Umsetzung der Prinzipien des Supported Employment in Deutschland

Positionspapier einer Task-Force der DGPPN

Implementation of the principle of supported employment in Germany

Position paper of a task force of the DGPPN

Zusammenfassung

Die Auswirkungen psychischer Erkrankungen auf die Arbeits- und Erwerbssituation können erheblich sein. Sie sind eine der Hauptursachen für Arbeitsunfähigkeit sowie Erwerbsminderung. Vor diesem Hintergrund stellt sich die Frage nach geeigneten beruflichen Wiedereingliederungsmaßnahmen für Menschen mit schweren psychischen Erkrankungen, wobei sich in den letzten Jahren international das Prinzip des Supported Employment als zunehmend erfolgreich erwiesen hat. Hierbei werden psychisch erkrankte Menschen mit beruflichem Rehabilitationsbedarf primär auf einem Arbeitsplatz des ersten Arbeitsmarktes platziert und vor Ort durch einen Jobcoach unterstützt. Dieses Konzept ist inklusiv, individuell, nachhaltig und evidenzbasiert. Trotz erwiesener Wirksamkeit ist es im deutschsprachigen Raum bislang noch wenig umgesetzt. Es wird zukünftig darauf ankommen, stärker als bislang den individuellen Hilfebedarf psychisch erkrankter Menschen aufzunehmen und mit funktional, im besten Fall multiprofessionell und mobil aufgestellten Angeboten zu begegnen.

Abstract

The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers.

This is a preview of subscription content, access via your institution.

Literatur

  1. 1.

    Gühne U, Riedel-Heller S (2015) Die Arbeitssituation von Menschen mit schweren psychischen Erkrankungen in Deutschland. DGPPN, Berlin

    Google Scholar 

  2. 2.

    Bundespsychotherapeutenkammer (2019) BPtK-Auswertung 2018 „Langfristige Entwicklung der Arbeitsunfähigkeit“. https://www.bptk.de/die-laengsten-fehlzeiten-weiterhin-durch-psychische-erkrankungen/. Zugegriffen: 7. Jan. 2020

  3. 3.

    Westcott C, Waghorn G, McLean D et al (2015) Interest in employment among people with schizophrenia. Am J Psychiatr Rehabil 18(2):187–207

    Article  Google Scholar 

  4. 4.

    Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (2017) Behindertenhilfe in Deutschland. Zahlen – Daten – Fakten. Ein Trendbericht. https://www.bgw-online.de/SharedDocs/Downloads/DE/Medientypen/Wissenschaft-Forschung/BGW55-83-140-Trendbericht-Behindertenhilfe.pdf?__blob=publicationFile. Zugegriffen: 24. Sept. 2020

  5. 5.

    Stengler K, Riedel-Heller S, Becker T et al (2014) Berufliche Rehabilitation bei schweren psychischen Erkrankungen. Nervenarzt 85:97–107

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  6. 6.

    Stengler K, Becker T (2016) Supported Employment – ein falsches Konzept für Deutschland? – Kontra. Psychiatr Prax 43(05):243–244

    PubMed  Article  PubMed Central  Google Scholar 

  7. 7.

    Kilian K (2016) Supported Employment – ein falsches Konzept für Deutschland? – Pro. Psychiatr Prax 43(05):242–243

    PubMed  Article  PubMed Central  Google Scholar 

  8. 8.

    Jäckel D, Leopold K, Bechdolf A (2016) Improving functional and clinical recovery by combining Individual Placement and Support (IPS) and Motivational Interviewing-based Adherence Therapy (AT) in people with early psychosis. Mailand, The iFEVR and iphYs Joint Meeting

    Google Scholar 

  9. 9.

    Jäckel D, Leopold K, Bechdolf A (2017) Vocational recovery: mental health and employment in evidence and clinical practice. Berlin, WPA Congress

    Google Scholar 

  10. 10.

    Jäckel D, Leopold K, Bechdolf A (2018) Individual Placement and Support (IPS) in der stationären und teilstationären Versorgung – Nutzungsmuster und Outcome. Berlin, DGPPN Kongress

    Google Scholar 

  11. 11.

    Nischk D, Hauk S, Flügel S et al (2019) Praktikabilität und Effektivität von „Individual Placement and Support“ (IPS) im Landkreis Konstanz. Zwischenbericht 2015–2018. https://www.zfp-reichenau.de/fileadmin/Freigabe_ZfP_Reichenau/Dokumente/Jahresbericht_2018.pdf. Zugegriffen: 7. Jan. 2020

  12. 12.

