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Updated 2/12/14 by Gary Bond
Evidence for the Effectiveness of
Individual Placement and Support Model of
Supported Employment
Presentation Outline
Role of work in recovery Core principles of Individual
Placement and Support (IPS)Evidence for effectivenessImplementation strategies
Why Focus on Work?Most clients want to work!Most clients see work as an essential
part of recovery Being productive = Basic human needIn most societies, typical adult roleMost clients live in povertyWorking may prevent entry into
disability system
Most Clients Want Jobs in Competitive (Open) Employment
Regular community job Pays at least minimum wageNondisabled coworkersNot temporary or “make work”Job belongs to the client, not to
the mental health or rehabilitation agency
The Gap Between Need and Access
2/3 want to work
1%-2% have access to evidence-based employment services(SAMHSA, 2009; Brown, 2012, Twamley, 2013)
15% employed at any time(Lindamer, 2003; Pandiani, 2012; Perkins, 2002;
Rosenheck 2006; Salkever, 2007)
IPS Principles1. Open to anyone who wants to work2. Focus on competitive employment3. Rapid job search4. Systematic job development 5. Client preferences guide decisions6. Individualized long-term supports 7. Integrated with treatment8. Benefits counseling included
6 Day Treatment Conversions to Supported Employment:
Common Study DesignDiscontinued day treatmentReassigned day treatment staff to new
positions Implemented new supported
employment programCompared to 3 sites not converting
Sources: Drake and Becker
Similar Results in All Day Treatment Conversions
Large increase in employment ratesNo negative outcomes (e.g., relapses)Clients, families, staff liked changeOverall, all former day treatment
clients got out into community more Resulted in cost savings
20 Randomized Controlled Trials (RCTs) of Individual Placement and Support (IPS)Best evidence available on
effectivenessRCTs are gold standard in medical
research:Random assignment = Participants
assigned by a flip of a coin
Overall Findings for 20 RCTs
All 20 studies showed a significant advantage for IPS
Mean competitive employment rates for the 20 studies:–57% for IPS (Median = 60%)–24% for controls (Median = 26%)
(Each study weighted equally in calculating mean rates)
Four Measurement Domains of Employment OutcomesJob acquisition (% employed)Job duration (weeks worked)Hours worked per weekTotal hours worked/earnings
(Bond,Campbell, & Drake, 2012)
18-Month Competitive Employment Outcomes in 4 Controlled Trials of IPS
(Bond, Campbell, & Drake, 2012)
IPS for SSDI Beneficiaries
Mental Health Treatment Study (MHTS) (Drake et al. submitted)
Large multi-site controlled trialRecruited SSDI beneficiaries with mental illness
–Most were not receiving community mental health services
–Unemployed at baseline
MHTS DesignStudy population: Cold calls to SSDI
beneficiaries on SSA rolls 23 communities throughout US Randomized controlled trial
–Intervention group: IPS + other mental health services
–Control group: Usual servicesTwo-year follow-up
MHTS Sample
14% of nearly 16,000 beneficiaries contacted agreed to participate
Final sample: 2,055 Intervention: 1,004Control: 1,051
What About Long-Term Outcomes?
Many psychosocial interventions produce improvements in short-term outcomes
BUT improvements often disappear over the long term
True for IPS?
2 Long-Term IPS Follow-up Studies (Salyers 2004; Becker, 2007)
Clients also reported: Greater self-confidence and hopefulness, more energy,
less loneliness and boredom
Conclusion: IPS Has…
Strong Evidence for Effectiveness Across a Range
of Employment Measures, Including Long-Term
Outcomes
Is Work Too Stressful?
As compared to what?Joe Marrone: If you
think work is stressful, try unemployment
Benefits of Steady Competitive Employment
Improved self esteemImproved social networksIncreased quality of lifeReduced psychiatric symptomsReduced substance useLess use of disability system
Arns, 1993, 1995; Barreira, 2011; Bond, 2001; Burns, 2009;Drake, in press: Fabian, 1992; Krupa, 2012; Kukla, 2012; McHugo, 2012; Mueser, 1997; Van Dongen, 1996, 1998; Xie, 2005
Fidelity
Fidelity defined as: the degree to which a service model is implemented as intended
Working hypothesis: Better implemented programs (with higher fidelity) have better outcomes
Implementation Factors in National EBP Project
After 2 years, 29 (55%) of 53 sites implemented at high fidelity–Training, staff attitudes, and
barriers not predictiveStrongly predictive:
–Leadership at all levels–Integration of new practices into
work flow(Torrey, Bond, et al., 2011)
8 Keys to Implementing IPSEnd old ways of doing things
(e.g., day programs)Use fidelity reviews as guideExercise leadership:
–Agency directors provide resources
–Supervisors set firm behavioral expectations
8 Keys to Implementing IPS(continued)
Hire and retain staff suited for IPSProvide field mentoringCollaborate closely with treatment
teamsTrack indicators you want to
improve(Bond et al., 2008)
IPS Learning Collaborative
(Becker et al., 2011)
Launched in 2002 Grown to 130 programs in 14 states83% of programs joining since 2002
have been sustained
Features of IPS Learning Collaborative
Provide time-limited seed moneyCreate position of IPS state leaderState agency buy-in (MH and VR)Start small, grow graduallyCommit to fidelity and outcome
reportingNurture mechanisms for sharing of
experiences
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