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Cited by 26Disability Education and EmploymentSchizophrenia research and treatmentOccupational Therapy Practice and Research

An enhanced individual placement and support (iPS) intervention based on the model of human occupation (MOHO); a prospective cohort study

Open access
Prior, Susan, Maciver, Donald, Aas, Randi W., Kirsh, Bonnie, Lexen, Annika, van Niekerk, Lana, Irvine Fitzpatrick, Linda, Forsyth, Kirsty·2020·BMC Psychiatry
DOI 10.1186/s12888-020-02745-3PMC PMC7346406
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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 R 2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ 2(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).

AI snapshot

Written from the paper’s full text.

TL;DR

An enhanced IPS service delivered by occupational therapists and underpinned by MOHO achieved employment or education for 63% of people with severe mental illness and prolonged absence from work. The final model found that adapting routines to minimise difficulties, work-related goals, and living in a less deprived area predicted successful goal attainment.

Key findings

  • Of 202 participants, 128 (63%) attained employment or education and 74 (37%) did not; in the multiple logistic regression sample of 195 cases, 124 (64%) succeeded and 71 (36%) did not.
  • The final multiple logistic regression model was significant, Model χ2(7) = 41.38, p < .001, with R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), and 0.26 (Nagelkerke).
  • Significant predictors in the final model were Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation; Age had borderline significance (p < 0.1).
  • A “supports” rating for Adapting Routines to Minimise Difficulties increased the likelihood of goal attainment by 261%, Work Related Goals by 143%, and living in a less deprived area improved the odds by 166%.

Methods

  • Prospective cohort study using secondary analysis of routine clinical data from an established vocational rehabilitation service delivering enhanced IPS by occupational therapists, underpinned by the Model of Human Occupation; referrals from 2015–2018 were screened (353 people), and 202 met inclusion criteria.
  • Inclusion criteria were SMI, age 18+, consented to enhanced IPS, had a goal of paid employment or education, and had ongoing intervention or discharge prior to successful outcome; exclusions included no employment/education goal, already in employment, refused engagement, or withdrew.
  • Measures included the Worker Role Interview (WRI), with the 4-point scale collapsed into binary “supports” vs “interferes,” and Scottish Indices of Multiple Deprivation (SIMD); analysis used bivariate chi-square/Yates and t-tests, a p < 0.06 inclusion threshold, clinical consultation, and backward stepwise multiple logistic regression in R.

Limitations

  • The paper states the demographic profile does not represent the SMI population: more males than females, very few younger people, 17% married/de facto, 51% living alone, 60% educated beyond school, low ethnic diversity, and 32% in the least deprived area; excluded patients may have skewed data, though more than half were not appropriate IPS participants.
  • The paper states previous employment was unusually high (90%) because it was defined as any work from teenage life to present, ignoring recency, so comparisons with other studies are not possible; reliance on routine clinical data captured only attainment, not retention, type, or duration of work/education.
  • The paper states missing data occurred, especially for environmental WRI items, because therapists found some items difficult to rate in people with long-term unemployment; evident from the design, this was an observational cohort without a control group, so causal attribution to enhanced IPS is not possible.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12888-020-02745-3

Cites

80 of 80 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 82 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The final multiple logistic regression model had R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke).

    “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).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Sixty-three percent of participants in the enhanced IPS successfully attained employment or education.

    “Sixty-three percent of participants in the enhanced IPS successfully attained employment or education.”
    • Also stated in: § Intervention · plain
      “Positive outcomes of the enhanced IPS intervention were first attainment of employment or educational opportunity, 128 participants (63%) had a positive outcome and 74 (37%) were unsuccessful.”
    Quote in the paperSubstantial claim
  • Findingown data

    Adapting Routines to Minimise Difficulties was significant in predicting employment or education in the final multiple logistic regression model.

    “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).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Collapsing the 4-point WRI scale into a binary rating (supports vs interferes) is a valid way to measure the psychosocial variables.
  • Findingown data

    Living in an Area of Lesser Deprivation was significant in predicting employment or education in the final multiple logistic regression model.

