Background: Investigations of implementation factors are recommended to better understand and add... more Background: Investigations of implementation factors are recommended to better understand and address inadequate implementation outcomes. Little is known about the relationship between implementation factors and outcome, especially in later phases of an implementation effort. The aims of this study were to assess the association between implementation success (measured by program fidelity) and care providers’ perceptions of implementation factors during an implementation process and to investigate whether these perceptions can be affected by systematic implementation support.Methods: Using a cluster-randomized design, mental health clinics were drawn to receive implementation support for one (intervention) and not for another (control) of four evidence-based practices. Program fidelity and care providers’ perceptions (Implementation Process Assessment Tool questionnaire) were scored for both intervention and control groups every sixth month for 18 months. Assessments and group diffe...
Administration and Policy in Mental Health and Mental Health Services Research, 2021
The COVID-19 pandemic has caused massive unemployment, exacerbated pre-existing behavioral health... more The COVID-19 pandemic has caused massive unemployment, exacerbated pre-existing behavioral health (mental health and substance use) disorders for many people, and created new disorders for others. Although policy changes have increased health care and unemployment benefits, most people want jobs and self-sufficiency rather than handouts. A robust evidence base shows that supported employment can enable unemployed people with behavioral health conditions to find competitive, integrated employment and behavioral health supports. Millions of U.S. citizens may need these services as the pandemic recedes and jobs become available. Government attention to supported employment is necessary now more than ever.
Employment is a key to community reintegration for both people with mental illness and those with... more Employment is a key to community reintegration for both people with mental illness and those with justice involvement. At present, the empirical literature on employment services for justice-involved people with or without mental illness is meager. By contrast, an extensive evidence base documents the effectiveness of a specific employment model for people with severe mental illness: the Individual Placement and Support (IPS) model of supported employment. This brief (1) describes the IPS model and its evidence base, (2) identifies current trends in IPS services for justice-involved people, (3) summarizes studies of employment services for justiceinvolved people, and (4) suggests IPS adaptations for justice-involved people with mental illness.
ABSTRACT Military personnel face numerous challenges transitioning from military jobs to meaningf... more ABSTRACT Military personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. The Independence Project compared an innovative employment program (National Career Coach Program) with standard employment services (Local Community Resources) in a randomized controlled trial. Study participants were transitioning veterans with self-reported service-connected disabilities seeking permanent employment. The primary outcomes were paid employment and disability ratings over 1 year. Secondary outcomes included health and well-being. At 1-year follow-up, National Career Coach Program participants were significantly more likely to work, had significantly greater earnings, and reported significantly greater improvements in physical and mental health compared with participants assigned to Local Community Resources. Both groups increased in disability ratings over 12 months, with no difference between groups. Multifaceted supports delivered by the National Career Coach Program increased employment, earnings, mental health, and physical health over 1 year. These significant differences appeared even though control group participants achieved considerable employment success.
Service providers need effective strategies to implement evidence-based practices (EBPs) with hig... more Service providers need effective strategies to implement evidence-based practices (EBPs) with high fidelity. This study aimed to evaluate an intensive implementation support strategy to increase fidelity to EBP standards in treatment of patients with psychosis. The study used a cluster randomized design with pairwise assignment of practices within each of 39 Norwegian mental health clinics. Each site chose two of four practices for implementation: physical health care, antipsychotic medication management, family psychoeducation, illness management and recovery. One practice was assigned to the experimental condition (toolkits, clinical training, implementation facilitation, data-based feedback) and the other to the control condition (manual only). The outcome measure was fidelity to the EBP, measured at baseline and after 6, 12, and 18 months, analyzed using linear mixed models and effect sizes. The increase in fidelity scores (within a range 1–5) from baseline to 18 months was sign...
BACKGROUND: While the Individual Placement and Support (IPS) model of supported employment has be... more BACKGROUND: While the Individual Placement and Support (IPS) model of supported employment has been shown to improve competitive employment outcomes, randomized controlled trials have consistently failed to show improved nonvocational outcomes for IPS participants compared to participants receiving traditional vocational services. AIMS: This study evaluated the impact of IPS on nonvocational outcomes for clients with severe mental illness (SMI). METHODS: A longitudinal analysis of data from a randomized controlled trial compared IPS to a stepwise vocational approach on employment outcomes over two years. Nonvocational outcomes were symptoms, psychiatric hospitalizations, quality of life, and social networks. Results: Although the total sample showed improvement in several nonvocational domains over time, there were largely no differences between groups in nonvocational outcomes at follow-up or in their rates of improvement over time. CONCLUSIONS: Participation in supported employment alone is not sufficient to positively impact most nonvocational outcomes in people with severe mental illness.
