An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study

Abstract

Background: Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes. Methods: This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education). Results: Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R 2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ 2 (7) = 41.38 p < .001. Conclusion: An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment. Trial registration: NCT04083404 Registered 05 September 2019 (retrospectively registered).

Experiences with Individual Placement and Support and employment – a qualitative study among clients and employment specialists

“…Additional interventions, such as motivational interviewing, can be used by the employment specialist to further enhance the client’s motivation [ 36 , 37 ]. This use of additional interventions is likely to reinforce the effects of IPS for clients [ 16 , 37 , 42 , 43 ]. The finding that the client’s relevant work experience, competences and/ or skills were experienced as facilitators to obtaining employment, also suggests that additional interventions or training for the client during the IPS trajectory may reinforce the effects of IPS [ 16 ].…”

“…Some barriers to obtaining employment identified in this study, such as the client’s lack of self-confidence and/ or self-esteem, appear to have psychosocial underpinnings. Although pre-employment assessments are not recommended in IPS programmes [ 13 ], this finding suggests that assessing psychosocial factors in an early phase of the IPS trajectory may be useful for identifying clients with psychosocial issues who would benefit from additional interventions [ 43 ].…”

Long-Term Effects of the Individual Placement and Support Intervention on Employment Status: 6-Year Follow-Up of a Randomized Controlled Trial

“…Qualitative analysis by de Greef showed that the risk of disclosure of the medical diagnosis might represent a potential issue for people with mental conditions seeking employment (85). Lastly, since the spread of the IPS model, different variants and types were invented to fit the needs of specific population groups (50,86,87), explaining the individualistic approach to the implementation of this strategy and an opportunity for further development improvements and developments (88).…”

Implementing individual placement and support (IPS): the experiences of employment specialists in the early implementation phase of IPS in Northern Norway. The IPSNOR study

“…The study found negligible effect modification by country, welfare system and labour market situations [ 11 ]. Yet, the challenge of sustainability in mainstream practice beyond trials is a well-known phenomenon [ 12 – 14 ] and we do not know as much about what happens in mainstream practice in the process of implementing IPS in a non-trial environment. Also, the implementation of IPS may be more country and culture specific than the efficacy of IPS.…”