Evidence-based supported employment for people with severe mental illness: Past, current, and future research

Abstract

BACKGROUND: Individual Placement and Support (IPS) is an evidence-based vocational rehabilitation intervention for people with severe mental illness. IPS emphasizes client choice, rapid job finding, competitive employment, team-oriented approaches, benefits counseling, and ongoing supports. OBJECTIVE: This paper summarizes 20 years of research on IPS, describes studies in the field now, and proposes priorities for future research. METHODS: To identify published and unpublished IPS research studies, we conducted an electronic search of qualitative and quantitative IPS studies, findings from recent reviews, and sought expert recommendation. RESULTS: Past research indicates that IPS supported employment is the most effective and cost-effective approach for helping people with psychiatric disabilities find and maintain competitive employment. Employment improves clinical, social, and economic outcomes. Current studies on IPS address several research gaps: IPS modification, generalizability, program settings, international dissemination, cultural awareness, and supportive technology. Looking forward, the field needs studies that report long-term outcomes, financing mechanisms, cost offsets, and standardized supported education models. CONCLUSIONS: While IPS is one of the most extensively studied of all vocational models, significant literature gaps remain.

Individual placement and support for young adults at risk of early work disability (the SEED trial). A randomized controlled trial

“…It is however also important to note that participation in IPS was not associated with any negative impact on health, even though participants represented a vulnerable group qualified for sheltered work training. This aligns with the previous research on IPS (40) and suggests that concerns for potential detrimental health effects of non-sheltered approaches for this group may be unsubstantiated.…”

Mainstreaming Effective Employment Support for Individuals with Health Conditions: An Analytical Framework for the Effective Design of Modified Individual Placement and Support (IPS) Models

“…Of particular relevance to the present argument, modification of IPS fidelity and services has also been a lively area of activity and discussion in the literature (Paulson et al, 2002;Mowbray et al, 2003;Bond et al, 2011;Luciano et al, 2014), whether that augmentation be to add additional programme elements felt to be potentially usefulfor example a growing evidence base around the benefits of including additional cognitive remediation elements (McGurk et al, 2007) or else to remove or dilute programme elements in order, for example, to reduce costsfor example evidence that IPS time-limited to nine months rather than being time-…”

“…Despite its significant potential, however, traditional IPS is a niche employment support model that is in its current configuration ill-suited to making significant inroads into the totality of the health-related (un)employment challenge across advanced economies, even if some experimentation with IPS to new cohorts, settings, functions and larger volumes has occurred (Li Tsang et al, 2008;Coole et al, 2012;Ferguson et al, 2012;Luciano et al, 2014;Sveinsdottir et al, 2014;Ellison et al, 2015;Poremski et al, 2017;Smith et al, 2017). Specifically, traditional IPS is limited in four key respects:  Cohort: IPS models have supported individuals with severe mental health conditions only, despite the far larger number of individuals with low to moderate mental health issues in need of support and the frequent co-occurrence of mental and physical health issues (comorbidity);  Setting: IPS models have operated in secondary mental health services, but only a small minority of the wider cohorts identified above are (rightly) ever supported in such services;  Function: IPS services have focused exclusively on the out-of-work cohort, despite the significant support needs for those already in employment around absenteeism (e.g.…”

Occupational Participation of Persons with Schizophrenia: Exploring Issues of Job-Termination in Supported-Employment

“…The Schizophrenia Patient Outcomes Research Team recommends, "supported-employment" as one of the eight evidence-based psychosocial treatment modality (Kreyenbuhl et al, 2010). There are several variations of this model, but the Individual-placement support (IPS) model of supported-employment, has been practiced across international regions (Latimer et al, 2007;Campbell et al, 2011;Luciano et al, 2014;van Busschbach et al, 2014;Oshima et al, 2014;Waghorn et al, 2014;Modini et al, 2016). A limitation of supported-employment programs relates to, job tenure -and periods of 70-133 days (Xie et al, 2001), 122-214 days ( Burns et al, 2007;Campbell et al, 2011;Burns et al, 2015), or 36.17 weeks (Tsang et al, 2010) have been documented, but in general are too short for sustainable benefits either to patients or employer.…”