    Stengler K, Alberti M, Dress L et al (2017) PIA2Work. Psychiatr Prax 44(3):175–176

    Article  Google Scholar 

  13. 13.

    DGPPN (Hrsg) (2019) S3-Leitlinie Psychosoziale Therapien bei schweren psychischen Erkrankungen, 2. Aufl. Springer, Berlin

    Google Scholar 

  14. 14.

    Reker T, Eikelmann B (2004) Berufliche Eingliederung als Ziel psychiatrischer Therapie. Psychiatr Prax 31:251–255

    Article  Google Scholar 

  15. 15.

    Matschnig T, Frottier P, Seyringer M et al (2008) Arbeitsrehabilitation psychisch kranker Menschen – ein Überblick über Erfolgsprädiktoren. Psychiatr Prax 35(6):271–278

    PubMed  Article  PubMed Central  Google Scholar 

  16. 16.

    Bond GR, Drake RE, Mueser KT et al (1997) An update on supported employment for people with severe mental illness. Psychiatr Serv 48(3):335–346

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  17. 17.

    Drake RE, Bond GR (2014) Introduction to the special issue on individual placement and support. Psychiatr Rehabil J 37(2):76–78

    PubMed  Article  PubMed Central  Google Scholar 

  18. 18.

    NICE (2014) Psychosis and schizophrenia in adults. The NICE guideline on treatment and management – updated edition 2014. https://www.nice.org.uk/Guidance/CG178. Zugegriffen: 7. Jan. 2020

  19. 19.

    Twamley EW, Jeste DV, Lehman AF (2003) Vocational rehabilitation in schizophrenia and other psychotic disorders: a literature review and meta-analysis of randomized controlled trials. J Nerv Ment Dis 191(8):515–523

    PubMed  Article  PubMed Central  Google Scholar 

  20. 20.

    Bond GR, Drake RE, Becker DR (2008) An update on randomized controlled trials of evidence-based supported employment. Psychiatr Rehabil J 31(4):280–290

    PubMed  Article  PubMed Central  Google Scholar 

  21. 21.

    Kinoshita Y, Furukawa TA, Kinoshita K et al (2013) Supported employment for adults with severe mental illness. Cochrane Database Syst Rev 9:CD8297. https://doi.org/10.1002/14651858.CD008297.pub2

    Article  Google Scholar 

  22. 22.

    Suijkerbuijk YB, Schaafsma FG, van Mechelen JC et al (2017) Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 9:CD11867. https://doi.org/10.1002/14651858.CD011867.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Cook JA, Burke-Miller JK, Roessel E (2016) Long-term effects of evidence-based supported employment on earnings and on SSI and SSDI participation among individuals with psychiatric disabilities. Am J Psychiatry 173(10):1007–1014

    PubMed  Article  PubMed Central  Google Scholar 

  24. 24.

    Hoffmann H, Jäckel D, Glauser S et al (2014) Long-term effectiveness of supported employment: 5‑year follow-up of a randomized controlled trial. Am J Psychiatry 171(11):1183–1190

    PubMed  Article  PubMed Central  Google Scholar 

  25. 25.

    Chan JY, Hirai HW, Tsoi KK (2015) Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials. J Psychiatr Res 68:293–300

    PubMed  Article  PubMed Central  Google Scholar 

  26. 26.

    Kalkan R, Dorn W, Ehiosun U et al (2009) Unterstützte Beschäftigung bei Menschen mit schweren psychischen Erkrankungen. Erfahrungen im deutschen Studienzentrum der europäischen EQOLISE-Studie. Sozialpsychiatr Inf 39(4):40–45

    Google Scholar 

  27. 27.

    Rinaldi M, Killackey E, Smith J, Shepherd G, Singh SP, Craig T (2010) First episode psychosis and employment: a review. Int Rev Psychiatry 22(2):148–162

    PubMed  Article  PubMed Central  Google Scholar 

  28. 28.

    Bertolote J, McGorry P (2018) Early intervention and recovery for young people with early psychosis: consensus statement. Br J Psychiatry 187(S48):s116

    Article  Google Scholar 

  29. 29.

    Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E (2010) Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry 197(5):350–356

    PubMed  PubMed Central  Article  Google Scholar 

  30. 30.

