SUPPORTED EMPLOYMENT

EVIDENCE-BASED PRACTICE

Why Focus on Employment? Viewed by many as an essential

part of recovery Most consumers want to work A typical role for adults in our

society >2/3 of clients live in poverty

employment may be a way out

Positive Outcomes from Competitive Work Higher self-esteem Better control of psychiatric

symptoms More satisfaction with

finances and with leisure

(Bond et al., 2001)

Negative Effects of Unemployment in General

Population Increased substance abuse Increased physical problems Increased psychiatric disorders Reduced self-esteem Loss of social contacts Alienation and apathy

(Warr, 1987)

Competitive Employment for People with Severe Mental

Illness Say they want to work: 70% Are currently working: <15%

Individual Placement and Support (IPS)

Is

Effective

20 Randomized Controlled Trials of IPS

Best evidence available on effectiveness

RCTs are gold standard in medical research

Competitive Employment Rates in 20 Randomized Controlled Trials of Individual Placement and Support

Competitive Employment Rates in 20 Controlled Trials of IPS

Placement and Support

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

96 NH

12 AL

07 IL

04 CT

12 AUST

08 HK

12 CA

08 AUST

06 SC

99 DC

12 SWZ

12 CA

07 EUR

13 US

06 QUE

14 JAP

10 HOL

14 IL

02 MD

11 UK

IPS Control Control 2

Exhaustive review of best evidence

Studies conducted all around the world

(Bond, Drake & Becker, 2012)

20 Randomized Controlled Trials of IPS

Overall Findings for 20 RCTs All 20 studies showed a significant

advantage for IPS Mean competitive employment rates

for the 20 studies: –57% for IPS (Median = 60%) –24% for controls (Median = 25%) (Each study weighted equally in calculating

mean rates)

2 Long-Term IPS Follow-up Studies (Salyers 2004; Becker, 2007)

Steady Workers (> 50% Follow-up)

52%

Length of Follow-up

10 years

Sample Size 74

Clients also reported:

Greater self-confidence and hopefulness More energy Less loneliness and

boredom

IPS Is

Well Defined

The Road Map

IPS Fidelity Scale IPS fidelity scale measures core

principles 25 - item checklist the essential

ingredients Ratings made by fidelity assessors

during 1.5 day site visit Becker et al. (2008)

IPS fidelity and Outcomes in 88 sites in Learning Collaborative

IPS Fidelity Category

N (%) Mean Competitive Employment Rate

Exemplary Fidelity Good Fidelity Fair Fidelity Not Supported Employment

8 (9%)

45 (51%)

30 (34%)

5 (6%)

44%

39%

32%

29%

(Bond et al., 2012)

IPS Supported Employment Practice Principles

IPS Supported Employment Practice Principles

Eligibility is based upon client choice

IPS supported employment services are closely integrated with mental health treatment

services

Competitive jobs are the goal

Employer contact begins rapidly after clients enter

the program.

Employment specialists build relationships with

employers based upon client job interests

Job supports are continuous

Consumer preferences are honored

Benefits planning (work incentives planning) is

offered to all clients that receive entitlements