1 / 27

IPS in E urope

IPS in E urope. Research, practice and current challenges Tom Burns University of Oxford. Principles of IPS. Competitive employment Open to anyone who wants to work Rapid job search Attention to client preferences Time-unlimited support Integrated with mental health care

efrat
Download Presentation

IPS in E urope

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. IPS in Europe Research, practice and current challenges Tom Burns University of Oxford

  2. Principles of IPS • Competitive employment • Open to anyone who wants to work • Rapid job search • Attention to client preferences • Time-unlimited support • Integrated with mental health care • Personalised benefits counselling

  3. US evidence • >13 studies (5 RCTs) consistently and overwhelmingly favour IPS over train and place • 20–60% obtain jobs in IPS • 10–20% in train and place • Accepted as the evidence-based standard

  4. Why, then, a European study? • Good evidence from Assertive Community Treatment literature that Mental Health Services research into complex interventions may not travel • Opportunity to exploit differences in European context to illuminate processes

  5. US and Europe very different • Employment culture • US ‘hire and fire’ versus European employment protection and stability • Welfare state provision • European benefits generally higher • Varies considerably across Europe

  6. Benefit trap • Benefits > Salaries • Benefits to make up shortfall in salary; • UK, NT • Benefits ≈ salaries • Benefits linked to previous income; • DE & SW • Benefits < salaries • BG & IT (like USA)

  7. Design and Method • Randomised control trial (RCT) in six European countries • Comparing ‘place and train’ (IPS) with ‘train and place’ • Psychotic patients with extensive unemployment • Randomisation at the patient level, • Stratified using minimisation technique by: • Centre, gender and work history • N=300, 50 from each centre • Assessments at baseline, 6, 12 and 18 months • Primary outcome open employment for one day

  8. Three questions • Is IPS effective in Europe? • Is its effectiveness influenced by broader social factors? • Does return to work for SMI patients involve health risks?

  9. Is IPS effective in Europe?

  10. Vocational outcomes

  11. Is IPS affected by local socio-economic circumstances?

  12. Worked for a day by centre

  13. Socio-economic sources of heterogeneity

  14. Effect of local unemployment rate on IPS vs outcomes

  15. Effect of benefit trap on getting a job overall

  16. Effect of benefit trap on IPS effect size

  17. Does returning to work make you ill?

  18. Hospitalisation during study

  19. Conclusions • IPS is twice as effective in obtaining employment in Europe as standard rehab • 54.5% vs 27.6% • Close to US levels • Effect varies and is influenced by • Local unemployment rates • The benefit trap • Patients are not made unwell by IPS

  20. Current UK IPS Trials • IPS + CBT module • IPS + motivational interviewing • IPS in first onset psychosis • IPS-LITE

  21. IPS-LITE • 9 months, no job – refer back to MH team • ‘perhaps not the right time’ • ‘welcome back if things change’ • 9 months in job • 4 months persisting support with discharge clearly understood • Back to MH team or discharge

  22. Hypotheses • Less effective but higher throughput thus more cost beneficial • Lower right hand corner of cost-benefit plane • More effective • Focuses both client and job coach on getting on with it

  23. What are the challenges? SWAN Trial

  24. What challenges from SWAN? • IPS in high unemployment - recession • Voluntary sector or Health services provision? • Differences between US and UK management cultures for services • Balancing principles • Rapid job search vs client choice • Training or quality control?

  25. Thank you for you time Greetings from Oxford

More Related