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Brinchmann B, Wittlund S, Lorentzen T, Moe C, McDaid D, Killackey E, Rinaldi M, Mykletun A. The societal impact of individual placement and support implementation on employment outcomes for young adults receiving temporary health-related welfare benefits: a difference-in-differences study. Psychol Med 2024; 54:1787-1795. [PMID: 38197145 DOI: 10.1017/s0033291723003744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Individual placement and support (IPS) is an evidence-based practice that helps individuals with mental illness gain and retain employment. IPS was implemented for young adults at a municipality level through a cross-sectoral collaboration between specialist mental healthcare, primary mental healthcare, and the government funded employment service (NAV). We investigated whether IPS implementation had a causal effect on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation (work assessment allowance, WAA) welfare benefit, measured at the societal level compared to municipalities that did not implement IPS. METHOD We used a difference in differences design to estimate the effects of IPS implementation on the outcome of workdays per year using longitudinal registry data. We estimate the average effect of being exposed to IPS implementation during four-years of implementation compared to ten control municipalities without IPS for all WAA recipients. RESULTS We found a significant, positive, causal effect on societal level employment outcomes of 5.6 (p = 0.001, 95% CI 2.7-8.4) increased workdays per year per individual, equivalent to 12.7 years of increased work in the municipality where IPS was implemented compared to municipalities without IPS. Three years after initial exposure to IPS implementation individuals worked, on average, 10.5 more days per year equating to 23.8 years of increased work. CONCLUSIONS Implementing IPS as a cross sectoral collaboration at a municipality level has a significant, positive, causal, societal impact on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation welfare benefit.
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Affiliation(s)
- Beate Brinchmann
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
| | - Sina Wittlund
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Institute of Sociology, University of Bergen, Bergen, Norway
- Department of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Thomas Lorentzen
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Institute of Sociology, University of Bergen, Bergen, Norway
| | - Cathrine Moe
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Faculty of Nursing and Health sciences, Nord University, Bodø, Norway
| | - David McDaid
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Eoin Killackey
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Miles Rinaldi
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- South West London and St George's Mental Health NHS Trust, London, UK
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Department of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Oswald TK, Nguyen MT, Mirza L, Lund C, Jones HG, Crowley G, Aslanyan D, Dean K, Schofield P, Hotopf M, Das-Munshi J. Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. Psychol Med 2024; 54:1475-1499. [PMID: 38523245 DOI: 10.1017/s0033291724000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.
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Affiliation(s)
- Tassia Kate Oswald
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Minh Thu Nguyen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Luwaiza Mirza
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- University Hospitals Sussex, UK
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Hannah Grace Jones
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Grace Crowley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Daron Aslanyan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Justice Health and Forensic Mental Health Network, New South Wales, Australia
| | - Peter Schofield
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- ESRC Centre for Society and Mental Health, King's College London, UK
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3
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Baxter S, Cullingworth J, Whitworth A, Runswick-Cole K, Clowes M. Understanding interventions and outcomes in supported employment and individual placement support: A qualitative evidence synthesis. Disabil Health J 2024; 17:101579. [PMID: 38242753 DOI: 10.1016/j.dhjo.2024.101579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Economically developed economies continue to display large and long-standing disability employment gaps. Train-then-place activation models have traditionally dominated efforts to support non-working disabled people to gain employment but recently there has been increasing interest in place-then-train Supported Employment (SE) activation models. OBJECTIVE Evidence regarding the effectiveness of SE approaches is growing. However, authors have called for greater understanding of the mechanisms underpinning these interventions. We therefore carried out a systematic review of qualitative research to understand the processes operating. METHODS We carried out a systematic review of qualitative research around SE interventions carried out in developed countries since 2000 in any population excepting those with severe mental illness. We used thematic synthesis and logic modelling methods and assessed the quality of the body of literature. RESULTS We identified and included 13 relevant source studies containing qualitative data. Key aspects of the programmes reported were the nature of the support, the employment advisor, and the type of employment. Influencing factors were client-related, employer and employment-related, programme-related, and system-related. Effects beyond the gaining of employment included a changed attitude to work, different outlook, increased skills and/or confidence. Suggested longer-term impacts were on health and wellbeing, financial security, independence, contribution to society and sense of belonging. CONCLUSIONS This review adds to the growing evidence regarding the value of SE interventions for disabled people. It adds insights regarding the key elements of the programmes, and suggests outcomes beyond the measures typically considered within quantitative studies.
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Affiliation(s)
- Susan Baxter
- University of Sheffield, School for Health and Related Research, Regent Court, Regent Street, Sheffield, S14DA, UK.
| | - Jane Cullingworth
- University of Glasgow, School of Social and Political Sciences, University Avenue, Glasgow, G128QQ, UK.
| | - Adam Whitworth
- University of Strathclyde, 16 Richmond St, Glasgow, G11XQ, UK.
| | - Katherine Runswick-Cole
- University of Sheffield, School of Education, The Wave, 2 Whitham Road, Sheffield, S10 2AH, UK.
| | - Mark Clowes
- University of Sheffield, School for Health and Related Research, Regent Court, Regent Street, Sheffield, S14DA, UK.
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Harkko J, Sipilä N, Nordquist H, Lallukka T, Appelqvist-Schmidlechner K, Donnelly M, Kouvonen A. External context in individual placement and support implementation: a scoping review with abductive thematic analysis. Implement Sci 2023; 18:61. [PMID: 37946209 PMCID: PMC10636871 DOI: 10.1186/s13012-023-01316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Context including the external context may considerably affect the adoption, implementation, sustainment, and scale-up of evidence-based practices. We investigated external contextual features by conducting a scoping review of empirical research regarding the implementation of an evidence-based psychiatric or mental health vocational rehabilitation service called Individual Placement and Support (IPS). METHODS The protocol for the scoping review was registered with the Open Science Framework. We used the methodology by Joanna Briggs Institute for conducting the scoping review and reported it according to the PRISMA-ScR checklist. We searched 12 databases for research regarding 'Individual Placement and Support' or 'Evidence-Based Supported Employment'. We retained peer-reviewed empirical studies investigating external contextual factors and their impact on IPS implementation outcomes. We extracted data from the eligible articles and conducted descriptive and thematic analyses. RESULTS Fifty-nine original research papers met our eligibility requirements and were retained after reviewing 1124 titles and abstracts and 119 full texts. The analysis generated two main themes: (1) external contextual determinants of service delivery and (2) external systems influencing the evidence-to-practice process. The first main theme encompassed policies and laws, financing, and administratively instituted support resources, and organizational arrangements associated with external stakeholders that may facilitate or hinder the local implementation. The second main theme comprised strategies and actions used by different stakeholders to facilitate implementation locally or scale-up efforts at a system level. DISCUSSION Our scoping review illustrates the important role that external contextual factors play and how they may facilitate or hinder the implementation and scale-up of the IPS model across mental health services in different countries. Consideration of these factors by decision-makers in mental health and welfare services, planners, providers, and practitioners is likely to facilitate the development of effective strategies for bridging the evidence-practice gap in implementing the EBPs. Finally, the scoping review identified gaps in knowledge and offered suggestions for future research. TRIAL REGISTRATION Open Science Framework.
