In this interview, we ask Human Flourishing Program Research Affiliate, Dr. Donald E Frederick about his recent article, “Supported employment: Meta-analysis and review of randomized controlled trials of individual placement and support,” recently published in the Public Library of Science (PLOSE ONE) with co-author Dr. Tyler VanderWeele.
What is the background for this study? What are the key points of the paper?
A significant number of people suffer from a severe mental illness (or other disability) that prevents them from working even when they wish to work. A common treatment pattern is for clinicians to first treat the underlying illness and then attempt to assist the patient in finding employment. A second way to help these individuals find employment is through what is known as individual placement and support (“IPS”). This method is unique in that it treats the individual for the underlying illness or disability while at the same time helping individuals find competitive employment.
Competitive employment is employment in which a person who has a disability is employed in an integrated setting. This typically means that the person is paid at least minimum wage and works with other employees who may not also have a disability.
We performed a meta-analysis, which is a technique that allowed us to look at and synthesize information from 30 randomized controlled trials, to identify what the underlying effects of IPS vs. conventional methods of treatment were. We found that IPS is better than previous methods. IPS treated persons were 63% more likely to find competitive employment. IPS treated persons also fared better in all other vocational outcomes that we examined, including income, job tenure (duration of longest held job), and job length (total duration of all jobs). We also found some evidence that IPS may help individuals with non-work outcomes such as increased quality of life. 2.
Why is this study significant? What should readers take away from your report?
The study is significant because it shows that IPS is an extremely effective treatment for helping those with severe mental illness and other disabilities to find competitive employment at far greater rates than previous interventions. The study also provides some evidence that IPS is also effective in helping to improve non-work outcomes such as improving quality of life.
Is this an incremental step forward in the research or a big step?
The results in this study are a solid step forward. The results are based upon 30 randomized controlled trials and thus allowed us to ascertain causal effects. It ought to be clear from this study that IPS is significantly better at helping the reported populations (especially those with severe mental illness) find competitive employment at much higher rates than those undergoing the more traditional treatment regimen.
Did any findings surprise you?
The variety of settings in which IPS works was at first surprising. We found research that expanded the use of IPS from individuals with severe mental illness to others such as veterans with spinal cord injuries. The IPS intervention appears to be significantly better than the traditional interventions used in these expanded settings. We were also pleasantly surprised at the possible improvements in non-work outcomes, such as quality of life. With that said, the effect that we found for this was not as certain as with the vocational outcomes. Part of this could be due to the fact that not all of the underlying studies that we examined measured these other outcomes.
What are the societal or public health implications?
The societal and public health implications are fairly straightforward. IPS is better at increasing competitive employment for those who have severe mental illnesses (as well as other disabilities). If the purpose is to help those with these conditions find competitive employment, then IPS ought to be the preferred treatment option.
(Frederick DE, VanderWeele TJ (2019) Supported employment: Meta-analysis and review of randomized controlled trials of individual placement and support. PLOS ONE 14(2): e0212208. https://doi.org/10.1371/journal.pone.0212208)
About the Author
Donald Frederick, Ph.D., worked as a post-doctoral fellow for the Human Flourishing Program under the supervision of Professor VanderWeele for two years during 2016 and 2017 on projects concerning the social science of work. His current research continues on the subject of work, with a focus on how its relates to (i.e., promotes or hinders) human flourishing with particular attention to the areas of happiness, well-being, virtue and character, health, and relationships.