    “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).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Scottish Indices of Multiple Deprivation (SIMD) provides a valid relative measure of deprivation by postcode.
  • Findingown data

    Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables.

    “Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Collapsing the 4-point WRI scale into a binary rating (supports vs interferes) is a valid way to measure the psychosocial variables.
  • Classified as probably not a substantial claim. 37
  • May combine two claims. 30

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The multiple logistic regression included 195 cases after excluding cases with missing data in covariates of interest.

    “The exclusion of cases containing missing data in the covariates of interest resulted in an inclusion of 195 cases in the multiple logistic regression [58].”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Missing data in the covariates of interest were missing at random, so excluding cases with missing data did not bias the multiple logistic regression results.

  • May combine two claims.

    Findingown data

    Our study found seven psychosocial items from the intake assessment were significantly correlated with outcome (p < 0.01), and two of these items (Adapts Routines to Minimise Difficulties and Work Related Goals) contribute to a multiple regression model.

    “Our study found seven psychosocial items from the intake assessment were significantly correlated with outcome (p < 0.01), and two of these items (Adapts Routines to Minimise Difficulties and Work Related Goals) contribute to a multiple regression model.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Age had borderline significance within the multiple logistic regression model.

    “The variable Age has borderline significance within the model.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Therapists involved in this present study concurred with other authors that environmental factors are clinically important.

    “Additionally, therapists involved in this present study concurred with other authors [34, 70, 71] that the environmental factors are clinically important.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34] Kirsh BH. Client, contextual and program elements influencing supported employment: a literature review. Community Ment Health J. 2016;52:809–20. source

      Not checked in the free run.

    • cites [70] Argentzell E, Eklund M. Perceptions of the worker role among people with psychiatric disabilities: description and investigation of associated factors. Work. 2013;45:289–98. source

      Not checked in the free run.

    • cites [71] Prior S, Maciver D, Forsyth K, Walsh M, Meiklejohn A, Irvine L. Readiness for employment: perceptions of mental health service users. Community Ment Health J. 2013;49:658–67. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Of the 195 cases in the multiple logistic regression, 124 (64%) had a successful outcome and 71 (36%) were unsuccessful.

    “One hundred and twenty four (64%) had a successful outcome and 71 (36%) were unsuccessful.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Outcome was borderline significantly associated with Educational Attainment (p = 0.05) and Assesses Abilities and Limitations (p = 0.06).

    “Borderline significant relationships were identified between Outcome and Educational Attainment (p = 0.05) and Assesses Abilities and Limitations (p = 0.06).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Therapists described difficulty rating some of the WRI items due to the absence of recent employment experience to reflect upon and this resulted in missing data.

    “Therapists described difficulty rating some of the WRI items due to the absence of recent employment experience to reflect upon and this resulted in missing data.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Perception of Family and Peers was not found to be significant, but was considered a clinically important factor by therapists in this present study.

    “Perception of Family and Peers, was not found to be significant, however, was considered a clinically important factor by therapists in this present study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The present study had a high rate of those in marital/equivalent relationships; more males than females and very few younger people.

    “The present study had a high rate of those in marital/equivalent relationships; more males than females and very few younger people.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Age was a significant variable at univariate analysis in this present study but was not significant in the multiple regression model.

    “Age was a significant variable at univariate analysis in this present study but was not significant in the multiple regression model.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The sample was predominately well educated, with 60% having pursued education beyond school level, had a low ethnic diversity and a third (32%) of the sample lived in an area classified as in least deprived.

    “The sample was also predominately well educated, with 60% having pursued education beyond school level, had a low ethnic diversity and a third (32%) of the sample lived in an area classified as in least deprived.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In the present study 17% of the sample were married or de facto relationship, while in UK population study only 0.5% of those with a psychotic illness were in a similar relationship.

