Additional interventions to enhance the effectiveness of individual placement and support: A rapid evidence assessment | Knowledge Translation for Employment Research Center

Authors:	Brooks, B. M., Rose, F. D., Atree, E. A., & Elliot-Square, A.
Year Published	2012
Publication	Rehabilitation Research and Practice
Volume	2012
Number	1
Pages	101-108
Publisher	Hindawi Publishing Corporation
Background	Individual placement and support (IPS) has been developed as a standardized approach to supported employment aimed at helping people with severe mental health problems find competitive work. IPS has proven very effective in improving vocational outcomes amongst people with severe mental illness when compared to other vocational services, with a recent review reporting that 61% of participants enrolled in IPS programs gained employment, compared to 23% of those on other vocational programs. IPS does have limitations, however. As the results above would suggest, around 40% of people on IPS programs do not gain employment despite the support. A second criticism of IPS relates to job tenure of the people employed through these schemes, which tends to be short
Purpose	To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness. The aim of this rapid evidence assessment was to identify studies which have sought to improve on the effectiveness of standard IPS by adding a supplementary intervention. The aims are to answer the following questions: (1) what supplementary interventions have been used with IPS? (2) What are the results and what is the quality of those studies? (3) Do supplementary interventions improve employment rates and job tenure compared to IPS alone? (4) Are any supplementary interventions superior to others?
Setting	This study is a systematic review. The included studies were undertaken in various locations and settings.
Sample	The search was for empirical studies conducted from 1980 to July 2011. Studies were considered for inclusion if they: involved people with a severe mental illness; indicated the use of IPS or IPS core principles; involved supplementary interventions categorised as skills training, education, cognitive training, or psycho-therapeutic techniques. Studies meeting these criteria were only included if the design compared IPS alone with enhanced IPS. The sample included 11 studies involving individuals with mental illness.
Data Collection	A Rapid evidence assessment provides an overview of existing research on a specific research topic, as well as a simple extraction and synthesis of the relevant data. The methods used to search for and appraise the research are systematic and rigorous, but the depth of the search is limited by the development of search terms and breadth of resources searched. This type of assessment is particularly useful to quickly gather existing evidence in a research area and determine what future research needs to be done. Data regarding employment rates and job tenure were extracted directly from the papers. Odds ratios were calculated where possible using data on participants employed/not employed per experimental group in each study. Where necessary, authors were contacted for further clarification or information.
Control	There were no comparison or control conditions.
Findings	In total 627 papers were identified and 246 remained after duplicates were removed, of which 241 were excluded at this stage (reasons are given below). References of the 5 included papers and relevant (excluded) systematic reviews were screened for potentially relevant titles, which identified a further 15 records for screening once duplicates had been removed. Of these, 6 further papers met the inclusion criteria. In total, 11 papers were included in the review and 250 papers were excluded. Averaging across the employment rates reported by four studies, enhanced IPS does appear to produce higher rates of competitive employment compared to IPS or control groups alone. The average enhanced rate of 76% would also appear to be higher than the average IPS employment rates reported in previous reviews [3], and this difference is accentuated when focusing on studies using skills training, where on average the employment rate is 25% higher. In addition, rates were moderately higher than previous reviews for studies involving cognitive training.
Conclusions	Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.
URL	http://www.hindawi.com/journals/rerp/2012/382420/
Disabilities	Emotional disturbance
Populations	Male & Female
Outcomes	Employment acquisition \| Increase in hours worked \| Increase in tenure \| Wages
NIDILRR Funded	Not Reported
Research Design	Systematic reviews and meta-analysis
Peer Reviewed	Yes

Year Published

2012

Publication

Rehabilitation Research and Practice

Volume

2012

Number

1

Pages

101-108

Publisher

Hindawi Publishing Corporation

Background

Individual placement and support (IPS) has been developed as a standardized approach to supported employment aimed at helping people with severe mental health problems find competitive work. IPS has proven very effective in improving vocational outcomes amongst people with severe mental illness when compared to other vocational services, with a recent review reporting that 61% of participants enrolled in IPS programs gained employment, compared to 23% of those on other vocational programs. IPS does have limitations, however. As the results above would suggest, around 40% of people on IPS programs do not gain employment despite the support. A second criticism of IPS relates to job tenure of the people employed through these schemes, which tends to be short

Purpose

To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness. The aim of this rapid evidence assessment was to identify studies which have sought to improve on the effectiveness of standard IPS by adding a supplementary intervention. The aims are to answer the following questions: (1) what supplementary interventions have been used with IPS? (2) What are the results and what is the quality of those studies? (3) Do supplementary interventions improve employment rates and job tenure compared to IPS alone? (4) Are any supplementary interventions superior to others?

Setting

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample

The search was for empirical studies conducted from 1980 to July 2011. Studies were considered for inclusion if they: involved people with a severe mental illness; indicated the use of IPS or IPS core principles; involved supplementary interventions categorised as skills training, education, cognitive training, or psycho-therapeutic techniques. Studies meeting these criteria were only included if the design compared IPS alone with enhanced IPS. The sample included 11 studies involving individuals with mental illness.

Data Collection

A Rapid evidence assessment provides an overview of existing research on a specific research topic, as well as a simple extraction and synthesis of the relevant data. The methods used to search for and appraise the research are systematic and rigorous, but the depth of the search is limited by the development of search terms and breadth of resources searched. This type of assessment is particularly useful to quickly gather existing evidence in a research area and determine what future research needs to be done.
Data regarding employment rates and job tenure were extracted directly from the papers. Odds ratios were calculated where possible using data on participants employed/not employed per experimental group in each study. Where necessary, authors were contacted for further clarification or information.

Control

There were no comparison or control conditions.

Findings

In total 627 papers were identified and 246 remained after duplicates were removed, of which 241 were excluded at this stage (reasons are given below). References of the 5 included papers and relevant (excluded) systematic reviews were screened for potentially relevant titles, which identified a further 15 records for screening once duplicates had been removed. Of these, 6 further papers met the inclusion criteria. In total, 11 papers were included in the review and 250 papers were excluded. Averaging across the employment rates reported by four studies, enhanced IPS does appear to produce higher rates of competitive employment compared to IPS or control groups alone. The average enhanced rate of 76% would also appear to be higher than the average IPS employment rates reported in previous reviews [3], and this difference is accentuated when focusing on studies using skills training, where on average the employment rate is 25% higher. In addition, rates were moderately higher than previous reviews for studies involving cognitive training.

Conclusions

Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.

URL

http://www.hindawi.com/journals/rerp/2012/382420/

Disabilities

Emotional disturbance

Populations

Male & Female

Outcomes

Employment acquisition | Increase in hours worked | Increase in tenure | Wages

NIDILRR Funded

Not Reported

Research Design

Systematic reviews and meta-analysis

Peer Reviewed

Yes