Career Management to Improve Education, Employment and Retention for People With Anxiety and Depression (CAREER)

Effectiveness and Cost Effectiveness of Individual Career Management for People With Anxiety and Depression: A Randomised Controlled Trial

The aim of the investigation is to evaluate the effectiveness and costeffectiveness of a model of supported employment (the Individual Career Management (ICM) model) designed to help people with common mental illness return to work.

Study Overview

• Status: Completed
• Conditions: Depression; Anxiety
• Intervention / Treatment: Behavioral: Individual Career Management (ICM); Behavioral: Standard Care

Detailed Description

The design of the study is a randomised controlled trial of two groups in a natural setting (intervention group vs control group). The primary outcome is paid employment. Standard care for all participants is a package of psychological therapy (IAPT). The intervention is an additional package of employment support (ICM) delivered alongside standard care.

The intervention group and control group will both receive standard care. The intervention group will receive ICM support in addition to standard care and the control group will be given details of other employment programmes in the local area, in line with current IAPT practice. The control period will last six months. There will be no fewer than 184 participants in the study (92 in each arm).

The study will take place at the Southwark Psychological Therapies Service at the SLaM NHS Foundation Trust. Patients that meet the inclusion criteria will be invited to attend an interview where written informed consent and baseline measures will be obtained. The participant will then be randomly assigned to either the intervention or control group. All participants will be invited to attend a second interview at the end of a six month period where followup measures will be taken. If the intervention is available at this time, control group participants may then be offered the opportunity to receive it.

A randomised controlled trial of supported employment for people with common mental health problems has never been carried out in the UK, therefore this study will be the first of its kind. The results will help to determine if ICM is an effective and costeffective service and will provide the foundations for further research in this area.

• Study Type: Interventional
• Enrollment (Actual): 261
• Phase: Phase 2

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, SE5 8AZ
    • Southwark Psychological Therapies Service

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Must be either unemployed or off sick for at least two weeks if employed at the time of entry to the study
• Must be legally allowed to work in the UK
• Must be between the age of 18-65 for men, and 18-60 for women (based on UK retirement age)
• Must have received an IAPT assessment and been offered psychological therapy
• Must not have been receiving therapy for more than one month
• Must be interested in obtaining competitive employment
• Must have given full written consent to participate in the study

Exclusion criteria:

• People who are employed and attending work or off sick for less than two weeks at the time of entry to the study
• People who do not have the legal right to work in the UK
• People who have not yet received an IAPT assessment
• People who have received an IAPT assessment but not eligible for psychological therapy
• People who have been receiving therapy for more than one month
• People who are not interested in obtaining competitive employment
• People who do not give written consent or who lack mental capacity to give consent at the time of the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; Standard Care (IAPT Therapy) + Individual Career Management (ICM)	Behavioral: Individual Career Management (ICM); The intervention will be Individual Career Management (ICM) support for a six month period. ICM consists of individually tailored support to help an individual to obtain and retain in employment. ICM follows the seven principles of supported employment (often referred to an Individual Placement and Support), but includes the additional principles of career counselling, motivational coaching, education and training support, and specialist job retention support. The length and frequency of ICM support sessions is determined by the needs of the client.; Other Names: IPS; Supported Employment; Behavioral: Standard Care; A package of psychological therapy delivered by an Improving Access to Psychological Therapies (IAPT) practitioner.; Other Names: CBT; IAPT
Active Comparator: Control; Standard Care (IAPT Therapy)	Behavioral: Standard Care; A package of psychological therapy delivered by an Improving Access to Psychological Therapies (IAPT) practitioner.; Other Names: CBT; IAPT

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of Competitive Employment	Length of competitive employment during the 6 month study period. The following definition of competitive employment will be used: A job paying at least the national minimum wage.; A job located in a mainstream setting not set aside for people with disabilities.; A job that is not owned by the ICM service.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Working Hours	Average number of hours worked each week	6 months
Time to Employment	Number of days between baseline date and the employment start date.	6 months
Salary	Average weekly salary over the 6 month period	6 months
Number of Jobs	Number of different jobs held during the 6 month period	6 months
Job Terminations	Number of job terminations over the 6 month period and the reason for each termination	6 months
Other occupational activity	Non-competitive employment (e.g. sheltered work), education, training or volunteering	6 months
Anxiety	Generalised Anxiety Disorder Assessment (GAD 7) score	6 months
Depression	Patient Health Questionnaire (PHQ-9) score	6 months
Social Functioning	Work and Social Adjustment Scale (WSAS)	6 months
Health-related quality of Life	EQ-5D score	6 months
Work-related quality of Life	WRQoL score	6 months
Self Esteem	Rosenberg Self Esteem Scale	6 months
Career Search Efficacy	Career Search Efficacy Scale (CSES) score	6 months
Return to Work Efficacy	Return to Work Self Efficacy Scale (RTW-SE) score	6 months
Productivity	Absenteeism and presenteeism questions from the World Health Organization's Health and Work Performance Questionnaire (HPQ)	6 months

Collaborators and Investigators

• Sponsor: South London and Maudsley NHS Foundation Trust
• Investigators: Principal Investigator: Claire Price, CPsychol, South London and Maudsley NHS Foundation Trust

Study record dates

Study Major Dates

• Study Start: October 1, 2011
• Primary Completion (Actual): April 1, 2014
• Study Completion (Actual): April 1, 2014

Study Registration Dates

• First Submitted: May 14, 2012
• First Submitted That Met QC Criteria: May 14, 2012
• First Posted (Estimate): May 16, 2012

Study Record Updates

• Last Update Posted (Estimate): August 20, 2015
• Last Update Submitted That Met QC Criteria: August 19, 2015
• Last Verified: August 1, 2015

More Information

Terms related to this study

• Keywords: Depression; Anxiety; Sickness absence; Supported Employment; Common mental illness
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Mood Disorders; Depression; Depressive Disorder; Anxiety Disorders
• Other Study ID Numbers: SLAM-ICM-1011