Validation of the revised individual placement and support fidelity scale
|Authors:||Bond, G. R., Peterson, A., Becker, D., & Drake, R.|
|Publisher||American Psychiatric Association|
|Background||Systematic reviews have concluded that the Individualized Placement and Support (IPS) model of supported employment is an evidence-based practice. The IPS model is a systematic approach to helping clients with severe mental illness obtain competitive employment The 15-item IPS Fidelity Scale (IPS-15) was developed and has been widely adopted in routine practice as a quality improvement tool and in formal research studies to monitor treatment integrity and drift. Nine of ten evaluations have found a positive association between the IPS-15 and competitive employment outcomes. Since the publication of the IPS-15 in 1997, researchers and fidelity assessors have noted deficiencies in the IPS-15, some owing to under-specification of the IPS model in early publications. Specifically, early conceptualizations of the IPS model gave little attention to benefits counseling about Social Security, Medicaid, and other government programs in relation to gaining employment.|
|Purpose||The individual placement and support (IPS) model of supported employment for people with severe mental illness is an evidence-based practice. The 15-item IPS Fidelity Scale (IPS-15) was developed to measure program fidelity and has been shown to have good psychometric properties, including predictive validity. On the basis of field experience and research updates, the authors developed an expanded and revised version of this scale, the IPS-25, also known as the Supported Employment Fidelity Scale. This study evaluated the psychometric properties of the IPS-25. The primary hypothesis was that the IPS-25 would be positively associated with the competitive employment rate. Our two secondary hypotheses were that the unemployment rate would be negatively correlated with the competitive employment rate and that program longevity would be positively correlated with both the IPS-25 and competitive employment rate.|
|Setting||The study drew on secondary data analysis from an ongoing quality improvement strategy employed in an IPS learning collaborative in 13 states devoted to implementing high-fidelity IPS services. Eight of the 13 states in the IPS learning collaborative participated. We excluded the one state not using the IPS-25 and three states that were still in the start-up phase of IPS implementation. One state opted not to participate in the project.|
|Sample||The sample consisted of 79 sites; the number of sites per state varied (range two to 21), consistent with the stage of IPS dissemination within each state. On average, programs had an active caseload of 59 clients (range ten to 334). Most sites had reported outcomes for at least one year before the most recent fidelity assessment. However, 17 sites had been reporting outcomes for fewer than three quarters before the date of the fidelity assessment used in the analysis.|
As part of the agreement for participating in the IPS learning collaborative, individual sites agree to collect annual fidelity assessments and quarterly competitive employment outcomes. Fidelity reviews were conducted according to each state's procedures. The fidelity assessors for each state included trainers from technical assistance centers and state mental health and vocational rehabilitation agencies.
Following exploratory data analysis to plan statistical methods, the study used multiple regression to examine the fidelity-outcome relationship, controlling for unemployment rate and program longevity. Finally, the study conducted the analysis of variance linear trend analysis on the classification based on benchmark fidelity levels.
|Findings||Internal consistency reliability for the IPS-25 was .88. Predictive validity, measured as the correlation between the IPS-25 and site-level employment rate, was .34. Eight of the IPS-25 items were significantly positively correlated with employment rate. Items related to the vocational generalist role, disclosure, follow-along support, and vocational unit were the most strongly correlated with employment. Program longevity was positively associated with employment, whereas the unemployment rate was not.|
|Conclusions||The IPS-25 has promising psychometric properties, with greater precision and content coverage than the IPS-15. However, it has not demonstrated an advantage over the IPS-15 in predictive validity. Research directly comparing the two scales is needed.|
|Populations||Asian | Black / African American | White / Caucasian | Male & Female|
|Research Design||Mixed methods|