INVEST: Individualised vocational support for youth with borderline personality disorder: A randomised controlled trial

Intervention

Intervention code Other interventions

Individual Placement and Support (IPS) IPS is an evidence based vocational services model for people with mental illness, with eight core principles: 1. Competitive employment/mainstream education. This principle describes the main aim of IPS. Job seekers are helped to find employment in the open labour market and students are assisted to engage with mainstream education. Vocational specialists do not help in finding sheltered employment, unpaid internships or jobs set aside for people with ment .... Individual Placement and Support (IPS) IPS is an evidence based vocational services model for people with mental illness, with eight core principles: 1. Competitive employment/mainstream education. This principle describes the main aim of IPS. Job seekers are helped to find employment in the open labour market and students are assisted to engage with mainstream education. Vocational specialists do not help in finding sheltered employment, unpaid internships or jobs set aside for people with mental illness so often associated with the stepwise approach which has dominated the vocational rehabilitation sphere. 2. Eligibility based on client choice. No one is excluded on the basis of vocational readiness, diagnoses, severity of disability, symptoms, substance abuse or legal system involvement. The basis of involvement in an IPS service is based on desire to work in a competitive job or to be in mainstream education. 3. Integration of vocational services and mental health services. This means IPS providers and mental health treatment teams are not only collocated but are closely integrated and work collaboratively. Vocational specialists attend treatment team meetings and share ideas and information to develop ways to improve client functioning and recoveries. 4. Attention to Client Preferences. Vocational searches are based on individual client preferences rather than vocational provider judgements. Vocational searches are based on what the client wants, their strengths and previous experiences. Vocational seekers list their education and employment history, and identify characteristics they liked about previous vocational roles. Employment clients also decide on work settings, wages and hours. Vocational specialists provide suggestions to expand options and discuss the advantages and disadvantages of disclosing their illness to the prospective employers/educational institutions. Job seekers also determine whether vocational specialists will be in direct contact with employers and discuss the types of supports they require. 5. Personalised benefits counselling. Vocational specialists provide or help find accurate and understandable information about the effects work/education will have on the job seeker’s welfare payments. 6. Rapid vocational search. IPS providers start looking for vocational opportunities immediately and help seekers to find work/education as soon as possible, rather than providing lengthy assessments and counselling. Vocational specialists work with clients in the first session to develop a plan and vocational profile based on client preferences, past experiences, skills, strengths, career goals and education. 7. Systematic job/educational development. IPS providers must build employer and education networks and relationships through systematic contacts. This refers to creating relationships with employers/educators by understanding the business and human resources. 8. Time unlimited and individualised support. This means that vocational seekers can continue to receive support for as long as they require, up to 9 months in the case of the present study. IPS providers continue ongoing supports long after employment/education is found. Frequent contacts between vocational specialists and clients are important even once in work/education to help with any required training and difficulties faced in the new environment. Participants assigned to IPS will have an initial face-to-face consultation with their vocational specialist within 14 days following randomisation. Subsequent contact may be face-to-face, by telephone, text message, email, and the frequency is dependent upon the needs of each client. Each interaction between vocational specialist and young person will be recorded on a checklist, detailing method, content, and duration. The vocational specialist will work with each young person to establish their skills, preferences, and needs. This will inform building a vocational plan, based on long-term career goals. Training may include apprenticeships, or other courses, that will allow the client to obtain skills or qualifications necessary or beneficial to attaining their vocational goals. The IPS fidelity scale, including educational and employment information, as well as vocational specialist checklists and notes, will be used to review the level of adherence to eight core principles of the model. For example, the fidelity review includes monitoring of case load, integration of vocational specialist within clinical team, client placement outcomes etc.
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Comparison

Control group Active

Usual Vocational Services (UVS) Orygen Youth Health currently offers a range of educational support for young people who are aged 15-18 years, the details of which are below. Employment support, and educational support for those aged 19-25, is not provided as part of UVS at Orygen Youth Health. Case managers inform young people about this type support, which can be obtained through Centrelink and/or employment agencies and case managers refer to such agencies. Travancore Education is a program o .... Usual Vocational Services (UVS) Orygen Youth Health currently offers a range of educational support for young people who are aged 15-18 years, the details of which are below. Employment support, and educational support for those aged 19-25, is not provided as part of UVS at Orygen Youth Health. Case managers inform young people about this type support, which can be obtained through Centrelink and/or employment agencies and case managers refer to such agencies. Travancore Education is a program of the Travancore School in conjunction with Orygen Youth Health (OYH). The program is available to young people between 15 and 18 years old, with the educational objective of maintaining engagement with education or re-engaging young people into an appropriate educational settings.
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Outcomes

Outcome: IPS efficacy (vocational outcomes) as measured by number of days in mainstream/competitive education/employment. Number of days will be recorded via weekly text messages to participants (eg "Thinking about the past 7 days, not including today, on how many days did you attend work or employment for which you were paid?"). In addition, participants will be asked to estimate at each research assessment how many days have been spent in education and/or employment.
Timep .... Outcome: IPS efficacy (vocational outcomes) as measured by number of days in mainstream/competitive education/employment. Number of days will be recorded via weekly text messages to participants (eg "Thinking about the past 7 days, not including today, on how many days did you attend work or employment for which you were paid?"). In addition, participants will be asked to estimate at each research assessment how many days have been spent in education and/or employment.
Timepoint: Primary endpoint at 52 weeks from baseline assessment. Outcome measures will be assessed at research visits 13, 26, 39 and 52 weeks. Outcome will also be assessed weekly via text messages to each participant.
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