    “In the present study 17% of the sample were married or de facto relationship, while in UK population study only 0.5% of those with a psychotic illness were in a similar relationship [79].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] McManus S, Meltzer H, Brugha TS, Bebbington PE, Jenkins R. Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. The NHS Information Centre for Health and Social Care (2009). Leeds: The NHS Information Centre for Health and Social Care. p. 2009.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The continuous variable age met the assumptions for unpaired t-test, and the assumptions regarding estimated distribution was confirmed for each categorical variable applying Yates correction when required.

    “The continuous variable age met the assumptions for unpaired t-test, and the assumptions regarding estimated distribution was confirmed for each categorical variable applying Yates correction when required.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Nineteen percent of occupational therapists did not complete certificated IPS training during their time with the service, but mentorship and supervision ensured an evidence-based approach was maintained in IPS and MOHO.

    “Nineteen percent did not complete certificated IPS training during their time with the service, but mentorship and supervision ensured an evidence-based approach was maintained in IPS and MOHO.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The WRI identifies psychosocial and environmental factors that influence a client's ability to find a job, remain in work, or return to work after injury or disease.

    “The WRI identifies psychosocial and environmental factors that influence a client’s ability to find a job, remain in work, or return to work after injury or disease [36, 46].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [36] Taylor RR. In: Taylor RR, editor. Kielhofner's model of human occupation. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2017.

      Not checked in the free run.

    • cites [46] Braveman B, Robson M, Velozo CA, Kielhofner G, Fisher GS, Forsyth K, et al. Worker role interview (WRI) (version 10.0). Chicago: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago; 2005.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other studies, including a meta-analysis, have found no association between active positive symptoms and employment outcomes.

    “Some studies have found active, positive symptoms are associated with failure to attain employment [22, 23] or loss of employment [24]; while others, including a meta-analysis [15], have found no association.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Tsang HW-H, Leung AY, Chung RCK, Bell MD, Cheung W. Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998. Aust NZ J Psychiatry. 2010;44:495–504.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some studies have found active positive symptoms are associated with failure to attain employment or loss of employment.

    “Some studies have found active, positive symptoms are associated with failure to attain employment [22, 23] or loss of employment [24]; while others, including a meta-analysis [15], have found no association.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [22] Salkever DS, Karakus MC, Slade EP, Harding CM, Hough RL, Rosenheck RA, et al. Measures and predictors of community-based employment and earnings of persons with schizophrenia in a multisite study. Psychiatr Serv. 2007;58:315–24. source

      Not checked in the free run.

    • cites [23] Rosenheck RA, Leslie D, Keefe R, McEvoy J, Swartz M, Perkins D, et al. Barriers to employment for people with schizophrenia. Am J of Psychiat. 2006;163:411–7. source

      Not checked in the free run.

    • cites [24] Marwaha S, Johnson S, Bebbington PE, Angermeyer MC, Brugha TS, Azorin J-M, et al. Predictors of employment status change over 2 years in people with schizophrenia living in Europe. Epidemiol Psychiatr Soc. 2009;18:344–51. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The WRI has a sound theoretical base in MOHO.

    “The WRI has a sound theoretically base, the Model of Human Occupation (MOHO) [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Taylor RR. In: Taylor RR, editor. Kielhofner's model of human occupation. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2017.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Final model diagnostics included checking for independence of errors, absence of multicollinearity, and lack of strongly influential outliers.

    “Final model diagnostics included checking for independence of errors, absence of multicollinearity, and lack of strongly influential outliers [53, 55, 56].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [53] Stoltzfus JC. Logistic Regression: a brief primer. Acad Emerg Med. 2011;18:1099–104 Blackwell Publishing Ltd. source

      Not checked in the free run.

    • cites [55] Field A. Logistic Regression. Discovering Statistics Using R. Thousand Oaks: Sage Publications, Incorporated; 2012. p. 312–59.

      Not checked in the free run.

    • cites [56] Regression FA. Discovering statistics using R. Thousand Oaks: Sage Publications, Incorporated; 2012. p. 245–311.

