Abstract
Background The effect of Individual Placement and Support (IPS) has been widely documented, but in many studies, the majority of participants remains unemployed. Structured process evaluations that use mixed methods are scarce, although they could identify components that may enhance the effect of IPS. The aim of the current study is to provide a description of a structured mixed methods process evaluation of IPS in Norway. Methods The process evaluation was conducted alongside a randomized controlled trial including six IPS centers, comparing IPS with treatment as usual in a population of patients in treatment for moderate to severe mental illness. Mixed methods were used in the process evaluation, and outcome measures were reach, barriers and facilitators, and fidelity. Results The intervention reached the intended target group. All centers reached fair to good fidelity within the project period. Certain fidelity items seemed to indicate implementation issues related to employer contact, community-based services, and integration with health services. Less than half of the participants regarded their illness as a barrier for participation in IPS. Participants were overall satisfied and found the intervention useful, emphasizing the availability of the employment specialist and their consistent job focus, as well as the freedom to disclose their illness or not. Conclusions Certain fidelity items indicated implementation issues during the first year, namely providing community-based services, ensuring quality in employer contact, and integration with health treatment. The employment specialist clearly played an important role for participants. Most participants described this relationship as positive, empowering, and encouraging. Trial Registration The study was registered on clinicaltrials.gov prior to the inclusion period (reg.no: NCT01964092, registered 17/07/2013, https://clinicaltrials.gov/ct2/show/NCT01964092 ).
An individual placement and support programme is more effective than skills training and temporary employment for people with severe mental illness
