Psychiatric Rehabilitation Journal 2014, Vol. 37, No. 2, 76 –78

© 2014 American Psychological Association 1095-158X/14/$12.00 http://dx.doi.org/10.1037/prj0000083

INTRODUCTION

Introduction to the Special Issue on Individual Placement and Support Robert E. Drake and Gary R. Bond

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Dartmouth Psychiatric Research Center, Lebanon, New Hampshire

The sum of 20 positive randomized controlled trials around the world has essentially resolved the issue of effectiveness, although three papers in this issue show that some policymakers want to study the effectiveness of IPS in their own countries (Michon et al., 2014; Morris, Waghorn, Robson, Moore, & Edwards, 2014; Oshima et al., 2014). Current studies are exploring myriad new territories. Several papers in this special issue examine the mechanisms and strategies for improving the quality, implementation, and availability of IPS services, such as through service integration (Swanson, Courtney, Meyer, & Reeder, 2014), learning collaboratives (Becker, Drake, & Bond, 2014), new technology tools (Lord et al., 2014), workplace accommodations and supports (Corbière et al., 2014), and family advocacy (Cohen & Becker, 2014). Several other papers address IPS for new populations: people with mental illnesses in Europe (Fioritti et al., 2014), Japan (Oshima et al., 2014), and Australia (Morris et al., 2014), Latino Americans with mental illnesses in the U.S. (Mueser et al., 2014), parents with mental illness (Nicholson, 2014), and people with other disabilities, such as veterans in the U.S. Veterans Affairs Health Care System with posttraumatic stress disorder (Davis et al., 2014) or spinal cord injuries (Ottomanelli, Barnett, & Toscano, 2014). Although IPS programs have proliferated substantially in the past several years, widespread implementation and universal access remain critical problems. Some states, regions, and countries have achieved greater success than others. In most regions, the essential barrier remains public policy: Funding mechanisms are not aligned with evidence-based practices, meaningful outcomes, and patients’ preferences. These public policy failures result in disparities, irrational systems, and inhumane care— especially in wealthy countries like the U.S., in which health services continue to serve the needs of for-profit companies and vested-interest groups rather than those of people with disabilities. The editorial in this issue highlights that the Affordable Care Act provides a new opportunity to finance IPS programs (Hogan, Drake, & Goldman, 2014). Unfortunately this opening requires choosing one Medicaid option over other needed programs. The most disenfranchised citizens in wealthy countries continue to be the victims of inequities. The papers in this special issue testify to the enormous potential of the IPS model. Clients, families, researchers, policy experts, practitioners, and administrators continue to identify creative ways to expand services to reach more people. Recently, for example, the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) announced an initiative labeled “Transforming Lives Through Supported Employment,” identifying IPS as the model that state

This issue of the Psychiatric Rehabilitation Journal presents an update on individual placement and support (IPS), the evidencebased practice of supported employment for people with psychiatric disabilities. Previous special issues on IPS supported employment appeared in 1998 and 2008. We did not wait for another decade to pass before updating readers on the rapid pace of research, dissemination, and policy changes. The scope of publications on IPS supported employment has expanded widely. Since the 2008 special issue on IPS, the number of randomized controlled trials has nearly doubled, increasing from 11 (Bond, Drake, & Becker, 2008) to the current count of 20 (Bond et al., 2007; Bond & Swanson, 2014; Burns et al., 2007; Davis et al., 2012; Drake et al., 2013; Drake et al., 1999; Drake, McHugo, Becker, Anthony, & Clark, 1996; Gold et al., 2006; Heslin et al., 2011; Hoffmann, Jäckel, Glauser, & Kupper, 2012; Killackey et al., 2012; Killackey, Jackson, & McGorry, 2008; Latimer et al., 2006; Lehman et al., 2002; Michon et al., 2014; Mueser et al., 2004; Nuechterlein, 2010; Oshima, Sono, Bond, Nishio, & Ito, 2014; Twamley et al., 2012; Wong et al., 2008). The follow-up competitive employment rates for IPS and control groups in these studies are shown in Figure 1. Remarkably, every one of these 20 studies found IPS to be significantly more effective than the control condition (many were active, well-funded control conditions) in improving competitive employment outcomes. Overall, more than twice as many of the IPS participants worked competitively as the control participants. The IPS model has proven to be extraordinarily robust across a wide spectrum of conditions and populations. These 20 randomized controlled trials included studies spanning four continents and programs serving clients from a variety of ethno-racial communities. Participants have included both young adults and older adults and people with a range of significant life challenges, including serious mental illness, minority status, homelessness history, posttraumatic stress disorder, substance-use disorders, substantial hospitalization histories, criminal justice involvement, and years of dependence on Social Security disability insurance, to name a few. IPS has been consistently a much better program model than any active alternative.

