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.

Vocational Service Models and Approaches to Improve Job Tenure of People With Severe and Enduring Mental Illness: A Narrative Review

Employment is a valued occupation that offers a sense of meaning, identity, and belonging. For people with severe and enduring mental illness, employment has also been associated with personal recovery and decreased use of mental health services. However, this population continues to be underrepresented in the labor market. Sustainable employment is often challenging for people with severe and enduring mental illness, due to a combination of personal, organizational and systemic issues. While Individual Placement and Support is an evidence-based model of employment support known to improve job attainment for people with mental illness, job retention and sustained workforce participation continue to be challenges. This narrative literature review was undertaken to address the question: “What vocational service models and approaches improve job tenure for this population?” CinAHL, Medline, Embase, PsycINFO, and Cochrane Library were searched for the period 2005–2020, using key terms and subject headings, including “severe mental illness,” “psychiatric disabilit*,” “job tenure,” and “job retention.” Several adjunct interventions may enhance job retention, including skills training, cognitive interventions, psychological interventions, and supported education, while social firms offer a different approach focused on creating new, sustainable job opportunities. Peer support and support from family and friends also appear to be important, and emerging evidence suggests that employment specialist practices, technology, self-management, and workplace accommodations may each also influence job tenure. Service providers could make more use of these non-clinical vocational approaches to improve employment retention for people with severe and enduring mental illness.

Työnantajayhteistyö ammatillisessa kuntoutuksessa ja tuetussa työllistymisessä. Integroiva kirjallisuuskatsaus

Tässä integroivassa kirjallisuuskatsauksessa selvitettiin, miten ammatillista kuntoutusta ja tuettua työllistymistä koskevassa kansainvälisessä kirjallisuudessa on jäsennetty työnantajien ja työhönvalmennuksen ammattilaisten välistä yhteistyötä ja suhdetta. Keskityimme siihen, millaiset työnantajayhteistyön toimintatavat ja strategiat on nähty toimiviksi ja miten yhteistyösuhdetta rakennetaan ja ylläpidetään. Aineiston muodostivat yksilöityjen hakukriteerien avulla valikoidut 19 tekstiä tieteellisistä aikakauslehdistä. Aineisto analysoitiin temaattisen analyysin periaatteita hyödyntäen. Analyysissa hahmottui neljä teemaa. Keskeisiä yhteistyöhön liittyviä toimintatapoja olivat jalkautuminen työnantajien maailmaan ja tämän maailman ymmärtäminen sekä molemminpuolisten hyötyjen ja yhteisten arvojen löytäminen konsultoivan työotteen avulla. Yhteistyösuhteen rakentumisen kannalta olennaista oli pitkäkestoisten suhteiden ylläpito sekä luottamus ja työhönvalmennuksen ammattilaisen saatavilla olo. Tärkeää oli myös yhteistyötä tukevien resurssien riittävyyden varmistaminen ja resurssien vahvistaminen palveluita tuottavissa organisaatioissa. Abstract Employer cooperation in vocational rehabilitation and supported employment. An integrative literature review In this integrative literature review, we explore how the relationship and cooperation between the employers and employment specialists have been described in the international vocational rehabilitation and supported employment literature. We examine, what kind of practices and strategies of cooperation have been assessed as functional and how the cooperative relationship is built and maintained. The data consisted of 19 texts published in academic journals and selected by using customized search criteria. The data was analyzed by applying the principles of thematic analysis. Four themes were identified. Essential practices of cooperation included entering and understanding the world of the employers and furthermore, finding mutual benefits and shared values through a consultative working approach. In building the cooperative relationship, maintaining long-term relationships as well as reliability and availability of the employment specialist were crucial. In addition, it appeared important that the service provider organizations ensure and provide the sufficient resources for the cooperation. Keywords: vocational rehabilitation, job coaching, supported employment, employer cooperation

Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial

BackgroundPoverty, unemployment and substance abuse are inter-related problems. This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting drug abstinence and employment in unemployed adults in outpatient treatment for opioid use disorder.MethodsA randomised controlled trial was conducted in Baltimore, MD, from 2014 to 2019. After a 3-month abstinence initiation and training period, participants (n=91) were randomly assigned to a usual care control group that received employment services or to an abstinence-contingent wage supplement group that received employment services plus abstinence-contingent wage supplements. All participants were invited to work with an employment specialist to seek employment in a community job for 12 months. Abstinence-contingent wage supplement participants could earn training stipends for working with the employment specialist and wage supplements for working in a community job, but had to provide opiate and cocaine-negative urine samples to maximise pay.ResultsAbstinence-contingent wage supplement participants provided significantly more opiate and cocaine-negative urine samples than usual care control participants (65% vs 45%; OR=2.29, 95% CI 1.22 to 4.30, p=0.01) during the 12-month intervention. Abstinence-contingent wage supplement participants were significantly more likely to have obtained employment (59% vs 28%; OR=3.88, 95% CI 1.60 to 9.41, p=0.004) and lived out of poverty (61% vs 30%; OR=3.77, 95% CI 1.57 to 9.04, p=0.004) by the end of the 12-month intervention than usual care control participants.ConclusionAbstinence-contingent wage supplements can promote drug abstinence and employment.Trial registration numberClinicalTrials.gov NCT02487745.

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

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 ).