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Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
| | - Noora Sipilä
- The Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
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5
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Holder N, Holliday R, Ranney RM, Bernhard PA, Vogt D, Hoffmire CA, Blosnich JR, Schneiderman AI, Maguen S. Relationship of social determinants of health with symptom severity among Veterans and non-Veterans with probable posttraumatic stress disorder or depression. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1523-1534. [PMID: 37173595 DOI: 10.1007/s00127-023-02478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/30/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Social determinants of health (SDoH) refer to the conditions in the environments in which people live that affect health outcomes and risks. SDoH may provide proximal, actionable targets for interventions. This study examined how SDoH are associated with posttraumatic stress disorder (PTSD) and depression symptoms among Veterans and non-Veterans with probable PTSD or depression. METHODS Four multiple regressions were conducted. Two multiple regressions with Veterans examined the impact of SDoH on PTSD symptoms and on depression symptoms. Two multiple regressions with non-Veterans examined the impact of SDoH on PTSD symptoms and on depression symptoms. Independent variables included demographic characteristics, adverse experiences (in childhood and adulthood), and SDoH (discrimination, education, employment, economic instability, homelessness, justice involvement, and social support). Correlates that were statistically significant (p < 0.05) and clinically meaningful (rpart >|0.10|) were interpreted. RESULTS For Veterans, lower social support (rpart = - 0.14) and unemployment (rpart = 0.12) were associated with greater PTSD symptoms. Among non-Veterans, greater economic instability (rpart = 0.19) was associated with greater PTSD symptoms. In the depression models, lower social support (rpart = - 0.23) and greater economic instability (rpart = 0.12) were associated with greater depression for Veterans, while only lower social support was associated with greater depression for non-Veterans (rpart = - 0.14). CONCLUSION Among Veterans and non-Veterans with probable PTSD or depression, SDoH were associated with PTSD and depression symptoms, particularly social support, economic instability, and employment. Beyond direct treatment of mental health symptoms, addressing social support and economic factors such as instability and employment in the context of PTSD and depression are potential intervention targets that would benefit from future research.
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Affiliation(s)
- Nicholas Holder
- San Francisco Veterans Affairs Health Care System, 4150 Clement Street (116-P), San Francisco, CA, 94121, USA.
- University of California San Francisco, San Francisco, USA.
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Rachel M Ranney
- San Francisco Veterans Affairs Health Care System, 4150 Clement Street (116-P), San Francisco, CA, 94121, USA
- University of California San Francisco, San Francisco, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Center, San Francisco, USA
| | - Paul A Bernhard
- Health Outcomes Military Exposures Epidemiology Program, Patient Care Services, U.S. Department of Veterans Affairs, Washington, D.C., USA
| | - Dawne Vogt
- Women's Health Sciences Division of the National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, USA
- Boston University School of Medicine, Boston, USA
| | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, USA
| | - Aaron I Schneiderman
- Health Outcomes Military Exposures Epidemiology Program, Patient Care Services, U.S. Department of Veterans Affairs, Washington, D.C., USA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, 4150 Clement Street (116-P), San Francisco, CA, 94121, USA
- University of California San Francisco, San Francisco, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Center, San Francisco, USA
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6
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Adams WE, Rogers ES, McKnight L, Lynde D. Examination of Adaptations to the Evidence Based Supported Employment Model: Individual Placement and Support. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01267-w. [PMID: 37162603 DOI: 10.1007/s10488-023-01267-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
Individual Placement and Support (IPS) is a long-standing and innovative employment service for individuals with mental illness with dozens of clinical trials demonstrating effectiveness. Little is known, however, about intentional adaptations to IPS, especially those outside of the context of research studies. Using an implementation science framework, we conducted an exploratory study to better understand the characteristics of stakeholder-reported adaptions to IPS, the impetus for their development, and perceived impacts. We conducted qualitative interviews to analyze and describe these adaptations. Numerous adaptations of IPS were found that address the needs of new and underserved populations both within and outside of the mental health field. Programs reported adapting IPS because of the dearth of other evidence-based employment services, to serve diverse populations in need, and based on financial incentives. Benefits of adaptations were weighed against impacts on fidelity. As evidence-based practices (EBPs) are adapted, developers of EBPs should determine how fidelity of a program or service can be assessed or preserved in light of adaptations. This is critical with the increase in different service delivery methods, new populations, new service recipient needs, and new settings in need of EBPs.
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Affiliation(s)
- Wallis E Adams
- Center for Psychiatric Rehabilitation at Boston University, 940 Commonwealth Avenue, Boston, MA, 02215, USA
- Department of Sociology, California State University, East Bay, Hayward, USA
| | - E Sally Rogers
- Center for Psychiatric Rehabilitation at Boston University, 940 Commonwealth Avenue, Boston, MA, 02215, USA.
| | - Lauren McKnight
- Center for Psychiatric Rehabilitation at Boston University, 940 Commonwealth Avenue, Boston, MA, 02215, USA
| | - David Lynde
- Independent Mental Health Consultant, Concord, NH, USA
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7
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Bond GR. IPS supported employment and peer support for young adults: Next steps. Early Interv Psychiatry 2023. [PMID: 37040898 DOI: 10.1111/eip.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/19/2022] [Accepted: 01/01/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Gary R Bond
- Social Policy and Economics Research, Westat, Lebanon, New Hampshire, USA
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8
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Bond GR, Al-Abdulmunem M, Marbacher J, Christensen TN, Sveinsdottir V, Drake RE. A Systematic Review and Meta-analysis of IPS Supported Employment for Young Adults with Mental Health Conditions. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:160-172. [PMID: 36219318 DOI: 10.1007/s10488-022-01228-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 02/04/2023]
Abstract
Young adults with mental health conditions want to work and advance their education, but many need help attaining these goals. Individual Placement and Support (IPS), originally developed for working-age adults with serious mental illness, is an evidence-based employment model that may benefit young adults. This study is the first systematic review and meta-analysis of randomized controlled trials (RCTs) of IPS for this population. We conducted a systematic review of the effectiveness of IPS for young adults with mental health conditions, supplementing our electronic search of the published literature with secondary analyses of two published RCTs. Using meta-analysis, we evaluated employment rate, job duration, and education rate. Seven studies met the inclusion criteria. Four evaluated IPS for young adults with early psychosis and three evaluated IPS for other young adult subgroups. All found a significantly higher employment rate for IPS than the control group. Overall, 208 (58.3%) of 357 IPS participants and 110 (32.4%) of 340 control participants were competitively employed during follow-up, yielding an overall risk ratio of 1.69 (95% CI 1.43, 1.99), z = 6.24, p < 0.001. Six of the seven studies also reported longer job duration for IPS than the control group, yielding an overall g = 0.34 (95% CI 0.09, 0.58), z = 2.72, p < 0.01. None of four RCTs examining education outcomes found a significant difference favoring IPS, but the overall risk ratio was significant: 1.33 (95% CI 1.06, 1.66), z = 2.51, p < 0.01. Although the empirical literature is limited, IPS appears to be effective in helping young adults with serious mental illness or early psychosis gain and keep competitive jobs. The impact of IPS on education outcomes is unclear. Future research should evaluate the generalizability of these findings to the broad range of young adults with mental health conditions needing help with their employment goals.
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Affiliation(s)
- Gary R Bond
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH, 03766, USA.
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA.
| | - Monirah Al-Abdulmunem
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH, 03766, USA
| | | | - Thomas N Christensen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen, Denmark
| | | | - Robert E Drake
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH, 03766, USA
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de Boer AGEM, de Wind A, Coenen P, van Ommen F, Greidanus MA, Zegers AD, Duijts SFA, Tamminga SJ. Cancer survivors and adverse work outcomes: associated factors and supportive interventions. Br Med Bull 2022; 145:60-71. [PMID: 36372773 PMCID: PMC10075241 DOI: 10.1093/bmb/ldac028] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The number of cancer survivors in a working age is rising. An awareness of factors associated with adverse work outcomes, and of supportive interventions, is needed. SOURCES OF DATA A narrative review of research obtained via several databases, including Medline and PsycINFO, was conducted. AREAS OF AGREEMENT A range of factors is associated with adverse work outcomes such as prolonged sick leave, delayed return to work, disability pension and unemployment in cancer survivors. They include the cancer type and treatment, fatigue, cognitive functioning, work factors and elements of health care systems. Effective supportive interventions encompass physical and multicomponent interventions. AREAS OF CONTROVERSY The role of behaviour determinants and legislative and insurance systems is unclear. It is furthermore uncertain what the optimal timing of delivering supportive interventions is. GROWING POINTS Further focus on vulnerable groups, including specific cancer types and those with lower income, lower educational level and in precarious employment, is needed. AREAS TIMELY FOR DEVELOPING RESEARCH Recent developments are tailored and timely interventions.
