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Supported Employment: Latest Guidance and Research

Over the past 20 years, the Individual Placement Services model of vocational support has been validated by more than a dozen controlled research studies. In this column, researchers at the Dartmouth Psychiatric Research Center survey the latest developments and research on the program.

imprint logoSince 2001 and the establishment of a learning collaborative to help encourage the use of supported employment, the IPS model has begun to take hold in agencies across the country. Through the learning collaborative, the Dartmouth Psychiatric Research Center has administered the national program in 12 states and the District of Columbia, and currently 127 mental health agencies partner with local vocational rehabilitation groups to work toward implementing the program (D. R. Becker et al. 2011).

The IPS model of supported employment features a client-centered approach to helping people with severe mental illness find competitive employment. Clients play an active role in defining the work they want and move to job-seeking without the need to complete work-readiness programs. (Read an excerpt from the program.)

Use of the model has sparked improvements in employment outcomes for participants. In a review of randomized controlled trials, IPS participants were found to have achieved a mean competitive employment rate of 60%, more than twice that of participants in traditional jobs programs (Bond, Drake, & Becker  2008; cited in D. R. Becker et al. 2011).  These results have encouraged further research on the program's implementation.

In a recent issue of the American Journal of Psychiatric Rehabilitation specifically focusing on the vocational model, Robert E. Drake and Gary R. Bond survey the research and offer a few observations in their article "IPS Support Employment: A 20-Year Update." In this column, we highlight some of the findings of Dartmouth researchers' work featured in the journal issue.

Deborah R. Becker, Robert E. Drake, and Gary R. Bond consider how to establish benchmarks for client outcomes. The authors maintain that results from controlled studies may not be easily generalized for use in specific settings since study timelines vary from those used in clinics and participant clients may not typify the consumers found in most clinic settings. To establish what the authors call "realistic benchmarks for employment programs in routine community mental health settings," the authors turned to quarterly data generated from the 127 programs participating in the national learning collaborative from 2001 through 2010. Based on this data analysis, the researchers recommend a good-performance benchmark of 45% for rates of competitive employment among active clients who receive evidence-based vocational services. (See "Benchmark Outcomes in Supported Employment")

As the IPS model of supported employment becomes established, questions have arisen as to what impact locations have on the success of the program. In the article "Individual Placement and Support: Does Rurality Matter?" William R. Haslett and co-authors consider whether IPS Supported Employment can be effectively implemented in rural settings. Working with data drawn from the learning collaborative and census-based population density data, the authors categorized agencies by population density and tested for an association between rates of employment and agency locale in metropolitan, "micropolitan," or small town settings. Results indicate that the setting in which the program is carried out-large or small city or small town-does not appear to adversely affect program outcomes.

Sarah Swanson and co-authors consider the common barriers to implementing supported employment and consult with six program stakeholders-including practitioners, senior planners, and an executive director-- to find their successful strategies for overcoming these obstacles.  Some of the challenges discussed include difficulties in moving away from fee-earning traditional vocational services, lack of funding and training, practitioner doubts about client readiness for work, and concerns about loss of disability benefits through participation in IPS. The authors report on stakeholders' responses to these challenges and the results they achieved, noting the role of leadership and commitment to the program as predictors of program success. (See "Implementation Issues for IPS Supported Employment: Stakeholders Share Their Strategies.")

In an article on the pathways into IPS supported employment programs, Charles E. Drebing and co-authors tracked data on 80 adults who were receiving care for mental health disorders and who had a vocational need but were not enrolled in vocational services.  Of this group, 81% had identified a vocational need, and more than half had sought help in this area at least one time before the study period. Even so, the average time for the vocational need to have been present was 4.4 years. The authors maintain that most of this delay represents the length of time the vocational need went unrecognized, suggesting that efforts to support early recognition might have the most impact on reducing delays. The findings, they argue, also suggest the need for clients to be directed toward evidence-based supported employment. (See "Help seeking and Entry into Vocational Services by Adults Enrolled in New Hampshire State Mental Health Services: A Pathways-To-Care Study.")

Cited article:  Deborah R. Becker, Robert E. Drake, and Gary R. Bond (2011): Benchmark Outcomes in Supported Employment, American Journal of Psychiatric Rehabilitation, 14:3, 230-236.


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