    Gmitroski T, Bradley C, Heinemann L, Liu G, Blanchard P, Beck C, Mathias S, Leon A, Barbic SP (2018) Barriers and facilitators to employment for young adults with mental illness: a scoping review. BMJ Open 8(12):e24487

    PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    Sveinsdottir V, Lie SA, Bond GR, Eriksen HR, Tveito TH, Grasdal AL, Reme SE (2019) Individual placement and support for young adults at risk of early work disability (the SEED trial). A randomized controlled trial. Scand J Work Environ Health 45(1):33–41

    PubMed  Article  PubMed Central  Google Scholar 

  32. 32.

    Bond GR, Drake R, Luciano A (2015) Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review. Epidemiol Psychiatr Sci 24(5):446–457

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  33. 33.

    ten Velden Hegelstad W, Joa I, Heitmann L, Johannessen JO, Langeveld J (2019) Job- and schoolprescription: a local adaptation to individual placement and support for first episode psychosis. Early Interv Psychiatry 13(4):859–866

    Article  Google Scholar 

  34. 34.

    Killackey E, Allott K, Jackson HJ, Scutella R, Tseng YP, Borland J, Proffitt TM, Hunt S, Kay-Lambkin F, Chinnery G, Baksheev G, Alvarez-Jimenez M, McGorry PD, Cotton SM (2019) Individual placement and support for vocational recovery in first-episode psychosis: randomised controlled trial. Br J Psychiatry 214(2):76–82

    PubMed  Article  PubMed Central  Google Scholar 

  35. 35.

    Nuechterlein KH, Subotnik KL, Ventura J, Turner LR, Gitlin MJ, Gretchen-Doorly D, Becker DR, Drake RE, Wallace CJ, Liberman RP (2019) Enhancing return to work or school after a first episode of schizophrenia: The UCLA RCT of Individual Placement and Support and Workplace Fundamentals Module training. Psychol Med. https://doi.org/10.1017/S0033291718003860

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Rosenheck R, Mueser KT, Sint K, Lin H, Lynde DW, Glynn SM, Robinson DG, Schooler NR, Marcy P, Mohamed S, Kane JM (2017) Supported employment and education in comprehensive, integrated care for first episode psychosis: effects on work, school, and disability income. Schizophr Res 128:120–128

    Article  Google Scholar 

  37. 37.

    Stengler K, Kauffeldt S, Theißing A, Bräuning-Edelmann M, Becker T (2015) Medizinisch-berufliche Rehabilitation in Rehabilitationseinrichtungen für psychisch kranke Menschen in Deutschland: Analyse von Aufnahme- und Entlassdaten. Nervenarzt 86(5):603–608. https://doi.org/10.1007/s00115-014-4207-3

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Stengler K, Becker T, Kilian R (2018) Maßnahmen zur beruflichen Integration in RPK- und BTZ-Einrichtungen mit und ohne Supported-Employment-Anteile für Menschen mit schweren psychischen Erkrankungen (RPK_BTZ_MOSES). DGPPN Kongressbeitrag

    Google Scholar 

  39. 39.

    Bond GR, Drake RE, Becker DR (2012a) Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US. World Psychiatry 11(1):32–39

    PubMed  PubMed Central  Article  Google Scholar 

  40. 40.

    Drake RE, Bond GR, Becker DR (2012) Individual placement and support: an evidence-based approach to supported employment. Oxford University Press, New York

    Google Scholar 

  41. 41.

    Bond GR, Becker DR, Drake RE, Vogler KM (1997) A fidelity scale for the individual placement and support model of supported employment. Rehabil Couns Bull 40(4):265–284

    Google Scholar 

  42. 42.

    Bond GR, Evans L, Salyers MP, Williams J, Kim HW (2000) Measurement of fidelity in psychiatric rehabilitation. Ment Health Serv Res 2(2):75–87

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  43. 43.

    Bond GR, Peterson AE, Becker DR, Drake RE (2012b) Validation of the revised individual placement and support fidelity scale (IPS-25). Psychiatr Serv 63(8):758–763

    PubMed  Article  PubMed Central  Google Scholar 

  44. 44.

    Swanson S, Becker D (2013) IPS supported employment: a practical guide. Psychiatric Research Center, Dartmouth

    Google Scholar 

  45. 45.

    Lockett H, Waghorn G, Kydd R, Chant D (2016) Predictive validity of evidence-based practices in supported employment: a systematic review and meta-analysis. Ment Health Rev J 21(4):261–281

    Article  Google Scholar 

  46. 46.