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Affiliation(s)
- Angela G E M de Boer
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Public Health, Societal Participation and Health, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Astrid de Wind
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Public Health, Societal Participation and Health, Amsterdam, the Netherlands
| | - Pieter Coenen
- Amsterdam Public Health, Societal Participation and Health, Amsterdam, the Netherlands.,Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit, Amsterdam, De Boelelaan 1117 Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
| | - Fenna van Ommen
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Public Health, Societal Participation and Health, Amsterdam, the Netherlands
| | - Michiel A Greidanus
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Public Health, Societal Participation and Health, Amsterdam, the Netherlands
| | - Amber D Zegers
- Amsterdam Public Health, Societal Participation and Health, Amsterdam, the Netherlands.,Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit, Amsterdam, De Boelelaan 1117 Amsterdam, the Netherlands
| | - Saskia F A Duijts
- Amsterdam Public Health, Societal Participation and Health, Amsterdam, the Netherlands.,Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit, Amsterdam, De Boelelaan 1117 Amsterdam, the Netherlands.,Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Sietske J Tamminga
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Public Health, Societal Participation and Health, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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10
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van Dam M, van Weeghel J, Castelein S, Stiekema A, Quee P, Kidd S, Allott K, Maples N, Velligan D, Pijnenborg M, van der Meer L. Development and validation of a fidelity instrument for Cognitive Adaptation Training. Schizophr Res Cogn 2022; 31:100272. [PMCID: PMC9634354 DOI: 10.1016/j.scog.2022.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Purpose Cognitive Adaptation Training (CAT) is a psychosocial intervention with demonstrated effectiveness. However, no validated fidelity instrument is available. In this study, a CAT Fidelity Scale was developed and its psychometric properties, including interrater reliability and internal consistency, were evaluated. Methods The fidelity scale was developed in a multidisciplinary collaboration between international research groups using the Delphi method. Four Delphi rounds were organized to reach consensus for the items included in the scale. To examine the psychometric properties of the scale, data from a large cluster randomized controlled trial evaluating the implementation of CAT in clinical practice was used. Fidelity assessors conducted 73 fidelity reviews at four mental health institutions in the Netherlands. Results After three Delphi rounds, consensus was reached on a 44-item CAT Fidelity Scale. After administration of the scale, 24 items were removed in round four resulting in a 20-item fidelity scale. Psychometric properties of the 20-item CAT Fidelity Scale shows a fair interrater reliability and an excellent internal consistency. Conclusions The CAT fidelity scale in its current form is useful for both research purposes as well as for individual health professionals to monitor their own adherence to the protocol. Future research needs to focus on improvement of items and formulating qualitative anchor point to the items to increase generalizability and psychometric properties of the scale. The described suggestions for improvement provide a good starting point for further development.
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Affiliation(s)
- Michelle van Dam
- Lentis Psychiatric Institute, Department of Rehabilitation, Zuidlaren, the Netherlands,University Medical Center Groningen, Rob Giel Research Center, Groningen, the Netherlands
| | - Jaap van Weeghel
- Phrenos center of expertise on severe mental illness, Utrecht, the Netherlands,Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
| | - Stynke Castelein
- Lentis Psychiatric Institute, Research Department, Groningen, the Netherlands,University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Annemarie Stiekema
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Piotr Quee
- GGZ Breburg, Centre for Anxiety and Mood Disorders, Breda, the Netherlands
| | - Sean Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada,Centre for Addiction and Mental Health, Toronto, Canada
| | - Kelly Allott
- Orygen Youth Health Research Centre, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Natalie Maples
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Dawn Velligan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Marieke Pijnenborg
- GGZ Drenthe, Department of Psychotic Disorders, Assen, the Netherlands,University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Groningen, the Netherlands
| | - Lisette van der Meer
- Lentis Psychiatric Institute, Department of Rehabilitation, Zuidlaren, the Netherlands,University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Groningen, the Netherlands,Corresponding author.
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Walker-Bone K, Fraser SDS, Price C, Maguire N, Cooper C, Madan I, Ntani G, Linaker CL. A pilot trial investigating the feasibility of a future randomised controlled trial of Individualised Placement and Support for people unemployed with chronic pain recruiting in primary care. Prim Health Care Res Dev 2022; 23:e39. [PMID: 35866327 PMCID: PMC9309751 DOI: 10.1017/s1463423622000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/18/2022] [Accepted: 05/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We investigated the feasibility of recruiting patients unemployed for more than 3 months with chronic pain using a range of methods in primary care in order to conduct a pilot trial of Individual Placement and Support (IPS) to improve quality of life outcomes for people with chronic pain. METHODS This research was informed by people with chronic pain. We assessed the feasibility of identification and recruitment of unemployed patients; the training and support needs of employment support workers to integrate with pain services; acceptability of randomisation, retention through follow-up and appropriate outcome measures for a definitive trial. Participants randomised to IPS received integrated support from an employment support worker and a pain occupational therapist to prepare for, and take up, a work placement. Those randomised to Treatment as Usual (TAU) received a bespoke workbook, delivered at an appointment with a research nurse not trained in vocational rehabilitation. RESULTS Using a range of approaches, recruitment through primary care was difficult and resource-intensive (1028 approached to recruit 37 eligible participants). Supplementing recruitment through pain services, another 13 people were recruited (total n = 50). Randomisation to both arms was acceptable: 22 were allocated to IPS and 28 to TAU. Recruited participants were generally not 'work ready', particularly if recruited through pain services. CONCLUSION A definitive randomised controlled trial is not currently feasible for recruiting through primary care in the UK. Although a trial recruiting through pain services might be possible, participants could be unrepresentative in levels of disability and associated health complexities. Retention of participants over 12 months proved challenging, and methods for reducing attrition are required. The intervention has been manualised.
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Affiliation(s)
- Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Simon DS Fraser
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Cathy Price
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Nick Maguire
- Department of Psychology, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Ira Madan
- Occupational Health Service, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- King’s College London Faculty of Life Sciences and Medicine, London, UK
| | - Georgia Ntani
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Cathy L Linaker
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
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12
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Abstract
AIMS Individual placement and support (IPS) is an evidence-based service model to support people with mental disorders in obtaining and sustaining competitive employment. IPS is increasingly offered to a broad variety of service users. In this meta-analysis we analysed the relative effectiveness of IPS for different subgroups of service users both based on the diagnosis and defined by a range of clinical, functional and personal characteristics. METHODS We included randomised controlled trials that evaluated IPS for service users diagnosed with any mental disorder. We examined effect sizes for the between-group differences at follow-up for three outcome measures (employment rate, job duration and wages), controlling for methodological confounders (type of control group, follow-up duration and geographic region). Using sensitivity analyses of subgroup differences, we analysed moderating effects of the following diagnostic, clinical, functional and personal characteristics: severe mental illness (SMI), common mental disorders (CMD), schizophrenia spectrum disorders, mood disorders, duration of illness, the severity of symptoms, level of functioning, age, comorbid alcohol and substance use, education level and employment history. RESULTS IPS is effective in improving employment outcomes compared to the control group in all subgroups, regardless of any methodological confounder. However, IPS was relatively more effective for service users with SMIs, schizophrenia spectrum disorders and a low symptom severity. Although IPS was still effective for people with CMD and with major depressive disorder, it was relatively less effective for these subgroups. IPS was equally effective after both a short and a long follow-up period. However, we found small, but clinically not meaningful, differences in effectiveness of IPS between active and passive control groups. Finally, IPS was relatively less effective in European studies compared to non-European studies, which could be explained by a potential benefits trap in high welfare countries. CONCLUSIONS IPS is effective for all different subgroups, regardless of diagnostic, clinical, functional and personal characteristics. However, there might be a risk of false-positive subgroup outcomes and results should be handled with caution. Future research should focus on whether, and if so, how the IPS model should be adapted to better meet the vocational needs of people with CMD and higher symptom severity.
