Stakeholders’ Perspectives on Individual Placement and Support: A Scoping Review

1. Stakeholders’ Perspectives on Individual Placement and Support: A Scoping Review Ningru Chen, MOT Shalini Lal, PhD, MSc, BScOT (Reg. QC)

2. Introduction 1. Mental health and work Paradigm shift since the 90s • Traditional vocational programs • Sheltered workshops • Transitional work • Social enterprises • Supported employment programs • Boston model (Choose Get Keep) • PACT (Assertive community treatment) • IPS (Individual Placement and support) 2. IPS An evidence-based supported employment program • Employment-related outcomes • Achieving competitive work • Speed in achieving work • Number of hours worked • Seniority achieved at work

3. 3. Occupational therapy and IPS • Existing role within the return to work domain • Understanding our place within the paradigm transition • Harmony between IPS principles and occupational therapy • Work is a cornerstone of recovery 4. What led us to our objectives • Current state of research on IPS: • Mainly quantitative methods • Focused on vocational outcomes • Few qualitative reviews • Relevance of our project: • Access to high quality IPS programs remains limited • Shed light on influencing procedural factors • Optimize program implementation • Shed light on necessary modifications

4. Objectives Main objectives: • To synthesise qualitative literature on IPS to gain a better understanding of how stakeholders experience and perceive this intervention • To determine the implications of the reviewed literature for OTs working in IPS programs or planning to implement these initiatives Sub-objectives: • Document the populations of interest in the articles retrieved • Identify predominant concepts linked to clients’, practitioners’, and employers’ experiences of IPS • Document and compare methodological approaches used in the articles retrieved

5. Methodsbased upon the framework proposed by Arskey & O’Malley (2005) Step 1: Identification of the research question: “What is currently known about the experiences and the perceptions of clients, employers and professionals with IPS programs?” Step 2: Identification of relevant studies: MEDLINE, Embase, CINAHL, PsycInfo, Business Source Premier et Proquest Step 3: Selection of articles: 2744 articles werenarrowed down to 26 Step 4: Data extraction: Done for the followingcategories (year of publication, journal, authors and place of study, objective of the study, methodologicalapproach, samplecaracteristics, key results, key conclusions, limitations, mentions of occupationaltherapy) Step 5: Data analysis(inspired by Braun & Clarke, 2006): Manualcodingyielded 103 codes whichweresubsequentlyorganizedinto 4 categories. These 4 categoriesconstitute the main findings of ourreview

6. Prisma flow diagram

7. Results • Overview of articles: • Publishedbetween 1995 and 2018 • 24 articles (85.7%) published in the last 10 years • All werepublished in developed countries • Occupationaltherapy and IPS: • Articles written by at least one occupationaltherapist (n = 9, 35%) • Articles that mention occupationaltherapy at least once (n = 11, 42.3%), of whichsix were conducted in Sweden (n = 6, 54.5%), two in Canada (n = 2, 18.2%) and the rest were from other countries

8. MAIN FINDINGS

9. Category: Features of the IPS model thatstakeholdersappreciate i. Support given by the EmploymentSpecialist (ES) • General • Value of the ES was mentioned by all stakeholder groups • « Vital » (Besse et al., 2017; Boycott et al., 2015; Johnson et al., 2009), « the foundation » (Nygren et al., 2016 ), « the most useful » (Bejerholm et al., 2013) • Personal • Acknowledgement of preferences, honesty and flexibility (clients and ES) (Areberg’s et al., 2013; Gammelgaard et al., 2017) • Informal contact with the ES (e.g. by phone, informal meeting spots) (Johnson et al., 2009) • ES having knowledge on psychiatric disabilities was cited as important to clients because they did not have to explain their condition which made the relationship easier (Areberg et al., 2013) • Practical • Help with CVs, interview preparations and filling out job applications (Areberg et al., 2013; Boycott et al., 2015; Johnson et al., 2009; Larson et al., 2014) • ES presence (eg. during negotiations) positively affected how other professionals saw them and even how clients perceived themselves (Areberg et al., 2013) • Employers valued the presence of the ES at the workplace in terms of practical support involving safety, support and problem solving (Lexen et al., 2016) MAIN FINDINGS

