Additional interventions to enhance the effectiveness of individual placement and support: A rapid evidence assessment

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.

Intervention: 

A rapid evidence assessment of the literature was conducted for studies where behavioral or psychological interventions have been used to supplement standard IPS. Published and unpublished empirical studies of IPS with additional interventions were considered for inclusion.

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: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Implementing supported employment as an evidence-based practice

Authors: 
Bond, G. R., Campbell, K., & Drake, R.
Year Published: 
2001
Publication: 
Psychiatric Services
Volume: 
52
Number: 
3
Pages: 
313-322
Publisher: 
American Psychiatric Association
Background: 

The implementation of evidence-based practices in support of people with mental illness is considerably behind "state of the art knowledge" (p. 313). Supported employment is one of those practices.

Purpose: 

The intent of the paper was to "to familiarize clients, families, clinicians, administrators, and mental health policy makers with supported employment; to review the findings and limitations of current research; and to discuss implementation issues, including availability, barriers, and strategies" (p. 313).

Setting: 

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

Sample: 

The study sample included the findings from eight randomized controlled trials and three quasi-experimental studies. All studies related to individuals with severe mental illness.

Data Collection: 

A review of literature, including recent studies, was conducted to provide a comprehensive discussion of supported employment.

Intervention: 

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

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 following components "are almost always present in successful vocational programs" (p. 315):
1. The agency providing supported employment services is committed to competitive employment as an attainable
goal for its clients with severe mental illness, devoting its resources for rehabilitation services to this endeavor rather than to day treatment
or sheltered work. . .
2. Supported employment programs use a rapid job search approach to help clients obtain jobs directly, rather than providing lengthy pre-employment assessment, training, and counseling. . .
3. Staff and clients find individualized job placements according to client preferences, strengths, and work experiences. . .
4. Follow-along supports are maintained indefinitely. . .
5. The supported employment program is closely integrated with the mental health treatment team" (p. 315).

Limitations of supported employment are:
1. Not all clients want to work; therefore, encouraging clients to make informed decisions may reduce dropout rates.
2. Job availability is often restricted due to "limited work experience, education, and training" (p. 316).
3. Most positions are part-time; clients limit their own availability to avoid jeopardizing their benefits.
4. Specific details about the best way to implement supported employment has not been researched.
5. The relationship between employment and medication have not been addressed.
6. Long-term outcomes have not been studied.
7. Most clients lack access to supported employment.
8. Funding support is devoted primarily to administrative and pre-employment activities, rather than actual supported employment. For example, vocational activities are restricted from Medicaid reimbursement.
9. Inadequate resources -- funding, as well as staff availability -- are two of the major difficulties.

Conclusions: 

Supported employment offers improved employment outcomes across many settings and populations. However, overcoming employment barriers to ensure supported employment services are widely available is critical.

URL: 
http://www.worksupport.com/kter/documents/pdf/ImplementingSupportedEmployment.pdf
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

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.
Year Published: 
2012
Publication: 
World Psychiatry
Volume: 
11
Number: 
1
Pages: 
32-39
Publisher: 
World Psychiatric Association
Background: 

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.

Purpose: 

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.

Setting: 

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).

Sample: 

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 Collection: 

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).

Intervention: 

The intervention was the Individual Placement and Support (IPS) model which is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

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: 

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.

Conclusions: 

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.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22295007
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A Supported Employment program for people with Mental Illness in Hong Kong

Authors: 
Wong, K. K., Chiu, R., Tang, B., Mak, D., Liu, J., & Chiu, S. N.
Year Published: 
2004
Publication: 
American Journal of Psychiatric Rehabilitation
Volume: 
7
Number: 
1
Pages: 
83-96
Publisher: 
Routledge, Taylor and Francis
Background: 

People with mental illness have high rates of unemployment and underemployment. Hong Kong is interested in investigating new ways to assist this population with employment. Research is needed.

