New IPS Research Findings Gary Bond May 22, 2018 IPS Learning Community Annual Meeting Nashville, TN

Some General Trends IPS research continues to flourish, with continued growth in number of new studies Researchers are exploring the boundaries of the IPS model Some research raises questions about adaptation versus fidelity to IPS

Four Trends in IPS Research Expanding the evidence base Expanding IPS to new populations Balancing fidelity and adaptation Growing acceptance of IPS as the standard for employment services

1. Expanding the evidence base Number of studies showing IPS effectiveness continues to grow Recent long-term follow-up of IPS studies show sustained improvement in employment outcomes

Characteristics of RCTs of IPS 12 U.S. studies and 14 outside U.S. In most studies, participants were already enrolled in mental health services prior to entering study In most studies the control group received services as usual (sometimes best practices) 2/3 studies had at least 18-month follow-up

International Growth of IPS Evidence Base

Competitive Employment Rates in 26 Randomized Controlled Trials of IPS

Overall Findings for 26 RCTs 25 of 26 studies showed a significant advantage for IPS (One exception: trial in Wuxi, China) Mean competitive employment rates for the 26 studies: 55% for IPS 23% for controls

Long-Term IPS Outcomes IPS aims at changing the life trajectory Understanding the long-term outcomes is critical for any intervention

Steady Worker Rate in 3 Long-Term Studies Follow-up periods: Hoffmann (2014): 5 years; Salyers (2004): 10 years; Becker (2007) 8-12 years

Mental Health Treatment Study: 6-8 years later Outcome IPS Control p-value n=1,114 n=1,107 Competitively employed during 2 years after enrollment (self-report) 52.4% 33.0% <.0001 Competitively employed during 5 years of follow-up (IRS data) 48.0% 39.2% Mean total earnings during 5 years of follow-up $13,049 $9,145 0.003 Mean total earnings during 5 years of follow-up, earners only $27,172 (N = 535) $23,362 (N = 434) 0.168

Long-Term Outcomes in MHTS: Significance of Findings (Baller, 2017) Largest IPS study ever conducted Long-term outcomes based on objective administrative data from IRS Data set is 99% complete Strong support that IPS effects are enduring after participants end IPS services

2. Expanding IPS to New Populations The range of work-limiting conditions is much larger than serious mental illness The single largest group is musculoskeletal (MSK) disorder “Common mental disorders,” which include anxiety and depression, is another large group

3. Expanding IPS to new populations

Expanding IPS to new populations (Continued) Autism spectrum disorders (McLaren, 2017) Intellectual disabilities (Noel, 2018) Chronic medical conditions (Davis, in progress)

Competitive Employment Rates in Evaluations of IPS for Special Populations

3. Balancing Fidelity and Adaptation Does IPS need to be adapted for new populations? Does IPS need to be modified to accommodate labor laws, disability policies, and economies in different countries (Metcalfe, 2018)? Can IPS be enhanced, for example, by adding cognitive remediation (McGurk, 2014)?

Fidelity-Employment Outcome Findings Hypothesis: Programs that attain high fidelity to an evidence-based practice will obtain similar outcomes as in the original studies Therefore, fidelity to IPS should predict better employment outcomes Many research studies are modifying IPS – often hard to evaluate outcomes from these studies

IPS Fidelity is Positively Correlated with Competitive Employment Outcomes

4. Growing Acceptance of IPS as the Standard for Employment Services IPS is now widely recognized in among researchers, program leaders, and policy planners in mental health, VR, and VA as the gold standard for employment services

Among 26 vocational practices, only IPS rated highly relevant (3rd) and highly evidence-based (3rd) by VR subject matter experts (Leahy et al., 2018)

Wewiorski et al. (2018). Promising practices in vocational services for the community reintegration of returning veterans: The individual placement and support model and beyond. Psychological Services, 15(2), 191-199. Abstract Supporting returning veterans’ job-seeking, hiring, and retention issues has become an essential goal for effective community reintegration. Given both the particular strengths and challenges associated with veterans transitioning from military to civilian life, multiple models for supported employment have become integrated into Veterans Affairs health care facilities across the nation. In this article, we review the state of vocational rehabilitation for veterans, with a particular focus on individual placement and support—supported employment (IPS-SE), the current vocational services model that is considered the gold standard of vocational rehabilitation. Various modifications to the IPS-SE model are presented, including additions such as cognitive rehabilitation, contingency management, motivational interviewing, supported self-employment, and transitional work. Finally, recommendations are made about future directions and strategies to expand access to IPS-SE-based programs and to effectively meet the needs of returning veterans for employment in jobs of their choice. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Summary The effectiveness of IPS has been replicated in scores of studies over the last three decades International studies and tests of IPS in new populations are accelerating the growth of IPS research