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13
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Thompson JL, Holloway K, Karyczak S, Serody MR, Lane IA, Ellison ML, Gill KJ, Davis M, Mullen MG. Evaluating Educational and Employment Services for Young People With Psychiatric Conditions: A Systematic Review. Psychiatr Serv 2022; 73:787-800. [PMID: 34875848 DOI: 10.1176/appi.ps.202000033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors conducted a systematic review of studies evaluating vocational interventions for young people with psychiatric conditions to determine the extent to which services were adapted for young people and whether services promoted gains in postsecondary education and employment. METHODS Five databases (PubMed, PsycINFO, Web of Science, Academic Search Premier, and ERIC) were searched. Sources eligible for inclusion were controlled studies published between 2000 and mid-2020 that evaluated a vocational intervention and examined postsecondary educational or employment outcomes for youths or young adults (ages 14-35 years) with psychiatric conditions. RESULTS Ten studies met the inclusion criteria. Several of the studies evaluated services that were adapted for young people, including through the incorporation of educational supports. The most consistent finding was that services based on the individual placement and support (IPS) model improved employment outcomes more effectively than did comparison approaches and treatment as usual. Fewer studies assessed educational outcomes, and they yielded mixed results; however, recent findings from a controlled trial indicate that an enhanced IPS intervention that included well-specified supported education and skills training led to significantly superior outcomes in both education and employment. CONCLUSIONS These results provide support for the efficacy of IPS-based services to improve employment outcomes among young people with psychiatric conditions and suggest that adapting IPS to include comprehensive educational supports and skills training may be important for efforts to improve postsecondary educational outcomes. Additional well-controlled intervention studies that examine educational and longer-term outcomes should further inform the development and delivery of vocational services for this population.
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Affiliation(s)
- Judy L Thompson
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Thompson, Serody); Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey (Thompson, Holloway, Karyczak, Gill); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lane, Ellison, Davis, Mullen)
| | - Katherine Holloway
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Thompson, Serody); Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey (Thompson, Holloway, Karyczak, Gill); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lane, Ellison, Davis, Mullen)
| | - Sean Karyczak
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Thompson, Serody); Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey (Thompson, Holloway, Karyczak, Gill); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lane, Ellison, Davis, Mullen)
| | - Megan R Serody
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Thompson, Serody); Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey (Thompson, Holloway, Karyczak, Gill); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lane, Ellison, Davis, Mullen)
| | - Ian A Lane
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Thompson, Serody); Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey (Thompson, Holloway, Karyczak, Gill); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lane, Ellison, Davis, Mullen)
| | - Marsha L Ellison
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Thompson, Serody); Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey (Thompson, Holloway, Karyczak, Gill); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lane, Ellison, Davis, Mullen)
| | - Kenneth J Gill
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Thompson, Serody); Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey (Thompson, Holloway, Karyczak, Gill); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lane, Ellison, Davis, Mullen)
| | - Maryann Davis
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Thompson, Serody); Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey (Thompson, Holloway, Karyczak, Gill); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lane, Ellison, Davis, Mullen)
| | - Michelle G Mullen
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Thompson, Serody); Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey (Thompson, Holloway, Karyczak, Gill); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lane, Ellison, Davis, Mullen)
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14
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Davis LL, Mumba MN, Toscano R, Pilkinton P, Blansett CM, McCall K, MacVicar D, Bartolucci A. A Randomized Controlled Trial Evaluating the Effectiveness of Supported Employment Integrated in Primary Care. Psychiatr Serv 2022; 73:620-627. [PMID: 34521208 DOI: 10.1176/appi.ps.202000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Mental health issues can cause serious problems in occupational functioning, including higher rates of unemployment. Individual placement and support (IPS) is an evidence-based supported employment intervention that is typically integrated within a mental health setting; however, many primary care patients view referral to a mental health clinic as stigmatizing. Thus, this study examined whether delivery of IPS in a primary care setting provides an effective treatment option and avoids unnecessary delays in obtaining competitive employment. METHODS U.S. military veterans (N=119) who had a diagnosis in a broad range of nonpsychotic psychiatric disorders and who were receiving care from Veterans Health Administration (VHA) patient-aligned care teams were prospectively randomly assigned to IPS (N=58) or standard VHA non-IPS vocational rehabilitation (VR) (N=61). The primary outcome was achievement of steady worker status, defined as holding a competitive job for ≥6 months of the 12-month follow-up. RESULTS As hypothesized, a significantly greater proportion of IPS participants achieved steady worker status (45%), compared with VR participants (25%) (p=0.02; odds ratio=2.49, 95% confidence interval=1.14-5.43). On average, the IPS participants worked significantly more weeks (p=0.003) and earned significantly more income (p=0.033) from competitive jobs, compared with VR participants. CONCLUSIONS The results provide supporting evidence for offering IPS within primary care with the aim of restoring meaningful and sustained competitive employment for veterans living with a mental disorder. Such modifications could improve veterans' vocational outcomes, moving a significantly greater number of disabled veterans back to full and productive lives in the community.
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Affiliation(s)
- Lori L Davis
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Mercy N Mumba
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Richard Toscano
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Patricia Pilkinton
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Catherine M Blansett
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Kimberly McCall
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - David MacVicar
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Al Bartolucci
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
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15
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Juurlink TT, Lamers F, van Marle HJF, Zwinkels W, Spijkerman MA, Beekman ATF, Anema JR. Individual placement and support and employment in personality disorders: a registry based cohort study. BMC Psychiatry 2022; 22:188. [PMID: 35300624 PMCID: PMC8932290 DOI: 10.1186/s12888-022-03823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/09/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To explore the relative impact of Individual Placement and Support (IPS) in patients with personality disorders (PDs) as compared to patients with other mental disorders. METHODS Data from the Dutch Employee Insurance Agency of participants enrolled in a national IPS trajectory between 2008 and 2018 were linked to corresponding data on employment outcomes, diagnostic and sociodemographic information from Statistics Netherlands. This resulted in a sample of 335 participants with PDs who could be compared with 1073 participants with other mental disorders. RESULTS Participants with PD just as often found competitive employment as participants with other mental disorders (37.6% vs. 38.0%, ORadjusted = 0.97, 95% confidence interval (CI) 0.74 to 1.27). The median time to gaining employment for those gaining employment (37.9%) was 195.5 days (mean number of days 252.5) in the PD group and 178.5 days (mean number of days 234.6) in the other mental disorders group (HRadjusted = 0.95, 95% CI 0.77 to 1.18). Also, total number of hours paid for competitive employment did not differ significantly between groups (median hours 686.5 vs 781.5, IRRadjusted = 0.85 95% CI 0.69 to 1.05). CONCLUSIONS Based on this study, which includes the largest sample of patients with PDs in any published IPS study, IPS seems to result in an equal percentage of patients with PDs and other mental disorders, gaining and maintaining employment. Although future studies should determine whether PD-specific adaptations to IPS are useful, our findings indicate that IPS could be an effective way to increase employment outcomes in PDs. This is important because the enormous societal costs of PDs are largely driven by loss of economic productivity, and because clinical recovery in PDs is suggested to be enhanced when patients are employed.
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Affiliation(s)
- T. T. Juurlink
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Social Medicine, Amsterdam Public Health Research Institute, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - F. Lamers
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,GGZ in Geest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - H. J. F. van Marle
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Social Medicine, Amsterdam Public Health Research Institute, De Boelelaan, 1117 Amsterdam, The Netherlands ,grid.484519.5Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - M. A. Spijkerman
- grid.491487.70000 0001 0725 5522UWV, Dutch Social Security Administration, Amsterdam, The Netherlands
| | - A. T. F. Beekman
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,GGZ in Geest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - J. R. Anema
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Social Medicine, Amsterdam Public Health Research Institute, De Boelelaan, 1117 Amsterdam, The Netherlands
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16
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Sveinsdottir V, Jacobsen HB, Ljosaa TM, Linnemørken LTB, Knutzen T, Ghiasvand R, Reme SE. The Individual Placement and Support (IPS) in Pain Trial: A randomized controlled trial of IPS for patients with chronic pain conditions. PAIN MEDICINE 2022; 23:1757-1766. [PMID: 35234931 PMCID: PMC9527610 DOI: 10.1093/pm/pnac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/13/2022] [Accepted: 02/11/2022] [Indexed: 11/12/2022]
Abstract
Objectives Although complex pain conditions require an interdisciplinary approach, employment services are rarely provided in pain centers. Individual Placement and Support (IPS) is an effective approach to increase work participation among patients with severe mental illness, and recent evidence suggests that this method can be successfully repurposed for new target groups. We aimed to investigate the effectiveness of IPS integrated with interdisciplinary treatment as usual (TAU) for patients with chronic pain in a tertiary pain center. Methods A randomized controlled trial comparing IPS integrated with TAU (n = 38) with TAU alone (n = 20) was conducted. Participants were patients with chronic pain who were 18–65 years of age and currently on long-term sick leave or disability benefits or unemployed. The primary outcome was employment within 12 months after enrollment, with additional long-term follow-up after 24 months. Secondary outcomes included health and quality of life, measured at baseline, 6 months, and 12 months. Results During 12-month follow-up, 52.8% in the IPS group and 38.9% in the TAU group had attained employment. The difference increased during 24-month follow-up but did not reach statistical significance. Findings on secondary outcomes were generally nonsignificant. Conclusions The IPS in Pain trial is the first study to evaluate the effect of IPS for patients with chronic pain conditions. It shows that IPS can be integrated into the daily practice of interdisciplinary pain treatment, with employment rates exceeding 50% in 1 year and a clear trend in favor of the IPS group. Results did not, however, reach significance. Larger randomized controlled trials are needed to draw clear conclusions about effectiveness.
