A meta‐regression of the impact of policy on the efficacy of individual placement and support

Abstract

Objective Individual placement and support (IPS) has shown consistently better outcomes on competitive employment for patients with severe mental illness than traditional vocational rehabilitation. The evidence for efficacy originates from few countries, and generalization to different countries has been questioned. This has delayed implementation of IPS and led to requests for country‐specific RCTs. This meta‐analysis examines if evidence for IPS efficacy can be generalized between rather different countries. Methods A systematic search was conducted according to PRISMA guidelines to identify RCTs. Overall efficacy was established by meta‐analysis. The generalizability of IPS efficacy between countries was analysed by random‐effects meta‐regression, employing country‐ and date‐specific contextual data obtained from the OECD and the World Bank. Results The systematic review identified 27 RCTs. Employment rates are more than doubled in IPS compared with standard vocational rehabilitation (RR 2.07 95% CI 1.82–2.35). The efficacy of IPS was marginally moderated by strong legal protection against dismissals. It was not moderated by regulation of temporary employment, generosity of disability benefits, type of integration policies, GDP, unemployment rate or employment rate for those with low education. Conclusions The evidence for efficacy of IPS is very strong. The efficacy of IPS can be generalized between countries.

An update on Individual Placement and Support

“…Over the last decade, a number of systematic reviews and meta-analyses have confirmed this basic finding 4,5 . One metaanalysis reported moderate to large effects favoring IPS for a range of other employment outcomes 5 .…”

“…Rapid expansion of IPS across the world 8 includes at least 19 high-income countries outside the US over the past 20 years (Australia, Belgium, Canada, China, Czech Republic, Denmark, France, Germany, Iceland, Ireland, Italy, Japan, New Zealand, the Netherlands, Norway, Spain, Sweden, Switzerland, and the UK). The flexibility and adaptability of the IPS model facilitate successful adoption with high fidelity and good employment outcomes in countries with diverse sociocultural conditions, labor laws, welfare systems, and economic conditions 4 .…”

INdividual Vocational and Educational Support Trial (INVEST) for young people with borderline personality disorder: study protocol for a randomised controlled trial

“…It is a client-driven model, delivered by a vocational specialist, that allows for ongoing personalised support, even after a suitable placement has been obtained. IPS has consistently proved more effective than other employment services in randomised controlled trials (RCTs) in countries with varying labour markets, economic conditions and attitudes towards mental health [32,[36][37][38][39][40][41][42]. IPS, inclusive of educational support, has been implemented successfully in young people experiencing first-episode psychosis [43][44][45][46].…”

A structured mixed method process evaluation of a randomized controlled trial of Individual Placement and Support (IPS)

“…IPS programs obtaining high scores on this scale, as measured by evaluators, obtain higher shares of employment in ordinary jobs [8][9][10]. Through several experimental studies, the IPS method has proved more effective than traditional employment services, providing a robust empirical base for implementation across a wide variety of cultural contexts [11].…”