Individual placement and support for young adults: One-year outcomes.

OBJECTIVE: Many young adults who are unemployed and not in school need support achieving employment goals. Individual Placement and Support (IPS) is an evidence-based employment practice for adults with serious mental illness, but its applicability to young adults with mental health conditions has not been well-researched. The present study prospectively assessed IPS effectiveness in a national sample of young adults enrolled in routine practice settings in the U.S. public mental health system. METHOD: Nine community agencies in five states participated in a 1-year follow-up study of young adults (aged 16-24) enrolled in IPS services. The study examined three outcomes: retention in services, employment, and education. State fidelity reviewers examined IPS fidelity using a new fidelity scale, the IPS-Y. RESULTS: In a sample of 111 participants, the mean age was 19.2, 72 (64.9%) had never worked, and 76 (68.5%) had a diagnosis of depressive and/or anxiety disorder. Participants averaged 8 months of enrollment before terminating from IPS services. During follow-up, 51 (45.9%) participants obtained a competitive job (N = 50) or paid internship (N = 1); 14 (12.6%) achieved a new education outcome. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: IPS has promising outcomes for helping young adults with mental health conditions achieve positive employment outcomes, but its effectiveness in helping young adults achieve education goals has not been demonstrated. IPS should be offered to young adults with employment goals. Targeted funding for supported education and training for IPS specialists in delivering educational supports may be necessary to ensure optimal education outcomes in IPS. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Digital Mental Health and Its Discontents: Assumptions About Technology That Create Barriers to Equitable Access.

Despite the potential of digital mental health interventions to aid recovery for people with serious mental illness, access to these digital tools remains a key barrier. In this column, the authors discuss three key assumptions that shape the integration of digital mental health tools into community health settings: clinical context, digital literacy, and financial burden. Clinical contexts have shifted with the increased use of telehealth, altering intervention environments; access to a mobile device is not the same as digital literacy; and digital mental health care is not necessarily affordable. Context-centered study design through ethnography will facilitate transfer of digital resources to real-world settings.

Individual placement and support programmes for young adults: Where are they and whom do they serve?

AIM: Individual Placement and Support (IPS), an evidence-based supported employment model developed for adults with serious mental illness, has been recently targeted to young adults with mental health conditions, but little is known about its adoption in this age group in the United States. METHODS: We recruited a volunteer sample of nine IPS programmes in five states serving young adults with mental health conditions aged 16 to 24. IPS team leaders reported programme and participant characteristics and rated barriers to employment and education. RESULTS: Most IPS programmes were located in community mental health centres, served a small number of young adults, and received most referrals from external sources. The study sample of 111 participants included 53% female, 47% under 21 years old, 60% diagnosed with a depressive disorder; 92% had an employment goal, and 40% had an education goal. IPS specialists reported that managing mental health symptoms was the most common barrier to achieving employment and education goals. CONCLUSION: Future research should examine how IPS programmes could best provide services to young adults.

A Systematic Review and Meta-analysis of IPS Supported Employment for Young Adults with Mental Health Conditions.

Young adults with mental health conditions want to work and advance their education, but many need help attaining these goals. Individual Placement and Support (IPS), originally developed for working-age adults with serious mental illness, is an evidence-based employment model that may benefit young adults. This study is the first systematic review and meta-analysis of randomized controlled trials (RCTs) of IPS for this population. We conducted a systematic review of the effectiveness of IPS for young adults with mental health conditions, supplementing our electronic search of the published literature with secondary analyses of two published RCTs. Using meta-analysis, we evaluated employment rate, job duration, and education rate. Seven studies met the inclusion criteria. Four evaluated IPS for young adults with early psychosis and three evaluated IPS for other young adult subgroups. All found a significantly higher employment rate for IPS than the control group. Overall, 208 (58.3%) of 357 IPS participants and 110 (32.4%) of 340 control participants were competitively employed during follow-up, yielding an overall risk ratio of 1.69 (95% CI 1.43, 1.99), z = 6.24, p < 0.001. Six of the seven studies also reported longer job duration for IPS than the control group, yielding an overall g = 0.34 (95% CI 0.09, 0.58), z = 2.72, p < 0.01. None of four RCTs examining education outcomes found a significant difference favoring IPS, but the overall risk ratio was significant: 1.33 (95% CI 1.06, 1.66), z = 2.51, p < 0.01. Although the empirical literature is limited, IPS appears to be effective in helping young adults with serious mental illness or early psychosis gain and keep competitive jobs. The impact of IPS on education outcomes is unclear. Future research should evaluate the generalizability of these findings to the broad range of young adults with mental health conditions needing help with their employment goals.

A Randomized Controlled Trial of an Employment Program for Veterans Transitioning from the Military: Two-Year Outcomes.

BACKGROUND: Military personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. Many veterans seek help finding employment, but few veteran employment programs have been rigorously studied. Transitioning veterans generally have access to Local Community Resources (LCR), which include the Veterans Health Administration vocational rehabilitation services, the state-federal Vocational Rehabilitation program, and the Department of Labor's American Job Centers. By contrast, the innovative National Career Coach Program (NCCP) offers intensive career coaching and financial incentives for working. METHODS: This study used a randomized controlled design to compare the NCCP and LCR approaches for 208 transitioning service members (recent or pending transition). Researchers conducted interviews by telephone every four months for two years. Outcomes included earnings, months worked, and standardized self-report measures of health and well-being. Findings At two-year follow-up, significantly more NCCP participants had worked in paid employment than LCR participants (95% vs. 83%). NCCP participants averaged $2568 in monthly earnings compared to $1865 for LCR participants, thus averaging $16,872 more total income per participant over the two-year period. Employment outcomes significantly improved between Year 1 and Year 2. NCCP participants also reported significantly greater improvements in both physical and mental health compared to LCR participants. Average monthly earnings correlated with changes in health outcomes. CONCLUSIONS: Veterans receiving multi-faceted employment services early in the transition from the military showed sustained benefit over a two-year period with increased earnings over time and improved mental and physical outcomes. Positive employment outcomes may have contributed to improved health outcomes.

