Table 2

Implementation context for IPS intervention studies

ReferenceLong-term conditionCountryCommunity and economic contextIntervention team settingKey implementation information reported
Bejerholm et al, 201714Affective disorderSwedenSwedish context (little information regarding community and economic context). Middle-sized cities, geographically diverse.Employment specialist (with additional specialist training in cognitive behavioural therapy, motivational interviewing and time-for-work strategies) and participant working closely with outpatient (mental health?) team, family, social insurance agency and public employment service.This service was delivered in the context of mental health services. The theory appears to be that this population can benefit from leading the process more through motivational and empowerment strategies. Two additional principles specific to the population focus on enabling motivation and creating cognitive strategies characterise the Individual Enabling Support (IES). These are in addition to the usual IPS principles: ‘(1) handling change and developing motivational and cognitive strategies, (2) having a time-use pattern that supports work-life balance.’ (p213)
‘The extent of the counselling is individualized to fit the intervention need of the participant. IES involves phases of (1) enabling mobilization of motivational, cognitive, and lifestyle strategies, (2) completion of a career profile and plan, (3) job-seeking, and (4) supported employment phase during which mobilized strategies are intertwined. Phases 1 and 2 last for 1–2 months. Phase 3 lasts until employment is reached. Phase 4 is the remaining time. The duration and intensity of phases 1, 2, and 3 are approximately one hour per week, while phase 4 requires 20 min per week.’ (p214)
Davis et al, 201243Veterans with Post Traumatic Stress DisorderUSAArmed forces veterans are able to receive compensation from the veteran’s health administration. Medical centres specifically for veterans. Programme delivered through a medical centre in Tucaloosa.Employment specialist integrated into the veterans mental health treatment teamIPS service was delivered in line with two IPS manuals, but operated as part of the Veterans Health Administration Compensation Work Therapy programme. 25 client maximum caseload. Table 1 (p466) in the article outlines the difference between the IPS service and the usual care service provided through the same programme.
Davis et al, 201842Veterans with Post Traumatic Stress DisorderUSAArmed forces veterans are able to receive compensation from the veteran’s health administration (VA). Medical centres specifically for veterans. Programme delivered through these VA medical centres was a stepped programme that included transitional work.Employment specialist integrated into the veterans mental health treatment team25 client maximum caseload. Brief reporting, the intervention format appears similar to the 2012 study.
Hellström et al, 201712Affective disorder or anxietyDenmarkJob centres in Denmark deliver a variety of vocational support services for people who need to find work. Benefits can be received for a maximum of 52 weeks. In contrast to the usual job centre services, the intervention was delivered by a private company.Each individual allocated a mentor (minimum 10 years experience in mental health as nurse, occupational therapist or social worker) and a career counsellor.Eligible participants had not received any metal health services in the last 3 years.
IPS–MA is detailed in full in the published protocol.48
‘Briefly, the intervention consisted of mentor support and career counselling, providing five basic services: individualised mentor support based on psychiatric knowledge; coordination of services provided; career counselling; impartial help to clarify private economy (this included benefits counselling if required); and contact with employers to help participants obtain jobs and keep them. Focus was on competitive employment and support was time unlimited. A plan of action was created based on goals, resources and challenges related to work/education, social relations and leisure activities, and the plan was evaluated regularly. Participants had the same mentor throughout the intervention, and support continued for as long as needed. The number and duration of contacts depended on the individual needs; most met with their mentor once a week for 1–1 1/2 hours. Each mentor had a maximum caseload of 20 participants in order to secure the flexibility of the support.’ (p718)
Poremski et al, 201713Mental illnessCanadaPeople with recent homelessness. Delivered in the context of a Housing First programme.Employment specialist (trained by a senior member from a local IPS service) integrated into the Housing First clinical services teamOnly reported that they delivered the IPS approach, delivered by an employment specialist located within the Housing First service.
Reme et al, 201527Mainly anxiety and/or depression, including subthreshold for diagnosisNorwayWorker’s compensation programme that provides 100% of former income until return to work or up to 52 weeks, and long-term benefits after that averaging 66% of former income. Employment support is an aspect of the services offered. These services are an adaptation of the Individual Placement and Support model (see implementation info). The adaptations were related to the mild–moderate population but also the service delivery constraints.‘Mini-team’ of team leader (psychologist), employment specialist knowledgeable in IPS and psychological therapist (psychology or similar degree and cognitive behavioural therapy trained).Eligibility assessment conducted by clinical psychologist. Based on self-report symptoms.
Participants needed to express motivation to return to work to participate.
Up to 15 cognitive behavioural therapy sessions were offered in addition to the IPS principle-based approach
The hypothesis was that the interaction between these two aspects of services for the particular population that would make the difference. The online protocol provides a full breakdown of the interpretation of the principles of Individual Placement and Support in the context of the At Work And Coping intervention: https://oem.bmj.com/content/oemed/suppl/2015/07/24/oemed-2014-102700.DC1/oemed-2014-102700supp_Protocol.pdf
Reme et al, 201939Diagnosed psychiatric disorder (moderate severity)NorwaySmall, open economy with low unemployment rate. The authors describe the policy context as ‘high job security and a comprehensive welfare system’. High sickness absence rates compared with other OECD countries.Employment specialist as part of the mental health treatment team.IPS was delivered in a special ‘IPS centre’. This was in contrast to the usual vocational services which these authors have described in the previous study as IPS-based. Note that this may influence effect size. The protocol describes the principles of IPS and fidelity information is provided. No further detail on implementation is reported.
  • IPS, Individual Placement and Support.