Standardizing Fidelity to Evidence-Based Practice in the Early Psychosis Intervention Network.

OBJECTIVE: This study investigated variations in the measurement of fidelity to coordinated specialty care (CSC) within the Early Psychosis Intervention Network (EPINET), a learning health system that consists of 101 CSC programs within eight hubs. The study investigated the degree to which five fidelity scales could be mapped onto a standard scale. METHODS: The investigators identified six fidelity scales in use by EPINET participants; examined their item content, scoring, and data sources; and mapped five scales onto the First Episode Psychosis Services Fidelity Scale (FEPS-FS), which is the most widely used scale. RESULTS: Mapping five fidelity scales onto the FEPS-FS showed that the percentage of FEPS-FS components successfully mapped ranged from 42% to 81%. CONCLUSIONS: Mapping five scales onto one that uses dichotomous scoring identified the degree of variation in measures and reduced the amount and quality of usable fidelity data. Identifying variations in fidelity measurement is a core function of a learning health system.

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).

Evidence-Based Supported Employment for Individuals With Obsessive-Compulsive Disorder.

Individuals with obsessive-compulsive disorder (OCD), a chronic and disabling psychiatric disorder, experience high rates of occupational impairment. OCD symptoms commonly affect individuals' vocational aspirations and result in disability and the need for financial support, problems that are not addressed by current clinical practice guideline recommendations for treating OCD. This Open Forum highlights the need to address occupational impairment caused by OCD and makes the case for formally evaluating whether evidence-based supported employment can help individuals with OCD find and succeed in meaningful work.

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.

Modification of the Individual Placement and Support Model of Supported Employment.

Individual placement and support (IPS) is a robust evidence-based model of supported employment for people with mental health conditions that has been implemented in high-income countries. The model is now being extended to new populations and settings, often with modifications. Current evidence indicates that minor modifications may increase fit, major alterations of core principles generally reduce effectiveness, and augmentations have mixed success. The authors recommend that those who implement IPS adhere to its core principles whenever possible, use standardized methods to document and assess modifications, and follow basic scientific procedures to develop, measure, and evaluate modifications before recommending policy changes.

Individual Placement and Support (IPS) for High School Aged Youth: Provider Perspective and Practice.

Semi-structured interviews were conducted with nine Individual Placement and Support (IPS) employment specialists who expanded and enhanced the IPS model for the youngest of working age youth with mental health conditions (ages 16-21). Semi-structured interviews were conducted with 100% of the providers delivering IPS-based career services for high school aged youth during an exploratory pilot. Content coding was applied to interview transcripts. Findings reflect the complexities of providing career services to high school age youth, suggesting components needed for effective services. These components include: provision of supports that help youth complete high school and negotiate the transition to college, coaching and skill development to improve executive functioning for work and school, coping skills coaching for mental health symptoms, flexible engagement strategies that assure youth self-determination of goals, longer range career and goal planning, and close collaboration with families.

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.

Individual placement and support: History, current status, and future directions.

Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.