Implementing individual placement and support (IPS): the experiences of employment specialists in the early implementation phase of IPS in Northern Norway. The IPSNOR study

Background For decades there has been a continuous increase in the number of people receiving welfare benefits for being outside the work force due to mental illness. There is sufficient evidence for the efficacy of Individual Placement and Support (IPS) for gaining and maintaining competitive employment. Yet, IPS is still not implemented as routine practice in public community mental health services. Knowledge about implementation challenges as experienced by the practitioners is limited. This study seeks to explore the experiences of the front-line workers, known as employment specialists, in the early implementation phase. Methods Qualitative data were collected through field notes and five focus group interviews. The study participants were 45 IPS employment specialists located at 14 different sites in Northern Norway. Transcripts and field notes were analysed by thematic analyses. Results While employment specialists are key to the implementation process, implementing IPS requires more than creating and filling the role of the employment specialist. It requires adjustments in multiple organisations. The new employment specialist then is a pioneer of service development. Some employment specialists found this a difficult challenge, and one that did not correspond to their expectations going into this role. Others appreciated the pioneering role. IPS implementation also challenged the delegation of roles and responsibilities between sectors, and related legal frameworks related to confidentiality and access. The facilitating role of human relationships emphasised the importance of social support which is an important factor in a healthy work environment. Rural areas with long distances and close- knit societies may cause challenges for implementation. Conclusion The study provides increased understanding on what happens in the early implementation phase of IPS from the employment specialists’ perspective. Results from this study can contribute to increased focus on job satisfaction, turnover and recruitment of employment specialists, factors which have previously been shown to influence the success of IPS. The greatest challenge for making “IPS efficacy in trials” become “IPS effectiveness in the real world” is implementation, and this study has highlighted some of the implementation issues.

Work Experiences and Challenges to Employment Sustainability for People With Mental Illness in Supported Employment Programs

Supported employment (SE) is an evidence-based program that has shown much promise in helping people with severe mental illnesses (SMIs) to gain and sustain competitive employment. However, there are significant variations in employment outcomes across SE programs in Canada that can be partly explained by SE service users’ experiences in their work environment. The work environment can exert a considerable influence on the interest in and ability to sustain the employment of a person with an SMI. This study explores the work experiences of individuals with SMIs who are involved in an SE program and who understand the challenges of and barriers to sustaining such employment. Semistructured, in-depth interviews were conducted with 15 individuals with SMIs, and the data were analyzed using a constructivist grounded theory approach. Challenges to the employment sustainability of an individual with SMI were found to arise primarily from three intersecting contexts: the SE program, the work environment, and the larger Canadian labor market. The findings suggest that SE programs will better promote employment sustainability if they adhere closely to individual placement and support model of SE. SE service providers (employment specialists) must be equipped with a wide range of knowledge and skills to meet the needs of individuals with SMIs if sustainable employment is to be achieved. It is recommended that there must be investment in training for employment specialists to assist SE service users to achieve sustainable employment outcomes.

Good fences make good neighbors: Collaborating with families to create employment opportunity

BACKGROUND: Collaboration between supported employment providers and parents/guardians of job seekers with intellectual and/or developmental disabilities is key to employment success. However, parents are often concerned about the efficacy of employment supports or the capacity of the professionals providing the service. Likewise, job coaches may consider certain kinds of parent involvement as detrimental to a successful job match. OBJECTIVE: This article provides context for why parents/guardians may be distrustful of the employment process, as well as why employment specialists may struggle to build strong partnerships with parents/guardians. METHODS: This article will discuss how to implement practices that not only welcome the critical input of families, but also maintain healthy and well-defined boundaries that affirm the autonomy, professionalism, and competence of the worker.

More than memes: Embracing social media for 21st century supported employment

BACKGROUND: Employment specialists assist individuals with disabilities in obtaining and maintaining employment, but the majority of practitioners only utilize techniques, tools, and avenues established in specific research domains from over 20 years ago. New technologies, such as social media, are powerful tools employment specialists can utilize to assist individuals with disabilities seeking employment. OBJECTIVE: This article provides context for why including social media into practice is important, what social media is, opportunities it can provide, and what social media platforms are best for employment specialists to use. This article explores how employment specialists can use Facebook, Twitter, and LinkedIn to find new opportunities, expand professional networks, and incorporate social media use into standard practices. CONCLUSION: Social media is a powerful tool used extensively in talent recruitment. Supported employment professionals can use the identified strategies to help individuals with disabilities access employment opportunities in an increasingly digital world.

Experiences with Individual Placement and Support and employment – a qualitative study among clients and employment specialists

Background Individual Placement and Support (IPS) is an evidence-based, effective approach to help people with severe mental illness (SMI) achieve competitive employment. The aim of the present study is to explore experiences with Individual Placement and Support using a multifaceted implementation strategy (IPS + MIS), and competitive employment. The goal of this strategy was to improve IPS implementation by enhancing collaboration between mental health care and vocational rehabilitation stakeholders, and realizing a secured IPS funding with a ‘pay for performance’ element. Methods A qualitative, exploratory study was performed using semi-structured interviews with IPS clients (n = 10) and two focus groups with IPS employment specialists (n = 7 and n = 8) to collect rich information about their experiences with IPS + MIS and competitive employment. Thematic content analysis was used to analyse the data. Results Themes related to experiences with IPS and the multifaceted implementation strategy were identified, including the importance of discussing the client’s motivation and motives to work, facilitators and barriers to obtaining and maintaining employment, facilitators to collaboration between stakeholders, barriers to benefits counselling, organizational barriers to IPS execution and collaboration between stakeholders, financial barriers to IPS execution and experiences with the pay for performance element. Conclusions Although the multifaceted implementation strategy seems to contribute to an improved IPS implementation, the barriers identified in this study suggest that further steps are necessary to promote IPS execution and to help people with SMI obtain and maintain competitive employment.

Implementation of a novel return-to-work approach for persons with affective disorders in a traditional vocational rehabilitation context: a case study

Background The person-centred Individual Enabling and Support (IES) model is a novel return-to-work (RTW) intervention for people with affective disorders that was developed from evidence-based supported employment for persons with severe mental illness. Typically, supported employment is integrated into mental healthcare and provides a network around the service user and close collaboration with employment and insurance services and employers. Introducing integrated models into a highly sectored welfare system that includes traditional mental healthcare and vocational rehabilitation is challenging. Greater knowledge is needed to understand how facilitating or hindering factors influence this introduction. The aim of this study was to investigate essential components in implementation of the IES model. Methods A case-study was conducted and included four mental healthcare services. Data collection was comprised of semi-structured interviews with 19 key informants, documentation from meetings, and reflection notes. Analyses were performed according to directed content analysis, using the components of the Consolidated Framework of Implementation Research (CFIR) as a guiding tool. Fidelity assessments were performed at 6 and 12 months. Results Anticipating RTW support for the target group, and building collaborative relationships and a network with employment specialists that engaged staff in every organization were components that resulted in the greatest facilitation if IES implementation. Barriers consisted of difficulty in integrating employment specialists into the mental healthcare teams, insufficient engagement of first line managers, reorganization and differing perceptions of the IES model fit into a traditional vocational context. Delivery of the IES model had good fidelity. Conclusions The IES model can be implemented with good fidelity, several model advantages, and context adaptation. Team integration difficulties and negative perceptions of model fit in a traditional vocational rehabilitation context can be overcome to a certain degree, but this is insufficient for sustainable implementation on a larger scale. Policy and guidelines need to promote integrative and person-centred RTW approaches rather than a segregated stepwise approach. Further implementation studies in the traditional vocational rehabilitation context are needed.