Purpose: 

The purpose of this article is to report on the vocational outcomes of people with mental illness participating in a supported employment (SE) program in Hong Kong.

Setting: 

The setting was community vocational rehabilitation providers and various places of business in Hong Kong.

Sample: 

The study sample included 748 individuals with mental illness who enrolled in supported employment programs in Hong Kong.

Data Collection: 

Employment data was collected on participants, including wages and job tenure was collected.

Intervention: 

The intervention was the Individual Placement and Support model of supported employment.

Control: 

There was no control or comparison group.

Findings: 

Of the 748 participants, 458 (61.2%) obtained competitive employment. The mean job tenure was 151 days. The mean salary was HK$4,561 (US$585.00) for full-time jobs and $2,368 (US$304.00) for part-time jobs. The majority of participants (62.4%) could sustain their job placement for more than 30 days, 110 (24.0%) participants could work for more than six months, and 59 (12.9%) could maintain their jobs for more than one year.

Conclusions: 

This study concluded that IPS programs could improve vocational outcomes for people with mental illness in Hong Kong. Recommendations for future research on evaluation of the effectiveness of SE program and for further development of SE in Hong Kong were suggested.

URL: 
http://www.tandfonline.com/doi/abs/10.1080/15487760490465004
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

A randomized controlled trial of a supported employment program for persons with long-term mental illness in Hong Kong

Authors: 
Wong, K. K., Chiu, S. N., Chiu, L. P., & Tang, S. W.
Year Published: 
2008
Publication: 
Psychiatric Services
Volume: 
59
Number: 
1
Pages: 
84-90
Publisher: 
American Psychiatric Association
Background: 

Supported employment is an evidence-based practice that has proved to be consistently more effective than conventional vocational rehabilitation in helping people with severe mental illness find and sustain competitive employment. Most research on the effectiveness of supported employment comes from the United States.

Purpose: 

This study examined the effectiveness and applicability of a supported employment program based on the individual placement and support model in a Hong Kong setting.

Setting: 

The setting was community rehabilitation programs in Hong Kong.

Sample: 

Ninety-two unemployed individuals with long-term mental illness who desired competitive employment were randomly assigned to either a supported employment program or a conventional vocational rehabilitation program.

Data Collection: 

Both vocational and non-vocational outcomes were measured in this study. Vocational outcomes include competitive employment rates, time to first job, total days employed, and total earnings. Non-vocational outcomes include self-perceived quality of life. Major assessments were conducted at baseline and at six and 18 month follow up points by the employment specialist.

Intervention: 

The intervention was the Individual Placement and Support model of supported employment.

Control: 

Traditional Vocational Rehabilitation Services

Findings: 

Over an 18 month study period, compared with participants in the conventional vocational rehabilitation program, those in the supported employment group were more likely to work competitively, held a greater number of competitive jobs, earned more income, worked more days and sustained longer job tenures.

Conclusions: 

Consistent with previous research findings, the supported employment program was more effective than the conventional vocational rehabilitation program in helping individuals with long-term mental illness find and sustain competitive employment in a Hong Kong setting.

URL: 
http://ps.psychiatryonline.org/doi/abs/10.1176/ps.2008.59.1.84
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A supported competitive employment programme for individuals with chronic mental illness

Authors: 
Wong, K., Chiu, L. P., Tang, S. W., Kan, H. K., Kong, C. L., Chu, H. W.,& Chiu, S. N.
Year Published: 
2001
Publication: 
Hong Kong Journal of Psychiatry
Volume: 
11
Number: 
2
Pages: 
13-18
Publisher: 
Hong Kong Academy of Medicine Press
Background: 

Supported employment has emerged in recent years as a viable employment service alternative for individuals with chronic mental illness. Numerous reports demonstrate enhanced vocational outcomes in the areas of employment rate, job retention rate, job tenure, and earnings for individuals with chronic mental illness. Not much is known about the program outcomes and applicability in Hong Kong.