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Affiliation(s)
- Vigdis Sveinsdottir
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,NORCE Norwegian Research Centre, Bergen, Norway
| | - Henrik Børsting Jacobsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,The Mind Body Lab, Department of Psychology, University of Oslo, Oslo, Norway
| | - Tone Marte Ljosaa
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Lene Therese Bergerud Linnemørken
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | | | - Reza Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.,Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Silje Endresen Reme
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,The Mind Body Lab, Department of Psychology, University of Oslo, Oslo, Norway
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17
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Weld-Blundell I, Shields M, Devine A, Dickinson H, Kavanagh A, Marck C. Vocational Interventions to Improve Employment Participation of People with Psychosocial Disability, Autism and/or Intellectual Disability: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212083. [PMID: 34831840 PMCID: PMC8618542 DOI: 10.3390/ijerph182212083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 11/16/2022]
Abstract
Objective: To systematically review interventions aimed at improving employment participation of people with psychosocial disability, autism, and intellectual disability. Methods: We searched MEDLINE, Embase, PsycINFO, Web of Science, Scopus, CINAHL, ERIC, and ERC for studies published from 2010 to July 2020. Randomized controlled trials (RCTs) of interventions aimed at increasing participation in open/competitive or non-competitive employment were eligible for inclusion. We included studies with adults with psychosocial disability autism and/or intellectual disability. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias II Tool. Data were qualitatively synthesized. Our review was registered with PROSPERO (CRD42020219192). Results: We included 26 RCTs: 23 targeted people with psychosocial disabilities (n = 2465), 3 included people with autism (n = 214), and none included people with intellectual disability. Risk of bias was high in 8 studies, moderate for 18, and low for none. There was evidence for a beneficial effect of Individual Placement and Support compared to control conditions in 10/11 studies. Among young adults with autism, there was some evidence for the benefit of Project SEARCH and ASD supports on open employment. Discussion: Gaps in the availability of high-quality evidence remain, undermining comparability and investment decisions in vocational interventions. Future studies should focus on improving quality and consistent measurement, especially for interventions targeting people with autism and/or intellectual disability.
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Affiliation(s)
- Isabelle Weld-Blundell
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
| | - Marissa Shields
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
| | - Alexandra Devine
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
- Correspondence:
| | - Helen Dickinson
- School of Business, University of New South Wales, Canberra 2610, Australia;
| | - Anne Kavanagh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
| | - Claudia Marck
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
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18
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Rognli EB, Aas EM, Drake RE, Marsden J, Anders P, Bond GR, Lystad JU, Reme SE, Arnevik EA. The effect evaluation of Individual Placement and Support (IPS) for patients with substance use disorders: study protocol for a randomized controlled trial of IPS versus enhanced self-help. Trials 2021; 22:705. [PMID: 34654464 PMCID: PMC8518218 DOI: 10.1186/s13063-021-05673-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background Employment is associated with better outcomes of substance use treatment and protects against relapse after treatment completion. Unemployment rates are high for people with substance use disorders (SUD) who undergo treatment, with Norwegian estimates ranging from 81 to 91%. Evidence-based vocational models are lacking for patients in SUD treatment but exist for patients with psychosis in terms of Individual Placement and Support (IPS). The aim of the IPS for substance use disorders (IPS-SUD) trial is to investigate the effect of IPS in a SUD population. Methods/design The IPS-SUD trial is a randomized controlled trial (RCT) comparing IPS to an enhanced control intervention. The study is a seven-site, two-arm, pragmatic, parallel-group, superiority RCT. Participants are randomly assigned (1:1) to receive either IPS plus treatment as usual (TAU) or to receive a self-help guide book and 12-h workshop plus 1-h individual vocational guidance plus TAU. Aiming to recruit 200 participants, we will be able to detect a 20% difference in the main outcome of employment with 90% power. We will make assessments at inclusion and at 6- and 12-month follow-ups and obtain outcome data on employment from national mandatory registries. The primary outcome will be at least 1 day of competitive employment during the 18-month follow-up period. Secondary employment outcomes will capture the pattern and extent of employment in terms of total time worked (days/hours), time to first employment, number of different jobs, duration of the longest employment, and sustained employment. Secondary non-employment outcomes will be substance use, mental distress, and quality of life measured by validated instruments at 6, 12, and 18 months follow-up assessments. To be eligible, participants must be between 18 and 65 years, currently unemployed and in treatment for SUD. Discussion The IPS-SUD trial will provide evidence for the use of IPS in a SUD population. Findings from the study will have implications for service delivery. Trial registration ClinicalTrials.gov NCT04289415. Registered on February 28, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05673-z.
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Affiliation(s)
- Eline Borger Rognli
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway.
| | - Erlend Marius Aas
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Robert E Drake
- Westat, Lebanon, New Hampshire, USA.,IPS Employment Center, Laconia, New Hampshire, USA
| | - John Marsden
- Addictions Department, Institute of Psychiatry, King's College London, London, UK
| | | | - Gary R Bond
- Westat, Lebanon, New Hampshire, USA.,IPS Employment Center, Laconia, New Hampshire, USA
| | - June Ullevoldsæter Lystad
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | | | - Espen Ajo Arnevik
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
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19
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Eklund M, Jansson JÅ, Eklund L, Pooremamali P, Gunnarsson AB. Work experiences, resources, and beliefs among vulnerable subgroups of mental health care users. Work 2021; 70:125-134. [PMID: 34487010 PMCID: PMC8673540 DOI: 10.3233/wor-213559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND: People with mental illness may have difficulties related to work and employment, especially if they experience additional difficult life situations. OBJECTIVE: To explore how subgroups with mental illness and additional adversities perceived their situation with respect to work and employment prospects. METHODS: Three subgroups were included, exposed to an additional difficult life situation: i) psychosis interrupting their career development at young age (n = 46), ii) having a history of substance use disorder (SUD) (= 57) or iii) having recently immigrated (n = 39). They responded to questionnaires addressing sociodemographics, work-related factors, everyday activity, and well-being. A professional assessed their level of functioning and symptom severity. RESULTS: The young people with psychosis had a low education level, little work experience, the poorest worker role resources, and a low level of functioning, but a high quality of life. The SUD group had the fewest work experiences, were the least satisfied with work experiences, and had the lowest activity level, but had the least severe psychiatric symptoms. The immigrant group had severe psychiatric symptoms, but high ratings on work experiences, work resources, and activity level. CONCLUSIONS: Each group presented unique assets and limitations pertaining to work and employment, suggesting that they also needed unique support measures.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Jan-Åke Jansson
- Department of Psychology and Department of Health Sciences, Lund University, Lund, Sweden
| | - Lisa Eklund
- Department of Sociology, Lund University, Lund, Sweden
| | - Parvin Pooremamali
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | - A Birgitta Gunnarsson
- Department of Research and Development, Region Kronoberg, Växjö, Sweden and Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Sweden
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20
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Yamaguchi S, Sato S, Shiozawa T, Matsunaga A, Ojio Y, Fujii C. Predictive Association of Low- and High-Fidelity Supported Employment Programs with Multiple Outcomes in a Real-World Setting: A Prospective Longitudinal Multi-site Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:255-266. [PMID: 34476622 PMCID: PMC8850236 DOI: 10.1007/s10488-021-01161-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The individual placement and support (IPS) model of supported employment is a leading evidence-based practice in community mental health services. In Japan, individualized supported employment that is highly informed by the philosophy of the IPS model has been implemented. While there is a body of evidence demonstrating the association between program fidelity and the proportion of participants gaining competitive employment, the association between fidelity and a wider set of vocational and individual outcomes has received limited investigation. This study aimed to assess whether high-fidelity individualized supported employment programs were superior to low-fidelity programs in terms of vocational outcomes, preferred job acquisition, and patient-reported outcome measures (PROMs). METHODS A prospective longitudinal study with 24-month follow-up analyzed 16 individualized supported employment programs. The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was used to assess the structural quality of supported employment programs (scores: low-fidelity program, ≤ 90; high-fidelity program, ≥ 91). Job acquisition, work tenure, work earnings, job preference matching (e.g., occupation type, salary, and illness disclosure), and PROMs such as the INSPIRE and WHO-Five Well-being index were compared between groups. RESULTS There were 75 and 127 participants in the low-fidelity group (k = 6) and high-fidelity group (k = 10), respectively. The high-fidelity group demonstrated better vocational outcomes than the low-fidelity group, i.e., higher competitive job acquisition (71.7% versus 38.7%, respectively, adjusted odds ratio (aOR) = 3.6, p = 0.002), longer work tenure (adjusted mean difference = 140.8, p < 0.001), and better match for illness disclosure preference (92.6% versus 68.0%, respectively, aOR = 5.9, p = 0.003). However, we found no differences between groups in other preference matches or PROM outcomes. CONCLUSION High-fidelity individualized supported employment programs resulted in good vocational outcomes in a real-world setting. However, enhancing service quality to increase desired job acquisition and improve PROMs will be important in the future. CLINICAL TRIAL REGISTRATION UMIN000025648.
