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    ABSTRACT: Background/Aims: This investigation compared the utility of two approaches to measuring the effectiveness of a supported employment programme. Both were multi-site trials of evidence-based supported employment which differed by research design. The first approach, a non-randomised multisite intervention, used a parallel group design that did not involve a control group at the site level. The second approach was conducted simultaneously in different locations. This was a controlled trial with randomisation to an evidence-based supported employment programme and a control condition consisting of existing local employment services. The results of the four-site randomised controlled trial (RCT) have recently been reported and provide benchmarks for this comparison. Methods: A four-site parallel group design (n=160) evaluated the implementation of the individual placement and support approach in Brisbane (two sites), Sunshine Coast and Bellerive (Tasmania). The employment intervention involved a full-time employment specialist employed by an existing employment service, to be hosted by a community mental health team. Results: There was no significant difference in commencing employment outcomes between the foursite non-randomised approach to implementation and the four-site RCT (35.6% vs 42.5%). The RCT provided two cohorts whose performance benchmarked the implementation in the non-controlled sites. The promising results of both evaluation approaches show that randomisation did not inflate results, and both methods show utility for programme evaluation in different settings. Conclusions: For the purpose of evaluating new programme implementations, both RCT and non-RCT parallel group designs have potential utility. If the focus is on determining which programme type or which programme ingredient is the most effective, then an RCT design with high internal validity is recommended. In this case, the non-randomised parallel group design had utility through its use of more natural implementation conditions with greater ecological validity. If suitable benchmarks are available and strong potential confounders, such as client age, diagnostic mix and service delivery attributes, are managed, then non-randomised evaluations can be informative, particularly when randomisation is neither practical nor feasible.
    No preview · Article · Sep 2015 · International Journal of Therapy and Rehabilitation
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    Rhonda van Veggel · Geoffrey Waghorn · Shannon Dias
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    ABSTRACT: Introduction: The aim of this research was to evaluate a large-scale implementation of evidence-based supported employment for people with severe mental illness, at 17 locations throughout Sussex, England. Method: A parallel group observational design was used to evaluate an implementation of the individual placement and support approach to supported employment. Three sites provided both a comparison pre-individual placement and support cohort (n=140), and a new post-individual placement and support cohort (n=107) as part of the individual placement and support implementation (n=446). All individual placement and support sites involved community mental health teams forming partnerships with Southdown Supported Employment to co-locate an employment specialist into each mental health team. The primary outcome was the proportion of participants commencing competitive employment during the follow-up period. Results: The new individual placement and support sites attained higher fidelity with respect to individual placement and support principles and practices (mean 97 of 125) than the pre-individual placement and support sites (mean 77 of 125). Significantly more individual placement and support participants commenced competitive employment than pre-individual placement and support participants (24.9% vs 14.3%). Individual placement and support participants experienced less delay before commencing their first job (153 vs 371 days), and when employed, worked more hours per week (24.3 vs 15.4 hours). Conclusion: This implementation of individual placement and support in Sussex improved on the previous vocational services. Although progress is encouraging there is much room for improvement. More resources appear needed to support programme development, specifically to strengthen site-level management, training, technical support, fidelity assessment, programme monitoring, and outcome evaluation.
    Full-text · Article · May 2015
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    ABSTRACT: The aim was to assess the initial psychometric properties of a survey designed to measure health professionals’ perceptions of an integrated supported employment program as a contributor to recovery from severe mental illness. Thirty four mental health professionals with a mean age of 44.4 years completed the survey at two time points, mean 50 days apart. The Health Professionals Perceptions of Employment Scale had good face validity, respondent acceptability, test-retest reliability and internal consistency. Two questions were removed as a result of these findings. The revised version is now available on request. The revised HPPE is an acceptable, reliable, and promising tool for monitoring the integration of a mental health service with an evidence-based supported employment program.
