Developing Evidence-Based Supported Employment Services for Young Adults Receiving Public Mental Health Services
Porteous, Nikki, Waghorn, Geoffrey, New Zealand Journal of Occupational Therapy
Occupational therapists working in public mental health in New Zealand and Australia are leading the implementation of evidence-based practices in the provision of supported employment services for people with psychiatric disabilities (Lloyd & Waghorn, 2007; Porteous & Waghorn, 2007; Waghorn, Collister, Killackey & Sheering, 2007). Occupational therapists are ideally positioned within Australian and New Zealand mental health systems, to help implement the latest evidence-based practices in psychiatric vocational rehabilitation.
The most effective form of supported employment for people with psychiatric disabilities was developed by Professors Robert Drake and Deborah Becker in New Hampshire, USA (Becker et al., 2001). Known as evidence-based supported employment or individual placement and support (IPS), it has been more extensively investigated than any other approach in psychosocial rehabilitation (Bond, 2004; Bond, Drake, & Becker, 2008). A defining feature is that employment services are integrated into public mental health services (Bond, 2004; Cook et al., 2005; King et al., 2006).
To date, 16 randomised controlled trials (RCTs) and six day treatment conversion studies in nine developed countries have compared IPS to the best alternative approaches. Of these, 11 RCTs examined high fidelity IPS services which reported employment outcomes of mean 60%, typically two to three times greater than the best alternative employment services (mean 24%). In addition to evidence for overall effectiveness, there is also evidence for four of seven core elements and emerging evidence that three other ingredients improve competitive employment outcomes (Bond, 1998; 2004; Bond et al., 2008).
Successful implementations of evidence-based supported employment for people with psychiatric disabilities are well documented in the USA (Bond et al., 2001) and in the UK (Rinaldi et al., 2004). In Australia, three recent reports (Killackey & Waghorn, 2008; King et al., 2006; Waghorn et al. 2007) identify country-specific factors which need to be addressed before a sustainable integrated program can be successfully established. Two further reports (Killackey, Jackson, & McGorry, 2008; Porteous & Waghorn, 2007) show that vocational outcomes of 60-80% can be expected in New Zealand or Australia, when the service users are young people with early psychosis, and formal study options are added to competitive employment as the primary vocational goals. While international reports are informative, the differences among developed countries in terms of labour markets, health, and welfare systems, means that Australian and New Zealand experiences can best guide the introduction of evidence-based practices in the Australian and New Zealand contexts. This report summarises recent results and describes the key management strategy used to manage the program's expansion to several new sites in the Wellington region.
The New Zealand context
The major changes in the New Zealand labour market during the past five years have been positive for workers with disabilities (Organisation of Economic Cooperation and Development, 2007). These changes can be attributed to increased labour demand driven by continuing economic growth and the ageing of the population. The New Zealand context is characterized by low inflation; economic growth of 2-4% per annum 2000-2004; and low official unemployment currently at 3.8%.
In addition to the labour market, health and welfare systems can also impact on labour force activity by people with severe mental illness (Burns et al., 2007). Public mental health treatment and care is funded by the government and delivered via semi autonomous District Health Boards. Disability employment services are funded via non government organisations contracted to the Ministry of Social Development to deliver disability employment services to eligible people in receipt of income support payments. …