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

Abstract

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.

Are attitudes in employees of public employment service in line with the principles of individual placement and support? A questionnaire‐based survey

“…It's interesting to note that all PES staff significantly decreased their positive attitudes towards specific questions regarding integration of employment support with health services and time unlimited support. These principles rely on close and timely collaboration between sectors, and although we see a large scale‐up of IPS in Norway, integration challenges are one of the biggest barriers (Fyhn et al, 2021; Moe et al, 2021).…”

Implementation structures at work. Exploring implementation and de‐implementation attempts regarding Housing First and Individual Placement and Support

“…Professionals who deliver these interventions are expected to adopt a trust‐based logic, while at the same time, they need to empower the individual through various bureaucratic, external organisations (such as receiving financial support from the social services, the Social Insurance Agency or the Public Employment Agency). System factors and the government‐controlled regulations of the diverse organisations are often incompatible with the logic of the recovery‐oriented interventions of HF and IPS and both interventions require policy accommodations on every level (Benjaminsen, 2014; Moe et al, 2021) Conflicts between values and different systems may pose challenges when the interventions are implemented (Moe et al, 2021), and informal, unspoken hierarchies as well as obvious differences in cultures and formal regulations can create problems. At the same time, national guidelines advocate implementation and person‐centred interventions and thus collaboration between agencies should be based on the users' best interests, but without clarifying how contrasting and often directly contradictory interventions should be addressed.…”

“…Although IPS measures of efficacy are generally robust, even across different welfare systems (Brinchmann et al, 2020), it is suggested that the actual implementation of IPS in real world settings may be more influenced by contexts as country or culture (Moe et al, 2021) and may pose organisational challenges to decentralised and/or specialised welfare states (cf. Moe et al, 2021).…”

“…Although IPS measures of efficacy are generally robust, even across different welfare systems (Brinchmann et al, 2020), it is suggested that the actual implementation of IPS in real world settings may be more influenced by contexts as country or culture (Moe et al, 2021) and may pose organisational challenges to decentralised and/or specialised welfare states (cf. Moe et al, 2021). Researchers have pointed out that “an implementation of the Housing First approach requires organisational change, and that the basic principles are rooted in the various links involved in the effort” (Benjaminsen & Nandrup, 2020, p. 13).…”

Evaluation of an implementation strategy for Individual Placement and Support in the Netherlands: a 30-month observational study

“…Although IPS is more effective than other programs, it is complicated to implement this model in both the Netherlands and other countries [11][12][13][14][15][16][17][18]. Inadequate funding and cooperation between mental health care and vocational rehabilitation services appear significant barriers to enhance further implementation in practice [4, 11-15, 17, 19-22].…”