“These are people just like us who can work”: Overcoming clinical resistance and shifting views in the implementation of Individual Placement and Support (IPS)

Abstract

Purpose Individual Placement and Support (IPS) is a recovery-based approach to support people with mental health difficulties back into employment. Embedding of IPS within the mental health Multi-Disciplinary Team (MDT) is a key component of IPS fidelity; however, few studies have examined how those involved with IPS implementation navigate this process. This article explores how IPS Employment Specialists (ES) and Occupational Therapist (OT) Managers integrated and embedded IPS within traditionally-oriented MDTs as part of a national reform program in the Republic of Ireland. Methods The study design was qualitative, descriptive with data collected through three focus groups with 17 IPS ESs and 11 OT Managers. Data were analyzed using thematic synthesis. Results Three key themes emerged from analysis. The first characterizes the context into which IPS landed, described as one marked by clinical resistance, doubt, and fear of risk. The second explores the strategies and factors that helped with the introduction of IPS into Irish mental health services. These included strategies, such as providing education and information about IPS and reassuring the MDT about IPS governance and IPS ES’ competencies. The evidenced-based nature of IPS and its attached accountabilities through IPS fidelity measures were perceived to be an important factor in its acceptance. The final theme encapsulates perceptions of how IPS impacted on the MDTs’ views of people with mental health difficulties. Findings suggest a shift in the ways in which MDTs view their clients. Initial fears about work capacity and risk shifted towards seeing people beyond the label of ‘service user’ and their diagnosis. Conclusions It is contended that IPS is an approach that allows practitioners to engage with real recovery-practice and may be one key to unlocking how a recovery approach can truly trickle down and embed itself within mental health service provision and support mental health system reform.

Learning the Principle of Zero Exclusion. Managers Challenging the Logic of Professionalism in Services for People with Psychosocial Disabilities

“…Zero exclusion is thus in line with the 'environmental turn' (Tøssebro 2004), emphasising that it is the environment that must change to successfully (re-)integrate individuals experiencing mental health conditions into the labour market. However, like Bonfils (2020) and Sharek et al (2022), this study has shown that working by the zero-exclusion principle is challenging.…”

“…This is because an individual's interest in working has shown to be a more significant predictor of success than assessments of job readiness conducted by professionals (Becker et al 2015: 68). Despite the political goal of prioritising opportunities over limitations, it has proven challenging to effectively achieve this, as shown in IPS implementation studies (e.g., Bonfils 2021;Sharek et al 2022). This is supported by research on welfare frontline workers, who were found to maintain a 'deficit approach'.…”

“…This was a point of significant emphasis for the interviewees in the current study. In addition, it mirrors the language used in IPS practices and research (e.g., Moe et al 2023;Sharek et al 2022) and the UN Convention on the Rights of Persons with Disabilities (CRPD) (United Nations 2006). Therefore, the person-first term 'people with psychosocial disabilities' is used throughout this article, while still relying on a relational model acknowledging that the environment plays a role in how disability is constituted.…”

Implementing Trauma Informed Care in Human Services: An Ecological Scoping Review

“…On this note, the use of Action Research to help implement evidence-based practices in service reform and complex change may be one method for those on the ground to consider [ 94 ]. Using action research to surface challenges during the implementation of TIC in real time and delivering this data to implementation groups on the ground has been found to be successful in managing complex change in healthcare.…”

Exploring the non-vocational outcomes of the individual placement and support (IPS) employment model

“…A national programme supports the roll-out of IPS, built on a partnership model between employment support organisations and the The current issue and full text archive of this journal is available on Emerald Insight at: https://www.emerald.com/insight/2398-8819.htm mental health services, and guided by the National IPS Steering Group. Sharek et al (2022) explored how IPS was integrated and embedded within the Irish context.…”