Objective: Despite the wish of many people with SMI to work in a competitive job, employment rates are low. IPS is more effective than other vocational rehabilitation methods in achieving employment and its use should be extended to bridge the gap between user wish and reality. This study measures possibilities to implement IPS in Flanders, by investigating current use, barriers and facilitators across a wide range of services.Method: Semi-structured interviews with 17 vocational rehabilitation agencies were conducted, using the IPS Fidelity Scale and a list of open-ended questions on perceived barriers and opportunities. Results were analyzed via thematic analysis.Results: Results show an overall lack of implementation of IPS in Flanders, especially on the four core elements for which most evidence exists. An external style of attributing barriers to environment factors or client characteristics is apparent which could lead to a sense of resignation among counselors.Conclusions: The use of the IPS fidelity scale and open-ended questions has provided concrete levers to prepare for implementation: a strong leadership in the agencies to encourage optimism towards regular employment for people with SMI; closer co-operations between employment agencies, care agencies and employers; and a more facilitating legislation concerning using IPS.

Background. People with mental disorders experience difficulties with finding competitive jobs. In countries with longer psychiatric hospitalization periods, the vocational rehabilitation process can start during hospitalization. Yet, rehabilitation can be hindered by a lack of focus by clinicians on the patients' vocational goals and a lack of agreement between clinicians and patients.

Vocational rehabilitation (VR) counselors do not always focus on competitive employment for people with severe mental illness (SMI). Based on the Theory of Planned Behavior (TPB), this study examines how three types of VR counselors (i.e., gatekeepers, case managers, and specialists) vary in their underlying beliefs about competitive employment. VR counselors (N = 286) from Belgium completed an online TPB survey measuring behavioral, normative, control, and self-efficacy beliefs. Differences in beliefs were analyzed by one-way ANOVAs and post hoc comparisons using Bonferroni correction. Results indicate that counselors differ in their beliefs regarding competitive employment for people with SMI. Specialized counselors are stronger convinced that competitive employment results in latent benefits (e.g., increased integration and self-confidence). In contrast, gatekeepers consider income as the most recurrent and positive effect. The more specialized VR counselors are, the more often they perceive significant others valuing competitive employment and the more often they may comply with these norms. Finally, specialized counselors experience fewer barriers, more control, and more self-efficacy in dealing with problems compared with less specialized counselors. The differences in beliefs determining the focus on competitive employment may result in a lack of an integrated approach. Training, outcome feedback, and intersectoral communication can enhance consistency between different VR services.

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