Economic, Labor, and Regulatory Moderators of the Effect of Individual Placement and Support Among People With Severe Mental Illness: A Systematic Review and Meta-analysis
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As Individual Placement and Support (IPS) has become the international standard for vocational rehabilitation of adults with serious mental illness, researchers must consider the relationship between IPS and local environments. This meta-analysis used mixed-effects meta-regressions to assess the impact of site-level moderators on the likelihood that IPS recipients, compared with recipients of alternative vocational services, achieved competitive employment. Potential moderators included change in gross domestic product (GDP), local unemployment and unionization rates, and indices describing employment protection regulations, level of disability benefits compensation, and efforts to integrate people with disabilities into the workforce. Regulatory moderators represent facilitators and barriers to employment that may reinforce or detract from the effectiveness of IPS. Across 30 sites drawn from 21 randomized controlled trials in 12 countries (33% in the United States), IPS recipients were 2.31 (95% CI 1.99-2.69) times more likely to find competitive employment than recipients of alternative vocational rehabilitation services. The significant competitive-employment rate advantage of IPS over control services increased in the presence of weaker employment protection legislation and integration efforts, and less generous disability benefits. Policy makers should recognize and account for the fact that labor and disability regulations can create an arrangement of incentives that reduces the relative efficacy of supported employment.
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Previous research has offered an explanation for the lower UK outcomes compared with US studies: differences in employment protection legislation and availability of welfare/disability benefits.
“Previous research has offered an explanation for the lower UK outcomes compared with US studies are differences in employment protection legislation availability of welfare/disability benefits [64, 65].”
From An enhanced individual placement and support (iPS) intervention based on the model of human occupation (MOHO); a prospective cohort study (2020) · cites this paper as [65]
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- Authors
- Metcalfe, J. D., Drake, R. E., & Bond, G. R.
- Affiliations
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- Westat (United States) (US)
- Corresponding author
- Metcalfe, Justin D
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-09-28
- Volume
- 44
- Issue
- 1
- Pages
- 22-31
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC5768052
- OpenAlex
- W2757770936
- Cited by
- 82
- References
- 42
- Citations by year
- 2026: 9 · 2025: 4 · 2024: 7 · 2023: 3 · 2022: 7 · 2021: 16 · 2020: 16 · 2019: 12 · 2018: 7 · 2017: 1
- FWCI
- 3.04
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Schizophrenia Bulletin (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Disability, Independent Living, and Rehabilitation Research
- Topics
- Social Sciences › Safety Research › Disability Education and Employment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Keywords
- Individual Placement and Support, severe mental illness
- MeSH terms
- Mental Disorders, Humans, Labor Unions, Rehabilitation, Vocational, Unemployment, Employment, Supported, Persons with Psychiatric Disorders, Mentally Ill Persons, Gross Domestic Product
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