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An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study

Prior, Susan; Maciver, Donald; Aas, Randi W.; Kirsh, Bonnie; Lexen, Annika; van Niekerk, Lana; Irvine Fitzpatrick, Linda; Forsyth, Kirsty

Authors

Susan Prior

Donald Maciver

Randi W. Aas

Bonnie Kirsh

Annika Lexen

Lana van Niekerk

Linda Irvine Fitzpatrick

Kirsty Forsyth



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 R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(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).

Citation

Prior, S., Maciver, D., Aas, R. W., Kirsh, B., Lexen, A., van Niekerk, L., Irvine Fitzpatrick, L., & Forsyth, K. (2020). An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study. BMC Psychiatry, 20(1), Article 361. https://doi.org/10.1186/s12888-020-02745-3

Journal Article Type Article
Acceptance Date Jun 19, 2020
Online Publication Date Jul 8, 2020
Publication Date 2020
Deposit Date Jun 12, 2025
Publicly Available Date Jun 16, 2025
Journal BMC Psychiatry
Electronic ISSN 1471-244X
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 20
Issue 1
Article Number 361
DOI https://doi.org/10.1186/s12888-020-02745-3
Keywords Severe mental illness, Employment, Enhanced Individual Placement & Support, Model of human occupation
Public URL http://researchrepository.napier.ac.uk/Output/4567654

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