Absence of conflict of interest.
Citation
Highlights
- The study's objective was to examine the impact of Individual Placement and Support (IPS) on employment.
- The study was a randomized control trial that assigned 45 individuals with moderate to severe opioid use disorder receiving methadone maintenance therapy to the treatment or control group. The primary data sources were interviews and surveys conducted at baseline, 3 months, 6 months, 9 months, and 12 months. The study used basic statistics to compare the outcomes of treatment and control group members.
- The study found that IPS participants had significantly higher rates of employment at 6 months than the waitlist comparison group.
- This study receives a moderate evidence rating. This means we are somewhat confident that the estimated effects are attributable to Individual Placement and Support (IPS), but other factors might also have contributed.
Intervention Examined
Individual Placement and Support (IPS)
Features of the Intervention
Individual Placement and Support (IPS) is an evidence-based supported employment model for people with severe mental illnesses. IPS incorporates eight principles: eligibility based on consumer choice, focus on competitive employment, integration of mental health and employment services, attention to patient preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. IPS has been found to improve employment outcomes, leading to increased self-esteem and overall satisfaction with life. Noting the similarities between people with severe mental illnesses and people with opioid use disorders receiving community-based services, this study examined the effectiveness of IPS for people with moderate to severe opioid use disorders receiving community-based methadone maintenance therapy in an opioid treatment program.
The IPS intervention was conducted in the opioid treatment program's clinic. The IPS specialist was notified by researchers when participants were assigned to IPS and waitlist participants became eligible for IPS. The same specialist provided all IPS participant services throughout the trial.
The study focused on adults aged 18 years or older who met DSM-V criteria for moderate to severe opioid use disorder, who had received methadone treatment for at least 14 days at the treatment program prior to informed consent, who had never received supported employment services from the program, who were currently unemployed, who had the desire to work, who lacked pending incarceration or housing which disallowed external work, and who provided informed consent.
Features of the Study
The study was a randomized control trial that assigned 45 individuals with moderate to severe opioid use disorder receiving methadone maintenance therapy to the treatment or control group. The study randomly assigned 22 participants to active IPS plus treatment-as-usual and 23 participants to the IPS waitlist plus treatment-as-usual.
The sample, selected from a large nonprofit opioid treatment program serving the greater Portland, OR area included 45 patients (22 treatment and 23 control) with severe and moderate opioid disorders receiving methadone therapy. The treatment group received the IPS intervention and the standard opioid treatment program care. The control group received only the standard opioid treatment program care for the first six months post-enrollment but could receive the ITS intervention after 6 months.
The primary data sources were surveys conducted at baseline, 3 months, 6 months, 9 months, and 12 months. The study used basic statistics to compare the outcomes of treatment and control group members. The study assessed crude differences between active IPS and waitlist groups as well as rate ratios to compare the probability of events occurring in the IPS and Waitlist groups.
Findings
Employment
- The study found that a significantly higher proportion of participants in the IPS group (50%) were employed at 6 months relative to participants in the waitlist comparison group (5%). The study found no statistically significant differences in employment at 12 months between the treatment and the waitlist comparison group.
Considerations for Interpreting the Findings
The study noted that ten participants were lost to follow-up (six in the treatment group and four in the waitlist group) but it is unknown if these individuals were included in the study; hence attrition cannot be calculated. Therefore, the study is not eligible for a high causal evidence rating, the highest rating available for randomized control trial designs. However, the study does demonstrate that the two groups were equivalent before program participation on a range of important baseline characteristics. Therefore, the study is eligible for a moderate causal evidence rating.
The study estimated multiple related impacts on outcomes related to employment. Performing multiple statistical tests on related outcomes makes it more likely that some impacts will be found statistically significant purely by chance and not because they reflect program effectiveness. The authors did not perform statistical adjustments to account for the multiple tests, so the number of statistically significant findings in these domains is likely to be overstated.
Causal Evidence Rating
The quality of the causal evidence presented in this study is moderate because, although it was based on a randomized controlled trial with unknown attrition, the authors demonstrated that the treatment and control groups were similar before the intervention. This means we are somewhat confident that the estimated effects are attributable to Individual Placement and Support (IPS) and not to other factors.