Fidelity and IPS: does quality of implementation predict vocational outcomes over time for organizations treating person
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ORIGINAL PAPER
Fidelity and IPS: does quality of implementation predict vocational outcomes over time for organizations treating persons with severe mental illness in the Netherlands? Lars de Winter1 · Christianne Couwenbergh1 · Jaap van Weeghel1 · Cris Bergmans1 · Gary R. Bond2 Received: 22 December 2019 / Accepted: 18 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Individual placement and support (IPS) is an evidence-based supported employment intervention. Quality of IPS implementation is assessed using a validated fidelity scale. Previous studies found a positive association between fidelity and employment outcomes at a single time-point. This study examines the longitudinal associations between IPS fidelity scores and employment outcomes. Methods We examined fidelity and employment outcome data for 27 IPS programs in the Netherlands providing IPS. These programs received at least one fidelity assessment and reported quarterly employment outcomes for at least one year to a central registry between 2014 and 2019. We first examined changes over time for fidelity and employment outcome. Then we analyzed the longitudinal associations between the quarterly employment outcomes and the IPS fidelity assessments on multiple time-points using a mixed-model analysis for the 17 programs with at least two fidelity assessments. Results Both IPS fidelity and employment outcomes improved over time, with the largest improvement in employment outcomes achieved after 18 months of implementation. We found a significant positive longitudinal association between IPS-fidelity and employment. Conclusions Improvement of fidelity is associated with improvement of employment outcomes over time. Future research should be focused on the improvement of specific elements of IPS implementation and their influence on employment outcomes. Keywords IPS · Fidelity · Employment · Work · Longitudinal
Introduction Employment is a key factor in rehabilitation for people with severe mental illnesses (SMI). Competitive employment offers clients financial independence, contributes to their recovery process and has beneficial effects on mental health, self-esteem and quality of life [1, 2]. However, employment rates for people with SMI are far lower than in the general population. National surveys in the Netherlands have found that only 10%–17% of clients with SMI in specialized secondary care were competitively employed, * Lars de Winter [email protected] 1
Phrenos Center of Expertise for Severe Mental Illness, Utrecht, The Netherlands
Westat, Lebanon, NH, USA
2
with no indications of improvement over time [3–5]. Mental health providers often view people with SMI as unable to work competitively. Partly as a reflection of these beliefs, 89% of people with SMI receive disability benefits [6] and, until recently, they were often placed in sheltered employment settings [7]. The disincentives for people with SMI to seek competitive employment are especially strong in high welfare countries such a
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