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Key assumptions of logistic regression were tested: independence of errors, linearity of relationship between continuous predictor variables and log-transformed outcome, absence of multicollinearity between predictor variables.

    “Key assumptions of logistic regression were tested: independence of errors, linearity of relationship between continuous predictor variables and log-transformed outcome, absence of multicollinearity between predictor variables.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The dataset was designed in collaboration with the academic team at inception, ensuring measurement tools and data would be appropriate to research purposes.

    “The dataset was designed in collaboration with the academic team at the inception of this service, thus ensuring that the measurement tools and data would be appropriate to research purposes [44, 45].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [44] Doolan DM, Froelicher ES. Using an existing data set to answer new research questions: a methodological review. Res Theory Nurs Pract. 2009;23:203–15. source

      Not checked in the free run.

    • cites [45] Cheng HG, Phillips MR. Secondary analysis of existing data: opportunities and implementation. Shanghai Arch Psychiatry. 2014;26:371–5.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The only other adaptation to standard IPS studied in the UK is IPS-Lite, which yielded a success rate of 41% compared to standard IPS employment rate of 46%.

    “To date the only other adaptation to standard IPS studied in the UK is the IPS-Lite [62], establishing that a time-limited (up to 9 months) implementation of IPS-Lite yielded a success rate of 41% compared to standard IPS employment rate of 46%.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Burns T, Yeeles K, Langford O, Montes MV, Burgess J, Anderson C. A randomised controlled trial of time-limited individual placement and support: IPS-LITE trial. Br J Psychiatry. 2015;207:351–6. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A study of IPS enhancement through cognitive remediation identified enhanced IPS (69.6%) over standard IPS (14.3%), but low adherence to IPS fidelity was reported in both arms.

    “A study of IPS enhancement through cognitive remediation [67] identified enhanced IPS (69.6%) over standard IPS (14.3%), but, low adherence to IPS fidelity was reported in both arms of the study, which may explain the poor standard IPS outcome.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] McGurk SR, Mueser KT, Feldman K, Wolfe R, Pascaris A. Cognitive training for supported employment: 2-3 year outcomes of a randomized controlled trial. Am J of Psychiat. 2007;164:437–41. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Another study investigating enhancement through cognitive remediation reported enhanced IPS yielding 15.2% employment outcomes and 14.9% for standard IPS.

    “Moreover, another study investigating enhancement through cognitive remediation reported enhanced IPS yielding 15.2% employment outcomes and 14.9% for standard IPS [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Sato S, Iwata K, Furukawa S-I, Matsuda Y, Hatsuse N, Ikebuchi E. The effects of the combination of cognitive training and supported employment on improving clinical and working outcomes for people with schizophrenia in Japan. CP EMH. 2014;10:18–27.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    This difference perhaps reflects how psychosocial variables vary depending on people having an employment experience to reflect upon and how daily routines change to reflect a short period of absence compared to a complete non-existence of worker role.

    “This difference perhaps reflects how psychosocial variables vary depending on people having an employment experience to reflect upon and how daily routines change to reflect a short period of absence compared to a complete non-existence of worker role.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The present study offers an additional enhanced IPS program not currently being studied within the field.

    “The present study offers an additional enhanced IPS program not currently being studied within the field.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Premisecitation

    In general, models with fewer variables are simpler; and without evidence of a significant difference, the simpler model is preferred.

    “In general, models with fewer variables are simpler; and without evidence of a significant difference, the simpler model is preferred [53, 54].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [53] Stoltzfus JC. Logistic Regression: a brief primer. Acad Emerg Med. 2011;18:1099–104 Blackwell Publishing Ltd. source

      Not checked in the free run.

    • cites [54] Hosmer DW Jr, Lemeshow S, Sturdivant RX. Applied Logistic Regression. 3rd ed. Hoboken: Wiley; 2013. p. 1–510. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Work Habits and Routines are emerging as promising predictors of employment or educational outcomes.

