van Erp, N., Giesen, F., van Weeghel, J., Kroon, H., Michon, H., Becker, D., McHugo, G., & Drake, R (2007). A multisite study of implementing supported employment in the Netherlands.
Psychiatric Services, 58
||A multisite study of implementing supported employment in the Netherlands
||van Erp, N., Giesen, F., van Weeghel, J., Kroon, H., Michon, H., Becker, D., McHugo, G., & Drake, R
||American Psychiatric Association
||In the Netherlands, a small western
European country with 16 million inhabitants,persons with severe mental
illnesses consistently have the worst
employment outcomes of all disability
groups; only 12% are enrolled in competitive jobs. The Dutch approach
to vocational rehabilitation for this
group has been a cautious one, mainly
encompassing prevocational training,
sheltered employment, volunteer
work, or trainee placements in regular
businesses (8). Many clinicians in the
Netherlands believe that competitive
employment is too ambitious or too
stressful for clients with severe mental
illnesses. Clients are offered work
tasks in segregated settings to prepare
them for competitive employment,
but the progression from sheltered to
competitive jobs is not substantial (9).
Another feature of Dutch practice is
the parallel organization of mental
health services and vocational services,
based on the belief that this segregation enables employment specialists to focus solely on vocational issues without causing any stigma.
||This article reports on the implementation of the individual placement and support model of supported employment in four Dutch regions.The main objective of the Dutch
study was to determine whether the
individual placement and support
model of supported employment
could be implemented in the Netherlands.
Study sought to answer the following
questions: what is the level of
fidelity of the implementation, what
are the employment outcomes in the
four sites (client outcomes and job
characteristics), what are the barriers
to implementation, and what strategies
to overcome these barriers are successful.
||In 2003 four Dutch mental health
agencies began to implement individual
placement and support programs of supported employment. Employment
specialists from vocational services
(such as generic vocational agencies,
sheltered workshops, and rehabilitation
centers) were assigned to mental health teams delivering comprehensive
treatment and care for persons with severe mental illnesses. Sites were selected on criteria including a case manager–client ratio of at most 1:30, a client population of at least 240, regular contacts with vocational services, and willingness to provide funding.
||The study group was predominantly male, the mean age was 35±10, and most
clients were living independently. At
intake 107 participants (46%) did not
perform any vocational activities. The
most common diagnoses were schizophrenia
and related psychotic disorders.
On average, participants had received
8±7 years of mental health
||Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice.
Control or comparison condition:
||There was no control or comparison condition.
Data collection and analysis:
||The authors used structured site visits, employment data, and semi-structured interviews to assess fidelity, employment outcomes, and facilitators of and barriers to successful implementation.
||At 24 months, the four sites reached a mean±SD fidelity score of 4.1±.3 (possible scores range from 1 to 5, with higher scores indicating closer adherence to the model). Of the 316 persons with mental ill-nesses, 57 (18%) obtained competitive jobs. Barriers to implementation included lack of organizational standards, loss of vocational staff, funding problems, insufficient time for program leaders, and inadequate cooperation between the involved organizations. Important facilitators were the skills and commitment of the vocational team members and the integration of vocational and mental health staff.
||To implement evidence-based supported employment in the Netherlands will require changes in financing, organizational structures, attitudes, cultural beliefs, and labor and disability regulations.