Supported employment: Randomized controlled trial | Knowledge Translation for Employment Research Center

Authors:	Ipsen, C., Seekins, T., & Arnold, N.
Year Published	2010
Publication	British Journal of Psychiatry
Volume	196
Number	5
Pages	401-410
Publisher	Royal College of Psychiatrists.
Background	There is evidence from North American trials that supported employment using the Individual Placement and Support (IPS) model is effective in helping individuals with severe mental illness gain competitive employment. There have been few trials in other parts of the world.
Purpose	The purpose of the study was to investigate the effectiveness and cost-effectiveness of Individual Placement and Support in the United Kingdom.
Setting	Individuals with severe mental illness in South London were randomized to IPS or local traditional vocational services.
Sample	Participants were recruited from community mental health teams in two boroughs of South London. Inclusion criteria were that participants should be receiving outpatient or community psychiatric care from local mental health services, have severe mental illness (duration of illness over 2 years, global assessment of functioning (GAF)8 score of 60 or less, and a diagnosis of a psychotic or chronic affective disorder), aged 18‚Äì65, able to read and speak English to a high enough standard to give informed written consent, to have been unemployed for at least 3 months.
Data Collection	All data were analyzed using SPSS for Windows (version 15.0). The primary and secondary hypotheses were tested on the whole group. For comparing groups, t-tests and ?2-tests were used to compare means and proportions respectively, unless the data were highly skewed, in which case non-parametric tests were used. Logistic and linear regression models were also fitted including potential confounding variables: (grouped) age, gender, ethnic group, educational level, symptomatology and diagnosis. All data were analyzed in groups as randomized, whether or not receiving an intervention (i.e. intention-to-treat). Data were compared for those followed up with those not followed up, overall and by each treatment arm.
Control	The control condition (treatment as usual) involved existing psychosocial rehabilitation and day care programmes available in the local area. Each service employed, on average, 7 vocational staff, had a median of 58 places available to clients (range 6‚Äì3000) and 79% of services received referrals from clinical teams. A range of courses were offered, most commonly pre-employment preparation (e.g. interview skills, curriculum vitae coaching and application form practice), computers/information technology and confidence building/motivation.
Findings	Two hundred and nineteen participants were randomized, and 90% assessed 1 year later. There were no significant differences between the treatment as usual and intervention groups in obtaining competitive employment (13% in the intervention group and 7% in controls; risk ratio 1.35, 95% CI 0.95‚Äì1.93, P = 0.15), nor in secondary outcomes.
Conclusions	There was no evidence that IPS was of significant benefit in achieving competitive employment for individuals in South London at 1-year follow-up, which may reflect suboptimal implementation. Implementation of IPS can be challenging in the UK context where IPS is not structurally integrated with mental health services, and economic disincentives may lead to lower levels of motivation in individuals with severe mental illness and psychiatric professionals.
URL	http://www.ncbi.nlm.nih.gov/pubmed/20435968
Disabilities	Emotional disturbance
Populations	Male \| Black / African American \| White / Caucasian
Outcomes	Employment acquisition
NIDILRR Funded	No
Research Design	Randomized Controlled Trials (RCTs)
Peer Reviewed	Yes

Year Published

2010

Publication

British Journal of Psychiatry

Volume

196

Number

5

Pages

401-410

Publisher

Royal College of Psychiatrists.

Background

There is evidence from North American trials that supported employment using the Individual Placement and Support (IPS) model is effective in helping individuals with severe mental illness gain competitive employment. There have been few trials in other parts of the world.

Purpose

The purpose of the study was to investigate the effectiveness and cost-effectiveness of Individual Placement and Support in the United Kingdom.

Setting

Individuals with severe mental illness in South London were randomized to IPS or local traditional vocational services.

Sample

Participants were recruited from community mental health teams in two boroughs of South London. Inclusion criteria were that participants should be receiving outpatient or community psychiatric care from local mental health services, have severe mental illness (duration of illness over 2 years, global assessment of functioning (GAF)8 score of 60 or less, and a diagnosis of a psychotic or chronic affective disorder), aged 18‚Äì65, able to read and speak English to a high enough standard to give informed written consent, to have been unemployed for at least 3 months.

Data Collection

All data were analyzed using SPSS for Windows (version 15.0). The primary and secondary hypotheses were tested on the whole group. For comparing groups, t-tests and ?2-tests were used to compare means and proportions respectively, unless the data were highly skewed, in which case non-parametric tests were used. Logistic and linear regression models were also fitted including potential confounding variables: (grouped) age, gender, ethnic group, educational level, symptomatology and diagnosis. All data were analyzed in groups as randomized, whether or not receiving an intervention (i.e. intention-to-treat). Data were compared for those followed up with those not followed up, overall and by each treatment arm.

Control

The control condition (treatment as usual) involved existing psychosocial rehabilitation and day care programmes available in the local area. Each service employed, on average, 7 vocational staff, had a median of 58 places available to clients (range 6‚Äì3000) and 79% of services received referrals from clinical teams. A range of courses were offered, most commonly pre-employment preparation (e.g. interview skills, curriculum vitae coaching and application form practice), computers/information technology and confidence building/motivation.

Findings

Two hundred and nineteen participants were randomized, and 90% assessed 1 year later. There were no significant differences between the treatment as usual and intervention groups in obtaining competitive employment (13% in the intervention group and 7% in controls; risk ratio 1.35, 95% CI 0.95‚Äì1.93, P = 0.15), nor in secondary outcomes.

Conclusions

There was no evidence that IPS was of significant benefit in achieving competitive employment for individuals in South London at 1-year follow-up, which may reflect suboptimal implementation. Implementation of IPS can be challenging in the UK context where IPS is not structurally integrated with mental health services, and economic disincentives may lead to lower levels of motivation in individuals with severe mental illness and psychiatric professionals.

URL

http://www.ncbi.nlm.nih.gov/pubmed/20435968

Disabilities

Emotional disturbance

Populations

Male | Black / African American | White / Caucasian

Outcomes

Employment acquisition

NIDILRR Funded

No

Research Design

Randomized Controlled Trials (RCTs)

Peer Reviewed

Yes