to vocational rehabilitation that involves trying to place clients in competitive jobs without any extended preparation. The Individual placement and support (IPS) model is a carefully specified form of supported employment. OBJECTIVES 1. To review the effectiveness of supported employment compared with other approaches to vocational rehabilitation or treatment as usual.2. Secondary objectives were to establish how far:(a) fidelity to the IPS model affects the effectiveness of supported employment,(b) the effectiveness of supported employment can be augmented by the addition of other interventions. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (February 2010), which is compiled by systematic searches of major databases, handsearches and conference proceedings. SELECTION CRITERIA All relevant randomised clinical trials focusing on people with severe mental illness, of working age (normally 16 to 70 years), where supported employment was compared with other vocational approaches or treatment as usual. Outcomes such as days in employment, job stability, global state, social functioning, mental state, quality of life, satisfaction and costs were sought. DATA COLLECTION AND ANALYSIS Two review authors (YK and KK) independently extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% (CI). We employed a fixed-effect model for analyses. A random-effects model was also employed where heterogeneity was present. MAIN RESULTS A total of 14 randomised controlled trials were included in this review (total 2265 people). In terms of our primary outcome (employment: days in competitive employment, over one year follow-up), supported employment seems to significantly increase levels of any employment obtained during the course of studies (7 RCTs, n = 951, RR 3.24 CI 2.17 to 4.82, very low quality of evidence). Supported employment also seems to increase length of competitive employment when compared with other vocational approaches (1 RCT, n = 204, MD 70.63 CI 43.22 to 94.04, very low quality evidence). Supported employment also showed some advantages in other secondary outcomes. It appears to increase length (in days) of any form of paid employment (2 RCTs, n = 510, MD 84.94 CI 51.99 to 117.89, very low quality evidence) and job tenure (weeks) for competitive employment (1 RCT, n = 204, MD 9.86 CI 5.36 to 14.36, very low quality evidence) and any paid employment (3 RCTs, n = 735, MD 3.86 CI -2.94 to 22.17, very low quality evidence). Furthermore, one study indicated a decreased time to first competitive employment in the long term for people in supported employment (1 RCT, n = 204, MD -161.60 CI -225.73 to -97.47, very low quality evidence). A large amount of data were considerably skewed, and therefore not included in meta-analysis, which makes any meaningful interpretation of the vast amount of data very difficult. AUTHORS' CONCLUSIONS The limited available evidence suggests that supported employment is effective in improving a number of vocational outcomes relevant to people with severe mental illness, though there appears to exist some overall risk of bias in terms of the quality of individual studies. All studies should report a standard set of vocational and non-vocational outcomes that are relevant to the consumers and policy-makers. Studies with longer follow-up should be conducted to answer or address the critical question about durability of effects.
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Affiliation(s)
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine / School of Public HealthDepartments of Health Promotion and Behavior Change and of Clinical EpidemiologyYoshida Konoe‐cho, Sakyo‐ku,KyotoJapan601‐8501
| | | | - Mina Honyashiki
- Kyoto University Graduate School of Medicine / School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan601‐8501
| | - Ichiro M Omori
- Toyokawa City HospitalDepartment of PsychiatryKoumei 1‐19ToyokawaAichiJapan442‐8561
| | - Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPreston.LancashireUK
| | - Gary R Bond
- Dartmouth Medical SchoolDepartment of PsychiatryRivermill Commercial Centre85 Mechanic StreetLebanonNew HampshireUSA03766
| | - Peter Huxley
- University of SwanseaApplied Social StudiesVivian BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Naoji Amano
- Shinshu University, School of MedicineDepartment of PsychiatryMatsumotoJapan
| | - David Kingdon
- University of SouthamptonMental Health GroupCollege Keep4‐12 Terminus TerraceSouthamptonUKSO14 3DT
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Ferguson KM. Using the Social Enterprise Intervention (SEI) and Individual Placement and Support (IPS) models to improve employment and clinical outcomes of homeless youth with mental illness. SOCIAL WORK IN MENTAL HEALTH 2013; 11:10.1080/15332985.2013.764960. [PMID: 24294127 PMCID: PMC3840385 DOI: 10.1080/15332985.2013.764960] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Prior research reveals high unemployment rates among homeless youth. The literature offers many examples of using evidence-informed and evidence-based supported employment models with vulnerable populations to assist them in obtaining and maintaining employment and concurrently addressing mental health challenges. However, there are few examples to date of these models with homeless youth with mental illness. The purpose of this article was thus to describe a methodology for establishing a university-agency research partnership to design, implement, evaluate, and replicate evidence-informed and evidence-based interventions with homeless youth with mental illness to enhance their employment, mental health, and functional outcomes. Data from two studies are used to illustrate the relationship between vocational skill-building/employment and mental health among homeless youth. The article concludes with a discussion of the implications of conducting community-based participatory employment and clinical intervention research. The author highlights the opportunities and tensions associated with this approach.
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Affiliation(s)
- Kristin M. Ferguson
- Silberman School of Social Work at Hunter College, 2180 Third Avenue, New York, NY 10035
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