Evidence-based supported employment (EBSE) Helen Lockett   Associate Director, Employment Programme
Presentation <ul><li>Context </li></ul><ul><li>A bit of history of the development of vocational rehabilitation services a...
Mental health and employment <ul><li>Definitions and abbreviations: </li></ul><ul><li>People who have a diagnosed mental i...
Context <ul><li>People who experience mental health problems consistently say they  want  to work (UK 70—90%). </li></ul><...
A bit of history… <ul><li>1980s - closure of large hospitals, moved ‘industrial therapy’ units into the community and rena...
Growth of supported employment <ul><li>During late 1980s started seeing PLACE then TRAIN approaches to supported employmen...
Key research milestone <ul><li>2001 Cochrane systematic review: </li></ul><ul><li>Supported employment is more effective t...
Who will benefit? <ul><li>Bob Grove & Helen Membrey, 2005 review of the literature: </li></ul><ul><li>Individual factors s...
A type of supported employment <ul><li>US studies  – ‘individual placement and support’  approach to supported employment ...
Individual Placement and Support <ul><li>7 evidence-based* principles: </li></ul><ul><li>1. Eligibility is based on indivi...
IPS Fidelity Scale <ul><li>Fidelity is the degree to which a particular program follows the standards for an evidence-base...
For example <ul><li>Integration of vocational services with mental health treatment through frequent team member contact <...
What makes IPS different? <ul><li>Not a gradual stepwise process, the goal is immediate competitive employment.  </li></ul...
Changing the way we think <ul><li>Service characteristics rather than individual characteristics, predict employment outco...
IPS and EBSE <ul><li>Individual Placement and Support (IPS) now referred to and used interchangeably with the phrase evide...
Depth and breadth of evidence <ul><li>16 published and qualifying Randomised Control Trials (RCTs)* </li></ul><ul><ul><li>...
Source:  Latimer, adapted from Gary Bond SE or pre-IPS
“ In following people for 30 years and then following patients who are in dozens and dozens of research studies that are s...
We have an evidence base and a methodology but... <ul><li>IPS supported employment services are still not routinely availa...
Thank you Helen Lockett [email_address] www.scmh.org.uk/employment
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Sharing what works - Evidence-Based Supported Employment

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Helen Lockett's presentation on implementing EBSE on a visit in New Zealand.

Originally uploaded on 28 May 2010.

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  • Presentation: to give information on EBSE and help differentiate it (show how it is different) from other employment services (and SE services) you may be familiar with; and to generate energy and enthusiasm for this way of working
  • Employment for people with mhps should be a top priority for health and social commissioners and providers; however access to evidence-base employment support is patchy and limited. There are now numerous local and national studies which estimate that between 70-90% of people in contact with specialist mental health services would like to work
  • (courses in managing mental health, general social skills, independent living, self-esteem);
  • people who received Supported Employment were significantly more likely to be in competitive employment than those who received Pre-vocational Training (at 12 months 34% employed in Supported Employment compared with 12% in Pre-vocational Training). 18 RCTs No evidence that pre-vocational was more effective than standard community care
  • Roadmap / compass
  • Fish without chip! (Fush without chips!)
  • Aim is to commence job searching within 4 weeks. [Place then train, not Train then place]. Thanks to Geoff Waghorn IPS has changed the way we think!
  • 11 of 16 RCTs compared high fidelity services to the best available local services (EB-SE vs. controls). More participants commenced competitive employment (11 studies, 62% vs. 25%); More participants worked 20 or more hours per week (4 studies, 43.6% overall, 66% vs. 14.2% at control sites). Less days to first job (6 studies, 144.5 vs. 214.0 days). Similar accumulated employment following commencement of first job (11 studies, 24.5 vs. 25.0 weeks). More weeks worked at longest job (11, studies, 22.0 vs 16.3 weeks). Time to first job, and job retention, are the major challenges.
  • Professor of Psychiatry, Dartmouth Medical School But – IPS services are still not readily available in the UK
  • Look at some of the challenges to implementation and what is important to ensure effective implementation
  • Sharing what works - Evidence-Based Supported Employment