Robert E. Drake and Gary R. Bond, Dartmouth Psychiatric Research Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth. Correspondence concerning this article should be addressed to Robert E. Drake, Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766. E-mail: [email protected] 76

This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

INTRODUCTION

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Figure 1. The y axis identifies percentage of clients achieving competitive employment. The x axis identifies studies by publication year and study site location (state or country). The color version of this figure appears in the online article only.

leaders should use to expand vocational services. For 25 years, IPS researchers have continued to conduct rigorous research—to a far greater extent than is true for any other vocational approach—and to subject IPS to critical appraisals. Basic principles identified in the original formulation of IPS (Becker & Drake, 1993) have been empirically supported, while new principles that refine and improve the program model have been added (Drake, Bond, & Becker, 2012). Thus the current model for high-fidelity IPS services (Swanson & Becker, 2013) is congruent with the supported employment toolkit developed over a decade ago and posted on the SAMHSA web site (Becker & Bond, 2002). Adherence to program principles has been one of the guiding principles of IPS, and the theme of fidelity of implementation permeates the papers in this special issue. The state of the art of IPS is expanding, changing, and ramifying broadly. IPS is appearing in middle-income countries in Latin America and in new populations, such as young adults with autism-spectrum disorders in Europe. Continued growth should follow the fundamental principles of values and science. First, we must honor basic values by listening to and learning from clients (Strickler, 2014), as well from IPS trainers, mental health and vocational rehabilitation leaders, and practitioners who face the daily realities of developing and sustaining recovery-oriented services (Swanson et al., 2014). Second, we must insist on rigorous research to ground our employment services in hard evidence.

References Becker, D. R., & Bond, G. R. (Eds.). (2002). Supported employment implementation resource kit. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Becker, D. R., & Drake, R. E. (1993). A working life: The Individual Placement and Support (IPS) Program. Concord, NH: New Hampshire– Dartmouth Psychiatric Research Center. Becker, D. R., Drake, R. E., & Bond, G. R. (2014). The IPS supported employment learning collaborative. Psychiatric Rehabilitation Journal, 37, 79 – 85. doi:10.1037/prj0000044 Bond, G. R., Drake, R. E., & Becker, D. R. (2008). An update on randomized controlled trials of evidence-based supported employment.