    IPS Employment Center (2019) IPS fidelity scale for young adults. https://ipsworks.org/wp-content/uploads/2019/03/IPS-fidelity-scale-for-young-adults-3-27-19.pdf. Zugegriffen: 7. Jan. 2020

  47. 47.

    Bond GR, Becker DR, Drake RE (2011) Measurement of fidelity of implementation of evidence-based practices: case example of the IPS fidelity scale. Clin Psychol Sci Prac 18(2):126–141

    Article  Google Scholar 

  48. 48.

    Kim SJ, Bond GR, Becker DR, Swanson SJ, Langfitt-Reese S (2015) Predictive validity of the individual placement and support fidelity scale (IPS-25): a replication study. J Vocat Rehabil 43(3):209–216

    Article  Google Scholar 

  49. 49.

    Metcalfe JD, Drake RE, Bond GR (2018) Economic, labor, and regulatory moderators of the effect of individual placement and support among people with severe mental illness: a systematic review and meta-analysis. Schizophr Bull 44(1):22–31

    PubMed  Article  PubMed Central  Google Scholar 

  50. 50.

    DGPPN (2019) S3-Leitlinie Schizophrenie. Langfassung, Version 1.0, zuletzt geändert am 15. März 2019. https://www.awmf.org/leitlinien/detail/ll/038-009.html. Zugegriffen: 7. Jan. 2020

  51. 51.

    Waghorn G, Dias S, Gladman B, Harris M (2015) Measuring what matters: effectiveness of implementing evidence-based supported employment for adults with severe mental illness. Int J Ther Rehabil 22(9):411–420

    Article  Google Scholar 

  52. 52.

    Waghorn G, van Veggel R, Chant D, Lockett H (2018) The utility of item level fidelity scores for developing evidence based practices in supported employment. J Vocat Rehabil 48(3):387–391

    Article  Google Scholar 

  53. 53.

    Catty J, White S, Koletsi M, Becker T, Fioritti A, Kalkan R, Lauber C, Lissouba P, Rössler W, Tomov T, van Busschbach JT, Wiersma D, Burns T (2011) Therapeutic relationships in vocational rehabilitation: predicting good relationships for people with psychosis. Psychiatry Res 187(1–2):68–73

    PubMed  Article  PubMed Central  Google Scholar 

  54. 54.

    Craig T, Shepherd G, Rinaldi M, Smith J, Carr S, Preston F, Singh S (2014) Vocational rehabilitation in early psychosis: cluster randomised trial. Br J Psychiatry 205(2):145–150

    PubMed  Article  PubMed Central  Google Scholar 

  55. 55.

    Corbière M, Brouwers E, Lanctôt N, van Weeghel J (2014) Employment specialist competencies for supported employment programs. J Occup Rehabil 24(3):484–497

    PubMed  PubMed Central  Google Scholar 

  56. 56.

    Glover CM, Frounfelker RL (2011) Competencies of employment specialists for effective job development. Am J Psychiatr Rehabil 14(3):198–211

    Article  Google Scholar 

  57. 57.

    King J, Waghorn G (2018) How higher performing employment specialists support job-seekers with psychiatric disabilities retain employment. J Rehabil 84(4):22–28

    Google Scholar 

  58. 58.

    Taylor A, Bond G (2014) Employment specialist competencies as predictors of employment outcomes. Community Ment Health J 50(1):31–40

    PubMed  Article  PubMed Central  Google Scholar 

  59. 59.

    Whitley R, Kostick K, Bush P (2010) Desirable characteristics and competencies of supported employment specialists: an empirically-grounded framework. Adm Policy Ment Health 37(6):509–519

    PubMed  Article  PubMed Central  Google Scholar 

  60. 60.

    Schwarz B, Specht T, Bethge M (2017) Fortschreibung von Desintegrationskarrieren statt Förderung beruflicher Wiedereingliederung: Eine qualitative Studie zur Arbeitgebereinbindung in den Reha-Prozess. Rehabilitation 56(6):365–371

    Article  Google Scholar 

  61. 61.

    Jäckel D, Siebert S, Baumgardt J, Leopold K, Bechdolf A (2020) Arbeitsbezogene Teilhabebeeinträchtigungen und Unterstützungsbedarf von Patienten in der (teil-)stationären psychiatrischen Versorgung. Psychiatr Prax. https://doi.org/10.1055/a-1112-5519

    Article  PubMed  PubMed Central  Google Scholar 

  62. 62.