10. ii. Time-unlimited support from IPS • Provides a sense of security (Nygren et al., 2016) (eg. clients who had obtained work still needed the ES when looking to negotiate pay raises or accommodations (Becker et al., 2007) • Helps during periods of symptom relapse (Becker et al., 2007; Coombes et al., 2016) iii. Collaboration between mental health teams and employment teams MAIN FINDINGS • Contributes to client-centered practice, according to clients (Besse et al., 2017; Johnson et al., 2009) and employment specialists (Larson et al., 2014) • Involvement of the mental health care team reassured clients since it made their goals seem more realistic despite their medical history (Areberg et al., 2013) • Bad cooperation between the ES and mental health team can be negative for the client (Areberg et al., 2013)

11. Discussion and Conclusion • The ES stands out as being at the forefront of the IPS intervention. ES role involves a large range of tasks and requirements to be successful which can result in a lot of pressure for one practitioner to carry. • There is a lack of research addressing the perspectives of healthcare professionals which make up the IPS mental health teams. For example, no articles were found to address occupational therapists’ experiences and perceptions of the IPS model. • Future research reporting on employers’ perspectives would be useful since little is known about the concrete strategies used by employment specialists to approach employers and which strategies have proven to be more or less successful in engaging employers to join the IPS network. • Our understanding of the collaboration between the mental health team and the employment team is still limited. Further qualitative research is necessary to report on the nature of this collaboration and the role that mental health clinicians play in IPS. • Overall, understanding the IPS process through stakeholders’ perspectives was challenging because of the lack of descriptive information on program functioning and practitioner roles.

12. References Arksey, H. & O'Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8:1, 19-32, DOI: 10.1080/1364557032000119616 *Areberg, C., Bjorkman, T., & Bejerholm, U. (2013). Experiences of the individual placement and support approach in persons with severe mental illness. Scandinavian Journal of Caring Sciences, 27(3), 589-596. doi:http://dx.doi.org/10.1111/j.1471-6712.2012.01056.x *Becker, D., Whitley, R., Bailey, E. L., & Drake, R. E. (2007). Long-term employment trajectories among participants with severe mental illness in supported employment. Psychiatric Services, 58(7), 922-928. *Besse, C., Poremski, D., Laliberte, V., & Latimer, E. (2018). The meaning and experience of stress among supported employment clients with mental health problems. Health & Social Care in the Community, 26(3), 383-392. doi:https://dx.doi.org/10.1111/hsc.12527 *Boycott, N., Akhtar, A., & Schneider, J. (2015). "Work is good for me": views of mental health service users seeking work during the UK recession, a qualitative analysis. Journal of Mental Health, 24(2), 93-97. doi:https://dx.doi.org/10.3109/09638237.2015.1019044 Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101. *Coombes, K., Haracz, K., Robson, E., & James, C. (2016). Pushing through: Mental health consumers' experiences of an individual placement and support employment programme. British Journal of Occupational Therapy, 79(11), 651-659. doi:10.1177/0308022616658297 *Gammelgaard, I., Christensen, T. N., Eplov, L. F., Jensen, S. B., Stenager, E., & Petersen, K. S. (2017). 'I have potential': Experiences of recovery in the individual placement and support intervention. International Journal of Social Psychiatry, 63(5), 400-406. doi:https://dx.doi.org/10.1177/0020764017708801 *Johnson, R. L., Floyd, M., Pilling, D., Boyce, M. J., Grove, B., Secker, J., . . . Slade, J. (2009). Service users' perceptions of the effective ingredients in supported employment. Journal of Mental Health, 18(2), 121-128. doi:http://dx.doi.org/10.1080/09638230701879151 *Larson, J. E., Sheehan, L., Ryan, C., Lemp, S., & Drandorff, L. (2014). Practitioner perspectives on Individual Placement and Support (IPS) for individuals with serious mental illness. Journal of Vocational Rehabilitation, 41(3), 225-235. doi:http://dx.doi.org/10.3233/JVR-140715

13. *Lexen, A., Emmelin, M., & Bejerholm, U. (2016). Individual Placement and Support is the keyhole: Employer experiences of supporting persons with mental illness. Journal of Vocational Rehabilitation, 44(2), 135-147. doi:http://dx.doi.org/10.3233/JVR-150786 *Nygren, U., Markström, U., & Bernspång, B. (2016). Processes towards employment among persons with psychiatric disabilities: a study of two individual placement and support programmes in Sweden. Scandinavian Journal of Disability Research, 18(1), 32-51. doi:10.1080/15017419.2014.964765 For those interested, please contact ningru.chen@gmail.com for a full list of references Acknowledgements The authors would like to acknowledge the assistance of Myriam Grondin, university librarian specialized in rehabilitation, in refining the research strategy of this study and Danielle Starcevic, research intern, for aiding in the pilot screening process for the selection of studies.