Refining Individual Placement and Support (IPS) and establishing its effectiveness: a pragmatic, non-inferiority RCT (IPS-LITE trial)

Background/Objectives: „Individual Placement and Support“ (IPS) is the evidence-based vocational rehabilitation approach in mental illness. IPS is a radically different approach to getting people back to work with rapid ‘job-searches’ based on a user's own preferences and the IPS worker's knowledge of local opportunities. Evidence has shown that IPS is at least twice as effective as traditional forms of vocational rehabilitation. However its provision is patchy and doubts remain about the best way to deliver it. The aim of this study is to test the comparative efficacy of standard IPS against IPS-LITE with structured reductions in the duration of persistence in engagement and the duration of IPS worker follow-up once open employment is obtained.

Methods: We aim to recruit 160 participants and assessments are conducted at baseline, 9 and 18 months. Recruitment is taking place in the local IPS ‘research’ service in Oxfordshire. Inclusion criteria are: aged 18–60 years, a clinically established diagnosis of mental illness, receiving secondary psychiatric care, unemployment for a minimum of six months, and a declared wish to obtain open employment. Structured interviews are administered by an independent researcher. Data is also obtained from medical records and the employment specialist. Participants are randomised to IPS-LITE (intervention group) or standard IPS group (control). In the standard IPS service client and employer are supported continuously and indefinitely regardless of their employment status. IPS-LITE service follows exactly the same principles as IPS. Clients unplaced after 9 months however are transferred back to the mental health team. Engagement and support are discontinued when clients have been continuously employed for 13 weeks.

Results: At the time of writing the abstract almost 100 participants have been recruited between October 2009 and November 2010. Recruitment is planned to end in the summer of 2011. The nine months follow-up assessment was conducted with 47 participants. The follow-up rate is satisfactory (79%). The full data set will be completed in February 2013.

Discussion/Conclusions: This study aims to provide evidence to improve services which help people with mental health problems to return to work and support them whilst they are there. The IPS-LITE trial is urgent in the current economic climate. The aim of this RCT is to refine and rationalise current practice that will have an impact on service improvements and cost-savings. Results of the study will potentially provide the basis for subsequent trials of refinements and modifications of IPS.

Funding: The Social Psychiatry Group, University of Oxford.

Keywords: Recovery-oriented interventions, randomised controlled trial, vocational rehabilitation.