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Harkko J, Sipilä N, Nordquist H, Lallukka T, Appelqvist-Schmidlechner K, Donnelly M, Kouvonen A. External context in individual placement and support implementation: a scoping review with abductive thematic analysis. Implement Sci 2023; 18:61. [PMID: 37946209 PMCID: PMC10636871 DOI: 10.1186/s13012-023-01316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Context including the external context may considerably affect the adoption, implementation, sustainment, and scale-up of evidence-based practices. We investigated external contextual features by conducting a scoping review of empirical research regarding the implementation of an evidence-based psychiatric or mental health vocational rehabilitation service called Individual Placement and Support (IPS). METHODS The protocol for the scoping review was registered with the Open Science Framework. We used the methodology by Joanna Briggs Institute for conducting the scoping review and reported it according to the PRISMA-ScR checklist. We searched 12 databases for research regarding 'Individual Placement and Support' or 'Evidence-Based Supported Employment'. We retained peer-reviewed empirical studies investigating external contextual factors and their impact on IPS implementation outcomes. We extracted data from the eligible articles and conducted descriptive and thematic analyses. RESULTS Fifty-nine original research papers met our eligibility requirements and were retained after reviewing 1124 titles and abstracts and 119 full texts. The analysis generated two main themes: (1) external contextual determinants of service delivery and (2) external systems influencing the evidence-to-practice process. The first main theme encompassed policies and laws, financing, and administratively instituted support resources, and organizational arrangements associated with external stakeholders that may facilitate or hinder the local implementation. The second main theme comprised strategies and actions used by different stakeholders to facilitate implementation locally or scale-up efforts at a system level. DISCUSSION Our scoping review illustrates the important role that external contextual factors play and how they may facilitate or hinder the implementation and scale-up of the IPS model across mental health services in different countries. Consideration of these factors by decision-makers in mental health and welfare services, planners, providers, and practitioners is likely to facilitate the development of effective strategies for bridging the evidence-practice gap in implementing the EBPs. Finally, the scoping review identified gaps in knowledge and offered suggestions for future research. TRIAL REGISTRATION Open Science Framework.
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Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
| | - Noora Sipilä
- The Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
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Cohen DA, Klodnick VV, Reznik SJ, Lopez MA. Expanding Early Psychosis Care across a Large and Diverse State: Implementation Lessons Learned from Administrative Data and Clinical Team Leads in Texas. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:861-875. [PMID: 37530982 PMCID: PMC10543575 DOI: 10.1007/s10488-023-01285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/03/2023]
Abstract
The U.S. is facing an unprecedented youth mental health crisis. Translating the findings from mental health intervention trials into large scale, accessible community-based services poses substantial challenges. Examination of state actions as a result of research-informed federal policy to improve youth access to quality mental healthcare is necessary. This mixed-methods study examines the implementation of evidence-informed multidisciplinary coordinated specialty care (CSC) for first-episode psychosis (FEP) services across Texas. The study explores CSC service model components, site location and participant characteristics, and implementation barriers. This cross-sectional study analyzes State of Texas public mental health administrative data from 2015 to 2020, including CSC site (n = 23) characteristics and CSC participant (n = 1682) demographics. Texas CSC site contracts were compared to OnTrackNY, a leading CSC model in the U.S. for CSC service element comparison. In-depth interviews with CSC Team Leads (n = 22) were analyzed to further understand CSC service elements and implementation barriers using qualitative content analysis. CSC was implemented across three waves in 2015, 2017, and 2019-serving 1682 participants and families. CSC sites were located in adult mental health programs; approximately one third of CSC participants were under 18 years. CSC implementation challenges reported by Team Leads included: staff role clarification, collaboration and turnover, community outreach and referrals, child and adult service billing issues, and adolescent and family engagement. Study findings have implications for large state-wide evidence-based practice implementation in transition-to-adulthood community mental health.
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Affiliation(s)
- Deborah A Cohen
- Dell Medical School Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin, 1601 Trinity St., Bldg, B., Austin, TX, 78712, USA.
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
| | - Vanessa V Klodnick
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Samantha J Reznik
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Molly A Lopez
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
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Drake RE, Bond GR. Individual placement and support: History, current status, and future directions. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e122. [PMID: 38867819 PMCID: PMC11114326 DOI: 10.1002/pcn5.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 06/14/2024]
Abstract
Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.
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Affiliation(s)
- Robert E. Drake
- Department of PsychiatryColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
- Westat CorporationRockvilleMarylandUSA
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Al-Abdulmunem M, Bond GR, Ressler DR, Becker DR, Swanson SJ, Marbacher J. Individual placement and support programmes for young adults: Where are they and whom do they serve? Early Interv Psychiatry 2023; 17:824-836. [PMID: 37211370 PMCID: PMC10524614 DOI: 10.1111/eip.13440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/08/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Abstract
AIM Individual Placement and Support (IPS), an evidence-based supported employment model developed for adults with serious mental illness, has been recently targeted to young adults with mental health conditions, but little is known about its adoption in this age group in the United States. METHODS We recruited a volunteer sample of nine IPS programmes in five states serving young adults with mental health conditions aged 16 to 24. IPS team leaders reported programme and participant characteristics and rated barriers to employment and education. RESULTS Most IPS programmes were located in community mental health centres, served a small number of young adults, and received most referrals from external sources. The study sample of 111 participants included 53% female, 47% under 21 years old, 60% diagnosed with a depressive disorder; 92% had an employment goal, and 40% had an education goal. IPS specialists reported that managing mental health symptoms was the most common barrier to achieving employment and education goals. CONCLUSION Future research should examine how IPS programmes could best provide services to young adults.