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Affiliation(s)
- Sosei Yamaguchi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
| | - Sayaka Sato
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Takuma Shiozawa
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Asami Matsunaga
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Yasutaka Ojio
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Chiyo Fujii
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
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21
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P Hong PY, Kim SH, Marley J, Park JH. Transforming Impossible into Possible (TIP) for SUD recovery: A promising practice innovation to combat the opioid crisis. SOCIAL WORK IN HEALTH CARE 2021; 60:509-528. [PMID: 34414853 DOI: 10.1080/00981389.2021.1958127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study is to examine the psychological self-sufficiency (PSS) process among low-income individuals participating in the Transforming Impossible into Possible (TIP) program and explore the implications of TIP as a SUD recovery intervention. A sample of 622 individuals from 9 local job training programs in a large Midwestern city was used to examine the group differences in substance abuse barrier and employment hope as they relates to economic self-sufficiency (ESS). Individuals in the TIP program (n = 315) had statistically significant path coefficients between substance abuse barriers, employment hope and ESS while the non-TIP counterpart (n = 307) showed a significant path only between employment hope and ESS. Also, the time difference score in substance abuse barrier and ESS was greater for the TIP group compared to the non-TIP comparison group. Results provide implications for social work practice among persons with SUDs. While the traditional employment programs focused only on the interview and job skills, TIP allowed participants to discover their resources to address the inner obstacles that have been holding them back. TIP could serve as a promising model to treat SUDs and support the recovery process.
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Affiliation(s)
| | - Suk-Hee Kim
- School of Social Work, Northern Kentucky University, Highland Heights, KY, USA
| | - James Marley
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
| | - Jang Ho Park
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
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22
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Drake RE, Sederer LI, Becker DR, Bond GR. COVID-19, Unemployment, and Behavioral Health Conditions: The Need for Supported Employment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:388-392. [PMID: 33791925 PMCID: PMC8011768 DOI: 10.1007/s10488-021-01130-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has caused massive unemployment, exacerbated pre-existing behavioral health (mental health and substance use) disorders for many people, and created new disorders for others. Although policy changes have increased health care and unemployment benefits, most people want jobs and self-sufficiency rather than handouts. A robust evidence base shows that supported employment can enable unemployed people with behavioral health conditions to find competitive, integrated employment and behavioral health supports. Millions of U.S. citizens may need these services as the pandemic recedes and jobs become available. Government attention to supported employment is necessary now more than ever.
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Affiliation(s)
- Robert E Drake
- Westat, Rivermill Commercial Center, 85 Mechanic Street Suite C3-1, Lebanon, NH, 03766, USA
| | | | - Deborah R Becker
- Westat, Rivermill Commercial Center, 85 Mechanic Street Suite C3-1, Lebanon, NH, 03766, USA
| | - Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street Suite C3-1, Lebanon, NH, 03766, USA.
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23
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Pichler EM, Stulz N, Wyder L, Heim S, Watzke B, Kawohl W. Long-Term Effects of the Individual Placement and Support Intervention on Employment Status: 6-Year Follow-Up of a Randomized Controlled Trial. Front Psychiatry 2021; 12:709732. [PMID: 34712153 PMCID: PMC8546221 DOI: 10.3389/fpsyt.2021.709732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
People with mental illness often experience difficulties with reintegration into the workplace, although employment is known to assist these individuals in their recovery process. Traditional approaches of "first train, then place" have been recently replaced by supported employment (SE) methods that carry strategy of "first place, then train." Individual placement and support (IPS) is one of the best-studied methods of SE, which core principles are individualized assistance in rapid job search with consequent placement in a paid employment position. A considerable amount of high-quality evidence supported the superiority of IPS over conventional methods in providing improved employment rates, longer job tenure, as well as higher salaries in competitive job markets. Nonetheless, our knowledge about the IPS-mediated long-term effects is limited. This non-interventional follow-up study of a previously published randomized controlled trial (RCT) called ZhEPP aimed to understand the long-term impact of IPS after 6 years since the initial intervention. Participants from the ZhEPP trial, where 250 disability pensioners with mental illnesses were randomized into either IPS intervention group or treatment as usual group (TAU), were invited to face-to-face interviews, during which employment status, job tenure, workload, and salaries were assessed. One hundred and fourteen individuals agreed to participate in this follow-up study. Although during the first 2 years post-intervention, the IPS group had higher employment rates (40% (IPS) vs. 28% (TAU), p < 0.05 at 24 months), these differences disappeared by the time of follow-up assessments (72 months). The results indicated no substantial differences in primary outcome measures between IPS and TAU groups: employment rate (36 vs. 33%), workload (10.57 vs. 10.07 h per week), job tenure (29 vs. 28 months), and salary (20.21CHF vs. 25.02 CHF). These findings provide important insights regarding the long-term effects of IPS among individuals with mental health illnesses. Further research is required to advance the current knowledge about IPS intervention and its years-long impact.