Purpose: 

The objective of this study was to ascertain the vocational outcomes of individuals with chronic mental illness participating in a supported employment program.

Setting: 

The setting included supported Employment Services in a hospital in Hong Kong.

Sample: 

The sample was 388 individuals with chronic mental illness.

Data Collection: 

Referral forms were used to collect demographic data. A job placement and follow up record was used to assess job retention rate, job tenure, nature of job placement and earnings. A job termination form was used to evaluate the reasons for the termination of employment.

Intervention: 

The intervention was the Individual Placement and Support model of supported employment.

Control: 

The comparison condition was traditional vocational rehabilitation services.

Findings: 

Of the 388 patients, 267 (68.8%) obtained competitive employment. The mean job tenure was 133 days. The mean salary was HK$4,737 for full-time jobs and HK$2,329 for part-time jobs. The majority of the patients (59.6%) sustained their job placement for more than 30 days, 69 patients (25.8%) worked for more than 6 months, and 35 (13.1%)maintained the job for more than 1 year.

Conclusions: 

This study concluded that a supported competitive employment program could be an effective approach to enhancing vocational outcomes for individuals with chronic mental illness. Recommendations for future research for evaluation of the effectiveness of the supported competitive employment program are suggested.

URL: 
https://www.questia.com/library/journal/1G1-169678962/a-supported-competitive-employment-programme-for-individuals
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Vocational outcomes of individuals with psychiatric disabilities participating in a supported competitive employment program

Authors: 
Xu, Y.W., Chan, C. C., Lam, C. S., Li-Tsang, C. W., Lo-Hui, K. Y., & Gatchel, R. J.
Year Published: 
2000
Publication: 
Work: A Journal of Prevention, Assessment and Rehabilitation
Volume: 
14
Number: 
3
Pages: 
247-256
Publisher: 
IOS Press
Background: 

Supported employment has emerged in recent years as a viable employment service alternative for individuals with chronic mental illness. Numerous reports demonstrate enhanced vocational outcomes in the areas of employment rate, job retention rate, job tenure, and earnings for individuals with chronic mental illness.

Purpose: 

This study provides information about vocational outcomes of individuals with psychiatric disabilities participating in a supported competitive employment (SCE) program.

Setting: 

The setting was a community based supported competitive employment program.

Sample: 

The sample was 458 individuals with chronic mental illness.

Data Collection: 

Demographic and employment data was collected by the employment specialists during the study.

Intervention: 

The intervention was the Individual Placement and Support model of supported employment.

Control: 

The comparison condition was traditional Vocational Rehabilitation.

Findings: 

Of the 458 subjects, 308 (67.3%) obtained competitive employment. The mean job tenure was 134 days. The mean salary was $4,740 for full-time jobs and was $2,321 for part-time jobs. The majority of subjects (59.4%) could sustain their job placement for more than 30 days, 74 (24.0%) subjects could work for more than six months, and 38 (12.3%) could maintain the job for more than one year.

Conclusions: 

Subjects who became employed were compared to those who did not gain employment on a variety of demographic variables. Significant differences were found between two groups in terms of sex and source of referral. The rate of employment in the current study was slightly higher, but the job retention rate was lower than in earlier studies. Recommendations for future research on evaluation of the effectiveness of SCE program are suggested.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/12441521
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Standardizing measures in four domains of employment outcomes for individual placement and support

Authors: 
Bond, G. R., Drake, R., & Becker, D.
Year Published: 
2012
Publication: 
Psychiatric Services
Volume: 
63
Number: 
8
Pages: 
751-757
Publisher: 
American Psychiatric Association
Background: 

Virtually all studies of the individual placement and support (IPS) model of supported employment measure outcomes for job acquisition, but studies are less consistent in measuring job tenure, hours worked, and employment earnings. Lack of a common set of employment measures limits comparisons across studies and cumulative knowledge about IPS.

