Abstract
| Original language | English |
|---|---|
| Article number | 101579 |
| Journal | Disability and Health Journal |
| Volume | 17 |
| Issue number | 2 |
| Early online date | 12 Jan 2024 |
| DOIs | |
| Publication status | Published - Apr 2024 |
Funding
Supported employment activation interventions are distinct not only because they adopt a place-then-train approach but also because they operate to a fidelity scale. The fidelity scale describes the key features of the SE service and provides a benchmark for services to operate to and be measured against. Fidelity is key since stronger adherence to fidelity is evidenced to associate with stronger job outcomes performance in SE services.1 Two different SE fidelity scales exist: Individual Placement and Support (IPS)2 and the Supported Employment Quality Framework (SEQF).3The IPS fidelity scale contains 25 items each scored out of five that relate to staffing (e.g. caseload size is below 20 per employment specialist ideally), organization (e.g. employment specialists are integrated into clinical teams) and service (e.g. employment specialists proactively engage employers) dimensions. IPS services have traditionally supported workless individuals with severe mental health conditions and robust evidence exists for their strong performance with this group.4 Over the past decade IPS has been tested and found to be effective in a wider range of population groups including individuals with chronic pain, low to moderate mental health and physical health, substance misuse issues, ex-offenders and the homeless. 5-7In contrast, the SEQF fidelity scale is structured and scored around the five phases of any SE service (whether IPS or SEQF) \u2013 engaging referrals, vocational profiling, employer engagement, job matching and securing work, and in-work support \u2013 alongside job outcomes performance and client and employer satisfaction. Unlike IPS, SEQF services have traditionally supported individuals with learning disabilities and autism and integration of employment specialists into clinical teams \u2013 central to IPS \u2013 is not part of the SEQF model.An information specialist (MC) developed a bespoke search strategy and ran searches in MEDLINE, PsycINFO, CINAHL, Social Sciences Citation Index via Web of Science and ProQuest Social Science Collection electronic databases in April 2022. In addition we carried out screening of reference lists of studies identified as potentially relevant, scrutinised available systematic reviews, sought citations for included studies and searched for relevant grey literature on websites of relevant organisations (Centre for Mental Health, British Association for Supported Employment, Department for Work and Pensions, IPS Grow). Steering committee members and other stakeholders (experts, commissioners and providers) were asked to suggest relevant reports and other forms of grey literature. See Ancillary material for a sample search strategy. Further details of the search strategy and other materials from the review are available from the authors on request.The person-centred nature of the these approaches was identified as an element distinguishing this approach from other interventions.23,31 Matching individuals to their employment preferences, listening to their needs and wishes regarding support journeys and the type of jobs applied for was particularly appreciated.23 Authors highlighted the need for long-term support in order to achieve and sustain successful employment including on-going in-work support.23,26,27 with one recommending that this should be time unlimited.32 This is an area of current debate in the IPS landscape with some evidence pointing to the potential benefits and minimal disadvantages at the aggregate level to time-limiting out-of-work support to 9-12 months.33A key principle of the IPS (but not of the SEQF) model is integration of services, and authors noted how this is key for programmes requiring vocational and clinical care for clients.30 Regular team meetings, co-locating services or identifying a worker responsible for coordinating support were ways that services facilitated integration.26 Partnership working was perceived to be an important aspect of the design in order to deliver services in a co-ordinated and complementary way.31 In some locations services were co-located, managers were shared and IPS team members spent time in psychological services.Key elements of the programmes described by studies are: the practical, individualised, long-term, intensive and (for IPS) integrated nature of the support; the expertise, understanding, and positive relationship with the employment advisor; the range of broker, guide and trouble shooter roles played by the employment advisor; and the stimulation, belonging, competence and sense of self-worth felt from the well-matched employment gained. The findings also highlight the multiple client, employer, employment, programme, and system-related factors which influence whether an employment outcome is likely to be successful.Fourth, these qualitative studies speak to the challenges of integration for any public policy such as these that seeks to connect actors and services from different parts of the health and welfare systems. The studies suggest two key integration needs: securing the right volume and type of referrals of individuals with health conditions from health partners into employment programmes and, secondly, effectively co-locating and integrating employment support into and alongside health teams and support. These may be factors contributing to success, and represent an on-going challenge across all SE services and particularly so for IPS services given its emphasis on service co-location and integration. Indeed, the IPS policy debate is increasingly recognising the benefits of \u2013 and potential need for \u2013 multi-disciplinary integration across multiple key teams rather than single team integration as seen in current IPS services. Whilst sensible in terms of meeting individual's multi-faceted support needs, any such shift in this direction would compound the integration challenge for IPS services. Further, whilst IPS fidelity is rooted in physical co-location and support these qualitative studies also highlight the importance and further potential of digital tools to facilitate delivery and integration. IPS and SEQF services necessarily switched towards digital tools during the physical restrictions throughout the Covid-19 pandemic. The role of digital within IPS services in particular remains a live debate given the inclusion of face-to-face meetings within several IPS fidelity items. This work was supported by the National Institute for Health and Care Research Policy Research Programme reference NIHR 202,996 . The views and opinions are those of the authors and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.
Keywords
- Systematic review
- Disabled people
- Supported employment
- Employment support
- Individual placement support
