Drake R E, McHugo G J, Bebout R R, Becker D R, Harris M, Bond G R, Quimby E
Dartmouth Medical School, Hanover, NH, USA.
Arch Gen Psychiatry. 1999 Jul;56(7):627-33. doi: 10.1001/archpsyc.56.7.627.
This experiment evaluated the effectiveness of 2 approaches to vocational services for persons with severe mental disorders: (1) individual placement and support (IPS), in which employment specialists within the mental health center help patients to obtain competitive jobs and provide ongoing support, and (2) enhanced vocational rehabilitation (EVR), in which stepwise vocational services are delivered by rehabilitation agencies.
One hundred fifty-two unemployed, inner-city patients with severe mental disorders who expressed interest in competitive employment were randomly assigned to IPS or EVR and followed up for 18 months. Following diagnostic assessment, participants were assessed with standardized measures of work, income, self-esteem, quality of life, symptoms, and hospitalization at baseline and at 6-, 12-, and 18-month follow-up evaluations. Employment was tracked monthly and job satisfaction every 2 months.
During the 18-month study, participants in the IPS program were more likely to become competitively employed (60.8% vs 9.2%) and to work at least 20 hours per week in a competitive job (45.9% vs 5.3%), whereas EVR participants had a higher rate of participation in sheltered employment (71.1% vs 10.8%). Total earnings, job satisfaction, and nonvocational outcomes were similarly improved for both groups.
The IPS model of supported employment is more effective than standard, stepwise EVR approaches for achieving competitive employment, even for inner-city patients with poor work histories and multiple problems.
本实验评估了两种为重度精神障碍患者提供职业服务的方法的有效性：（1）个别安置与支持（IPS），即心理健康中心的就业专家帮助患者获得有竞争力的工作并提供持续支持；（2）强化职业康复（EVR），即由康复机构提供逐步的职业服务。
152名对竞争性就业感兴趣的市中心失业重度精神障碍患者被随机分配到IPS或EVR组，并随访18个月。在诊断评估后，在基线以及6个月、12个月和18个月的随访评估中，使用标准化的工作、收入、自尊、生活质量、症状和住院情况测量方法对参与者进行评估。每月跟踪就业情况，每两个月跟踪工作满意度。
在为期18个月的研究中，IPS项目的参与者更有可能获得有竞争力的工作（60.8%对9.2%），并且更有可能在有竞争力的工作中每周至少工作20小时（45.9%对5.3%），而EVR参与者在庇护性就业中的参与率更高（71.1%对10.8%）。两组的总收入、工作满意度和非职业成果都有类似程度的改善。
即使对于工作经历不佳且存在多种问题的市中心患者，支持性就业的IPS模式在实现竞争性就业方面比标准的逐步EVR方法更有效。