Purpose: 

This study examined measures in four employment domains and their interrelationships. It examined two hypotheses. First, IPS improves both the rate of obtaining employment (job acquisition) and the amount of work (job duration, hours worked per week, and total hours and wages). Second, employment outcomes within domains are strongly correlated, whereas outcomes across domains are relatively weakly related.

Setting: 

All study participants were clients enrolled in public mental health programs. The four study groups were located in Manchester and Concord NH; Washington DC; Hartford CT, and Chicago

Sample: 

All study participants were clients enrolled in public mental health programs. They were unemployed adults who met each state's criteria for severe mental illness. Other common eligibility criteria included desire for competitive work, ability and willingness to give informed consent, and absence of significant general medical conditions precluding employment. The studies used similar protocols to track employment outcomes. Despite similar research methods, the four studies differed in geographic location and control group interventions.

Data Collection: 

Using a combined data set from four randomized controlled trials of IPS, this study examined mean differences between IPS participants (N=307) and participants in other vocational services (control sample) (N=374) in four domains (job acquisition, job duration, hours worked per week, and total hours and wages). Eight competitive employment measures were examined (employed at any time, total weeks worked, tenure in the longest-held job, total hours worked, average hours per week worked, total wages, days to first job, and working =20 hours per week during follow-up). Correlations between measures within both the IPS and control samples were determined.

Intervention: 

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

Control: 

The conditions include: 1) group skills training; initial training in choosing, getting, keeping a job; followed by job placement services from a stand alone rehabilitation program (2) enhanced rehabilitation services provided by a vocational rehabilitation counselor assigned to the project: club house and brokered supported employment (4) diversified placement services.

Findings: 

IPS participants had significantly better outcomes across all employment measures and domains. Correlations between measures were strong within each domain, but they were variable between domains

Conclusions: 

In addition to improving job acquisition, IPS improved job duration, hours worked per week, and total hours and wages. The correlational findings suggest proxy measures to assist meta-analysts in the synthesis of studies for which direct measures are unavailable. Initial steps toward a cross-disciplinary theoretical framework for employment outcomes are described.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/22660524
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Is job tenure brief in individual placement and support (IPS) employment programs?

Authors: 
Bond, G. R., Becker, D. R., & Drake, R. E.
Year Published: 
2011
Publication: 
Psychiatric Services
Volume: 
62
Number: 
8
Pages: 
950-953
Publisher: 
American Psychiatric Association
Background: 

Individual placement and support (IPS) is a well- model of supported employment for clients with severe mental illness. Competitive employment rates for IPS programs are more than twice those for other vocational approaches. However, despite strong and consistent findings for job acquisition, observers have noted that job retention rates for IPS clients are fairly brief. One widely cited review of eight studies concluded that job tenure for clients enrolled in supported employment was typically less than four months and ranged from 70 to 151 days. However, the studies reviewed were conducted between 1994 and 2004 and are now dated.

Purpose: 

The purpose of the study was to analyze the job tenure issue for high-fidelity IPS programs and to use standardized measures of job tenure and an adequate sample and follow-up period. To avoid some of the limitations mentioned earlier, this study estimated job tenure by defining the sample and follow-up period for IPS clients after they obtained competitive employment, thereby differentiating the question of job acquisition from job tenure.

Setting: 

Study participants were enrolled from November 2005 until June 2007. Two-year follow-up data collection ended in June 2009. This study was reviewed by the Indiana University-Purdue University Indianapolis Institutional Review Board and was deemed an exempt study. Four urban sites located in the Midwest region of the United States participated in the study. Three sites were community mental health centers, and each operated a single IPS program. The fourth site was a large psychiatric rehabilitation center with three IPS teams. In addition to offering IPS, all four sites provided comprehensive mental health and substance abuse services.