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Affiliation(s)
- Monirah Al-Abdulmunem
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire, USA
| | - Gary R. Bond
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire, USA
| | - Daniel R. Ressler
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire, USA
| | - Deborah R. Becker
- The IPS Employment Center, Research Foundation for Mental Hygiene, New York, New York, USA
| | - Sarah J. Swanson
- The IPS Employment Center, Research Foundation for Mental Hygiene, New York, New York, USA
| | - Jessica Marbacher
- The IPS Employment Center, Research Foundation for Mental Hygiene, New York, New York, USA
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Cook JA, Steigman PJ, Swarbrick M, Burke-Miller JK, Laing TB, Vite L, Jonikas JA, Brown I. Outcomes of Peer-Provided Individual Placement and Support Services in a Mental Health Peer-Run Vocational Program. Psychiatr Serv 2022; 74:480-487. [PMID: 36254454 DOI: 10.1176/appi.ps.20220134] [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: 11/30/2022]
Abstract
OBJECTIVE The authors sought to determine whether staff at a peer-run agency could deliver supported employment services with high fidelity to the individual placement and support (IPS) model and whether employment outcomes of peer-delivered IPS plus work-specific health promotion were superior to usual supported employment services. METHODS Two teams from a vocational program of a large peer-run agency were studied from July 2015 to July 2017. One team received training and supervision in delivering IPS plus employment-focused physical wellness support and mentoring. The other team continued providing usual supported employment services. Study data included vocational outcomes from 348 clients served by the two teams (IPS, N=184; comparison condition, N=164) and the results of IPS fidelity reviews of the IPS team at study baseline, midpoint, and end. The authors modeled the primary outcome of competitive employment with random-effects logistic regression and adjusted propensity scores for age, gender, race, ethnicity, education, and months of service receipt. RESULTS Following training, the IPS team demonstrated acceptable and increasing fidelity to the IPS model, achieving "good fidelity" by the end of the 25-month observation period. Among IPS recipients, 43% achieved competitive employment versus 21% of comparison recipients (p<0.001). Multivariable analysis indicated that IPS recipients were significantly more likely to achieve competitive employment than individuals in the comparison group (OR=4.06, p<0.001). CONCLUSIONS Providing training in IPS along with health promotion to the behavioral health peer workforce may help address the severe shortage of IPS services and enhance the competitive employment outcomes of people served by peer-run programs.
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Affiliation(s)
- Judith A Cook
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago (Cook, Steigman, Burke-Miller, Jonikas); Collaborative Support Programs of New Jersey, Freehold (Swarbrick); Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers, the State University of New Jersey, New Brunswick (Swarbrick); Baltic Street Advocacy, Employment, and Housing (AEH), Inc., New York City (Laing, Vite, Brown)
| | - Pamela J Steigman
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago (Cook, Steigman, Burke-Miller, Jonikas); Collaborative Support Programs of New Jersey, Freehold (Swarbrick); Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers, the State University of New Jersey, New Brunswick (Swarbrick); Baltic Street Advocacy, Employment, and Housing (AEH), Inc., New York City (Laing, Vite, Brown)
| | - Margaret Swarbrick
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago (Cook, Steigman, Burke-Miller, Jonikas); Collaborative Support Programs of New Jersey, Freehold (Swarbrick); Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers, the State University of New Jersey, New Brunswick (Swarbrick); Baltic Street Advocacy, Employment, and Housing (AEH), Inc., New York City (Laing, Vite, Brown)
| | - Jane K Burke-Miller
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago (Cook, Steigman, Burke-Miller, Jonikas); Collaborative Support Programs of New Jersey, Freehold (Swarbrick); Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers, the State University of New Jersey, New Brunswick (Swarbrick); Baltic Street Advocacy, Employment, and Housing (AEH), Inc., New York City (Laing, Vite, Brown)
| | - Taina B Laing
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago (Cook, Steigman, Burke-Miller, Jonikas); Collaborative Support Programs of New Jersey, Freehold (Swarbrick); Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers, the State University of New Jersey, New Brunswick (Swarbrick); Baltic Street Advocacy, Employment, and Housing (AEH), Inc., New York City (Laing, Vite, Brown)
| | - Laurie Vite
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago (Cook, Steigman, Burke-Miller, Jonikas); Collaborative Support Programs of New Jersey, Freehold (Swarbrick); Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers, the State University of New Jersey, New Brunswick (Swarbrick); Baltic Street Advocacy, Employment, and Housing (AEH), Inc., New York City (Laing, Vite, Brown)
| | - Jessica A Jonikas
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago (Cook, Steigman, Burke-Miller, Jonikas); Collaborative Support Programs of New Jersey, Freehold (Swarbrick); Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers, the State University of New Jersey, New Brunswick (Swarbrick); Baltic Street Advocacy, Employment, and Housing (AEH), Inc., New York City (Laing, Vite, Brown)
| | - Isaac Brown
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago (Cook, Steigman, Burke-Miller, Jonikas); Collaborative Support Programs of New Jersey, Freehold (Swarbrick); Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers, the State University of New Jersey, New Brunswick (Swarbrick); Baltic Street Advocacy, Employment, and Housing (AEH), Inc., New York City (Laing, Vite, Brown)
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