    1. 1. Evidence-based supported employment (EBSE) Helen Lockett Associate Director, Employment Programme
    2. 2. Presentation <ul><li>Context </li></ul><ul><li>A bit of history of the development of vocational rehabilitation services and research </li></ul><ul><li>An outline of what evidence-based supported employment is and how to measure and improve practice </li></ul><ul><li>An overview of the research evidence </li></ul>
    3. 3. Mental health and employment <ul><li>Definitions and abbreviations: </li></ul><ul><li>People who have a diagnosed mental illness, such as depression, schizophrenia, bi-polar disorder, anxiety, dual-diagnosis </li></ul><ul><li>People who are receiving treatment in secondary (specialist) mental health services in addition to their Doctor </li></ul><ul><li>Part-time and full-time paid work in ordinary every day workplaces </li></ul><ul><li>EBSE: Evidence-based supported employment </li></ul>
    4. 4. Context <ul><li>People who experience mental health problems consistently say they want to work (UK 70—90%). </li></ul><ul><li>Work is good for our health, unemployment is damaging for our health and especially our mental health. </li></ul><ul><li>There is established international research on what works to support people with mental health problems into work. </li></ul><ul><li>BUT </li></ul><ul><li>In most developed countries, people with mental heath problems still have the lowest employment rate of any disabled or disadvantaged group and EBSE services are still not readily purchased and provided. </li></ul>
    5. 5. A bit of history… <ul><li>1980s - closure of large hospitals, moved ‘industrial therapy’ units into the community and renamed them ‘sheltered workshops’. </li></ul><ul><li>Philosophy: TRAIN then PLACE </li></ul><ul><ul><li>Gradual stepwise process after clinical treatment and care is completed </li></ul></ul><ul><ul><li>Extensive pre-vocational training to help prepare people for work </li></ul></ul><ul><ul><li>Work readiness assessments for eligibility as in dividual and illness characteristics believed to predict work readiness </li></ul></ul>
    6. 6. Growth of supported employment <ul><li>During late 1980s started seeing PLACE then TRAIN approaches to supported employment </li></ul><ul><li>Research studies published, mainly from the United States on the high employment outcomes from these approaches </li></ul><ul><li>Increasing number of supported employment services in the UK; patchy and poorly funded </li></ul>
    7. 7. Key research milestone <ul><li>2001 Cochrane systematic review: </li></ul><ul><li>Supported employment is more effective than pre-vocational training in helping people with severe mental health problems to obtain competitive employment. There is no clear evidence that pre-vocational training is effective. </li></ul><ul><li>(Crowther et al , 2001) </li></ul><ul><li>www.cochrane.org/reviews/en/ab003080.html </li></ul>
    8. 8. Who will benefit? <ul><li>Bob Grove & Helen Membrey, 2005 review of the literature: </li></ul><ul><li>Individual factors such as diagnosis, length of illness, age, severity of symptoms are not predictors of whether people will achieve successful vocational outcomes’ </li></ul><ul><li>Best individual predictors are motivation and self-belief </li></ul><ul><li>What is important is the availability of high quality employment services </li></ul>
    9. 9. A type of supported employment <ul><li>US studies – ‘individual placement and support’ approach to supported employment </li></ul><ul><li> (Formerly known as the Drake & Becker supported employment model) </li></ul><ul><li>Far superior outcome rates </li></ul>
    10. 10. Individual Placement and Support <ul><li>7 evidence-based* principles: </li></ul><ul><li>1. Eligibility is based on individual choice (zero exclusion); </li></ul><ul><li>2. Supported employment is integrated with clinical treatment; </li></ul><ul><li>3. Competitive employment is the goal; </li></ul><ul><li>4. Rapid job search (within 4 weeks); </li></ul><ul><li>5. Job finding, and all assistance, is individualised; </li></ul><ul><li>6. Follow-along supports are continuous; </li></ul><ul><li>7. Financial planning is provided. </li></ul><ul><li>* Evidence for each principle as well as for the model as a whole (Bond, 2004; Bond et al , 2008; Psychiatric Rehabilitation Journal ). </li></ul>
