Individual Placement and Support (IPS) beyond severe mental health: An overview review and meta-analysis of evidence around vocational outcomes.

Objective: To provide an overview review of international evidence of vocational outcomes in Individual Placement and Support (IPS) interventions for populations other than severe mental health. Methods: An overview of reviews published in English since 2000 reporting vocational outcomes (job entry, work sustainment, earnings, work hours, time to job entry) against counterfactuals of IPS interventions for population groups other than severe mental health. The overview review maximises data from individual studies and includes additional recent primary studies. DerSimonian-Laird random effects meta-analysis was performed. Results: Thirteen eligible studies were identified from five reviews and five more recent individual studies were also identified. IPS studies covered a range of groups with a concentration towards mental health. For the primary vocational outcome of job entry all IPS studies showed superior job entry rates compared to control groups with an overall weighted odds ratio of 1.78 [1.42,2.22]. Substantial heterogeneity was identified by study size and the overall weighted odds ratio of 1.32 [1.2,1.46] estimated from the large and medium sized studies seems a more plausible estimate of the likely effects of scaled-up IPS interventions in groups beyond severe mental health. Secondary vocational outcomes including job sustainment, total earnings, average weekly hours worked and time to job entry were typically superior in IPS services than control groups. Conclusions: IPS services are consistently more effective in supporting diverse population groups into sustained employment compared to business-as-usual employment services. The evidence is limited by unclear terminology, small sample sizes, incomplete intervention fidelity, intervention contamination and inconsistent measurement.

Understanding interventions and outcomes in supported employment and individual placement support: A qualitative evidence synthesis.

BACKGROUND: Economically developed economies continue to display large and long-standing disability employment gaps. Train-then-place activation models have traditionally dominated efforts to support non-working disabled people to gain employment but recently there has been increasing interest in place-then-train Supported Employment (SE) activation models. OBJECTIVE: Evidence regarding the effectiveness of SE approaches is growing. However, authors have called for greater understanding of the mechanisms underpinning these interventions. We therefore carried out a systematic review of qualitative research to understand the processes operating. METHODS: We carried out a systematic review of qualitative research around SE interventions carried out in developed countries since 2000 in any population excepting those with severe mental illness. We used thematic synthesis and logic modelling methods and assessed the quality of the body of literature. RESULTS: We identified and included 13 relevant source studies containing qualitative data. Key aspects of the programmes reported were the nature of the support, the employment advisor, and the type of employment. Influencing factors were client-related, employer and employment-related, programme-related, and system-related. Effects beyond the gaining of employment included a changed attitude to work, different outlook, increased skills and/or confidence. Suggested longer-term impacts were on health and wellbeing, financial security, independence, contribution to society and sense of belonging. CONCLUSIONS: This review adds to the growing evidence regarding the value of SE interventions for disabled people. It adds insights regarding the key elements of the programmes, and suggests outcomes beyond the measures typically considered within quantitative studies.

Homopositivity Across Europe: Predictors, Pathways, and Moderators.

Although homopositivity, the attitudinal acceptance of homosexuality, has generally increased across Western societies, there remains considerable homonegativity across certain regions of the world as well as certain demographic and socioeconomic groups. Although previous cross-national research has successfully identified the key factors affecting homopositive attitudes, the literature neglects both potentially key mediation pathways and moderating interactions between those factors that may unlock more nuanced understanding of these variations in homopositive attitudes across individuals and places. In response, the present study innovatively applied a multivariate structural equation modelling approach to the latest Wave 9 (2018 data) of the large-scale cross-national European Social Survey data in order to shed new light on these currently neglected predictors, pathways, and moderating influences on homopositive attitudes. It used a three-item latent variable to measure the homopositive attitudes outcomes construct. Its explanatory variables were focused across three key sets of factors identified in theoretical and empirical literature (socioeconomics, religiosity, and values) alongside various wider controls. Our analyses made several innovative methodological and empirical contributions to existing debate. Key innovative findings include the original identification of important indirect effects of religious beliefs on homopositive attitudes via religious practices, important indirect effects of education on homopositive attitudes via household income, and the role of national welfare regimes to homopositive attitudes (and with its effects interestingly not moderated by household income).

The economic case for well-considered investment in health-related employment support: Costs and savings of alternative modified Individual and Placement Support (IPS) models.

BACKGROUND: Health-related unemployment is a major issue across advanced economies. Modified versions of well-evidenced Individual Placement and Support (IPS) models of employment support for health cohorts offer considerable potential. A significant gap currently however is the lack of evidence around their financial return on investment. OBJECTIVE/HYPOTHESIS: To provide robust financial return on investment estimates for analytically derived alternative specifications of modified IPS services for the first time in the literature, sensitivity tested across various levels of performance. METHODS: Brings together modelled cost and savings estimates based on best available evidence to deliver modelled return on investment estimates. RESULTS: The modelled estimates show that well-designed modified IPS services can deliver financial savings whilst tackling health-related unemployment, even at higher average unit costs than are typically considered viable in some national contexts. CONCLUSIONS: Modified IPS services offer a viable route to delivering enhanced employment outcomes for individuals with health conditions and disabilities and financial savings for governments.

Creaming and Parking in Quasi-Marketised Welfare-to-Work Schemes: Designed Out Of or Designed In to the UK Work Programme?

'Creaming' and 'parking' are endemic concerns within quasi-marketised welfare-to-work (WTW) systems internationally, and the UK's flagship Work Programme for the long-term unemployed is something of an international pioneer of WTW delivery, based on outsourcing, payment by results and provider flexibility. In the Work Programme design, providers' incentives to 'cream' and 'park' differently positioned claimants are intended to be mitigated through the existence of nine payment groups (based on claimants' prior benefit type) into which different claimants are allocated and across which job outcome payments for providers differ. Evaluation evidence suggests however that 'creaming' and 'parking' practices remain common. This paper offers original quantitative insights into the extent of claimant variation within these payment groups, which, contrary to the government's intention, seem more likely to design in rather than design out 'creaming' and 'parking'. In response, a statistical approach to differential payment setting is explored and is shown to be a viable and more effective way to design a set of alternative and empirically grounded payment groups, offering greater predictive power and value-for-money than is the case in the current Work Programme design.

Support for All in the UK Work Programme? Differential Payments, Same Old Problem.

The UK has been a high profile policy innovator in welfare-to-work provision which has led in the Coalition government's Work Programme to a fully outsourced, 'black box' model with payments based overwhelmingly on job outcome results. A perennial fear in such programmes is providers' incentives to 'cream' and 'park' claimants, and the Department for Work and Pensions has sought to mitigate such provider behaviours through Work Programme design, particularly via the use of claimant groups and differential pricing. In this article, we draw on a qualitative study of providers in the programme alongside quantitative analysis of published performance data to explore evidence around creaming and parking. The combination of the quantitative and qualitative evidence suggest that creaming and parking are widespread, seem systematically embedded within the Work Programme, and are driven by a combination of intense cost-pressures and extremely ambitious performance targets alongside overly diverse claimant groups and inadequately calibrated differentiated payment levels.