    “Work Habits and Routines are also emerging as promising predictors of employment or educational outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Three cases (1%) were identified as outliers to the final model, but Cook's influence level of 0.03 in all cases demonstrated they had little influence, so they were included.

    “outliers were identified, three cases (1%) were identified as outliers to the final model. A Cook’s influence level of only 0.03 in all cases demonstrated the outliers have little influence over the final model. Therefore these cases were included.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    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].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [64] Burns T, Catty J, Becker T, Drake R, Fioritti A, Knapp M, et al. The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet. 2007;370:1146–52. source

      Not checked in the free run.

    • cites [65] Metcalfe JD, Drake R, Bond GR. 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. Schizophr Bull. 2018;44:22–31. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The present study complements IPS-Lite by offering an enhanced IPS to support those unable to attain employment within the IPS-Lite defined 9 months, particularly those who require a more complex intervention than standard IPS.

    “The present study compliments IPS Lite by offering an enhanced IPS to support those unable to attain employment within the IPS-Lite defined 9 months, particularly those who require a more complex intervention than standard IPS.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Work Habits, while significant in the present study, has not been found to be significant in any other study predicting employment outcomes.

    “Work Habits, while significant in the present study, has not been found to be significant in any other study predicting employment outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Younger age increases the likelihood of a successful outcome, although age did not reach statistical significance in the model (p < 0.1).

    “Age while not reaching levels of statistical significance within the model (p < 0.1) a younger age increases the likelihood of a successful outcome.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Together these items offer measurable rating of the enactment of desire for employment.

    “Together these items offer measurable rating of the enactment of desire for employment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    UK randomised control trials of standard IPS outcomes are 46% and 22%.

    “In addition, the UK randomised control trials (RCT) of standard IPS outcomes are 46% [62] and 22% [63].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [62] Burns T, Yeeles K, Langford O, Montes MV, Burgess J, Anderson C. A randomised controlled trial of time-limited individual placement and support: IPS-LITE trial. Br J Psychiatry. 2015;207:351–6. source

      Not checked in the free run.

    • cites [63] Heslin M, Howard LM, Leese M, McCrone P, Rice C, Jarrett M, et al. Randomized controlled trial of supported employment in England: 2 year follow-up of the Supported Work and Needs (SWAN) study. World Psychiatry. 2011;10:132–7. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Alternative enhancements are still in development and reliable research findings are not yet established.

    “It could be concluded that alternative enhancements are still in development and reliable research findings not yet established.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous studies have argued that future research should investigate psychosocial variables which may predict success.

    “Previous studies have argued that future research should investigate psychosocial variables which may predict success [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Metcalfe JD, Riley J, McGurk SR, Hale T, Drake R, Bond GR. Comparing predictors of employment in individual placement and support: a longitudinal analysis. Psychiatry Res. 2018;264:85–90. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Work Habits and Assesses Abilities and Limitations were excluded from the initial logistic model because they were considered challenging to rate in clinical practice for long term unemployed and of limited clinical applicability in this population.

    “Following clinical consultation, two variables i.e., Work Habits and Assesses Abilities and Limitations, were excluded from the initial logistic model. Both variables were considered challenging to rate in clinical practice for long term unemployed and, therefore, of limited clinical applicability in this population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Individual placement and support enhanced with social skills training found 82.8% of participants in the enhanced IPS attained employment compared to 61.5% of standard IPS participants.

    “Individual placement and support enhanced with social skills training [66], found 82.8% of participants in the enhanced IPS attained employment compared to 61.5% of standard IPS participants.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] Tsang HW-H, Fung KMT, Leung AY, Li SMY, Cheung WM. Three year follow-up study of an integrated supported employment for individuals with severe mental illness. Aust N Z J Psychiatry. 2010;44:49–58. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The rating scale measures the impact of items on the client's work ability.

