The Evidentiary Basis for Supported Employment Practice for Workers with Schizophrenia: A Thematic Analysis

Abstract

The authors have conducted a thematic review of the literature on the evidence of, and enquiry into, individualized placement and support (IPS) efficacy as an intervention for people with schizophrenia or schizoaffective disorders. Eight studies were identified that met all inclusion criteria. Explicit themes in the research included (a) investigation of the impact of schizophrenia sequelae on IPS efficacy and the differential impact of neurocognitive enhancement therapy in minimizing psychiatric symptoms and improving IPS outcomes and (b) IPS as an alternative to treatment-as-usual in different age demographics (older and younger clients). Implicit themes coalesced around a general theme of dealing with change, in practice and research, that implementing IPS implies. Each theme represents a challenge or confound to the research corpus and included (a) vaguely defined rationale for the issue of return on investment, (b) practical burden of overstressed and unprepared service structures, (c) diffuse outcome measures, (d) poor attention to IPS fidelity, and (e) lack of standard practice assigned to control groups identified as “treatment as usual.” Seeing confounds as directions for improvement, these early studies open an important dialogue on best practice research in IPS application with workers with schizophrenia.

Keywords:

• Individual placement and support
• Supported employment
• Neurocognitive enhancement therapy
• Evidence-base
• Schizophrenia

Notes

¹We use the term “schizophrenia” from this point forward to represent all the diagnostic labels associated with the terms under ICD Chapter V., F20 (schizophrenia) and F25 (schizoaffective disorders). Although there is continued debate on the proper demarcation of the term, our conceptualization reflects its functional definition in the articles identified.

Note. RCT = random clinical trial; CC = case control; NET = neurocognitive enhancement therapy; IPS = individualized placement and support.