12-ips-evidence-10-23.pdf

dartmouth.edu

12-ips-evidence-10-23.pdf

Evidence for the

Effectiveness of

Individual Placement and

Support Model of

Supported Employment

Updated 10/23/12 by Gary Bond


17 Randomized Controlled

Trials of Individual

Placement and Support (IPS)

§� Best evidence available on

effectiveness

§� RCTs are gold standard in medical

research

Bond, Drake, & Becker (2012)


Principal

Investigator/

Year Pub

Study Site Location Control Condition

Months

Followup

N

(IPS)

Drake 1996 Mancester & Concord, NH Skills training, nonintegrated 18 73 67

Drake 1999 Washington, DC Sheltered workshop 18 74 76

Lehman 2002 Baltimore, MD PSR 24 113 106

Mueser 2004 Hartford, CT (1) Brokered SE; (2) PSR 24 68 136

Gold 2006 Rural SC Sheltered workshop 24 66 77

Latimer 2006 Montréal, Québec Traditional vocational services 12 75 74

Bond 2007 Chicago, IL Diversified placement approach 24 92 95

Burns 2007 6 cities in Europe Traditional vocational services 18 156 156

Wong 2008 Hong Kong VR referral 12 46 46

Killackey 2008 Melbourne, Australia Traditional vocational services 6 20 21

Michon 2010 4 cities in the Netherlands Traditional vocational services 18 71 80

Nuechterlein 2010 Los Angeles, CA VR referral 18 46 23

Heslin 2011 London, UK Usual Care 24 93 95

Twamley 2012 San Diego, CA VR referral 12 28 22

Hoffmann 2012 Bern, Switzerland Traditional Vocational Rehab 24 46 54

Davis 2012 Tuscaloosa, Alabama Standard VA vocational rehab 12 36 35

Killackey 2012 Australia Traditional vocational services 6 73 73

N

(Ctl)


90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Competitive Employment Rates in

17 Randomized Controlled Trials of

96

NH

Individual Placement and Support

12

AL

07

IL

04

CT

12

AUST

08

HK

10

CA

08

AUST

06

SC

99

DC

IPS Control Control 2

12

SWZ

12

CA

07

EUR

06

QUE

10

HOL

02

MD

11

UK


Overall Findings for 17 RCTs

§� All 17 studies showed a significant

advantage for IPS

§� Mean competitive employment rates

for the 17 studies:

– 59% for IPS (Median = 64%)

– 25% for controls (Median = 26%)

(Each study weighted equally in

calculating mean rates)


Four Measurement Domains

of Employment Outcomes

§� Job acquisition (% employed)

§� Job duration (weeks worked)

§� Hours worked per week

§� Total hours worked/earnings

(Bond,Campbell, & Drake, 2012)


18-Month Competitive Employment

Outcomes in 4 Controlled Trials of IPS

IPS Control p d

N = 307 N = 374

Job acquisition 216 (70.4%) 91 (24.3%)


Competitive Employment in 2-Year

Follow-up of IPS After 1st Job

Sample

1

Sample

2

Total

N = 82 N =60 N=142

Total months worked 11.0 13.7 12.9

Months worked 1st job 8.0 12.6 10.0

Number of jobs 1.9 2.0 1.9

Months between jobs 3.9 1.9 2.9

(N = 36) (N = 36) (N = 72)

(Bond & Kukla, 2011)


6 Day Treatment Conversions

to Supported Employment:

Common Study Design

§� Discontinued day treatment

§� Reassigned day treatment staff to new

positions

§� Implemented new supported

employment program

§� Compared to 3 sites not converting

Sources: Drake and Becker


Mean Competitive Employment

Rates in 6 Day Treatment Programs

Converting to IPS

Percentage

Employed

40%

35%

30%

25%

20%

15%

10%

5%

0%

37.5%

13.4%

15.2%

12.4%

Sites Converting to

IPS (n = 317)

Control Sites

(n = 184)

Before

After


2 Long-Term IPS Follow-up Studies

(Salyers 2004; Becker, 2007)

Steady Workers

(> 50% Follow-up)

52%

Length of Follow-up 10 years

Sample Size 74


IPS Fidelity Predicts

Competitive Employment Outcomes

Location # Sites Findings Reference

Vermont 10 r = .76 (p < .01) Becker et al. (2001)

7 states 26 r = .51 (p < .01) Becker et al. (2006)

USA 32 r = .35 (p < .05) Becker & Bond (2010)

Indiana 20 r = -.07 (n.s.) McGrew (2005)

Indiana 17 r = .37 (p < .06) McGrew (2007)

Indiana 23 r = .39 (p < .05) McGrew (2008)

Maryland

Statewide

Successful VR closures: Hepburn & Burns

IPS (60%), Non-IPS (36%) (2007)

Europe 6

Increased rate over usual

services (p = .08)

Catty et al. (2008)

Massachusetts 21 Odds ratio = 1.24 (p < .03) Henry (2009)

USA 23 r = .50 (p < .05) Frey et al. (2011)


IPS Fidelity and Outcomes

in 88 Sites in Learning Collaborative

IPS Fidelity

Category

N (%)

(Bond et al., 2012)

Mean Competitive

Employment Rate

Exemplary Fidelity 8 (9%) 44%

Good Fidelity 45 (51%) 39%

Fair Fidelity 30 (34%) 32%

Not Supported

Employment

5 (6%) 29%

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