AbstractIndividual Career Management (ICM) is an enhanced supported employment intervention for people with common mental illness. This thesis describes a randomised controlled trial (RCT), called the CAREER Study, which evaluated the effectiveness and cost-effectiveness of the ICM intervention.
ICM had been developed pragmatically in an NHS mental health trust in South London so existing service materials were used to create a written description of the intervention that could be used as the basis of a treatment manual. A semi-systematic review of the supported employment literature was undertaken to inform the design of the CAREER study methods and a further systematic review identified studies to inform the design of the economic evaluation.
The CAREER Study took place in an Improving Access to Psychological Therapies (IAPT) service in the London Borough of Southwark between October 2011 and March 2014. Two-hundred and sixty one participants entered the study and were randomised to receive either the ICM intervention in addition to treatment as usual (TAU), or TAU only. Assessments occurred pre-randomisation and at 6 months follow-up. The primary outcome was competitive employment. Secondary outcomes included length of competitive employment, job satisfaction, absenteeism, presenteeism, occupational activity, return-to-work self-efficacy, career search efficacy, self-esteem, anxiety, depression, social functioning and health-related quality of life. Regression analyses were undertaken to estimate the main effect of group on all outcomes.
The economic evaluation took a societal perspective and resource use data was collected including hospital, community health, social care and employment services, and medication. Productivity losses as a result of sickness absence were also calculated. A cost-utility analysis using Quality Adjusted Life Years (QALYs) as the main outcome was conducted.
Intention-to-treat analysis revealed that the ICM intervention was not effective in improving competitive employment and was not cost-effective in terms of QALYs. Significant effects were found for several secondary outcomes, including occupational activity, return-to-work self-efficacy, career search efficacy, self-esteem, and depression, indicating that the intervention may be useful in improving the level of ‘job readiness’ for this client group.
The key findings, strengths and limitations of the CAREER study are discussed in the final chapter of this thesis and suggestions for further research, policy and practice are presented.
|Date of Award
|Sarah Byford (Supervisor), Thomas Jamieson-Craig (Supervisor) & Barbara Barrett (Supervisor)