The CONFIDENT study protocol: a randomized controlled trial comparing two methods to increase long-term care worker confidence in the COVID-19 vaccines.

BACKGROUND: Clinical and real-world effectiveness data for the COVID-19 vaccines have shown that they are the best defense in preventing severe illness and death throughout the pandemic. However, in the US, some groups remain more hesitant than others about receiving COVID-19 vaccines. One important group is long-term care workers (LTCWs), especially because they risk infecting the vulnerable and clinically complex populations they serve. There is a lack of research about how best to increase vaccine confidence, especially in frontline LTCWs and healthcare staff. Our aims are to: (1) compare the impact of two interventions delivered online to enhanced usual practice on LTCW COVID-19 vaccine confidence and other pre-specified secondary outcomes, (2) determine if LTCWs' characteristics and other factors mediate and moderate the interventions' effect on study outcomes, and (3) explore the implementation characteristics, contexts, and processes needed to sustain a wider use of the interventions. METHODS: We will conduct a three-arm randomized controlled effectiveness-implementation hybrid (type 2) trial, with randomization at the participant level. Arm 1 is a dialogue-based webinar intervention facilitated by a LTCW and a medical expert and guided by an evidence-based COVID-19 vaccine decision tool. Arm 2 is a curated social media web application intervention featuring interactive, dynamic content about COVID-19 and relevant vaccines. Arm 3 is enhanced usual practice, which directs participants to online public health information about COVID-19 vaccines. Participants will be recruited via online posts and advertisements, email invitations, and in-person visits to care settings. Trial data will be collected at four time points using online surveys. The primary outcome is COVID-19 vaccine confidence. Secondary outcomes include vaccine uptake, vaccine and booster intent for those unvaccinated, likelihood of recommending vaccination (both initial series and booster), feeling informed about the vaccines, identification of vaccine information and misinformation, and trust in COVID-19 vaccine information provided by different people and organizations. Exploration of intervention implementation will involve interviews with study participants and other stakeholders, an in-depth process evaluation, and testing during a subsequent sustainability phase. DISCUSSION: Study findings will contribute new knowledge about how to increase COVID-19 vaccine confidence and effective informational modalities for LTCWs. TRIAL REGISTRATION: NCT05168800 at ClinicalTrials.gov, registered December 23, 2021.

Growth of IPS Supported Employment Programs in the United States: An Update.

OBJECTIVE: Individual placement and support (IPS), an evidence-based supported employment practice, is a core service in community mental health in the United States. Several factors promote the growth of IPS, including a network of 24 states participating in a learning community devoted to expanding IPS services. This study examined growth of IPS in the United States from 2016 to 2019, comparing growth rates for states within and outside the learning community. METHODS: This national survey included telephone interviews with 70 representatives from state mental health and vocational rehabilitation agencies in 50 states and the District of Columbia, replicating methods of a 2016 survey. The primary outcomes were the number of IPS programs and clients served. The survey inquired about four indicators of state-level support for IPS implementation and sustainment: collaboration between state agencies, independent fidelity reviews, technical assistance and training, and funding. RESULTS: In 2019, 41 (80%) of 50 states and the District of Columbia had IPS services, with 857 IPS programs serving an estimated 43,209 clients. Between 2016 and 2019, the number of programs increased from 272 to 486 in 22 learning-community states and two learning-community counties, and from 251 to 371 in 18 states outside the learning community. State-level support for IPS was significantly greater in learning-community states, compared with non-learning-community states. CONCLUSIONS: IPS services expanded substantially in the United States between 2016 and 2019. Learning-community states had more rapid growth and provided greater implementation support, facilitating implementation, expansion, and sustainment of high-fidelity IPS. Nevertheless, access to IPS remains limited.

A Tale of Four States: Factors Influencing the Statewide Adoption of IPS.

Evidence-based supported employment has become a core community mental health service in much of the U.S. Although a national learning community has facilitated progress in about half of the states, other states have tried to implement evidence-based supported employment on their own. Many studies have examined site-level factors influencing implementation of supported employment, but few have focused on the role of state agency policies and actions. This study examined four states that have not joined the learning community, comparing two that have implemented with success (adopting states) and two that have faced challenges (non-adopting states). This comparative case study approach compared barriers, facilitators, and strategies in two states adopting IPS to two states that did not. The authors examined quantitative data from public records and conducted content analysis of qualitative and quantitative data from key informant interviews. The two non-adopting states lacked model clarity, funding, focus on people with serious mental illness, and collaboration between state mental health and vocational rehabilitation agencies. The two successful states experienced similar barriers but overcame them following lawsuit settlements that required implementation of evidence-based supported employment. Key strategies for successful implementation were funding, fidelity monitoring, technical assistance, and collaboration between state mental health and vocational rehabilitation agencies. With legal settlements serving as the catalyst, states facing challenges to implementing evidence-based supported employment can achieve success using standard implementation strategies to fund and ensure the quality of services.

Expanding Individual Placement and Support to Populations With Conditions and Disorders Other Than Serious Mental Illness.

OBJECTIVE: A systematic review of studies of individual placement and support (IPS) for populations other than those with serious mental illness was conducted. METHODS: The authors searched three electronic databases (PubMed, Web of Science, and Scopus) for studies of IPS and modified IPS. Eligibility criteria for the systematic review included randomized controlled trials with prospective data collection on competitive employment rate and at least 10 study participants from a well-defined population other than people with serious mental illness. Results were compiled for competitive employment rates, IPS fidelity, and other outcomes. RESULTS: Three clinical groups other than people with serious mental illness have been studied: people with psychiatric disorders other than serious mental illness, people with substance use disorders, and people with musculoskeletal or neurological disorders. Nine controlled trials with a total of 2,902 participants included six trials with people who had psychiatric disorders other than serious mental illness, two with people who had substance use disorders, and one with people who had spinal cord injuries. In eight studies, results for competitive employment rates significantly favored IPS. Meta-analysis yielded an overall weighted odds ratio of 2.23 (95% confidence interval=1.53-3.24, p<.001). Findings for other employment outcomes also favored IPS, but findings on symptom reduction and quality of life were inconsistent. The strongest (and only replicated) findings were for veterans with posttraumatic stress disorder (PTSD). Methodological limitations included small samples, major modifications to IPS fidelity, and short follow-up periods. CONCLUSIONS: IPS, often with modifications, is a promising employment intervention for several populations in addition to people with serious mental illnesses. The strongest evidence pertains to veterans with PTSD. IPS should be offered to these veterans. Research on other populations, including people with anxiety, depression, substance use disorder, musculoskeletal or neurological conditions, or pain syndromes, needs development, amplification, and replication.