Predictors of employment for people with severe mental illness: Results of an international six-centre randomised controlled trial
|Authors:||Chan, F., Cheing, G., Chan, J.Y.C., Rosenthal, D.A., & Chronister, J.A.|
|Publication||The British Journal of Psychiatry|
|Publisher||The Royal College of Psychiatry|
An international six-centre randomised controlled trial comparing Individual Placement and Support (IPS) with usual vocational rehabilitation for people with serious mental illness found IPS to be more effective for all vocational outcomes.
The purpose of the study was to determine which patients with severe mental illness do well in vocational services and which process and service factors are associated with better outcomes. Patient characteristics and early process variables were tested as predictors of employment outcomes. Service characteristics were explored as predictors of the effectiveness of IPS. Aim was to explore who among a group of patients with severe mental illness would do well in vocational services in terms of both obtaining and maintaining open, competitive employment, and which process and service factors would be associated with better outcomes. Therefore, study aimed to determine predictors of employment outcomes from among demographic and illness characteristics, early process factors and service features
A randomized controlled trial was conducted in six European centres , London, Ulmnzburg, Rimini, Zurich, Groningen and Sofia comparing IPS with usual high-quality vocational rehabilitation based on the train and place model.
Patients (n=312) were recruited if they had psychotic illness, were aged between 18 and the local retirement age, had been ill and had major role dysfunction for at least 2 years, were in the community, had not been in competitive employment in the preceding year and wanted to enter competitive employment. Randomisation was carried out centrally and stratified by centre, gender and work history (1 month or less of continuous open employment v. more than 1 month in the previous 5 years), replicating the original IPS study.
Three analyses were conducted. First, patient characteristics collected at baseline, including illness characteristics and the patient‚ reported relationship with their clinical key worker, were tested as potential predictors of the employment outcomes. Second, early process factors, collected at patient level at the first follow-up interview (T1), when the patient had been in the service for up to 6 months, were tested as potential predictors. Service allocation (IPS v. vocational service) was included as a possible explanatory variable in the early process models, despite the fact that the greater effectiveness of the IPS service had already been demonstrated.7 This was to ensure that it was not confounding any significant associations between other potential predictor variables and employment outcomes. It was not included in the patient characteristics models, as these variables were measured before randomisation. The impact of service as such is not the focus of the current paper. Finally, key characteristics of the services themselves were tested. As the latter were service-level factors, they were tested against the effectiveness of the IPS service at each international centre.
The vocational service (control service) at each center was the best alternative vocational rehabilitation service available locally, with a structured program conducted mostly in day facilities (although mostly residential in Ulm). Each was based on the more traditional principles of train and place providing vocational training and job preparation before the client proceeded to seek competitive employment. Each vocational service had to guarantee taking patients into the service within 2 months of randomization.
Patients with previous work history, fewer met social needs and better relationships with their vocational workers were more likely to obtain employment and work for longer. Remission and swifter service uptake were associated with working more. Having an IPS service closer to the original IPS model was the only service characteristic associated with greater effectiveness.
The IPS service was found to be more effective for all vocational outcomes. In addition, maintaining high IPS fidelity and targeting relational skills would be a valuable focus for all vocational interventions, leading to improved employment outcomes. Motivation to find work may be decreased by satisfaction with current life circumstances.
|Populations||Male & Female|
|Outcomes||Employment acquisition | Increase in hours worked | Increase in tenure|
|Research Design||Randomized Controlled Trials (RCTs)|