An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MoHO); a prospective cohort study
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Date
2020-07-08Author
Prior, Susan
Maciver, Donald
Aas, Randi W.
Kirsh, Bonnie
Lexen, Annika
van Niekerk, Lana
Irvine-Fitzpatrick, Linda
Forsyth, Kirsty
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Prior, S., Maciver, D., Aas, R. W., Kirsh, B., Lexen, A., van Niekerk, L., Irvine-Fitzpatrick, L. & Forsyth, K. (2020) An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MoHO); a prospective cohort study. BMC Psychiatry, 20:361.
Abstract
Background: Employment is good for physical and mental health, however people with severe mental illness (SMI)
are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting
around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to
improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will
benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach
to predicting who may achieve successful outcomes. Methods: This prospective cohort study included people with SMI who participated in an enhanced IPS service
and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine
clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select
variables to be included in the initial model, followed by a backward stepwise approach to model building for the
final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or
education). Results: Sixty-three percent of participants in the enhanced IPS successfully attained employment or education.
Significant relationships from bivariate analyses were identified between outcomes (employment or education) and
seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of
Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic
regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(7) = 41.38 p < .001. Conclusion: An enhanced IPS service had a 63% rate success in achieving employment or education, higher than
comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations.
Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS
intervention supporting people after prolonged absence from employment. Trial registration: NCT04083404 Registered 05 September 2019 (retrospectively registered).