    11. 11. IPS Fidelity Scale <ul><li>Fidelity is the degree to which a particular program follows the standards for an evidence-based practice </li></ul><ul><li>The Supported Employment Fidelity Scale defines the critical ingredients of supported employment in order to differentiate programmes that follow EBSE from those who don’t </li></ul><ul><li>Research shows that high fidelity services achieve better outcomes </li></ul><ul><li>It is a tool for continuous service improvement </li></ul><ul><li>On-going internal and external fidelity reviews are conducted to improve practice (improves outcomes) </li></ul><ul><li>Service rated from 1 to 5 on a number of characteristics – staffing, organisation, services </li></ul>
    12. 12. For example <ul><li>Integration of vocational services with mental health treatment through frequent team member contact </li></ul><ul><ul><li>Employment consultants attends and actively participates in weekly mental health treatment team meetings (not admin meetings) – shared decision making </li></ul></ul><ul><ul><li>Close proximity of offices or shared with treatment team members </li></ul></ul><ul><ul><li>Integrated documentation of mental health treatment and employment services, single file </li></ul></ul><ul><ul><li>Employment consultant helps the team think about employment for people who haven’t yet been referred to the service. </li></ul></ul><ul><ul><ul><li>1= one or none are present </li></ul></ul></ul><ul><ul><ul><li>5 = five are present </li></ul></ul></ul>
    13. 13. What makes IPS different? <ul><li>Not a gradual stepwise process, the goal is immediate competitive employment. </li></ul><ul><li>Employment service is coordinated with health treatment. </li></ul><ul><li>No prevocational training. All training is highly individualised and linked to a particular job </li></ul><ul><li>No assessments of work-readiness. Main inclusion criteria are that applicants have a severe mental illness and are requesting assistance. </li></ul><ul><li>Assessments are ongoing once a job commences. Employers are provided with similar support. </li></ul><ul><li>Intensive one-to-one assistance is available at every step </li></ul>
    14. 14. Changing the way we think <ul><li>Service characteristics rather than individual characteristics, predict employment outcomes </li></ul><ul><li>Individual preferences guide every aspect of support. </li></ul><ul><li>Voluntary work, work experience, sheltered employment, transitional employment, wage subsidies and temporary jobs are rarely used </li></ul><ul><li>Job tryouts at casual rates are the preferred method to obtain career-learning experiences. These are often negotiated on behalf of individuals. </li></ul><ul><li>Continuing support is not arbitrarily discontinued or time-limited. </li></ul>
    15. 15. IPS and EBSE <ul><li>Individual Placement and Support (IPS) now referred to and used interchangeably with the phrase evidence-based supported employment (EBSE) </li></ul>
    16. 16. Depth and breadth of evidence <ul><li>16 published and qualifying Randomised Control Trials (RCTs)* </li></ul><ul><ul><li>12 in USA </li></ul></ul><ul><ul><li>1 in Hong Kong </li></ul></ul><ul><ul><li>1 in Canada </li></ul></ul><ul><ul><li>1 in Europe (six European countries) </li></ul></ul><ul><ul><li>1 in Australia </li></ul></ul><ul><li>11 RCTs involve services with high fidelity to IPS. </li></ul><ul><li>*See 2008 edition of Psychiatric Rehabilitation Journal </li></ul>
    17. 17. Source: Latimer, adapted from Gary Bond SE or pre-IPS
    18. 18. “ In following people for 30 years and then following patients who are in dozens and dozens of research studies that are sent around, it’s totally clear to me at this point that there’s nothing about medications or psychotherapies or rehabilitation programs or case management programs or any of the other things that we study that helps people to recover in the same way that supported employment does.” (Drake, 2008) Employment and recovery
    19. 19. We have an evidence base and a methodology but... <ul><li>IPS supported employment services are still not routinely available in the UK as part of mental health treatment.... </li></ul>
    20. 20. Thank you Helen Lockett [email_address] www.scmh.org.uk/employment

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