Approaches to improving employment outcomes for people with serious mental illness. Work accommodation and retention in mental health | Knowledge Translation for Employment Research Center

Authors:	Kukla, M., & Bond, G. R.
Year Published	2011
Publication	Journal of Mental Health
Volume	20
Number	4
Pages	368-380
Publisher	ISSN
Background	Certain models of vocational service have been shown to be effective in establishing persons with mental health problems back into employment. The individual placement and support (IPS) model has the widest evidence base in studies conducted in North America. Evidence from North America has led to an increasing interest in the use of IPS in the UK. Employment is dependent on economic and social factors which are often country specific.
Purpose	This review examines the evidence of the effectiveness of the IPS model of supported employment within the United Kingdom. The study conducted a systematic review of the literature to answer the principal research question: What is the evidence of effectiveness of the IPS model of supported employment within the United Kingdom?
Setting	This study is a systematic review. The included studies were undertaken in various locations and settings.
Sample	The majority of the population was patients recruited from community mental health teams, including an early intervention in psychosis service. Psychotic illness was the largest diagnostic group in the four studies that reported diagnostic categories.
Data Collection	Five studies met the inclusion criteria. These comprised one European mufti-centre RCT where London was one of six centers, one solely UK-based RCT, one cohort study, one naturalistic study and one small service evaluation. Critical Appraisal of papers was conducted using the NICE Quality appraisal checklist. Each study is awarded an overall study quality grading for internal validity (IV)and a separate one for external validity (EV): 1. All or most of the checklist criteria have been fulfilled, where they have not been fulfilled the conclusions are very unlikely to alter. 2. Some of the checklist criteria have been fulfilled, where they have not been fulfilled, or not adequately described, the conclusions are unlikely to alter. 3. Few or no checklist criteria have been fulfilled and the conclusions are likely or very likely to alter.
Control	Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.
Findings	The evidence base for the effectiveness of IPS within a UK context is small. There is promising evidence, including from a high quality RCT, that IPS is more effective than conventional training and place vocational rehabilitation in placing people into competitive employment. However, the quality of the evidence was generally weak. Several studies lacked adequate controls, meaning potential confounding factors were not controlled for.
Conclusions	This study has highlighted the need for better quality evidence on the effectiveness and application of IPS in the UK, preferably using an RCT approach. Where controlled trials are not feasible, good quality naturalistic evaluations could improve the evidence base. Evaluation should focus on the nature, quality and occupational level of the employment gained and the length of time employment is sustained. Examining both service (e.g. time from entry into service to employment) and patient factors (e.g. previous vocational history, motivational factors) would add to evidence. Integration of the IPS intervention with mental health teams, positive attitudes to competitive employment among staff and motivational assessment of clients may improve placement rates.
URL	http://link.springer.com/chapter/10.1007/978-1-4419-0428-7_11#page-1
Disabilities	Emotional disturbance
Populations	Male & Female
Outcomes	Employment acquisition
NIDILRR Funded	No
Research Design	Systematic reviews and meta-analysis
Peer Reviewed	Yes

Year Published

2011

Publication

Journal of Mental Health

Volume

20

Number

4

Pages

368-380

Publisher

ISSN

Background

Certain models of vocational service have been shown to be effective in establishing persons with mental health problems back into employment. The individual placement and support (IPS) model has the widest evidence base in studies conducted in North America. Evidence from North America has led to an increasing interest in the use of IPS in the UK. Employment is dependent on economic and social factors which are often country specific.

Purpose

This review examines the evidence of the effectiveness of the IPS model of supported employment within the United Kingdom. The study conducted a systematic review of the literature to answer the principal research question: What is the evidence of effectiveness of the IPS model of supported employment within the United Kingdom?

Setting

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

Sample

The majority of the population was patients recruited from community mental health teams, including an early intervention in psychosis service. Psychotic illness was the largest diagnostic group in the four studies that reported diagnostic categories.

Data Collection

Five studies met the inclusion criteria. These comprised one European mufti-centre RCT where London was one of six centers, one solely UK-based RCT, one cohort study, one naturalistic study and one small service evaluation. Critical Appraisal of papers was conducted using the NICE Quality appraisal checklist. Each study is awarded an overall study quality grading for internal validity (IV)and a separate one for external validity (EV):
1. All or most of the checklist criteria have been fulfilled, where they have not been fulfilled the conclusions are very unlikely to alter.
2. Some of the checklist criteria have been fulfilled, where they have not been fulfilled, or not adequately described, the conclusions are unlikely to alter.
3. Few or no checklist criteria have been fulfilled and the conclusions are likely or very likely to alter.

Control

Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.

Findings

The evidence base for the effectiveness of IPS within a UK context is small. There is promising evidence, including from a high quality RCT, that IPS is more effective than conventional training and place vocational rehabilitation in placing people into competitive employment. However, the quality of the evidence was generally weak. Several studies lacked adequate controls, meaning potential confounding factors were not controlled for.

Conclusions

This study has highlighted the need for better quality evidence on the effectiveness and application of IPS in the UK, preferably using an RCT approach. Where controlled trials are not feasible, good quality naturalistic evaluations could improve the evidence base. Evaluation should focus on the nature, quality and occupational level of the employment gained and the length of time employment is sustained. Examining both service (e.g. time from entry into service to employment) and patient factors (e.g. previous vocational history, motivational factors) would add to evidence. Integration of the IPS intervention with mental health teams, positive attitudes to competitive employment among staff and motivational assessment of clients may improve placement rates.

URL

http://link.springer.com/chapter/10.1007/978-1-4419-0428-7_11#page-1

Disabilities

Emotional disturbance

Populations

Male & Female

Outcomes

Employment acquisition

NIDILRR Funded

No

Research Design

Systematic reviews and meta-analysis

Peer Reviewed

Yes