    “The rating scale measures the impact of items on the client’s work ability [46].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Braveman B, Robson M, Velozo CA, Kielhofner G, Fisher GS, Forsyth K, et al. Worker role interview (WRI) (version 10.0). Chicago: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago; 2005.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Work Routines was significant in a study predicting return to work from sickness absence at both univariate level and within multivariate regression.

    “Work Routines was also significant in a study predicting return to work from sickness absence [38] at both univariate level and within multivariate regression.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Ekbladh E, Thorell L-H, Haglund L. Return to work: the predictive value of the worker role interview (WRI) over two years. Work. 2010;35:163–72. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous research has found work related goals expressed as a desire to work is predictive of positive employment outcome.

    “Previous research has also found work related goals expressed as a desire to work [29, 30] is predictive of positive employment outcome.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [29] Kirsh BH. Factors associated with employment for mental health consumers. Psychiatr Rehabil J. 2000;24:13–219p. source

      Not checked in the free run.

    • cites [30] Campbell K, Bond GR, Drake R. Who benefits from supported employment: a meta-analytic study. Schizophr Bull. 2011;37:370–80. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Non-significance of Perception of Family and Peers may be due to missing data (8%) resulting from difficulty rating the variable.

    “Non significance maybe due to missing data (8%) [55], resulting from the difficulty rating the variable.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Field A. Logistic Regression. Discovering Statistics Using R. Thousand Oaks: Sage Publications, Incorporated; 2012. p. 312–59.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Adapts Routines to Minimize Difficulties was significant at univariate level in a return to work from sickness absence study and has been found to differentiate between employed and unemployed US veterans.

    “Adapts Routines to Minimize Difficulties was also significant at univariate level in return to work from sickness absence study [38] and has also been found to differentiate between employed and unemployed US veterans [69].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [38] Ekbladh E, Thorell L-H, Haglund L. Return to work: the predictive value of the worker role interview (WRI) over two years. Work. 2010;35:163–72. source

      Not checked in the free run.

    • cites [69] Julian CH, Valente JM. Psychosocial factors related to returning to work in U.S. Army Soldiers. Albin TJ, editor. Work. 2015;52:419–31. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Four items overlapped by being significant across sickness absence population and a prolonged absence from employment population at univariate level (Adapts Routines; Daily Routines; Takes Responsibility and Commitment to Work), but the multiple regression model identified different items as being significant in each population.

    “While four items overlapped by being significant across sickness absence population and a prolonged absence from employment population at univariate level (Adapts Routines; Daily Routines; Takes Responsibility and Commitment to Work), the multiple regression model identified different items as being significant in each population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The present study relied upon routine collected clinical data and therefore only captured attainment of employment or education.

    “The present study relied upon routine collected clinical data and therefore only captured attainment of employment or education.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    It is recommended that variable selection should be guided by well-established theory, clinical observations, and preliminary analysis.

    “It is recommended that variable selection should be guided by well-established theory, clinical observations, and preliminary analysis [53].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Stoltzfus JC. Logistic Regression: a brief primer. Acad Emerg Med. 2011;18:1099–104 Blackwell Publishing Ltd. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The study adds to the evidence base of vocational rehabilitation introducing a new enhanced IPS intervention based on the MOHO which achieved 63% return to employment or education and can provide alternatives to standard IPS and IPS-Lite for people who have more complex needs.

    “The study adds to the evidence base of vocational rehabilitation introducing a new enhanced IPS intervention based on the MOHO which achieved 63% return to employment or education and can provide alternatives to standard IPS and IPS-Lite for people who have more complex needs.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Withdrawal from intervention is a widely recognised challenge in this population.

    “Withdrawal from intervention is also a widely recognised challenge in this population [81].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] Fiszdon JM, Kurtz MM, Choi J, Bell MD, Martino S. Motivational interviewing to increase cognitive rehabilitation adherence in schizophrenia. Schizophr Bull. 2016;42:327–34. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Studies in the field usually define this variable as a reported work history in the last 3-5 years.

