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

2. 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

3. 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

4. 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

5. 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

6. International Growth of IPS Evidence Base

7. Competitive Employment Rates in 26 Randomized Controlled Trials of IPS

8. 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

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

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

11. 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 years of follow-up
$13,049
$9,145
0.003
Mean total earnings during years of follow-up, earners only
$27, (N = 535)
$23, (N = 434)
0.168

12. 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

13. 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

15. 3. Expanding IPS to new populations

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

17. Competitive Employment Rates in Evaluations of IPS for Special Populations

18. 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)?

19. 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

20. IPS Fidelity is Positively Correlated with Competitive Employment Outcomes

21. 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

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

23. 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),
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)

24. 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