This study focuses primarily on the non-vocational outcomes and the changes in psychosocial funct... more This study focuses primarily on the non-vocational outcomes and the changes in psychosocial functioning of individuals with severe mental illness through competitive employment. Thirteen out of 56 participants in the Individual Placement & Support (IPS) group who were competitively employed were recruited from two community based mental health settings for the first interview. Eight of them who met the selection criteria for the second interview were interviewed again for comparison. Data were collected through a tailor-made interview guide during their third and sixth months of employment and were analyzed through an inductive process. Data analyses indicated that the employed participants in the IPS group showed positive outcomes in both personal well-being and self-efficacy after three months of employment, while positive and negative impacts were obtained after six months of employment. A dynamic model was suggested based on the findings to explain the job tenure of participants. Further integration of this model to the existing supported employment model is explored.
BACKGROUND: Individual Placement and Support (IPS) is an evidence-based vocational rehabilitation... more BACKGROUND: Individual Placement and Support (IPS) is an evidence-based vocational rehabilitation intervention for people with severe mental illness. IPS emphasizes client choice, rapid job finding, competitive employment, team-oriented approaches, benefits counseling, and ongoing supports. OBJECTIVE: This paper summarizes 20 years of research on IPS, describes studies in the field now, and proposes priorities for future research. METHODS: To identify published and unpublished IPS research studies, we conducted an electronic search of qualitative and quantitative IPS studies, findings from recent reviews, and sought expert recommendation. RESULTS: Past research indicates that IPS supported employment is the most effective and cost-effective approach for helping people with psychiatric disabilities find and maintain competitive employment. Employment improves clinical, social, and economic outcomes. Current studies on IPS address several research gaps: IPS modification, generalizability, program settings, international dissemination, cultural awareness, and supportive technology. Looking forward, the field needs studies that report long-term outcomes, financing mechanisms, cost offsets, and standardized supported education models. CONCLUSIONS: While IPS is one of the most extensively studied of all vocational models, significant literature gaps remain.
Administration and Policy in Mental Health and Mental Health Services Research, 2019
The control of epidemics taking place in complex networks has been an increasingly active topic i... more The control of epidemics taking place in complex networks has been an increasingly active topic in public health management. In this article, we propose an efficient networked epidemic control system, where a modified susceptible-exposedinfected-vigilant (SEIV) model is first built to simulate epidemic spreading. Then, different from existing continuous resource models which abstractly map resources to parameters of epidemic models, a concrete resource description model is built to simulate real-world goods/services and their allocation. Based on the two models, a cost-constraint subset selection problem in epidemic control is identified. To solve the problem, a swarm-based stochastic optimization policy is proposed, where each particle in the swarm can determine its own solutions according to the guidance of its superior peers and historical searching experience of the whole swarm, without extra problem-relative information. Theoretical proof about system equilibrium is provided, which is consistent with experimental observations. The competitive performance of the proposed optimizer is validated by theoretical analysis and comparison experiments. Finally, an application case is provided to illustrate the practicability.
BackgroundCrisis resolution teams (CRTs) offer brief, intensive home treatment for people experie... more BackgroundCrisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care.AimsTo evaluate a 1-year programme to improve CRTs’ model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233).MethodFifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being...
The authors studied the relationship between patients' expectations of therapeuti... more The authors studied the relationship between patients' expectations of therapeutic improvement and their actual outcomes after 8 and 12 months of group psychotherapy. Using patients' self-evaluations and assessments by therapists and independent judges, they found a positive relationship between expectations and outcomes only when assessments were derived from patients. The authors discuss the possibility of a continuing expectational set in patients toward psychotherapy.
This study examined outcomes of clients admitted to assertive community treatment programs simult... more This study examined outcomes of clients admitted to assertive community treatment programs simultaneously implemented at six sites in northeastern Indiana. A total of 212 clients at risk for psychiatric rehospitalization were assessed at baseline and at six-month intervals for 18 months after admission to assertive community treatment programs. Data on rehospitalization, quality of life, and level of functioning were compared using t tests. Progressive improvement was also examined by linear trend analysis. Frequency of psychiatric hospitalization was reduced by one-third and the number of inpatient days by 50 percent after admission to the program. Improvements were progressive, with continued reductions over the 18-month period. Progressive improvements also occurred in quality of life as measured by both client and staff ratings. Case managers rated clients as having improved family and social support, increased self-reliance and independence, and improved daily living skills. Clients reported significantly more legal problems, which may have been an artifact of increased monitoring during treatment. A key element of the programs' success was the position of clinical coordinator, important functions of which are described. Results of this study provide support for wide-scale dissemination of assertive community treatment as an effective form of community care for persons with serious mental illness.
