The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
IPS Employment Center, Westat Inc., Lebanon, NH.
Schizophr Bull. 2018 Jan 13;44(1):22-31. doi: 10.1093/schbul/sbx132.
As Individual Placement and Support (IPS) has become the international standard for vocational rehabilitation of adults with serious mental illness, researchers must consider the relationship between IPS and local environments. This meta-analysis used mixed-effects meta-regressions to assess the impact of site-level moderators on the likelihood that IPS recipients, compared with recipients of alternative vocational services, achieved competitive employment. Potential moderators included change in gross domestic product (GDP), local unemployment and unionization rates, and indices describing employment protection regulations, level of disability benefits compensation, and efforts to integrate people with disabilities into the workforce. Regulatory moderators represent facilitators and barriers to employment that may reinforce or detract from the effectiveness of IPS. Across 30 sites drawn from 21 randomized controlled trials in 12 countries (33% in the United States), IPS recipients were 2.31 (95% CI 1.99-2.69) times more likely to find competitive employment than recipients of alternative vocational rehabilitation services. The significant competitive-employment rate advantage of IPS over control services increased in the presence of weaker employment protection legislation and integration efforts, and less generous disability benefits. Policy makers should recognize and account for the fact that labor and disability regulations can create an arrangement of incentives that reduces the relative efficacy of supported employment.
随着个体安置与支持(IPS)已成为精神疾病成年人职业康复的国际标准,研究人员必须考虑 IPS 与当地环境之间的关系。本荟萃分析采用混合效应元回归来评估站点级别调节变量对 IPS 受助人(与接受替代职业服务的受助人相比)获得竞争性就业的可能性的影响。潜在的调节变量包括国内生产总值(GDP)的变化、当地失业率和工会化率、以及描述就业保护法规、残疾福利补偿水平和努力将残疾人融入劳动力市场的指数。监管调节因素代表了就业的促进和障碍因素,可能会增强或削弱 IPS 的有效性。在来自 12 个国家的 21 项随机对照试验中的 30 个地点(33%在美国)中,IPS 受助人找到竞争性就业的可能性是接受替代职业康复服务的受助人的 2.31 倍(95%CI 1.99-2.69)。与对照服务相比,IPS 的显著竞争就业率优势在就业保护立法较弱和融合努力以及残疾福利较少的情况下会增加。政策制定者应认识到并考虑到这样一个事实,即劳动和残疾法规可以创造一种激励安排,从而降低支持性就业的相对效果。