Using Outcomes, Participant Engagement, and Recovery Measures to Evaluate the Efficacy of Vocational Illness Management and Recovery (V-IMR) when Compared with Individual Placement and Support (IPS) By: Megan Louderman and Jim Linderman Introduction The Mental Health Center of Denver partnered with Boston University as a pilot site for a randomized clinical research study to evaluate a new clinical intervention, Vocational Illness Management and Recovery (V-IMR), which is intended to help people with mental illness obtain and keep a job. Control group participants received Individual Placement and Support (IPS) supported employment services, while experimental group participants received both IPS and V-IMR. In order to evaluate the efficacy of this program, participants’ progress was tracked over an 18-month period, and outcomes include job attainment and job retention. Additionally, participants’ engagement in services was analyzed, as were their MHCD recovery measures: Consumer Recovery Measure (CRM) and Recovery Markers Inventory (RMI). Evaluation Methods 125 participants, 13 with incomplete data, randomly assigned to receive VIMR services in addition to treatment as usual (IPS) or IPS alone. Participants were enrolled for 18 months. At the time of analysis, some participants had not yet discharged from the study.  Experimental n = 55  Control n = 57 Job attainment: pay, hours, title  Duration, reason for terminating employment Consumer Recovery Measure: consumer self-rating of symptom management and progress Recovery Markers Inventory: clinician rating of various recovery elements, including employment and education. Service usage for IPS and VIMR services Days of Service 6 month reassessments: BASIS-R, Work Hope Scale, Illness Management and Recovery Scale, Proactive Coping Inventory, Confidence Inventory Clinician Rating Illness Management and Recovery Scale ExperimentalControl Had 1+ job62%65% Time to first job117 days124 days Average length of all jobs110 days128 days Total number of jobs6263 Pre and Post RMI Scores: Employment *On a scale of 1- 12, the average decrease was 2.3 and the average increase was 3.6. n = 41 *On a scale of 1- 12, the average decrease was 1.9 and the average increase was 4.2. n = 42 *An “increase” can be considered a positive indicator. Pre and Post RMI Scores: Overall *On a scale of 1- 10, the average decrease was.79 and the average increase was.71 n = 41 *On a scale of 1- 10, the average decrease was.22 and the average increase was.42. n = 42 Experimental Control Pre and Post CRM Scores *On a scale of 1- 10, the average decrease was 1.13 and the average increase was 1.19 n = 47 *On a scale of 1- 10, the average decrease was.93 and the average increase was 1.42 n = 47 *An “increase” can be considered a positive indicator. Experimental Control Implications VIMR services are at least as good as evidenced-based IPS services. RMI scores appeared to increase more for control participants. CRM scores appeared to increase more for experimental participants. However, there may not be a large enough difference between the services themselves to illicit outcomes which might suggest that one is necessarily better than the other. Lessons Learned  Ideally, VIMR was to be implemented concurrently with IPS. However, approximately 1/2 of participants withdrew from IPS services during the course of the study.  Continued participation in VIMR  Varying levels of job readiness at enrollment  VIMR could be a “stepping stone” into IPS services, especially for those consumers in a contemplative state of change  Baseline conditions  Identify which participants are most likely to benefit from additional interventions  Engaging participants  No participants were closed out of VIMR services, regardless of their level of participation, which may have skewed the results  What level of of participation is optimal in order to ensure effectiveness of the intervention?  Service delivery  Feasibility and accessibility for participants  Anecdotal reports from participants at reassessment were overwhelmingly positive with regards to VIMR  What measures could be used to capture this data in a meaningful way?  Long term outcomes Are the effects of one intervention more enduring than another?  Incomplete data