Long-term vocational outcomes in low- and high-fidelity supported employment programs: A multi-site study with 6 years of follow-up

Abstract

Although the effectiveness of the Individual Placement and Support (IPS) model of supported employment has been recognized, the long-term vocational outcomes associated with variations in the structural quality of IPS programs remain unclear. This study investigated the impact of IPS program fidelity on long-term vocational outcomes over 6 years in Japan. The eligible study participants were 202 individuals in 16 IPS programs who were initially enrolled in a 2-year follow-up study and monitored for an additional 4 years. The fidelity of the participating IPS programs was measured using the Japanese version of the individualized Supported Employment Fidelity Scale. Seven and eight programs were classified as low and high fidelity, respectively. The analysis included 123 participants in 15 programs (follow-up rate: 61 %). During the follow-up period, the high-fidelity group had significantly higher employment rates (54.0 % vs. 88.3 %; adjusted odds ratio: 6.5, 95 % confidence interval [CI]: 1.3–31.2, p = 0.020), longer work tenures (adjusted mean difference [aMD]: 14.4 months, 95 %CI: 2.3–26.5, p = 0.020), and higher earnings (shown in USD) (aMD: 10,573.0, 95 %CI: 2119.3–19,026.7, p = 0.014). While the employment rates were significantly higher in the high-fidelity group than in the low-fidelity group until year 4, this difference diminished after year 5. Thus, high-fidelity IPS programs can achieve sustained vocational benefits, and ongoing fidelity reviews and maintenance appear essential for optimizing long-term employment outcomes. The findings also suggest practical considerations regarding the timing of IPS service termination and strategies for long-term engagement with service users who have left their jobs in real-world contexts.