Psychiatric Rehabilitation Journal, 31, 280 –290. doi:10.2975/31.4.2008 .280.290 Bond, G. R., Salyers, M. P., Dincin, J., Drake, R. E., Becker, D. R., Fraser, V. V., & Haines, M. (2007). A randomized controlled trial comparing two vocational models for persons with severe mental illness. Journal of Consulting and Clinical Psychology, 75, 968 –982. doi:10.1037/0022006X.75.6.968 Bond, G. R., & Swanson, S. J. (2014, February). Supported employment for justice-involved people with mental illness. Webinar presented at the GAINS Center Webinar Series on Evidence-Based Practices (EBPs), United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, MD. Burns, T., Catty, J., Becker, T., Drake, R. E., Fioritti, A., Knapp, M., . . . Wiersma, D. (2007). The effectiveness of supported employment for people with severe mental illness: A randomised controlled trial. The Lancet, 370, 1146 –1152. doi:10.1016/S0140-6736(07)61516-5 Cohen, M. J., & Becker, D. R. (2014). Family advocacy for the IPS Supported Employment Project: Accomplishments and challenges. Psychiatric Rehabilitation Journal, 37, 148 –150. Corbière, M., Villotti, P., Lecomte, T., Bond, G. R., Lesage, A., & Goldner, E. (2014). Work accommodations and natural supports for maintaining employment. Psychiatric Rehabilitation Journal, 37, 90 –98. Davis, L. L., Leon, A. C., Toscano, R., Drebing, C. E., Ward, L. C., Parker, P. E., . . . Drake, R. E. (2012). A randomized controlled trial of supported employment among veterans with posttraumatic stress disorder. Psychiatric Services, 63, 464 – 470. doi:10.1176/appi.ps.201100340 Davis, L. L., Pilkinton, P., Poddar, S., Blansett, C., Toscano, R., & Parker, P. E. (2014). Impact of social challenges on gaining employment for veterans with posttraumatic stress disorder: An exploratory moderator analysis. Psychiatric Rehabilitation Journal, 37, 107–109. doi: 10.1037/prj0000058 Drake, R. E., Bond, G. R., & Becker, D. R. (2012). Individual placement and support: An evidence-based approach to supported employment. New York, NY: Oxford University Press. doi:10.1093/acprof:oso/ 9780199734016.001.0001 Drake, R. E., Frey, W. D., Bond, G. R., Goldman, H. H., Salkever, D. S., Miller, A. L., . . . Milfort, R. (2013). Assisting Social Security disability insurance beneficiaries with schizophrenia, bipolar disorder, or major depression in returning to work. The American Journal of Psychiatry, 170, 1433–1441. doi:10.1176/appi.ajp.2013.13020214

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DRAKE AND BOND

Drake, R. E., McHugo, G. J., Bebout, R. R., Becker, D. R., Harris, M., Bond, G. R., . . . Quimby, E. (1999). A randomized clinical trial of supported employment for inner-city patients with severe mental illness. Archives of General Psychiatry, 56, 627– 633. doi:10.1001/archpsyc.56 .7.627 Drake, R. E., McHugo, G. J., Becker, D. R., Anthony, W. A., & Clark, R. E. (1996). The New Hampshire study of supported employment for people with severe mental illness: Vocational outcomes. Journal of Consulting and Clinical Psychology, 64, 391–399. doi:10.1037/0022006X.64.2.391 Fioritti, A., Burns, T., Hilarion, P., van Weeghel, J., Cappa, C., Suñol, R., & Otto, E. (2014). Individual Placement and Support in Europe. Psychiatric Rehabilitation Journal, 37, 123–128. Gold, P. B., Meisler, N., Santos, A. B., Carnemolla, M. A., Williams, O. H., & Kelleher, J. (2006). Randomized trial of supported employment integrated with assertive community treatment for rural adults with severe mental illness. Schizophrenia Bulletin, 32, 378 –395. doi:10.1093/ schbul/sbi056 Heslin, M., Howard, L., Leese, M., McCrone, P., Rice, C., Jarrett, M., . . . Thornicroft, G. (2011). Randomized controlled trial of supported employment in England: 2 year follow-up of the Supported Work and Needs (SWAN) study. World Psychiatry, 10, 132–137. Hoffmann, H., Jäckel, D., Glauser, S., & Kupper, Z. (2012). A randomised controlled trial of the efficacy of supported employment. Acta Psychiatrica Scandinavica, 125, 157–167. doi:10.1111/j.1600-0447.2011 .01780.x Hogan, M. F., Drake, R. E., & Goldman, H. H. (2014). A national campaign to finance supported employment. Psychiatric Rehabilitation Journal, 37, 73–75. Killackey, E. J., Allott, K. A., Cotton, S. M., Chinnery, G. L., Sun, P., Collins, Z., . . . Jackson, H. J. (2012). Vocational recovery in firstepisode psychosis: First results from a large controlled trial of IPS. Early Intervention in Psychiatry, 6 (Supplement 1), 13. Killackey, E., Jackson, H. J., & McGorry, P. D. (2008). Vocational intervention in first-episode psychosis: Individual placement and support v. treatment as usual. The British Journal of Psychiatry, 193, 114 –120. doi:10.1192/bjp.bp.107.043109 Latimer, E. A., Lecomte, T., Becker, D., Drake, R., Duclos, I., Piat, M., . . . Xie, H. (2006). Generalisability of the individual placement and support model of supported employment: Results of a Canadian randomised controlled trial. The British Journal of Psychiatry, 189, 65–73. doi: 10.1192/bjp.bp.105.012641 Lehman, A. F., Goldberg, R. W., Dixon, L. B., McNary, S., Postrado, L., Hackman, A., . . . McDonnell, K. (2002). Improving employment outcomes for persons with severe mental illness. Archives of General Psychiatry, 59, 165–172. doi:10.1001/archpsyc.59.2.165 Lord, S. E., McGurk, S. R., Nicholson, J., Carpenter-Song, E., Tauscher, J., Becker, D. R., . . . Bond, G. R. (2014). The potential of technology for