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Affiliation(s)
- Eva-Maria Pichler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland
| | - Niklaus Stulz
- Psychiatric Services Aargau, Windisch, Switzerland.,Integrated Psychiatric Services Winterthur-Zurcher Unterland (IPW), Winterthur, Switzerland
| | - Lea Wyder
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland
| | - Simone Heim
- Psychiatric Services Aargau, Windisch, Switzerland.,Praxis Dr. Pramstaller, Uetikon am See, Switzerland
| | - Birgit Watzke
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland.,Clienia Schlössli AG, Oetwil am See, Switzerland
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24
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Fadyl JK, Anstiss D, Reed K, Khoronzhevych M, Levack WMM. Effectiveness of vocational interventions for gaining paid work for people living with mild to moderate mental health conditions: systematic review and meta-analysis. BMJ Open 2020; 10:e039699. [PMID: 33122321 PMCID: PMC7597525 DOI: 10.1136/bmjopen-2020-039699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/31/2020] [Accepted: 09/25/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To evaluate the effectiveness of vocational interventions to help people living with mild to moderate mental health conditions gain paid work. METHODS Systematic review of international, peer-reviewed literature. Development of the prepublished protocol and search strategy was done in consultation with stakeholder reference groups consisting of people with lived experience of long-term conditions, advocates and clinicians. We searched academic databases MEDLINE, EMBASE, PsychINFO, AMED, CINAHL, Proquest Dissertations and Theses database, and Business Source Complete for controlled trials comparing a specific vocational intervention against a control intervention or usual care, published between 1 January 2004 and 1 August 2019. Two authors independently screened search results, extracted data and appraised studies using the Cochrane risk of bias tool. RESULTS Eleven studies met inclusion criteria. Seven studies investigated Individual Placement and Support (IPS) modified for people who were not in intensive mental health treatment services. These studies occurred settings such as community vocational rehabilitation services, a housing programme and community mental health services. The studies provided very low quality evidence that people who receive IPS-style vocational rehabilitation are more likely to gain competitive employment than people who receive usual care (risk ratio 1.70, 95% CI 1.23 to 2.34, seven studies, 1611 participants). The remaining four studies considered cognitive behavioural therapy or specific vocational rehabilitation interventions designed to fit a unique context. There was insufficient evidence from these studies to draw conclusions regarding the effectiveness of non-IPS forms of vocational rehabilitation for people with mild to moderate mental health conditions. DISCUSSION The meta-analysis showed a clear intervention effect but low precision, and more high-quality studies are needed in this field. There is currently very low quality evidence that IPS-style intervention results in more participants in competitive employment compared with 'usual care' control groups in populations with mild to moderate mental health conditions.
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Affiliation(s)
- Joanna K Fadyl
- Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - David Anstiss
- Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - Kirk Reed
- Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
- School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Mariya Khoronzhevych
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, Norway
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25
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26
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Pelizza L, Ficarelli ML, Vignali E, Artoni S, Franzini MC, Montanaro S, Andreoli MV, Marangoni S, Ciampà E, Erlicher D, Troisi E, Pupo S. Individual placement and support in Italian young adults with mental disorder: Findings from the Reggio Emilia experience. Early Interv Psychiatry 2020; 14:577-586. [PMID: 31642590 DOI: 10.1111/eip.12883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/26/2019] [Accepted: 09/24/2019] [Indexed: 01/26/2023]
Abstract
AIM Individual placement and support (IPS) has a considerable body of evidence for its effectiveness in helping people with mental disorder to achieve and maintain competitive jobs. However, little data in young adult populations are currently available, especially in Europe. Aim of this study was to assess the effect of IPS in Italian young adults with moderate-to-severe mental illness, examining the main competitive employment outcomes and drop out rates during a 3-year follow-up period. METHODS Participants (n = 54) were recruited from patients receiving psychiatric treatment in one of the seven adult Community Mental Health Centers of the Reggio Emilia Department of Mental Health. Together with drop out rates, we investigated job duration (total number of days worked), job acquisition (employment in the labour market for at least 1 day during the follow-up), total hours per week worked, and job tenure (weeks worked on the longest-held competitive job). RESULTS A crude competitive employment rate of 40.7% and a crude drop out rate of 22.2% over the 3-year follow-up period were found. However, 66% of 42 clients who remained in the program over 3 years gained competitive employment at some time during the 3-year period. CONCLUSIONS This research shows the feasibility of an IPS intervention model in the public mental health care system in Italy, especially for a young adult target population.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Maria L Ficarelli
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Vignali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Artoni
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria C Franzini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Serenella Montanaro
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria V Andreoli
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | | | - Elisa Troisi
- School of Psychiatric Rehabilitation Techniques, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Anesthesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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27
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LePage JP, Crawford AM, Cipher DJ, Anderson K, Rock A, Johnson JAP, Washington EL, Ottomanelli L. Blending Traditional Vocational Services and Individualized Placement and Support for Formerly Incarcerated Veterans. Psychiatr Serv 2020; 71:816-823. [PMID: 32393158 DOI: 10.1176/appi.ps.201900421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study compared two vocational programs: the About Face Vocational Program (AFVP), a traditional group-based vocational program created for formerly incarcerated veterans, and a hybrid program combining the AFVP with principles of individual placement and support-supported employment. METHODS The study evaluated 111 veterans with at least one felony conviction who had a mental illness, substance use disorder, or both. Veterans were randomly assigned to either vocational condition. RESULTS Veterans in the hybrid condition, compared with the AFVP alone, were more likely to find employment, had higher rates of full-time employment, and earned significantly more money over the course of the study. A comparison of only participants who found employment showed higher rates of full-time employment for veterans in the hybrid condition but similarities between the two groups in other measures of employment success. CONCLUSIONS Blended models of vocational services for veterans with mental illness, substance use disorders, or both are effective at returning formerly incarcerated veterans to competitive employment.
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Affiliation(s)
- James P LePage
- U.S. Department of Veterans Affairs (VA) North Texas Health Care System, Dallas (LePage, Rock); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (LePage); Dallas VA Research Corporation, Dallas (Crawford, Parish Johnson, Washington); College of Nursing and Health Innovation, University of Texas at Arlington, Arlington (Cipher); Department of Psychology, Colorado State University, Fort Collins (Anderson); James A. Haley Veterans Hospital, and Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa (Ottomanelli)
| | - April M Crawford
- U.S. Department of Veterans Affairs (VA) North Texas Health Care System, Dallas (LePage, Rock); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (LePage); Dallas VA Research Corporation, Dallas (Crawford, Parish Johnson, Washington); College of Nursing and Health Innovation, University of Texas at Arlington, Arlington (Cipher); Department of Psychology, Colorado State University, Fort Collins (Anderson); James A. Haley Veterans Hospital, and Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa (Ottomanelli)
| | - Daisha J Cipher
- U.S. Department of Veterans Affairs (VA) North Texas Health Care System, Dallas (LePage, Rock); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (LePage); Dallas VA Research Corporation, Dallas (Crawford, Parish Johnson, Washington); College of Nursing and Health Innovation, University of Texas at Arlington, Arlington (Cipher); Department of Psychology, Colorado State University, Fort Collins (Anderson); James A. Haley Veterans Hospital, and Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa (Ottomanelli)
| | - Kemol Anderson
- U.S. Department of Veterans Affairs (VA) North Texas Health Care System, Dallas (LePage, Rock); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (LePage); Dallas VA Research Corporation, Dallas (Crawford, Parish Johnson, Washington); College of Nursing and Health Innovation, University of Texas at Arlington, Arlington (Cipher); Department of Psychology, Colorado State University, Fort Collins (Anderson); James A. Haley Veterans Hospital, and Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa (Ottomanelli)
| | - Avery Rock
- U.S. Department of Veterans Affairs (VA) North Texas Health Care System, Dallas (LePage, Rock); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (LePage); Dallas VA Research Corporation, Dallas (Crawford, Parish Johnson, Washington); College of Nursing and Health Innovation, University of Texas at Arlington, Arlington (Cipher); Department of Psychology, Colorado State University, Fort Collins (Anderson); James A. Haley Veterans Hospital, and Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa (Ottomanelli)
| | - Julie A Parish Johnson
- U.S. Department of Veterans Affairs (VA) North Texas Health Care System, Dallas (LePage, Rock); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (LePage); Dallas VA Research Corporation, Dallas (Crawford, Parish Johnson, Washington); College of Nursing and Health Innovation, University of Texas at Arlington, Arlington (Cipher); Department of Psychology, Colorado State University, Fort Collins (Anderson); James A. Haley Veterans Hospital, and Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa (Ottomanelli)
| | - Edward L Washington
- U.S. Department of Veterans Affairs (VA) North Texas Health Care System, Dallas (LePage, Rock); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (LePage); Dallas VA Research Corporation, Dallas (Crawford, Parish Johnson, Washington); College of Nursing and Health Innovation, University of Texas at Arlington, Arlington (Cipher); Department of Psychology, Colorado State University, Fort Collins (Anderson); James A. Haley Veterans Hospital, and Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa (Ottomanelli)
| | - Lisa Ottomanelli
- U.S. Department of Veterans Affairs (VA) North Texas Health Care System, Dallas (LePage, Rock); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (LePage); Dallas VA Research Corporation, Dallas (Crawford, Parish Johnson, Washington); College of Nursing and Health Innovation, University of Texas at Arlington, Arlington (Cipher); Department of Psychology, Colorado State University, Fort Collins (Anderson); James A. Haley Veterans Hospital, and Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa (Ottomanelli)
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28
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Drake RE, Riley J, Goldman HH, Becker DR, Bond GR, Bennici FJ, Frey WD. Supporting a Working Life When Disability Is Not Permanent. Psychiatr Serv 2020; 71:310-311. [PMID: 31910751 DOI: 10.1176/appi.ps.201900478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robert E Drake
- Westat, Lebanon, New Hampshire (Drake, Becker, Bond), and Rockville, Maryland (Riley, Goldman, Bennici, Frey)
| | - Jarnee Riley
- Westat, Lebanon, New Hampshire (Drake, Becker, Bond), and Rockville, Maryland (Riley, Goldman, Bennici, Frey)
| | - Howard H Goldman
- Westat, Lebanon, New Hampshire (Drake, Becker, Bond), and Rockville, Maryland (Riley, Goldman, Bennici, Frey)
| | - Deborah R Becker
- Westat, Lebanon, New Hampshire (Drake, Becker, Bond), and Rockville, Maryland (Riley, Goldman, Bennici, Frey)
| | - Gary R Bond
- Westat, Lebanon, New Hampshire (Drake, Becker, Bond), and Rockville, Maryland (Riley, Goldman, Bennici, Frey)
| | - Frank J Bennici
- Westat, Lebanon, New Hampshire (Drake, Becker, Bond), and Rockville, Maryland (Riley, Goldman, Bennici, Frey)
| | - William D Frey
- Westat, Lebanon, New Hampshire (Drake, Becker, Bond), and Rockville, Maryland (Riley, Goldman, Bennici, Frey)
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29
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Brinchmann B, Widding-Havneraas T, Modini M, Rinaldi M, Moe CF, McDaid D, Park AL, Killackey E, Harvey SB, Mykletun A. A meta-regression of the impact of policy on the efficacy of individual placement and support. Acta Psychiatr Scand 2020; 141:206-220. [PMID: 31733146 DOI: 10.1111/acps.13129] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 12/16/2022]
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.
