A Feasibility Cluster Randomized Controlled Trial of Individual Placement and Support (IPS) for Patients With Offending Histories

Abstract

Objective: To examine the feasibility of conducting a fully powered randomized controlled trial (RCT) of Individual Placement and Support (IPS). IPS is a form of supported employment which aims to put people into open employment quickly and in accordance with their preferences. It is delivered by employment specialists collocated within clinical teams, and provides time unlimited support for the individual and their employer, along with welfare benefits counselling.Method: A feasibility cluster RCT of treatment as usual (TAU) plus IPS versus TAU alone was conducted over 12 months among patients with offending histories in a community forensic setting in the UK. The feasibility criteria were to achieve 50% recruitment rate; 50% completion rate for IPS; 50% completion rate of all outcome measures; and 80% acceptability rating for IPS. The primary efficacy outcome was the proportion of people in open employment at 12 months. The secondary outcomes were other vocational and educational activities; Brief Psychiatric Rating Scale; Rosenberg's Self-esteem Scale; Client Service Receipt Inventory; quality of life using the SF12-v2 and EQ5-D3; Social Functioning Questionnaire; Work Limitation Questionnaire; and reoffending.Results: Participants' mean age was 39.2 years. The majority were male (88.9), White British (72.2), and single (72.2%). Over 72% had no higher qualification beyond secondary education; mean years in education was 10.4. Over one third had schizophrenia, one fifth had depression, and the rest had personality disorder as their primary diagnosis. Participants had a lifetime average of 7.5 convictions for 15.5 offences. The recruitment rate of all referrals was 38.3% (IPS n = 11; TAU n = 7). Completion rate for IPS was 54.5, with 45.5% acceptability rating. Completion rates for outcome measures for the groups at baseline and 12 months ranged from 22.2 to 100%. The proportion of people in open employment at 12 months were 9.1 and 0% for IPS and TAU respectively.

Leipzig - Individual Placement and Support for people with mental illnesses (LIPSY): study protocol of a randomized controlled trial

“…Meta-analyses and reviews show that IPS is superior to traditional vocational rehabilitation in terms of achieving competitive employment and with regard to multiple other vocational outcomes like job tenure and total income [ 10 , 11 ]. This holds also true in specific groups like people diagnosed with a psychotic illness [ 12 ], patients with offending histories [ 13 ], or young adults [ 14 ]. All of the previous trials were conducted outside of Germany, e.g.…”

Economic analyses of supported employment programmes for people with mental health conditions: A systematic review

“…We assessed the quality of these economic studies using the CHEERS checklist; 41 had quality scores above 50%, including 24 with quality scores over 70%. Twelve studies that scored 70% or more on quality focused on IPS, were linked to RCTs, and concluded that it was cost-effective [17,18,20,25,30,31,[33][34][35][36][41][42][43]. Only two IPS studies were from the USA [30,36]; most IPS [3,18,20,23,31,41,51,56], where IPS services have been implemented and there is good access to welfare and health registry data to follow-up service users.…”

“…Of these, six studies reported cost per QALY gained, (five favourable to SE/IPS), eight NMBs (all positive), four ROI (three positive) and 13 cost per employment outcome (nine favourable, three inconclusive, one negative). 18 studies included impacts on health outcomes and/or service utilisation, as well employment [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Table 2 shows 16 of these 23 studies had a short timeframe (maximum two years) [17-21, 23, 24, 26-29, 32, 33, 35-37], but there is growing evidence on longer-term economic impacts [22,25,30,31,34,[38][39][40].…”

“…In total, 18 studies included impacts on health outcomes and/or service utilisation, as well employment [ 17 – 22 , 24 – 26 , 30 – 36 , 38 , 39 ]. Table 2 shows 16 of these 23 studies had a short timeframe (maximum 2 years) [ 17 – 21 , 24 , 25 , 27 – 33 , 36 , 38 ], but there is growing evidence on longer-term economic impacts [ 22 , 23 , 26 , 34 , 35 , 37 , 39 , 40 ]. For example, one Norwegian RCT compared IPS to traditional vocational rehabilitation for 327 people with moderate to severe mental illness [ 23 ].…”

“…Nine economic evaluations alongside RCTs showed IPS was less costly as well as more effective than usual support, including traditional vocational rehabilitation. [ 17 , 18 , 21 – 25 , 31 , 33 ]. For example, a multicentre trial across six European cities reported IPS had lower mean health care costs at first 6-month follow up than controls, $9,414 versus $13,909 (Mean difference $5,462, 95% CI −$9,286, −$1,682) [ 17 ].…”