Sharing what works - Evidence-Based Supported Employment

Evidence-based supported employment (EBSE) Helen Lockett Associate Director, Employment Programme

Presentation
Context
A bit of history of the development of vocational rehabilitation services and research
An outline of what evidence-based supported employment is and how to measure and improve practice
An overview of the research evidence

Mental health and employment
Definitions and abbreviations:
People who have a diagnosed mental illness, such as depression, schizophrenia, bi-polar disorder, anxiety, dual-diagnosis
People who are receiving treatment in secondary (specialist) mental health services in addition to their Doctor
Part-time and full-time paid work in ordinary every day workplaces
EBSE: Evidence-based supported employment

Context
People who experience mental health problems consistently say they want to work (UK 70—90%).
Work is good for our health, unemployment is damaging for our health and especially our mental health.
There is established international research on what works to support people with mental health problems into work.
BUT
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.

A bit of history…
1980s - closure of large hospitals, moved ‘industrial therapy’ units into the community and renamed them ‘sheltered workshops’.
Philosophy: TRAIN then PLACE
Gradual stepwise process after clinical treatment and care is completed
Extensive pre-vocational training to help prepare people for work
Work readiness assessments for eligibility as in dividual and illness characteristics believed to predict work readiness

Growth of supported employment
During late 1980s started seeing PLACE then TRAIN approaches to supported employment
Research studies published, mainly from the United States on the high employment outcomes from these approaches
Increasing number of supported employment services in the UK; patchy and poorly funded

Key research milestone
2001 Cochrane systematic review:
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.
(Crowther et al , 2001)
www.cochrane.org/reviews/en/ab003080.html

Who will benefit?
Bob Grove & Helen Membrey, 2005 review of the literature:
Individual factors such as diagnosis, length of illness, age, severity of symptoms are not predictors of whether people will achieve successful vocational outcomes’
Best individual predictors are motivation and self-belief
What is important is the availability of high quality employment services

A type of supported employment
US studies – ‘individual placement and support’ approach to supported employment
(Formerly known as the Drake & Becker supported employment model)
Far superior outcome rates

Individual Placement and Support
7 evidence-based* principles:
1. Eligibility is based on individual choice (zero exclusion);
2. Supported employment is integrated with clinical treatment;
3. Competitive employment is the goal;
4. Rapid job search (within 4 weeks);
5. Job finding, and all assistance, is individualised;
6. Follow-along supports are continuous;
7. Financial planning is provided.
* Evidence for each principle as well as for the model as a whole (Bond, 2004; Bond et al , 2008; Psychiatric Rehabilitation Journal ).

IPS Fidelity Scale
Fidelity is the degree to which a particular program follows the standards for an evidence-based practice
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
Research shows that high fidelity services achieve better outcomes
It is a tool for continuous service improvement
On-going internal and external fidelity reviews are conducted to improve practice (improves outcomes)
Service rated from 1 to 5 on a number of characteristics – staffing, organisation, services

For example
Integration of vocational services with mental health treatment through frequent team member contact
Employment consultants attends and actively participates in weekly mental health treatment team meetings (not admin meetings) – shared decision making
Close proximity of offices or shared with treatment team members
Integrated documentation of mental health treatment and employment services, single file
Employment consultant helps the team think about employment for people who haven’t yet been referred to the service.
1= one or none are present
5 = five are present

What makes IPS different?
Not a gradual stepwise process, the goal is immediate competitive employment.
Employment service is coordinated with health treatment.
No prevocational training. All training is highly individualised and linked to a particular job
No assessments of work-readiness. Main inclusion criteria are that applicants have a severe mental illness and are requesting assistance.
Assessments are ongoing once a job commences. Employers are provided with similar support.
Intensive one-to-one assistance is available at every step

Changing the way we think
Service characteristics rather than individual characteristics, predict employment outcomes
Individual preferences guide every aspect of support.
Voluntary work, work experience, sheltered employment, transitional employment, wage subsidies and temporary jobs are rarely used
Job tryouts at casual rates are the preferred method to obtain career-learning experiences. These are often negotiated on behalf of individuals.
Continuing support is not arbitrarily discontinued or time-limited.

IPS and EBSE
Individual Placement and Support (IPS) now referred to and used interchangeably with the phrase evidence-based supported employment (EBSE)

Depth and breadth of evidence
16 published and qualifying Randomised Control Trials (RCTs)*
12 in USA
1 in Hong Kong
1 in Canada
1 in Europe (six European countries)
1 in Australia
11 RCTs involve services with high fidelity to IPS.
*See 2008 edition of Psychiatric Rehabilitation Journal

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 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

We have an evidence base and a methodology but...
IPS supported employment services are still not routinely available in the UK as part of mental health treatment....

Thank you Helen Lockett [email_address] www.scmh.org.uk/employment

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Sharing what works - Evidence-Based Supported Employment

by Centre for Mental Health on Mar 09, 2011

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Sharing what works - Evidence-Based Supported Employment — Presentation Transcript