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Affiliation(s)
- B Brinchmann
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,UiT - The Arctic University of Norway, Tromsø, Norway
| | - T Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital, Bergen, Norway
| | - M Modini
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Concord Centre for Mental Health, NSW Health, Sydney, NSW, Australia
| | - M Rinaldi
- South West London & St George's Mental Health NHS Trust, London, UK
| | - C F Moe
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - D McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-L Park
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic, Australia
| | - S B Harvey
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - A Mykletun
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,UiT - The Arctic University of Norway, Tromsø, Norway.,Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital, Bergen, Norway.,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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Davis LL, Blansett CM, Mumba MN, MacVicar D, Toscano R, Pilkinton P, Gay W, Bartolucci A. The methods and baseline characteristics of a VA randomized controlled study evaluating supported employment provided in primary care patient aligned care teams. BMC Med Res Methodol 2020; 20:33. [PMID: 32066380 PMCID: PMC7027030 DOI: 10.1186/s12874-020-0919-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article describes the design and baseline sample of a single-site trial comparing Individual Placement and Support (IPS) supported employment delivered within a Veterans Health Administration (VHA) primary care Patient Aligned Care Team (PACT) to treatment-as-usual vocational rehabilitation (TAU-VR) that includes transitional work. METHODS Unemployed U.S. military veterans receiving care in a VHA PACT who were seeking competitive work, otherwise eligible for vocational rehabilitation, and diagnosed with a mental health condition other than a psychotic or bipolar I disorder were prospectively randomized to receive either IPS or TAU-VR. Employment outcomes and measures of quality of life, self-esteem, and community reintegration are being collected for 12 months. RESULTS The participant sample (n = 119) is comprised of 17.6% female, 73.1% African-Americans, and 1.7% Hispanic. Average age is 38.2 (SD ± 8.41) years; 80.7% served in the military since 2001; 78% are receiving or applying for U.S. Department of Veterans Affairs (VA) service-connected disability; 26.9% have not held a competitive job in the past 3 years; and the average length of pre-randomization unemployment is 1.4 (SD ± 2.3) years. CONCLUSIONS Unique design features include evaluating the efficacy of evidenced-based IPS within the primary care setting, having broad diagnostic eligibility, and defining the primary outcome criterion as "steady employment", i.e. holding a competitive job for ≥26 weeks of the 12-month follow-up period. The findings illustrate the characteristics of a primary care veteran sample in need of employment services. TRIAL REGISTRATION www.clinicaltrials.gov Identifier: NCT02400736.
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Affiliation(s)
- Lori L Davis
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA. .,Department of Psychiatry, University of Alabama School of Medicine, Birmingham, AL, USA.
| | - Catherine M Blansett
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA
| | - Mercy N Mumba
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA.,Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - David MacVicar
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA
| | - Richard Toscano
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA
| | - Patricia Pilkinton
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA.,Department of Psychiatry, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Whitney Gay
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA
| | - Al Bartolucci
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
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Bond GR, Drake RE. Assessing the Fidelity of Evidence-Based Practices: History and Current Status of a Standardized Measurement Methodology. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:874-884. [PMID: 31691055 DOI: 10.1007/s10488-019-00991-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence-based practices are effective only when implemented faithfully. This paper explicates the history, standardization, and methods for developing and validating measures of fidelity. We overviewed the past 20 years of developing fidelity measures, summarized standardization of the development procedures, and described needed psychometric assessments. Fidelity assessment has become the sine qua non of implementation, technical assistance, and research on evidence-based practices. Researchers have established standardized procedures for scale development and psychometric testing. Widescale use of fidelity measurement remains challenging. The implementation of evidence-based practice and the development and validation of fidelity measures are interdependent. International improvements of mental health care will require attention to both.
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Affiliation(s)
- Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA.
| | - Robert E Drake
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA
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Juurlink TT, Vukadin M, Stringer B, Westerman MJ, Lamers F, Anema JR, Beekman ATF, van Marle HJF. Barriers and facilitators to employment in borderline personality disorder: A qualitative study among patients, mental health practitioners and insurance physicians. PLoS One 2019; 14:e0220233. [PMID: 31335909 PMCID: PMC6650068 DOI: 10.1371/journal.pone.0220233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/11/2019] [Indexed: 12/02/2022] Open
Abstract
Background Borderline personality disorder (BPD) is associated with unemployment and impaired functioning. However, a comprehensive understanding of barriers and facilitators to employment from a multidisciplinary perspective is currently lacking. Therefore, the aim of this qualitative study was to explore barriers and facilitators in gaining and maintaining employment in BPD from the perspectives of patients, mental health practitioners (MHPs) and insurance physicians (IPs). Methods Fifteen semi-structured interviews were conducted in patients with BPD and two focus groups were carried out among MHPs (n = 7) and IPs (n = 6) following a thematic content analysis approach. Results All participants described barriers and facilitators relating to three overall themes: characteristics of BPD, stigma, and support to employment. Barriers to employment mainly related to characteristics of BPD, such as low self-image, difficulty posing personal boundaries, difficulty regulating emotions, and lack of structure. MHPs and IPs additionally mentioned externalization and overestimation of competencies on the part of patients. Enhancing emotion regulation and self-reflection by successful treatment was suggested as a facilitator to enhance employment. Increasing collaboration between mental health and vocational rehabilitation services, and increasing knowledge about BPD, were suggested to increase sustainable employment and decrease stigma. Conclusions The present findings revealed that both facilitators and barriers are important in gaining and maintaining employment in BPD in which diminishing symptoms, examining stigma and increasing support to employment are key. As a next step, supported employment strategies that follow patient preferences and integrate employment and mental health services, should be studied in the context of BPD.
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Affiliation(s)
- Trees T. Juurlink
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- * E-mail:
| | - Miljana Vukadin
- Department of Social Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Barbara Stringer
- Centre for Consultation and Expertise (CCE), Utrecht, The Netherlands
| | - Marjan J. Westerman
- Department of Health Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke Lamers
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Social Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Hein J. F. van Marle
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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