    “Studies in the field usually define this variable as a reported work history in the last 3–5 years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The challenge of sustainability is a factor to consider in RCT research, where well-funded and managed trials are successful for the duration of implementation but are not integrated into mainstream services.

    “The challenge of sustainability is a factor to consider in RCT research, where well-funded and managed trials are successful for the duration of implementation but are not integrated into mainstream services [82–84].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [82] Markström U, Svensson B, Bergmark M, Hansson L, Bejerholm U. What influences a sustainable implementation of evidence-based interventions in community mental health services? Development and pilot testing of a tool for mapping core components. J Ment Health. 2nd ed. Routledge. 2017;35:1–7.

      Not checked in the free run.

    • cites [83] Noel VA, Bond GR, Drake R, Becker D, McHugo GJ, Swanson SJ, et al. Barriers and facilitators to sustainment of an evidence-based supported employment program. Adm Policy Ment Health. 2017;44:331–8 Springer US. source

      Not checked in the free run.

    • cites [84] Bergmark M, Bejerholm U, Markström U. Implementation of evidence-based interventions: analyzing critical components for sustainability in community mental health services. Social Work Mental Health. 2nd ed. 2018;35:1–20.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Similar challenges were acknowledged in a previous study.

    “Similar challenges were acknowledged in a previous study [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Lohss I, Forsyth K, Kottorp A. Psychometric Properties of the Worker Role Interview (Version 10.0) in Mental Health. Br J Occup Ther. 2012;75:171–9. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A history of employment is recognised as predicting success.

    “A history of employment is recognised as predicting success [35, 77].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [35] Catty J, Lissouba P, White S, Becker T, Drake R, Fioritti A, et al. Predictors of employment for people with severe mental illness: results of an international six-Centre randomised controlled trial. Br J Psychiatry. 2008;192:224–31. source

      Not checked in the free run.

    • cites [77] Tsang HW-H, Lam P, Ng B, Leung O. Predictors of employment outcome for people with psychiatric disabilities: a review of the literature since the mid '80s. J Rehabil. 2000;66:19–3113p.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    This study also provides an example of embedding research into core health services promoting sustainability.

    “This study also provides an example of embedding research into core health services promoting sustainability.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    It is possible that the patients excluded from the study may have skewed data, however more than half of those excluded were not appropriate participants in an IPS programme not having an employment goal, being in employment or refusing to intervention.

    “It is possible that the patients excluded from the study may have skewed data however more than half of those excluded were not appropriate participants in an IPS programme not having an employment goal, being in employment or refusing to intervention.”
    Quote in the paperNot a substantial claim
55 of 55

  • The paper relies on this without support.

    Employment is good for physical and mental health.

    “Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment.”

  • The paper relies on this without support.

    Clinicians need to better understand who will benefit from enhanced IPS interventions.

    “Clinicians need to better understand who will benefit from these enhanced IPS interventions.”

  • The paper relies on this without support.

    The Scottish Indices of Multiple Deprivation (SIMD) provides a valid relative measure of deprivation by postcode.

    “Socioeconomic status was measured by Scottish Indices of Multiple Deprivation (SIMD) which provides a relative measure of deprivation by postcode.”

  • The paper relies on this without support.

    Collapsing the 4-point WRI scale into a binary rating (supports vs interferes) is a valid way to measure the psychosocial variables.

    “This study collapsed the 4 point WRI scale into a binary rating i.e., supports (4 = strongly supports and 3 = supports) and interferes (2 = interferes and 1 = strongly interferes).”

  • The paper relies on this without support.

    The enhanced IPS service's outcomes can be meaningfully compared to those of other studies (e.g., IPS-Lite, IPS-standard) to conclude it is higher.

    “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.”

  • The paper relies on this without support.

    Missing data in the covariates of interest were missing at random, so excluding cases with missing data did not bias the multiple logistic regression results.

    “The exclusion of cases containing missing data in the covariates of interest resulted in an inclusion of 195 cases in the multiple logistic regression [58].”

  • The paper relies on this without support.

