Stakeholder Perspectives on IPS for Employment: A Scoping Review

BACKGROUND.

Individual Placement and Support (IPS) has demonstrated effectiveness in achieving competitive employment for people with severe mental illness. Yet limited efforts have been made to synthesize the literature pertaining to the experiences and perspectives of key stakeholders regarding IPS, which could be helpful for occupational therapists, given their role in vocational rehabilitation.

PURPOSE.

To synthesize qualitative literature to understand how stakeholders (including occupational therapists) experience and perceive IPS and consider the implications for future occupational therapy practice and research.

METHOD.

A scoping review methodology guided our review. We conducted an electronic search of qualitative and mixed-method studies on IPS.

FINDINGS.

Twenty-six articles were retrieved. Most studies sought clients' perspectives (n = 15), followed by practitioners (mostly employment specialists; n = 10) and only one with employers.

IMPLICATIONS.

There is a need for research targeting practitioners and employers which will help improve the nature of the collaboration between mental health teams, vocational teams, and employers.

[Two "hybrid" vocational services for people with a severe mental illness in France and Quebec]

Many different types of vocational programs (services) exist to help people with severe mental disorders (e.g., schizophrenia) integrate the regular labor market: sheltered workshops, social enterprises, and supported employment programs to name a few. Each type of vocational services has its specificities: on one hand, some of them are following the "train and place" approach. For example, sheltered workshops offer to people with a severe mental illness a training during a long period of, with a small proportion obtaining competitive employment. On the other hand, other programs adopt the "place and train" philosophy, such as supported employment programs, in which employment specialists help people obtain a competitive job as fast as possible with no requested training. This article presents two original vocational services, the Messidor's sheltered workshops in France and the Accès-Cible SMT supported employment program in Quebec, following an "hybrid" approach including both philosophies "place and train" and "train and place". More particularly, they are both aiming at competitive employment on the regular labor market for people with a severe mental illness, with a different length of training. Messidor consists of a sheltered workplace for people with a severe mental illness in France, using this time of transition in the workshops as a tool to obtain a competitive job. Thanks to three key factors, Messidor succeeds in placing many of their workers in the French regular labor market: (1) Workers with severe mental disorders work on tasks and workplaces similar to those in regular labor market; (2) Messidor's managers have small teams (5-7 persons) that offer a nearby and personalized management to workers; (3) Each worker is followed by a Messidor's employment counsellor, to build together a working plan and put in place work strategies to obtain a competitive job. This "double management" seems to be a key ingredient of this support as it promotes some success in getting a job as well as in developing some recovery effects. Accès-Cible SMT located in Montreal (Quebec, Canada) is also an interesting "hybrid" program since people with severe mental disorders can be supported by a counsellor, with a short period of training (a 28-week program with 6 steps) before integrating the regular labor market. The philosophy of Accès-Cible SMT is to consider their clients as normal persons more than as patients, and its objective is mainly to restore confidence and self-esteem of the person by putting emphasis on their professional skills. Meetings in groups, practicums in the workplace, and the utilization of job search strategies are essential ingredients of Accès-Cible SMT, which are also efficient tools to develop a better empowerment of the person. Indeed, the common ingredients/elements of these two vocational services, Messidor and Accès-Cible SMT, seem to be the development of empowerment for people with severe mental disorders. The scientific literature supports that empowerment is one of the key factors of recovery for people with a mental illness, a recovery process that can be illustrated by their work integration in the regular labor market as a final goal.

Supported employment for persons with serious mental illness: current status and future directions

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.

[Practices and interventions related to the work integration of people with a severe mental illness: work outcomes and avenues of research]

Sustained work integration for people with a severe mental illness or handicap psychique in French (e.g., schizophrenia) is an important issue in our society today. Indeed, work is not only an essential factor in people's social integration but is also a stepping-stone toward recovery for this clientele. Well-defined programs and services related to work integration were developed and studied over the last three decades. Although the work integration of people with severe mental illness has been studied extensively in the Anglo-Saxon literature, the impact of these studies on the traditional beliefs and services in France remains uncertain. In terms of the scope of the studies so far, there has been an initial interest lasting over many years to uncover individual characteristics of people with severe mental illness which would best predict job tenure. Since, studies have been increasingly investigating various supports in order to facilitate the work integration process. These supports can be illustrated as direct supports or accommodations offered in the workplace, as needed, particularly when people with severe mental illness choose to disclose their mental disorder in the workplace. This awareness of the impact of the workplace environment on the work integration of people with a severe mental illness increases the need to find solutions and develop environmentally sensitive clinical strategies to overcome difficulties during the work integration. To illustrate this thematic, in this special issue, we have gathered together studies conducted in different countries but who share the focus on work integration of people with a severe mental illness. To reflect the advancement in this domain, this special issue is divided in three parts. The first part consists of the presentation of different types of vocational programs: supported employment programs, social firms, and hybrid models. Supported employment programs are very well documented in the specialised literature and are recognized as an evidence-based practice across the world to help people get competitive employment. Social firms is an another alternative model for facilitating the work integration of people with severe mental illness but has to date scarcely been studied empirically. Other hybrid vocational programs implemented in Québec (Canada) and France and inspired by supported employment programs and social firms' principles, are also described. The second part of this special issue is related to the presentation of two adjunct clinical interventions for helping people with a severe mental illness in their work integration, and more particularly for increasing job tenure: cognitive remediation and group cognitive behavioral therapy. Cognitive remediation was developed to reduce the impact of cognitive deficits, such as memory or attention, in people with a severe mental illness whereas group cognitive behavioral therapy was developed to change the dysfunctional beliefs and behaviours that might hinder job tenure in people receiving supported employment services. Finally, the third part of this special issue presents two papers on the influence of the workplace, of stakeholders from the organization (e.g., employers, supervisors) and of the work environment on the work integration of people with severe mental illness. The first paper discusses disclosure of the mental illness in the workplace and its positive and negative consequences such as receiving work accommodations and experiencing stigma, respectively. In the last paper, psychological processes during the hiring process are presented to better understand the elements related to discrimination and stigma during the work integration of people with severe mental illness.