Predictive Association of Low- and High-Fidelity Supported Employment Programs with Multiple Outcomes in a Real-World Setting: A Prospective Longitudinal Multi-site Study

Purpose The individual placement and support (IPS) model of supported employment is a leading evidence-based practice in community mental health services. In Japan, individualized supported employment that is highly informed by the philosophy of the IPS model has been implemented. While there is a body of evidence demonstrating the association between program fidelity and the proportion of participants gaining competitive employment, the association between fidelity and a wider set of vocational and individual outcomes has received limited investigation. This study aimed to assess whether high-fidelity individualized supported employment programs were superior to low-fidelity programs in terms of vocational outcomes, preferred job acquisition, and patient-reported outcome measures (PROMs). Methods A prospective longitudinal study with 24-month follow-up analyzed 16 individualized supported employment programs. The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was used to assess the structural quality of supported employment programs (scores: low-fidelity program, ≤ 90; high-fidelity program, ≥ 91). Job acquisition, work tenure, work earnings, job preference matching (e.g., occupation type, salary, and illness disclosure), and PROMs such as the INSPIRE and WHO-Five Well-being index were compared between groups. Results There were 75 and 127 participants in the low-fidelity group (k = 6) and high-fidelity group (k = 10), respectively. The high-fidelity group demonstrated better vocational outcomes than the low-fidelity group, i.e., higher competitive job acquisition (71.7% versus 38.7%, respectively, adjusted odds ratio (aOR) = 3.6, p = 0.002), longer work tenure (adjusted mean difference = 140.8, p < 0.001), and better match for illness disclosure preference (92.6% versus 68.0%, respectively, aOR = 5.9, p = 0.003). However, we found no differences between groups in other preference matches or PROM outcomes. Conclusion High-fidelity individualized supported employment programs resulted in good vocational outcomes in a real-world setting. However, enhancing service quality to increase desired job acquisition and improve PROMs will be important in the future. Clinical Trial Registration UMIN000025648

The effectiveness of supported employment programs: Meta-regression analysis of the global secular trend, 1990 - 2015

Importance: Supported employment programs aim to re-integrate unemployed people with mental illness into the competitive labour market. While it is known that short-term economic developments like the 2008 recession may have negative consequences on the supported employment effectiveness rates, research into long-term secular trends has not yet been conducted. Objective: The primary objective of the regression analysis was to assess the effectiveness of supported employment programs for clients with any mental disorder over a longer time period. Further objectives were a comparison to prevocational training and the identification of moderating variables.Data sources: We retrieved publications on randomized controlled trials and on routine implementation programs that were included in four recent systematic reviews on supported employment for people with mental illness, plus very recent publications that were identified by a new search. This search was conducted in the following databases: Pubmed, PsycInfo, CINAHL (Cumulative Index on Nursing and Allied Health Literature), and Google Scholar. Study selection: We included any publication that was used in the four meta-analyses plus very recently published studies. The included studies were conducted between 1990 and 2015. Data extraction and synthesis: 80 studies with 14,437 participants were included in the analysis. Data was extracted by one author and cross-checked by the second author. We have conducted univariate and multivariate meta-regressions on the basis of a random-effects meta-analysis of proportions. The best-fitting model was computed by utilizing a statistical model selection procedure. Main Outcome and Measures: The outcome was the competitive employment rate over time. The year of study conduction (1990 to 2015) was regressed on the competitive employment rate. Regression coefficient estimates were computed and graphically displayed.

CBT Groups for Psychosis With Other Targets

Groups using CBT principles or techniques but targeting either a specific symptom or a domain outside of typical CBT for psychosis have been developed and tested. Some of these groups have been presented briefly in Chapter 3 and have demonstrated their empirical efficacy. In this chapter we present them in more detail. Specifically, we present a group approach focusing on voices, another aiming at improving participants’ self-esteem, a group targeting stress management in people with severe mental illness, and CBT for work integration of people with severe mental illness participating in supported employment programs. The chapter also describes a CBT group for parents or family members of individuals with psychosis, which seems to be effective.