Khalifa Najat, Talbot Emily, Barber Shaun, Schneider Justine, Bird Yvonne, Attfield Julie, Bates Peter, Walker Dawn-Marie, Völlm Birgit
Department of Psychiatry, Queen's University, Kingston, ON, Canada.
Wells Road Centre, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom.
Front Psychiatry. 2020 Jan 13;10:952. doi: 10.3389/fpsyt.2019.00952. eCollection 2019.
To examine the feasibility of conducting a fully powered randomized controlled trial (RCT) of Individual Placement and Support (IPS). IPS is a form of supported employment which aims to put people into open employment quickly and in accordance with their preferences. It is delivered by employment specialists collocated within clinical teams, and provides time unlimited support for the individual and their employer, along with welfare benefits counselling. A feasibility cluster RCT of treatment as usual (TAU) plus IPS versus TAU alone was conducted over 12 months among patients with offending histories in a community forensic setting in the UK. The feasibility criteria were to achieve 50% recruitment rate; 50% completion rate for IPS; 50% completion rate of all outcome measures; and 80% acceptability rating for IPS. The primary efficacy outcome was the proportion of people in open employment at 12 months. The secondary outcomes were other vocational and educational activities; Brief Psychiatric Rating Scale; Rosenberg's Self-esteem Scale; Client Service Receipt Inventory; quality of life using the SF12-v2 and EQ5-D3; Social Functioning Questionnaire; Work Limitation Questionnaire; and reoffending. Participants' mean age was 39.2 years. The majority were male (88.9), White British (72.2), and single (72.2%). Over 72% had no higher qualification beyond secondary education; mean years in education was 10.4. Over one third had schizophrenia, one fifth had depression, and the rest had personality disorder as their primary diagnosis. Participants had a lifetime average of 7.5 convictions for 15.5 offences. The recruitment rate of all referrals was 38.3% (IPS n = 11; TAU n = 7). Completion rate for IPS was 54.5, with 45.5% acceptability rating. Completion rates for outcome measures for the groups at baseline and 12 months ranged from 22.2 to 100%. The proportion of people in open employment at 12 months were 9.1 and 0% for IPS and TAU respectively. It is not feasible to conduct a full RCT of IPS in community forensic settings in the UK owing to recruitment and retention difficulties. Conducting a trial of this kind requires a large pool of patients from multiple sites and longer IPS implementation and recruitment periods than those of this study. www.ClinicalTrials.gov, identifier NCT02442193.
为检验开展一项关于个人安置与支持（IPS）的全效随机对照试验（RCT）的可行性。IPS是一种支持性就业形式，旨在按照人们的偏好迅速让其进入公开就业状态。它由配置在临床团队中的就业专家提供，为个人及其雇主提供无时间限制的支持以及福利咨询。在英国一个社区法医环境中，对有犯罪史的患者进行了一项为期12个月的常规治疗（TAU）加IPS对比单纯TAU的可行性整群随机对照试验。可行性标准为达到50%的招募率；IPS的完成率达到50%；所有结局指标的完成率达到50%；以及IPS的可接受率达到80%。主要疗效结局是12个月时处于公开就业状态的人员比例。次要结局包括其他职业和教育活动；简明精神病评定量表；罗森伯格自尊量表；客户服务收据清单；使用SF12 - v2和EQ5 - D3评估的生活质量；社会功能问卷；工作限制问卷；以及再次犯罪情况。参与者的平均年龄为39.2岁。大多数为男性（88.9%）、英国白人（72.2%）且单身（72.2%）。超过72%的人没有高于中学教育的学历；平均受教育年限为10.4年。超过三分之一的人主要诊断为精神分裂症，五分之一的人主要诊断为抑郁症，其余的主要诊断为人格障碍。参与者一生平均有7.5次定罪，涉及15.5项罪行。所有转诊者的招募率为38.3%（IPS组n = 11；TAU组n = 7）。IPS的完成率为54.5%，可接受率为45.5%。两组在基线和12个月时结局指标的完成率在22.2%至100%之间。12个月时，IPS组和TAU组处于公开就业状态的人员比例分别为9.1%和0%。由于招募和保留困难，在英国社区法医环境中开展IPS的全效随机对照试验不可行。开展此类试验需要来自多个地点的大量患者群体，以及比本研究更长的IPS实施和招募期。www.ClinicalTrials.gov，标识符NCT02442193