    Kinn LG, Holgersen H, Borg M, Davidson L (2016) “Watch your steps”—Community mental health professionals’ perspectives on the vocational rehabilitation of people with severe mental illness. Scand Psychol 3:e16. https://doi.org/10.15714/scandpsychol.3.e16

    Article  Google Scholar 

  63. 63.

    Knaeps J, Neyens I, Donceel P, van Weeghel J, Van Audenhove C (2015) Beliefs of vocational rehabilitation counselors about competitive employment for people with severe mental illness in Belgium. Rehabil Couns Bull 58(3):176–188

    Article  Google Scholar 

  64. 64.

    Marwaha S, Balachandra S, Johnson S (2008) Clinicians’ attitudes to the employment of people with psychosis. Soc Psychiatry Psychiatr Epidemiol 44(5):349–360

    PubMed  Article  PubMed Central  Google Scholar 

  65. 65.

    Bonfils IS, Hansen H, Dalum HS, Eplov LF (2017) Implementation of the individual placement and support approach – facilitators and barriers. Scand J Disabil Res 19(4):318–333

    Article  Google Scholar 

  66. 66.

    Hamann J, Brieger P (2019) Return to Work – berufliches Entlassmanagement. Nervenheilkunde 38(07):481–484

    Article  Google Scholar 

  67. 67.

    Fioritti A, Burns T, Hilarion P, van Weeghel J, Cappa C, Sunol R, Otto E (2014) Individual placement and support in Europe. Psychiatr Rehabil J 37(2):123–128

    PubMed  Article  PubMed Central  Google Scholar 

  68. 68.

    Knaeps J, DeSmet A, Van Audenhove C (2012) The IPS fidelity scale as a guideline to implement supported employment. J Vocat Rehabil 37(1):13–23

    Article  Google Scholar 

  69. 69.

    Latimer E, Bordeleau F, Methot C, Barrie T, Ferkranus A, Lurie S, Whitley R (2019) Implementation of supported employment in the context of a national Canadian program: facilitators, barriers and strategies. Psychiatr Rehabil J. https://doi.org/10.1037/prj0000355

    Article  PubMed  PubMed Central  Google Scholar 

  70. 70.

    Moe C, Brinchmann B, McDaid D, Killackey E, Rinaldi M, Mykletun A (2019) Approaches to implementing individual placement and support in the health and welfare sectors: a scoping review protocol. JBI Database System Rev Implement Rep. https://doi.org/10.11124/JBISRIR-D-11119-00035

    Article  PubMed  PubMed Central  Google Scholar 

  71. 71.

    Rinaldi M, Miller L, Perkins R (2010b) Implementing the individual placement and support (IPS) approach for people with mental health conditions in England. Int Rev Psychiatry 22(2):163–172

    PubMed  Article  PubMed Central  Google Scholar 

  72. 72.

    Schneider J, Akhtar A (2012) Implementation of individual placement and support: the Nottingham experience. Psychiatr Rehabil J 35(4):325–332

    PubMed  Article  PubMed Central  Google Scholar 

  73. 73.

    van Erp NH, Giesen FB, van Weeghel J, Kroon H, Michon HW, Becker D, McHugo GJ, Drake RE (2007) A multisite study of implementing supported employment in the Netherlands. Psychiatr Serv 58(11):1421–1426

    PubMed  Article  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to R. Zeidler.

Ethics declarations

Interessenkonflikt

K. Stengler, A. Bechdolf, T. Becker, A. Döring, W. Höhl, D. Jäckel, H. Kilian, A. Theißing, A. Torhorst, G. Wirtz, R. Zeidler und S. Riedel-Heller geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Alle AutorInnen sind Mitglied der DGPPN-Task-Force „Supported Employment“ und haben zu gleichen Teilen an diesem Positionspapier mitgewirkt.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Stengler, K., Bechdolf, A., Becker, T. et al. Umsetzung der Prinzipien des Supported Employment in Deutschland. Nervenarzt (2021). https://doi.org/10.1007/s00115-020-01038-0

Download citation

Schlüsselwörter

  • Berufliche Teilhabe
  • Rehabilitation
  • Unterstützte Beschäftigung
  • Individual Placement and Support (IPS)
  • Jobcoaching

Keywords

  • Vocational recovery
  • Vocational rehabilitation
  • Supported employment
  • Individual placement and support (IPS)
  • Jobcoaching