Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Individual placement and support (IPS) is considered the gold standard as an employment intervention for adults with serious mental illness. Does the same hold true for individuals experiencing early psychosis? This systematic review examines the efficacy of IPS in early psychosis programs. It emphasizes the importance of collaboration between the IPS specialist and OT to encourage maintenance of clients’ vocational goals.
Primary Author and Speaker: Natalie Jones
PURPOSE: Early psychosis programs have shed a new light on treatment interventions for people experiencing psychosis by giving them a more optimistic outlook and supporting their transition into adulthood (Bond, Drake, & Luciano, 2015). The concepts of these programs align with occupational therapy by focusing on functional outcomes in one’s daily life. These programs focus on social skills, medication management, family education and vocational skills. Given the age of this population, most individuals have a desire to pursue a career or education that ultimately will lead them to employment (Bond et al., 2015). Research shows that about 65% of people with severe mental illness (SMI) want to work yet only 15% are employed (Sveinsdottir et al., 2014). To assist individuals in overcoming barriers to employment, a supported employment model was introduced called Individual Placement and Support (IPS). IPS is an evidence-based supported employment intervention, which was first developed and researched for people with SMI (Drake, Bond, Goldman, Hogan & Karakus, 2016). IPS and occupational therapy share a common value of taking a client-centered approach. IPS specialists work alongside the interdisciplinary care team to ensure support in vocational skills and encourage integration of vocational and clinical services (Modini, et al., 2016). Occupational therapists can work with IPS specialists to help reduce individual and environmental barriers. The purpose of this study is to examine the efficacy of the IPS model in early psychosis programs. This research is needed to gain a better understanding of how occupational therapists can assist in maintaining vocational outcomes. Most early psychosis programs provide an aspect of vocational training; however, it is not specified which vocational model is used most frequently or is most effective.
DESIGN: Systematic review of randomized control trials (RCT) with a meta-analysis.
METHOD: An electronic search was conducted in PubMed using the key words ‘first episode psychosis AND Individual Placement’. A data abstraction form was completed for each study. Comprehensive Meta-Analysis was used to calculate effect sizes.
RESULTS: Three studies met criteria and were reviewed. The meta-analysis resulted in an overall odds ratio of 4.23 (95% CI 2.37-7.54, p < 0.001) when comparing IPS to a control condition at six months; however, outcomes were not maintained at follow up. The Pedro Scale was used to determine the quality of each study. In general, the quality of all three studies was high. All three studies were RCT and provided at least one key outcome obtained from 85% of participants, which represent the strengths in each of the studies. Participants and administrators were not blinded, contributing to the weakness across each of the studies.
CONCLUSION: This systematic review supports the concept when IPS is implemented intensely for six months in early psychosis programs, employment and education outcomes are strong. More research needs to be done on IPS in early psychosis programs with longer implementation periods. Occupational therapists can help support clients and evaluate barriers to facilitate better long-term outcomes.
IMPACT STATEMENT: This review supports efficacy of the IPS model for individuals with early psychosis. As a result, it is important that occupational therapists become involved in IPS to bring their unique perspective and promote longer lasting employment outcomes.
References
Bond, G.R., Drake, R.E., & Luciano, A. (2015). Employment and educational outcomes in early intervention programmes for early psychosis: A systematic review. Epidemiology and Psychiatric Sciences, 24, 446- 457. https://doi.org/10.1017/S2045796014000419.
Bond, G. R., Drake, R. E., & Campbell, K. (2016). Effectiveness of individual placement and support supported employment for young adults. Early intervention in psychiatry, 10(4), 300-307. https://doi.org/10.1111/eip.12175
Modini, M., Tan, L., Brinchmann, B., Wang, M.J., Killackey, E., Glozier, N.,-¦Harvey, S.B. (2016). Supported employment for people with severe mental illness: Systematic review and meta-analysis of the international evidence. British Journal of Psychiatry, 209, 14-22. https://doi.org/10.1192/bjp.bp.115.165092.
Sveinsdottir, V., Lovik, C., Fyhn, T., Monstad, K., Ludvigsen, K., Overland, S., & Reme, E.S. (2014). Protocol for the effect evaluation of individual placement and support (IPS): A randomized controlled multicenter trial of IPS versus treatment as usual for patients with moderate to severe mental illness in Norway. BioMed Central Psychiatry, 14 (307), 1-10. https://doi.org/10.1186/s1288-014-0307-7