    The enhanced IPS intervention was delivered with sufficient fidelity to the MOHO-based model.

    “Participants in this enhanced IPS programme had a 63% successful attainment of employment or education”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Other OT interventions for SMI include vocational, individual placement and support (IPS), and place first then train interventions.

    “However, there are other interventions that can be used in SMI from OT such as vocational, individual placement and support (IPS) and place first then train interventions.62 63”

    From Occupational therapy interventions for adults with severe mental illness: a scoping review (2021) · cites this paper as [63]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • A variable said to be excluded appears in the final model

    Major

    The text says Assesses Abilities and Limitations was excluded from the initial logistic model, yet Table 7 includes the corresponding abilities-and-limitations variable in the final model.

  • Not all seven psychosocial associations have p < 0.01

    Minor

    The discussion assigns p < 0.01 to all seven significant psychosocial items, but Commitment to Work is reported with p = 0.02.

  • Least-deprived-area coefficient conflicts with its reported effect

    Minor

    Table 7 gives living in the least deprived area a negative coefficient, but reports an odds ratio above 1 and says that living there improves the odds of success.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 8

  1. Bond GR. Evidence for the Effectiveness of Individual Placement and Support Model of Supported Employment. Washington, DC: American Psychiatric Association; 2019. Available from: https://ipsworks.org/index.php/evidence-for-ips/. [cited 2019 Aug 1].
  2. Taylor RR. In: Taylor RR, editor. Kielhofner's model of human occupation. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2017.
  3. Braveman B, Robson M, Velozo CA, Kielhofner G, Fisher GS, Forsyth K, et al. Worker role interview (WRI) (version 10.0). Chicago: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago; 2005.
  4. R Core Team. R. A language and environment for statistical computing (software version 3.2.2) [online]. Vienna: R Foundation for Statistical Computing; 2015.
  5. Regression FA. Discovering statistics using R. Thousand Oaks: Sage Publications, Incorporated; 2012. p. 245–311.
  6. Field A, Miles J, Zow F. Discovering statistics using R. London: Sage Publications, Incorporated; 2012.
  7. Swanson SJ. Applying the individual placement and support (IPS) model to help clients compete in the workforce. Dartmouth: PRC-Hazelden; 2015.
  8. Scottish Household Survey Project Team. Scottish household survey 2016: annual report. Edinburgh: Scottish Government; 2017 Jan.

Cited by

Sorted by citations

Related

Authors
Prior, S., Maciver, D., Aas, R. W., Kirsh, B., Lexen, A., van Niekerk, L., Irvine Fitzpatrick, L., & Forsyth, K.
Affiliations
  • Queen Margaret University (GB)
  • OsloMet – Oslo Metropolitan University (NO)
  • University of Toronto (CA)
Corresponding author
Prior, Susan
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2020-07-08
Volume
20
Issue
1
Pages
361-361
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-020-02745-3
PMC
PMC7346406
OpenAlex
W3041889826
Semantic Scholar
37cbe427996defff1dae1cd494e09fb9929d2ef4
Cited by
26
References
80
Citations by year
2025: 2 · 2024: 5 · 2023: 3 · 2022: 8 · 2021: 8
FWCI
6.47
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Edinburgh Napier Research Repository (Edinburgh Napier University) (publishedVersion, cc-by)
  • TSpace (University of Toronto) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Queen Margaret University Publications Repository (Queen Margaret University) (submittedVersion, cc-by)
  • Lund University Publications (Lund University) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • SUNScholar (Stellenbosch University) (submittedVersion)
Funders
Scottish Government (n/a)
Topics
  • Social Sciences › Safety Research › Disability Education and Employment
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Therapy Practice and Research
Keywords
Individual Placement and Support, severe mental illness, employment, Model of Human Occupation, psychosocial predictors, goal achievement, neighborhood disadvantage, vocational rehabilitation
MeSH terms
Mental Disorders, Humans, Occupations, Prospective Studies, Rehabilitation, Vocational, Employment, Supported

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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