enhancing Individual Placement and Support supported employment. Psychiatric Rehabilitation Journal, 37, 99 –106. Michon, H., van Busschbach, J. T., Stant, A. D., van Vugt, M. D., van Weeghel, J., & Kroon, H. (2014). Effectiveness of Individual Placement and Support for people with severe mental illness in the Netherlands: A 30-month randomized controlled trial. Psychiatric Rehabilitation Journal, 37, 129 –136. Morris, A., Waghorn, G., Robson, E., Moore, L., & Edwards, E. (2014). Implementation of evidence-based supported employment in regional Australia. Psychiatric Rehabilitation Journal, 37, 144 –147. doi: 10.1037/prj0000051 Mueser, K. T., Bond, G. R., Essock, S. M., Clark, R. E., Carpenter-Song, E., Drake, R. E., & Wolfe, R. (2014). The effects of supported employment in Latino consumers with severe mental illness. Psychiatric Rehabilitation Journal, 37, 113–122. Mueser, K. T., Clark, R. E., Haines, M., Drake, R. E., McHugo, G. J., Bond, G. R., . . . Swain, K. (2004). The Hartford study of supported employment for persons with severe mental illness. Journal of Consulting and Clinical Psychology, 72, 479 – 490. doi:10.1037/0022-006X.72 .3.479 Nicholson, J. (2014). For parents with mental health conditions - The chance to “Have it All” at work and at home. Psychiatric Rehabilitation Journal, 37, 153–156. doi:10.1037/prj0000057 Nuechterlein, K. H. (2010, November). Individual placement and support after an initial episode of schizophrenia: The UCLA randomized controlled trial. Paper presented at the International Conference on Early Psychosis, Amsterdam, the Netherlands. Oshima, I., Sono, T., Bond, G. R., Nishio, M., & Ito, J. (2014). A randomized controlled trial of Individual Placement and Support in Japan. Psychiatric Rehabilitation Journal, 37, 137–143. Ottomanelli, L., Barnett, S. D., & Toscano, R. (2014). Individual Placement and Support (IPS) in physical rehabilitation and medicine: The VA spinal cord injury experience. Psychiatric Rehabilitation Journal, 37, 110 –112. Strickler, D. C. (2014). Rebirth through supported employment. Psychiatric Rehabilitation Journal, 37, 151–152. Swanson, S. J., & Becker, D. R. (2013). IPS supported employment: A practical guide. Lebanon, NH: Dartmouth Psychiatric Research Center. Swanson, S. J., Courtney, C. T., Meyer, R. H., & Reeder, S. A. (2014). Strategies for integrated employment and mental health services. Psychiatric Rehabilitation Journal, 37, 86 – 89. doi:10.1037/prj0000049 Twamley, E. W., Vella, L., Burton, C. Z., Becker, D. R., Bell, M. D., & Jeste, D. V. (2012). The efficacy of supported employment for middleaged and older people with schizophrenia. Schizophrenia Research, 135, 100 –104. doi:10.1016/j.schres.2011.11.036 Wong, K. K., Chiu, R., Tang, B., Mak, D., Liu, J., & Chiu, S. N. (2008). A randomized controlled trial of a supported employment program for persons with long-term mental illness in Hong Kong. Psychiatric Services, 59, 84 –90. doi:10.1176/appi.ps.59.1.84

Introduction to the special issue on individual placement and support.

This issue of the Psychiatric Rehabilitation Journal presents an update on individual placement and support (IPS), the evidence-based practice of supp...
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