Sample: 

Participants were clients with severe mental illness aged 18 and older and enrolled in IPS at one of the participating sites. To be eligible, a client was required to be identified by an employment specialist as meeting the study criteria: currently working at least ten hours per week in competitive employment and having begun a competitive employment position within the preceding six months. Most IPS clients who work competitively do so at least ten hours a week. In one large database of four IPS trials, 74% of IPS clients worked at least ten hours a week. The study enrolled all eligible clients during the study period.

Data Collection: 

Monthly data about job tenure were collected for 82 clients upon beginning competitive employment (prospective sample) and from 60 clients who had begun competitive employment in the preceding six months (retrospective sample). At study entry, information on demographic characteristics, employment history, diagnosis, Social Security entitlements, and current employment was collected. The monthly employment update included information on employment status (employed or unemployed), job losses, job starts, job type, days worked during the past month, changes in hours worked per week, and changes in wage rate.

Intervention: 

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice. The intervention was IPS services with high fidelity to the program model and practices.

Control: 

The comparison condition was a retrospective sample of IPS clients who were served prior to the initiation of high-fidelity services.

Findings: 

The 142 clients worked a mean of 12.86 months overall and 9.96 months at their first job; compared with the prospective sample, the retrospective sample worked for more months (13.69 versus 11.02; p<.05) and worked more months at the first job (12.63 versus 8.01; p<.01). A total of 100 (70%) clients remained enrolled in IPS during the 24-month follow-up period, and 42 (30%) did not. Of the 42 non-completers, four (3%) terminated during the first six months, 15 (10%) during months 7–12, 13 (9%) during months 13–18, and ten (7%) during months 19–24. Twenty-one (50%) non-completers were employed at the point of termination. Across 24 months of follow-up, the total sample worked an average of 15.6±10.2 hours per week and 10.7±6.8 days per month. Limiting the statistics to periods in which clients were employed, clients worked an average of 23.5±8.3 hours per week and 16.4±4.2 days per month. Mean wage rate for working clients was $7.90±$3.00 per hour

Conclusions: 

Job tenure among employed clients of high-fidelity IPS was twice as long as previously reported, and about 40% became steady workers over two years. The proportion of IPS clients who begin a long-term attachment to the labor market is higher than has sometimes been asserted in the literature. Long-term follow-up studies of IPS are needed. As this study suggests, short-term studies may not correctly forecast long-term outcomes.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/21807836
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Workplace impacts of anti-TNF therapies in rheumatoid arthritis: review of the literature

Authors: 
Blake, J., Brooks, J., Greenbaum, H., Chan, F.
Year Published: 
2009
Publication: 
Expert Opinion on Pharmacotherapy
Volume: 
10
Number: 
2
Pages: 
255-269
Publisher: 
Informa Healthcare
Background: 

Rheumatoid arthritis causes pain and serious functional impacts and substantially affects patients' daily lives, including their ability to work.

Purpose: 

The purpose of the paper is to examine recent studies of patients with Rheumatoid Arthritis treated with TNF antagonists and the impacts these therapies have on the workplace.

Setting: 

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

Sample: 

The sample included 133 articles and 14 poster abstracts that studied the impact of Rheumatoid Arthritis.

Data Collection: 

The studies were categorized into three distinct groups: general RA, DMARD, and TNF-antagonist literature. The general RA literature was used as a backdrop when examining literature regarding the impacts of DMARDs and the emergence of anti-TNF therapies on the workplace.

Intervention: 

The intervention was medical treatment of Rheumatoid Arthritis including TNF antagonists and DMARDs.

Control: 

There were no comparison or control conditions.

Findings: 

The results of early studies of the TNF antagonists varied regarding their effects on patients with RA in the workplace. Recent studies of adalimumab showed positive impacts across a range of workplace burdens.

Conclusions: 

Treatments such as adalimumab may help employees with RA to remain in the workforce and lead to reduced workplace costs to the employers and employees.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/19236197
Populations: 
Peer Reviewed: 
Yes