    No preview · Article · Mar 2015 · Journal of rehabilitation
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    ABSTRACT: The aim was to assess the initial psychometric properties of a survey designed to measure health professionals' perceptions of an integrated supported employment program as a contributor to recovery from severe mental illness. Thirty four mental health professionals with a mean age of 44.4 years completed the survey at two time points, mean 50 days apart. The Health Professionals Perceptions of Employment Scale had good face validity, respondent acceptability, test-retest reliability and internal consistency. Two questions were removed as a result of these findings. The revised version is now available on request. The revised HPPE is an acceptable, reliable, and promising tool for monitoring the integration of a mental health service with an evidence-based supported employment program.
    No preview · Article · Jan 2015 · Journal of rehabilitation
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    ABSTRACT: Background/aimThe Individual Placement and Support (IPS) approach is an evidence-based form of supported employment for people with severe and persistent mental illness. This approach is not yet widely available in Australia even though there is mounting evidence of its generalisability outside the USA. One previous Australian randomised controlled trial found that IPS is effective for young people with first episode psychosis. The aim of the current trial was to assess the effectiveness of evidence-based supported employment when implemented for Australian adult consumers of public mental health services by utilising existing service systems.MethodsA four-site randomised control trial design (n = 208) was conducted in Brisbane (two sites), Townsville and Cairns. The intervention consisted of an IPS supported employment service hosted by a community mental health team. The control condition was delivered at each site by mental health teams referring consumers to other disability employment services in the local area.ResultsAt 12 months, those in the IPS condition had 2.4 times greater odds of commencing employment than those in the control condition (42.5% vs. 23.5%). The conditions did not differ on secondary employment outcomes including job duration, hours worked, or job diversity. Attrition was higher than expected in both conditions with 28.4% completing the baseline interview but taking no further part in the study.Conclusion The results support previous international findings that IPS-supported employment is more effective than non-integrated supported employment. IPS can be successfully implemented this way in Australia, but with a loss of effect strength compared to previous USA trials.
    No preview · Article · Sep 2014 · Australian Occupational Therapy Journal
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    ABSTRACT: Objective: Prisoners with intellectual disability who have a coexisting mental health issue often have unmet health needs and are more likely to reoffend than those with intellectual disability alone. The aims of this study were to estimate the prevalence of co-occurring mental disorder among prisoners with intellectual disability and to explore the association between intellectual disability and mental disorder. Methods: Cross-sectional study of adult prisoners within 6 weeks of release from custody in seven prisons in Queensland, Australia between August 2008 and July 2010. Intellectual disability was assessed using a practical composite screening tool. Prisoners who scored <85 on the Hayes Ability Screening Index and reported either having attended a special school or having been diagnosed with intellectual disability were identified as having an intellectual disability. Mental health was assessed using self-reported psychiatric diagnoses, the Kessler Psychological Distress Scale (K-10), and the Mental Component Summary score of the Short-Form-36 health survey version 2. The association between intellectual disability and mental health was assessed using univariate and multivariate logistic regression. Results: Overall, 1279 prisoners completed the HASI: 316 (24%) scored below the recommended cut off for further diagnostic assessment of intellectual disability, 181 (14%) reported attending a special school, and 56 (4%) reported that they had been diagnosed with an intellectual disability. On our composite measure, 115 (9%) participants were identified as having an intellectual disability. Among prisoners with intellectual disability, the estimated lifetime and current prevalence of co-occurring mental disorders was 52.5% (95% CI 43.3-61.5) and 37.2% (95% CI 28.8-46.5), respectively. Of those with intellectual disability, 13.5% (95% CI 8.3-21.1) reported very high psychological distress, as measured by the K10. Prisoners with intellectual disability were significantly more likely than their non-disabled peers to report a current diagnosis of depression [adjusted odds ratio (AOR) 1.8, 95% CI 1.1-3.2] or substance dependence (AOR 3.7, 95% CI 1.6-8.4], after adjusting for potentially confounding variables. Prisoners with intellectual disability were also significantly more likely than their non-disabled peers to use antipsychotic medication (AOR 1.7, 95% CI 1.0-2.8). Conclusions: Prisoners with an intellectual disability were more likely than their non-disabled peers to have elevated rates of psychiatric comorbidity and unmet treatment needs. There is a need for enhanced collaboration between specialist intellectual disability psychiatric services and mainstream prison mental health services, to ensure coordinated service delivery for this dually disadvantaged group.