Background: Investigations of implementation factors are recommended to better understand and add... more Background: Investigations of implementation factors are recommended to better understand and address inadequate implementation outcomes. Little is known about the relationship between implementation factors and outcome, especially in later phases of an implementation effort. The aims of this study were to assess the association between implementation success (measured by program fidelity) and care providers’ perceptions of implementation factors during an implementation process and to investigate whether these perceptions can be affected by systematic implementation support.Methods: Using a cluster-randomized design, mental health clinics were drawn to receive implementation support for one (intervention) and not for another (control) of four evidence-based practices. Program fidelity and care providers’ perceptions (Implementation Process Assessment Tool questionnaire) were scored for both intervention and control groups every sixth month for 18 months. Assessments and group diffe...
Administration and Policy in Mental Health and Mental Health Services Research, 2021
The COVID-19 pandemic has caused massive unemployment, exacerbated pre-existing behavioral health... more The COVID-19 pandemic has caused massive unemployment, exacerbated pre-existing behavioral health (mental health and substance use) disorders for many people, and created new disorders for others. Although policy changes have increased health care and unemployment benefits, most people want jobs and self-sufficiency rather than handouts. A robust evidence base shows that supported employment can enable unemployed people with behavioral health conditions to find competitive, integrated employment and behavioral health supports. Millions of U.S. citizens may need these services as the pandemic recedes and jobs become available. Government attention to supported employment is necessary now more than ever.
Employment is a key to community reintegration for both people with mental illness and those with... more Employment is a key to community reintegration for both people with mental illness and those with justice involvement. At present, the empirical literature on employment services for justice-involved people with or without mental illness is meager. By contrast, an extensive evidence base documents the effectiveness of a specific employment model for people with severe mental illness: the Individual Placement and Support (IPS) model of supported employment. This brief (1) describes the IPS model and its evidence base, (2) identifies current trends in IPS services for justice-involved people, (3) summarizes studies of employment services for justiceinvolved people, and (4) suggests IPS adaptations for justice-involved people with mental illness.
ABSTRACT Military personnel face numerous challenges transitioning from military jobs to meaningf... more ABSTRACT Military personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. The Independence Project compared an innovative employment program (National Career Coach Program) with standard employment services (Local Community Resources) in a randomized controlled trial. Study participants were transitioning veterans with self-reported service-connected disabilities seeking permanent employment. The primary outcomes were paid employment and disability ratings over 1 year. Secondary outcomes included health and well-being. At 1-year follow-up, National Career Coach Program participants were significantly more likely to work, had significantly greater earnings, and reported significantly greater improvements in physical and mental health compared with participants assigned to Local Community Resources. Both groups increased in disability ratings over 12 months, with no difference between groups. Multifaceted supports delivered by the National Career Coach Program increased employment, earnings, mental health, and physical health over 1 year. These significant differences appeared even though control group participants achieved considerable employment success.
Service providers need effective strategies to implement evidence-based practices (EBPs) with hig... more Service providers need effective strategies to implement evidence-based practices (EBPs) with high fidelity. This study aimed to evaluate an intensive implementation support strategy to increase fidelity to EBP standards in treatment of patients with psychosis. The study used a cluster randomized design with pairwise assignment of practices within each of 39 Norwegian mental health clinics. Each site chose two of four practices for implementation: physical health care, antipsychotic medication management, family psychoeducation, illness management and recovery. One practice was assigned to the experimental condition (toolkits, clinical training, implementation facilitation, data-based feedback) and the other to the control condition (manual only). The outcome measure was fidelity to the EBP, measured at baseline and after 6, 12, and 18 months, analyzed using linear mixed models and effect sizes. The increase in fidelity scores (within a range 1–5) from baseline to 18 months was sign...
BACKGROUND: While the Individual Placement and Support (IPS) model of supported employment has be... more BACKGROUND: While the Individual Placement and Support (IPS) model of supported employment has been shown to improve competitive employment outcomes, randomized controlled trials have consistently failed to show improved nonvocational outcomes for IPS participants compared to participants receiving traditional vocational services. AIMS: This study evaluated the impact of IPS on nonvocational outcomes for clients with severe mental illness (SMI). METHODS: A longitudinal analysis of data from a randomized controlled trial compared IPS to a stepwise vocational approach on employment outcomes over two years. Nonvocational outcomes were symptoms, psychiatric hospitalizations, quality of life, and social networks. Results: Although the total sample showed improvement in several nonvocational domains over time, there were largely no differences between groups in nonvocational outcomes at follow-up or in their rates of improvement over time. CONCLUSIONS: Participation in supported employment alone is not sufficient to positively impact most nonvocational outcomes in people with severe mental illness.