Transition from Military Service: Mental Health and Well-being Among Service Members and Veterans with Service-connected Disabilities.

Transitioning from military service is stressful for veterans with service-connected disabilities seeking civilian employment. This descriptive study examined self-assessed mental health, well-being, and substance use of men and women shortly before or after transition from US military service, compared to norms from community and military samples. As part of a prospective study evaluating an innovative employment program, researchers interviewed 229 current and former service members with service-connected disabilities transitioning from U.S. military service. Compared to published norms, respondents reported significantly poorer outcomes on 5 of 6 standardized measures, indicating less life satisfaction, poorer mental health, more symptoms of depression and posttraumatic stress disorder, and greater financial distress. In the previous year, 42% were prescribed opioid medications, over twice the annual opioid prescription rate of 19% in the general US population. Systematic strategies are needed to ensure access for transitioning veterans with serious behavioral health issues to appropriate evidence-based practices.

Individualized Intervention to Support Mental Health Recovery Through Implementation of Digital Tools into Clinical Care: Feasibility Study.

Myriad digital tools exist to support mental health but there are multiple barriers to using these tools in routine care. This study aimed to assess the feasibility of an intervention incorporating a support role to help the clinical team identify and use technology to promote recovery. The technology specialist intervention is 3 months in duration and comprises four stages: goal setting, researching and evaluating tools, demonstrating and selecting tools, and ongoing support. We implemented the intervention in a community mental health center and a dual diagnosis treatment program, working with eight clients and their case managers. Clients and case managers willingly engaged with the technology specialist and found the intervention beneficial. Integration and collaboration with the care team facilitated implementation of the technology specialist in these real-world settings. Clients reported that the intervention made it easy to try a digital tool. Six of the eight participants stated that they made substantial progress toward their goals. The technology specialist is a promising new role for mental health care delivery to augment traditional services and enhance individualized recovery.

Evaluation of an Employment Intervention for Veterans Transitioning From the Military: A Randomized Controlled Trial.

ABSTRACT: Military personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. The Independence Project compared an innovative employment program (National Career Coach Program) with standard employment services (Local Community Resources) in a randomized controlled trial. Study participants were transitioning veterans with self-reported service-connected disabilities seeking permanent employment. The primary outcomes were paid employment and disability ratings over 1 year. Secondary outcomes included health and well-being. At 1-year follow-up, National Career Coach Program participants were significantly more likely to work, had significantly greater earnings, and reported significantly greater improvements in physical and mental health compared with participants assigned to Local Community Resources. Both groups increased in disability ratings over 12 months, with no difference between groups. Multifaceted supports delivered by the National Career Coach Program increased employment, earnings, mental health, and physical health over 1 year. These significant differences appeared even though control group participants achieved considerable employment success.

Evidence-Based Supported Employment in the Rural United States: Challenges and Adaptations.

OBJECTIVE: The authors examined how individual placement and support (IPS), an evidence-based model of supported employment, has been successfully adapted in rural communities across the United States. METHODS: Interviews with 27 key informants in 15 states with successful IPS programs in rural communities identified challenges that IPS workers faced because of rurality and the work-around methods they used to overcome these challenges. The authors conducted a thematic analysis of interviews. RESULTS: Significant challenges to implementing IPS in rural areas included limited availability of public transportation, Internet connectivity, employment opportunities, and workforce. The work-around strategies used by IPS teams differed in relation to local circumstances and cultures, but effective services generally used natural supports for transportation, provided computer access for job applicants, developed relationships with local employers, and hired IPS workers with local knowledge. CONCLUSIONS: The adaptations made to IPS in rural areas are specific to local communities but retain core IPS principles.

Knowledge among patients with heart failure: A narrative synthesis of qualitative research.

BACKGROUND: Patients' knowledge of heart failure (HF) is integral to improved outcomes. However, the HF literature has not adequately explored the nature of patients' knowledge of HF as part of their lived experience. OBJECTIVES: We aimed to characterize the nature of patients' knowledge of HF, in the context of living with the disease. METHODS: We conducted a narrative synthesis of qualitative studies that addressed patients' knowledge of HF. Studies were systematically searched and retrieved from MEDLINE, CINAHL, PsycINFO and PsycARTICLES databases. Findings were synthesized using an iterative coding process carried out by multiple analysts and reported following Enhancing Transparency in the Reporting of Qualitative Health Research (ENTREQ) criteria. RESULTS: Analysis of 73 eligible articles produced five themes: the content that comprises HF knowledge; development of HF knowledge over time; application of HF knowledge for decision making; communication of information between clinicians and patients; and patients' experience of knowledge. CONCLUSION: The nature of patients' knowledge of HF is both explicit and implicit, dynamic, and personal. This multidimensional model of knowledge-in-context calls for equally multidimensional research and intervention design.