    No preview · Article · May 2013 · Australian and New Zealand Journal of Psychiatry
  • S Dias · R S Ware · S A Kinner · N G Lennox
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    ABSTRACT: Background: People with intellectual disability (ID) in the general population and people in prison experience unrecognised medical conditions and inadequate disease prevention. Among prisoners, those with an ID may be particularly disadvantaged. The aim of this study was to identify demographic, health and health-related characteristics of adult prisoners who screened positive for ID. Methods: Cross-sectional data were collected via face-to-face administration of a structured questionnaire in seven prisons in Queensland, Australia, between 2008 and 2010. Participants were adult prisoners within 6 weeks of release from custody. We identified ID using a pragmatic screening tool. Prisoners who scored <85 on the Hayes Ability Screening Index and either (a) reported having attended a special school or (b) reported having been diagnosed with an ID were considered to have screened positive for ID. We compared the characteristics of participants who screened positive and negative for ID using univariable and multivariable logistic regression. Results: Screening positive for ID was associated with younger age, identifying as Indigenous and lower educational achievement. Prisoners who screened positive for ID were more likely to have been diagnosed with medical conditions such as heart disease (odds ratio; 95% confidence interval = 2.1; 1.0-4.2) and hearing problems (2.2; 1.3-3.7), after adjustment for age, sex, education level and Indigenous status. Screen-positive prisoners were less likely to have received preventive care interventions such as testing for hepatitis A infection (0.4; 0.2-0.6), and immunisation for tuberculosis (0.4; 0.2-0.8). Prisoners with possible ID were more likely to be obese (1.7; 1.1-2.7). Conclusions: Adult prisoners who screen positive for ID have worse health outcomes than their non-disabled peers. An improved understanding of physical health characteristics prior to release can direct treatment and support pathways out of the criminal justice system and inform transitional planning of health services for this profoundly disadvantaged group.
    No preview · Article · Oct 2012 · Journal of Intellectual Disability Research
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    ABSTRACT: The potential for an expanded HIV epidemic in Papua New Guinea (PNG) demands an effective, evidence-based and locally-appropriate national response. As sexually transmitted infections (STIs) may be important co-factors in HIV transmission nationally, it is timely to conduct a systematic review of STI prevalences to inform national policy on sexual health and HIV/STI prevention. We undertook a systematic review and meta-analysis of HIV and STI prevalences in PNG, reported in peer-reviewed and non-peer-reviewed publications for the period 1950-2010. Prevalence estimates were stratified by study site (community or clinic-based), geographic area and socio-demographic characteristics. The search strategy identified 105 reports, of which 25 studies (10 community-based; 10 clinic-based; and 5 among self-identified female sex workers) reported STI prevalences and were included in the systematic review. High prevalences of chlamydia, gonorrhoea, syphilis and trichomonas were reported in all settings, particularly among female sex workers, where pooled estimates of 26.1%, 33.6%, 33.1% and 39.3% respectively were observed. Pooled HIV prevalence in community-based studies was 1.8% (95% CI:1.2-2.4) in men; 2.6% (95% CI:1.7-3.5) in women; and 11.8% (95% CI:5.8-17.7) among female sex workers. The epidemiology of STIs and HIV in PNG shows considerable heterogeneity by geographical setting and sexual risk group. Prevalences from community-based studies in PNG were higher than in many other countries in the Asia-Pacific. A renewed focus on national STI/HIV surveillance priorities and systems for routine and periodic data collection will be essential to building effective culturally-relevant behavioural and biomedical STI/HIV prevention programs in PNG.
    Preview · Article · Dec 2010 · PLoS ONE

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