This study focuses primarily on the non-vocational outcomes and the changes in psychosocial funct... more This study focuses primarily on the non-vocational outcomes and the changes in psychosocial functioning of individuals with severe mental illness through competitive employment. Thirteen out of 56 participants in the Individual Placement & Support (IPS) group who were competitively employed were recruited from two community based mental health settings for the first interview. Eight of them who met the selection criteria for the second interview were interviewed again for comparison. Data were collected through a tailor-made interview guide during their third and sixth months of employment and were analyzed through an inductive process. Data analyses indicated that the employed participants in the IPS group showed positive outcomes in both personal well-being and self-efficacy after three months of employment, while positive and negative impacts were obtained after six months of employment. A dynamic model was suggested based on the findings to explain the job tenure of participants. Further integration of this model to the existing supported employment model is explored.
BACKGROUND: Individual Placement and Support (IPS) is an evidence-based vocational rehabilitation... more BACKGROUND: Individual Placement and Support (IPS) is an evidence-based vocational rehabilitation intervention for people with severe mental illness. IPS emphasizes client choice, rapid job finding, competitive employment, team-oriented approaches, benefits counseling, and ongoing supports. OBJECTIVE: This paper summarizes 20 years of research on IPS, describes studies in the field now, and proposes priorities for future research. METHODS: To identify published and unpublished IPS research studies, we conducted an electronic search of qualitative and quantitative IPS studies, findings from recent reviews, and sought expert recommendation. RESULTS: Past research indicates that IPS supported employment is the most effective and cost-effective approach for helping people with psychiatric disabilities find and maintain competitive employment. Employment improves clinical, social, and economic outcomes. Current studies on IPS address several research gaps: IPS modification, generalizability, program settings, international dissemination, cultural awareness, and supportive technology. Looking forward, the field needs studies that report long-term outcomes, financing mechanisms, cost offsets, and standardized supported education models. CONCLUSIONS: While IPS is one of the most extensively studied of all vocational models, significant literature gaps remain.
Administration and Policy in Mental Health and Mental Health Services Research, 2019
The control of epidemics taking place in complex networks has been an increasingly active topic i... more The control of epidemics taking place in complex networks has been an increasingly active topic in public health management. In this article, we propose an efficient networked epidemic control system, where a modified susceptible-exposedinfected-vigilant (SEIV) model is first built to simulate epidemic spreading. Then, different from existing continuous resource models which abstractly map resources to parameters of epidemic models, a concrete resource description model is built to simulate real-world goods/services and their allocation. Based on the two models, a cost-constraint subset selection problem in epidemic control is identified. To solve the problem, a swarm-based stochastic optimization policy is proposed, where each particle in the swarm can determine its own solutions according to the guidance of its superior peers and historical searching experience of the whole swarm, without extra problem-relative information. Theoretical proof about system equilibrium is provided, which is consistent with experimental observations. The competitive performance of the proposed optimizer is validated by theoretical analysis and comparison experiments. Finally, an application case is provided to illustrate the practicability.
BackgroundCrisis resolution teams (CRTs) offer brief, intensive home treatment for people experie... more BackgroundCrisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care.AimsTo evaluate a 1-year programme to improve CRTs’ model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233).MethodFifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being...
The authors studied the relationship between patients' expectations of therapeuti... more The authors studied the relationship between patients' expectations of therapeutic improvement and their actual outcomes after 8 and 12 months of group psychotherapy. Using patients' self-evaluations and assessments by therapists and independent judges, they found a positive relationship between expectations and outcomes only when assessments were derived from patients. The authors discuss the possibility of a continuing expectational set in patients toward psychotherapy.
This study examined outcomes of clients admitted to assertive community treatment programs simult... more This study examined outcomes of clients admitted to assertive community treatment programs simultaneously implemented at six sites in northeastern Indiana. A total of 212 clients at risk for psychiatric rehospitalization were assessed at baseline and at six-month intervals for 18 months after admission to assertive community treatment programs. Data on rehospitalization, quality of life, and level of functioning were compared using t tests. Progressive improvement was also examined by linear trend analysis. Frequency of psychiatric hospitalization was reduced by one-third and the number of inpatient days by 50 percent after admission to the program. Improvements were progressive, with continued reductions over the 18-month period. Progressive improvements also occurred in quality of life as measured by both client and staff ratings. Case managers rated clients as having improved family and social support, increased self-reliance and independence, and improved daily living skills. Clients reported significantly more legal problems, which may have been an artifact of increased monitoring during treatment. A key element of the programs' success was the position of clinical coordinator, important functions of which are described. Results of this study provide support for wide-scale dissemination of assertive community treatment as an effective form of community care for persons with serious mental illness.
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Papers by Gary Bond