Evidence-based supported employment for people with mental illness recently housed by a housing first project: helping homeless people achieve their goals of employment

by Daniel Poremski

Institution: McGill University
Department: Department of Psychiatry
Degree: PhD
Year: 2015
Keywords: Health Sciences - Mental Health
Record ID: 2057956
Full text PDF: http://digitool.library.mcgill.ca/thesisfile130618.pdf


People with mental illness, recently housed by a Housing First program, experience rates of unemployment exceeding 95%. A large majority would like to return to employment, but face significant obstacles that result from their experiences of homelessness and mental illness. Some of these obstacles persist after they receive housing support, suggesting that they require assistance attaining their employment goals. Individual placement and support (IPS) is effective at increasing employment rates among stably-housed people with mental illness. Less is known about the impact of IPS on homeless people with mental illness. This mixed methods study was undertaken to evaluate the effect of IPS and Housing First on employment and includes three datasets (two quantitative and one qualitative). It is from these datasets that the content of this thesis is derived: 1) A large dataset of 2148 participants from the At home/ Chez Soi Housing First randomized controlled trial (RCT). 2) A site-specific sample of 90 participants from an RCT testing the effect of IPS. And 3) a sample of 27 participants interviewed as part of the qualitative strand. Dataset 3 was obtained from a subsample of dataset 2, which was a subsample of dataset 1. The randomized control trials of IPS and Housing First suggest that neither alone is sufficient to significantly increase peoples' odds of obtaining employment compared with usual services, but that IPS does increase the odds slightly to a statistically significant extent. With time Housing First does have an impact, but the odds remain lower than those observed in the control group. The effect of IPS may have been diluted by problems related to implementation and homelessness. Qualitative interviews suggest that IPS appears to have beneficial effects on participants' search for employment by facilitating the establishment of trusting working alliances. Les personnes atteintes de maladie mentale, récemment logés par un programme «logement d'abord» (type «Housing First») ont un taux de chômage qui dépasse 95%. Une grande majorité souhaite retourner à l'emploi, mais font face à des obstacles importants qui résultent de leurs expériences d'itinérance et de maladie mentale. Certains de ces obstacles persistent après avoir reçu de l'aide d'un programme «Housing First», ce qui suggère qu'ils ont besoin d'aide additionnelle pour atteindre leurs objectifs d'emploi. Le model Individual Placement and Support (IPS) est efficace et augment le taux d'emploi chez les personnes atteintes de maladie mentale logés de manière stable. Nous connaissons moins à propos de l'impact d'IPS sur les personnes sans-abri atteintes de maladie mentale. Cette étude, de méthodes mixtes, a été menée pour évaluer l'effet d'IPS et du programme «Housing First» sur l'emploi compétitif, et comprend trois bases de données (deux quantitatives et une qualitative). C'est à partir de ces bases de données que le contenu de cette thèse est dérivée: 1) Une grande base de données de 2148 participants de l'étude randomisés At Home/ Chez Soi. 2) Un…