ips in e urope
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/1.jpg)
1
IPS in Europe
Research, practice and current challenges
Tom BurnsUniversity of Oxford
![Page 2: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/2.jpg)
4
Principles of IPS
1. Competitive employment2. Open to anyone who wants to work3. Rapid job search4. Attention to client preferences5. Time-unlimited support6. Integrated with mental health care7. Personalised benefits counselling
![Page 3: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/3.jpg)
5
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
![Page 4: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/4.jpg)
6
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
![Page 5: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/5.jpg)
7
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
![Page 6: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/6.jpg)
9
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)
![Page 7: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/7.jpg)
10
![Page 8: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/8.jpg)
11
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
![Page 9: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/9.jpg)
13
Three questions
1. Is IPS effective in Europe?
2. Is its effectiveness influenced by broader social factors?
3. Does return to work for SMI patients involve health risks?
![Page 10: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/10.jpg)
Is IPS effective in Europe?
14
![Page 11: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/11.jpg)
15
Difference between IPS and Vocational Services – vocational and hospitalisation outcomes Outcome IPS Vocational Differenceª 95% CIª p-valueWorked for at least one day 85 (54.5%) 43 (27.6%) 26.9% (16.4, 37.4) <0.001Number of hours worked a 428.8
(706.8)119.1 (311.9) 308.7 (189.2, 434.2)
Number of days employed a 130.3 (174.1)
30.5 (80.1) 99.8% (70.7, 129.3)
Job tenure (days) a 213.6 (159.4)
108.4 (112.0)
104.9% (56.0, 155.0)
Drop-out from service 20 (12.8%) 70 (44.9%) -32.1% (-41.5, -22.7) <0.001
Hospitalized 28 (20.1%) 42 (31.3%) -11.2% (-21.5, -0.90) 0.034
Percentage of time spent in hospital
4.6 (13.6) 8.9 (20.1) -4.3 (-8.40, -0.59)
Vocational outcomes
![Page 12: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/12.jpg)
Is IPS affected by local socio-economic
circumstances?
16
![Page 13: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/13.jpg)
Worked for a day by centre
17
![Page 14: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/14.jpg)
19
Socio-economic sources of heterogeneity
IPS effect Getting a job
Local unemployment rates
0.016 0.001
GDP per capita growth
0.002
% GDP spent on healthLong term unemployment
0.001
Benefit trap 0.004
![Page 15: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/15.jpg)
20
Effect of local unemployment rate on IPS vs outcomes
![Page 16: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/16.jpg)
21
Effect of benefit trap on getting a job overall
![Page 17: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/17.jpg)
22
Effect of benefit trap on IPS effect size
![Page 18: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/18.jpg)
Does returning to work make you ill?
23
![Page 19: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/19.jpg)
24
Difference between IPS and Vocational Services – vocational and hospitalisation outcomes Outcome IPS Vocational Difference 95% CI p-valueWorked for one day at least 85 (54.5%) 43 (27.6%) 26.9% (16.4%,
37.4%)<0.001
Number of hours worked a 428.8 (706.8%)
119.1% (311.9%)
308.7% (189.22%, 434.17%)
Number of days employed a 130.3 (174.1%)
30.5 (80.1%) 99.8% (70.71%, 129.27%)
Job tenure (days) a 213.6 (159.4%)
108.4 (112.0%)
104.9% (56.03%, 155.04)
Drop-out from service 20 (12.8%) 70 (44.9%) -32.1% (-41.5%, -22.7%)
<0.001
Hospitalized 28 (20.1%) 42 (31.3%) -11.2% (-21.5%, -0.90%)
0.034
Percentage of time spent in hospital
4.6 (13.6%) 8.9 (20.1%) -4.3% (-8.40%, -0.59%)
Hospitalisation during study
![Page 20: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/20.jpg)
25
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
![Page 21: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/21.jpg)
Current UK IPS Trials
• IPS + CBT module
• IPS + motivational interviewing
• IPS in first onset psychosis
• IPS-LITE
![Page 22: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/22.jpg)
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
![Page 23: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/23.jpg)
Hypotheses
1. Less effective but higher throughput thus more cost beneficial – Lower right hand corner of cost-benefit plane
2. More effective – Focuses both client and job coach on getting
on with it
![Page 24: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/24.jpg)
What are the challenges?SWAN Trial
29
![Page 25: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/25.jpg)
30
![Page 26: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/26.jpg)
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?
31
![Page 27: IPS in E urope](https://reader036.vdocument.in/reader036/viewer/2022062305/5681668d550346895dda5635/html5/thumbnails/27.jpg)
32
Thank you for you timeGreetings from Oxford