scholarly journals A structured mixed method process evaluation of a randomized controlled trial of Individual Placement and Support (IPS)

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Tonje Fyhn ◽  
Kari Ludvigsen ◽  
Silje E. Reme ◽  
Frederieke Schaafsma

Abstract Background Individual Placement and Support (IPS) is an evidence-based work rehabilitation program helping people with moderate to severe mental illness to obtain ordinary employment. Although IPS has proven superior to other work rehabilitation programs, in many studies, the majority of the participants remain unemployed. Structured process evaluations of IPS that use mixed methods are scarce, although they could identify implementation aspects that may enhance its effect. The aim of the current study is to assess reach, fidelity, and identify barriers and facilitators to implement IPS. 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, including focus group interviews with service providers, individual interviews and survey data from participants, and fidelity reviews using the validated IPS Fidelity Scale. Results The intervention reached the intended target group. All centers reached fair to good fidelity according to the IPS Fidelity Scale within the project period (range 97–109, SD 8.1) (see Table 5). Certain fidelity items indicated implementation issues related to employer contact, community-based services, and integration with health services. Survey data showed that less than half of the participants regarded their illness as a barrier for participating in IPS and that freedom of disclosure was important. Participant interviews gave further insight into the role of the IPS specialist, emphasizing their availability and consistent job focus. Conclusions Indications of implementation challenges across centers during the first year suggest special attention should be given to these aspects in an early phase to ensure higher fidelity from the start and thus enhance the effectiveness of IPS. The IPS specialist played an important role for participants and was described as positive, pushing in a positive way, and encouraging. More knowledge on the characteristics of successful IPS specialists could further enhance the effectiveness of the intervention. Trial registration The study was registered on clinicaltrials.gov prior to the inclusion period (reg.no: NCT01964092, registered 17/07/2013).

2020 ◽  
Author(s):  
Tonje Fyhn ◽  
Kari Ludvigsen ◽  
Silje E Reme ◽  
Frederieke Schaafsma

Abstract Background: Individual Placement and Support (IPS) is an evidence-based work rehabilitation program helping people with moderate to severe mental illness to obtaini ordinary employment. Although IPS has proven superior to other work rehabilitation programs, in many studies, the majority of the participants remains unemployed. Structured process evaluations of IPS that use mixed methods are scarce, although they could identify implementation aspects that may enhance its effect. The aim of the current study is to assess reach, fidelity, and identify barriers and facilitators to implement IPS. 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, including focus group interviews with service providers, individual interviews and survey data from participants, and fidelity reviews using the validated IPS Fidelity Scale. Results: The intervention reached the intended target group. All centers reached fair to good fidelity according to the IPS Fidelity Scale within the project period (range 89-108, SD 7). Certain fidelity items indicated implementation issues related to employer contact, community-based services, and integration with health services. Survey data showed that less than half of the participants regarded their illness as a barrier for participating in IPS and that freedom of disclosure was important. Participant interviews gave further insight into the role of the IPS specialist, emphasizing their availability and consistent job focus. Conclusions: Indications of implementation challenges across centers during the first year suggest special attention should be given to these aspects in an early phase to ensure higher fidelity from the start and thus enhance the effectiveness of IPS. The IPS specialist played an important role for participants, and was described as positive, pushing in a positive way, and encouraging. More knowledge on the characteristics of successful IPS specialists could further enhance the effectiveness of the intervention. 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).


2020 ◽  
Author(s):  
Tonje Fyhn ◽  
Kari Ludvigsen ◽  
Silje E Reme ◽  
Frederieke Schaafsma

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 ).


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