Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US
|Authors:||Bond, G. R., Drake, R.E., & Becker, D. R.|
|Publisher||World Psychiatric Association|
While reviews of controlled studies of the Individual Placement and Support (IPS) model of supported employment for clients with severe mental illness have documented its effectiveness in the US, its ability to generalize to other countries has not been systematically evaluated. This is the first review to compare US to non-US studies.
The current review has two goals. First, given the growing international attention to IPS, it examines the effectiveness of IPS in studies conducted outside the US compared to US studies. Second, it expands the scope of prior IPS reviews by adding recent randomized controlled trials (RCTs) and enlarging the range of outcome measures in order to examine the hypothesis that IPS yields better competitive employment outcomes across a range of measures than alternative vocational programs.
In most studies, participants were recruited from clients receiving services from community mental health centers. Altogether, the 15 studies analyzed Control enrolled 1063 IPS participants (mean = 70.9 per study) and 1117 control participants (mean = 74.5 per study).
The study identified 15 randomized controlled trials of IPS programs, 9 in the US and 6 outside the US. It examined competitive employment outcomes, including employment rate, days to first job, weeks worked during follow-up, and hours worked. We also considered non-competitive employment, program retention, and nonvocational outcomes.
Data were recorded directly from published reports or calculated from information presented in the published studies. For the measure of job duration, the study converted total weeks worked to an annualized rate, reporting the findings for both the full intent-to-treat sample and the worker subsample (those who obtained at least one competitive job during follow-up).
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.
Rigorous evaluations of IPS suggest that 60% or more of IPS clients obtain competitive jobs, compared to about 25% of those who receive other types of vocational assistance. One way of interpreting this finding is that approximately 25% of clients who express an interest in competitive employment will succeed in obtaining a job in diverse and ineffective vocational programs or even without any vocational services, but IPS helps an additional 35% of the target group who otherwise would remain unemployed. The finding of a large and statistically significant beneficial impact of IPS is robust, upheld in all 15 studies. The effectiveness of IPS is also suggested by other measures of competitive employment outcome, including time to first job, job duration and total hours employed during the follow-up period. Most IPS clients work part-time, typically half-time; about two-thirds of those who obtain competitive employment work 20 hours or more per week. Few IPS clients work full-time, likely due to preferences, limited stamina, and/or fear of losing health insurance or other benefits. Consistent with the principle of rapid job search, the time to first competitive job for IPS participants is nearly 10 weeks sooner than for controls. The mean length of time to first job for IPS participants (19 weeks) is, however, still lengthy for a model that prescribes rapid job search.
To summarize, the question of IPS transportability outside the US remains unanswered. While the published studies suggest that the labor and disability laws in some European countries may make a direct replication of IPS difficult, there are also indications that IPS transports well to other countries, such as Australia and the Hong Kong region of China. Finally, before concluding that the IPS must undergo radical adaptations in another nation, IPS programs should receive sufficient training and guidance to implement the model with high fidelity.
|Populations||Male & Female | Hispanic or Latino | Black / African American | White / Caucasian|
|Outcomes||Employment acquisition | Increase in hours worked | Increase in tenure|
|Research Design||Randomized Controlled Trials (RCTs)|