Enhancing educational and vocational recovery in adolescents and young adults with early psychosis through Supported Employment and Education (SEEearly): study protocol for a multicenter randomized controlled trial

[Individual placement and support in mental health services: evaluation of routine clinical data using a retrospective chart review]

BACKGROUND

People with severe mental illnesses are often excluded from working life and would like support to (re)enter the general labor market as part of the psychiatric treatment. Individual placement and support (IPS) is an effective method of finding and retaining work in the general labor market. The aim of the study was to determine the integration rates of IPS into the general labor market in acute and postacute psychiatric settings, identifying patient, setting and program characteristics associated with (re)entering work.

METHOD

A retrospective chart review (RCR) of routine clinical data between 2016 and 2021 was carried out. The IPS program adherence was rated using the IPS fidelity scale.

RESULTS

A total of 375 patients participated in the IPS with at least 4 appointments. The (re)integration rate into the general labor market was 51.7%. A shorter time period to the last working day, diagnosis of F1, F2, F3 (vs. F4), change of treatment setting and IPS in the psychiatric institute outpatient department (PIA), IPS fidelity and the number of IPS coaching sessions were positively correlated with (re)integration into work.

CONCLUSION

The implementation of IPS in clinical mental healthcare is possible and leads to high integration rates in the open labor market. An early start of IPS during the clinical treatment can promote social inclusion.

[Effectiveness and Cost-Effectiveness of Individual Placement and Support (Ips) in Germany - A Controlled Trials with Individuals with Psychosis]

OBJECTIVE

To establish the effectiveness of Individual Placement and Support (IPS) to integrate people with mental illness into the general labor market, controlled comparisons with usual rehabilitative practice in terms of employment rates and cost-effectiveness are needed.

METHODS

20 IPS participants with psychoses (primarily schizophrenia spectrum disorders) were compared with 20 controls who were offered usual rehabilitative practices in adjacent counties (rehabilitation as usual, RAU) over 18 months.

RESULTS

IPS was significantly superior to RAU on all job-related criteria with moderate to high effect sizes, with no differences in absenteeism, hospital days, or dropout rates. IPS was significantly superior to RAU on cost-effectiveness.

CONCLUSION

This study provides evidence that IPS is an effective and cost-efficient addition to existing vocational rehabilitation services for people with psychoses.

Service users' perceptions of relevant and helpful components of an integrated care concept (ACCESS) for psychosis

Introduction

Psychotic disorders have a significant impact on patients' lives and their families, and long-term treatment with individually tailored multimodal combinations of therapies is often required. Integrated care (IC) concepts such as the "Hamburg Model (ACCESS)" with a focus on psychotic disorders, includes different (therapeutic) components with pharmaco- and psychotherapy, family involvement, home treatment and the option of using a 24/7 crisis hotline. All components are offered by a therapeutically-oriented assertive community treatment (TACT) team in a need-adapted manner. So far, however, little is known about which specific components are regarded as especially relevant and helpful by the users of IC.

Methods

Patients currently participating in IC completed a questionnaire as part of the continuous quality assurance study (ACCESS II) in which they were asked to rate the different components of treatment according to their relevance and helpfulness, considering the individual's unique experiences with IC and needs in mental health care. Furthermore, they were asked to make suggestions regarding additional helpful components of treatment.

Results

Fifty patients participated in this survey (23% of the patients currently participating in the IC concept). For participants, the most helpful and important factors were having the same therapist in the long-term and the 24/7 crisis telephone. Additional components suggested by patients included more addiction-specific therapies and increased focus on vocational rehabilitation and integration.

Conclusion

From the perspective of the users of IC, long-term care from a trusted therapist with whom there is a therapeutic relationship and the possibility to reach someone they already know from the TACT team 24/7 serves as the best basis for effective care, fostering trust, understanding, and open communication. In contrast, home treatment remains a relevant aspect of evidence-based care for people with severe mental illness, but perhaps surprisingly, is not viewed as the most important issue.