Individual Placement and Support in Sweden—A randomized controlled trial

Ulrika Bejerholm · Cecilia Areberg · Caisa Hofgren · Mikael Sandlund · Miles Rinaldi

138 citations0/0 files storedNordic Journal of Psychiatry

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Disability Education and Employment Schizophrenia research and treatment Employment and Welfare Studies

Abstract

BACKGROUND: Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden. AIMS: To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect. METHODS: A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024. RESULTS: One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18-54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this. CONCLUSIONS: IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.

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References

2008Cochrane Handbook for Systematic Reviews of Interventions 1962The Brief Psychiatric Rating Scale 1999Application and Results of the Manchester Short Assessment of Quality of Life (Mansa)2008An update on randomized controlled trials of evidence-based supported employment.2001Implementing Supported Employmentas an Evidence-Based Practice 2007The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial 2000Definition and prevalence of severe and persistent mental illness 2001Helping people with severe mental illness to obtain work: systematic review

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