Academic journal article The Journal of Rehabilitation

Establishing IPS in Clinical Teams-Some Key Themes from a National Implementation Programme

Academic journal article The Journal of Rehabilitation

Establishing IPS in Clinical Teams-Some Key Themes from a National Implementation Programme

Article excerpt

The international evidence in favour of the effectiveness of 'Individual Placement and Support' (IPS) (1) in helping people with major mental health problems into employment is now convincingly strong (Bums et al., 2007; Bond, Drake & Becker, 2008; Porteus & Waghorn, 2007; Rinaldi & Perkins, 2007). Only one report has emerged with negative findings (Howard, Heslin, Leese, McCrone, Rice, Jarrett & Spokes (2010) and this appeared to be due to a lack of adherence to the evidence-based model (Latimer, 2010). It is therefore of critical importance that IPS is implemented with maximum 'fidelity' to the research evidence (Bond, 2007) and this means regular review of services using an appropriate fidelity scale (Waghorn, 2009; Bond, Becker, Drake, Robert & Vogler, 1997).

In most countries, IPS can be delivered by trained workers employed by specialist agencies and 'out-posted' to clinical teams or by trained workers employed by the clinical agencies themselves and embedded in the teams. There is little evidence in favour of one model over the other, but in either case the issue of successfully integrating vocational and clinical interventions must be successfully addressed if high fidelity is to be achieved (Bond, 2007; Waghorn, Collister, Killackey & Sherring, 2007; Rinaldi, Miller & Perkins, 2010). This can be more difficult where the IPS workers are employed by an outside agency. However, the problems of integration can also occur even if the workers are employed by the same agency due to differences in culture and priorities between employment-oriented and clinically-oriented staff. It is the purpose of this paper to describe our experiences derived from conducting fidelity reviews in clinical teams where the workers are from either independent supported employment agencies or clinical services and the common challenges that we have observed in the development of these services. The study was carried out in the context of a national programme undertaken by the Centre for Mental Health aimed at increasing the number of clinical teams in the England who are using an evidence-based approach (IPS) to vocational rehabilitation (Sainsbury Centre for Mental Health, 2010).

The 'Centres of Excellence' programme

In 2009 the Centre for Mental Health invited sites to apply to become members of a network which would provide support for the development of IPS services through regular meetings, workshops and conference events. Central to participation in the network was an agreement to undertake fidelity reviews of the current quality of local IPS services being delivered on each site and a commitment to improving services based on the results of these reviews (and the collection of outcome data). Initially, 24 sites applied to the programme and five were selected as 'Centres of Excellence' having at least 2 teams (median 11, range 6-22) already including trained IPS workers, from either specialist supported employment agencies or appointed by the clinical services themselves. Another four sites were also selected as 'emerging' Centres of Excellence. They were just beginning the process of IPS implementation with only one team established or about to be established. Both 'established' and 'emerging' Centre of Excellence were struggling with similar issues of implementation.

The analysis of themes presented below was undertaken by the authors on the basis of 16 IPS fidelity reviews undertaken as part of the programme and conducted between January 2010 and March 2011. The U.S. scale version 8 (Dartmouth IPS Supported Employment Centre (last update March 14, 2011) was used with minor modifications to make it appropriate for a British context. The scale consists of 25 items grouped in three sections ('Staffing', 'Organisation' and 'Services') and each item is arranged on a five point scale, with each point clearly anchored by behavioural descriptions. (Copies are available from the Dartmouth IPS Supported Employment Centre, http://dms. …

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