Abstract
Individual Placement and Support (IPS) is a long-standing and innovative employment service for individuals with mental illness with dozens of clinical trials demonstrating effectiveness. Little is known, however, about intentional adaptations to IPS, especially those outside of the context of research studies. Using an implementation science framework, we conducted an exploratory study to better understand the characteristics of stakeholder-reported adaptions to IPS, the impetus for their development, and perceived impacts. We conducted qualitative interviews to analyze and describe these adaptations. Numerous adaptations of IPS were found that address the needs of new and underserved populations both within and outside of the mental health field. Programs reported adapting IPS because of the dearth of other evidence-based employment services, to serve diverse populations in need, and based on financial incentives. Benefits of adaptations were weighed against impacts on fidelity. As evidence-based practices (EBPs) are adapted, developers of EBPs should determine how fidelity of a program or service can be assessed or preserved in light of adaptations. This is critical with the increase in different service delivery methods, new populations, new service recipient needs, and new settings in need of EBPs.
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Data Availability
Not all data are freely accessible because no informed consent was given by the participating agencies for open data sharing.
Notes
In this manuscript, we use the term mental illness to refer to the individuals being served by employment programs. We recognize that this term is used interchangeably with terms such as mental health conditions, psychiatric disability, psychiatric disorder. We chose mental illness because that is the terminology used by the developers of IPS, the subject of this paper.
It is important to note that while the terms adaptations and modifications are often used interchangeably, Stirman distinguishes between the adaptation being a planned undertaking and the broader concept of modification as any alteration to a service, including those that are made impromptu, or reactively, Stirman, et al., 2019. In this manuscript, we use adaptations consistently and avoid other potentially confusing terms such as enhancements and augmentation.
2 It should be noted that in Oregon, another model of supported education has evolved not as an adaptation of IPS, but with their own practice principles (SAMHSA, Supported Education Evidence-Based Practices (EBP) KIT | SAMHSA Publications and Digital Products). These programs work closely with IPS programs to better serve individuals needing both services, but this approach, while representing an important service, was not considered an adaptation of IPS.
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This paper was developed with support from the National Institute on Disability, Independent Living, and Rehabilitation Research Grant (90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this project do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government. The authors are grateful for their support.
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The first, second and fourth authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by WA, ESR, and LM. The first draft of the manuscript was written by ESR and all authors assisted with interpretation of the results and edited and added to subsequent versions. All authors read and approved the final manuscript.
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Adams, W.E., Rogers, E.S., McKnight, L. et al. Examination of Adaptations to the Evidence Based Supported Employment Model: Individual Placement and Support. Adm Policy Ment Health 50, 644–657 (2023). https://doi.org/10.1007/s10488-023-01267-w
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DOI: https://doi.org/10.1007/s10488-023-01267-w