Improving the effectiveness of evidence-based practices in vocational rehabilitation for people with severe mental illnesses

Abstract

Background: Advances in the science and practice of vocational rehabilitation have defined and validated evidence-based practices for people with severe mental illnesses, collectively known as Individual Placement and Support (IPS). However, there is wide variation in IPS program performance both within, and across international contexts. Research to improve performance has focused on increasing adherence (fidelity) to known evidence-based practices. An alternative strategy could involve increasing the quality of implementation more broadly. This alternative strategy is reflected in the four aims of this investigation.1. To examine the association between program fidelity and program performance. 2. To identify and prioritise other factors that could further explain performance. 3. To investigate how a country’s socio-economic context influences program implementation. 4. To conceptualise, construct, and operationalise a measure of general program implementation quality that could, if validated, further explain and predict performance. Methods: 1. A systematic review and meta-analysis of the empirical evidence on vocational rehabilitation program implementation internationally. 2. A review of the conceptual and empirical literature related to the science of psychosocial program implementation and performance. 3. An analysis of the socio-economic policy context of New Zealand in relation to implementing IPS practices. 4. A conceptual analysis of eight new dimensions of program implementation quality. Results: 1. Program fidelity is an important predictor of performance. Yet, in the example program studied, fidelity explains only 16.8% of the total variance in program performance. 2. A new Implementation Framework for Vocational Rehabilitation (IFVR) identifies and prioritises candidates for improving the performance of vocational rehabilitation programs. 3. A country’s socio-economic policy context influences the availability and implementation of evidence-based practices. 4. The partial operationalisation of eight dimensions of implementation quality supports further development and testing. Conclusions: Fidelity to evidence-based practices is important for program performance but this strategy alone is not sufficient. Broadening the conceptual framework for implementing vocational rehabilitation, beyond a focus on program fidelity, is an alternative strategy that has identified other promising ways to improve program performance. If measures based on the IFVR are found to be sufficiently valid and reliable, the IFVR promises to assist program leaders, administrators, and policymakers to better describe, define, predict, and improve the performance of vocational rehabilitation programs.