Background
Methods
Study design
Context information
IPS before the start of the collaboration
IPS within the collaboration
Organizational implementation strategy
Financial implementation strategy
Socio-political context: The participation act
Study participants
Interviews
Analysis
Ethical considerations
Results
Participant characteristics
Level (n) Organization Stakeholder | Experience in current role, years |
---|---|
Decision maker (n = 7) | |
MHA | |
Director | 7 |
Policy adviser | 8.5 |
IPS program leader | 1 |
Staff member/ occupational therapist | 36 |
UWV | |
Manager | 2.5 |
Municipality of Amsterdam | |
Participation adviser | 10 |
HIC | |
Mental health care adviser | 7 |
Practitioner (n = 8) | |
MHA | |
IPS specialist (a) | 2 |
IPS specialist (b) | 2 |
IPS specialist (c) | 2 |
IPS specialist (d) | 2 |
UWV | |
Insurance physician | 28 |
Labour expert (a) | 15 |
Labour expert (b) | 5 |
Municipality of Amsterdam | |
Case manager | 6 |
Experiences, facilitators and barriers
Themes | Facilitators | Barriers |
---|---|---|
1. Innovation | ||
1.1 IPS | ||
Intervention | Evidence based effectiveness of IPS | Costs of IPS |
Key principles of the IPS model | IPS model fidelity scale and fidelity reviews | |
Compatibility of IPS with existing work procedures | ||
1.2 Collaboration | ||
Between organizations involveda | Regular meetings of stakeholders | Clients’ privacy and medical confidentiality |
Sharing information, knowledge and expertise | Organization of the structural meetings | |
Pre-existing relationships and collaboration between stakeholders | Lack of involvement of practitioners in vocational rehabilitation | |
Shared interests, goals and vision of stakeholders | Lack of communication between decision makers and practitioners | |
Professionals involved | ||
Stakeholders characteristics | Mandate and influence of decision makers | |
Attitude and beliefs | Ownership of IPS and collaboration | IPS not experienced as part of the mental health treatment |
Work not experienced as a achievable goal for people with SMI | ||
1.3 IPS funding | ||
Secured fundingb | Substantial funding for IPS | Fragmented funding |
Lack of clarity with regard to costs of IPS services | ||
Ethics | ||
Pay for performanceb | Pay for performance might encourage IPS specialists | Not appropriate to receive extra payments within health care setting |
Sustainability | Covenant between involved organizations stimulates collaboration and funding | Lack of proven cost-effectiveness of IPS Temporary financial agreements between the organizations involved |
2. Socio-political context | ||
Government | Support and funding of Ministry of Social Affairs and Employment New Participation Act provides sense of urgency regarding participation of people with SMI | Dutch social safety net does not stimulate participation in paid work New Participation Act has unwanted consequences Health insurance act limits IPS funding by health insurance company |
Innovation
MHA decision maker (policy adviser): “Our healthcare system is continuously changing. That’s a good thing (…) I think you have to keep an open mind for these changes and should not stick to the model fidelity that rigidly.”
MHA practitioner (IPS specialist (a)): “I considered it a useful meeting (...) the lines of communication are short… and it’s quite useful to have a contact person within those organizations.”
MHA decision maker (staff member/ occupational therapist): “You need people that are inspired (…) with an extreme level of involvement, because otherwise you won’t make it; just procedures aren’t enough. You need people that step up and say: I’m going to do this!”
UWV decision maker (manager): “No, I don’t know [how these regular meetings between practitioners work in practice] and I suppose that’s strange, because I proposed to initiate these meetings [between practitioners] myself.”
MHA practitioner (IPS specialist (c)): “I think the agreements between MHA and UWV (…) should be documented, because at the moment there is no written information available.”
MHA practitioner (IPS specialist (d)): “Some managers and colleagues see things differently. They don’t support recovery as much as we do within IPS and that is an obstacle (...). [Colleagues argue:] My clients can’t work, my clients won’t work (…). I simply don’t believe that if a case manager has a caseload of 40 clients, none of them wants to work”.
UWV decision maker (manager): “Maybe some see it as a perverse incentive, but it does provide a reason not to give up for a client if you get a fee for success. Therefore, all in all, I think it’s a very good strategy.”
MHA decision maker (IPS program leader): “(…) it’s not just one financial agreement, of course that always creates issues. Ideally, there would be one all-in package [IPS funding] for three years.”
HIC decision maker (mental health care adviser): “The municipality has ensured IPS financing for two years, but that means financing ends next year. The same goes for us, we have agreed on financing up to February 2018. In the period ahead, we will all have to discuss how we can ensure sustainable IPS funding.”
Socio-political context
MHA practitioner (IPS specialist (d)): “I think the Participation Act is really complicated, because your access to [IPS] services depends on the municipality you live in. (…) you depend on the political orientation of your municipality, how rich your municipality is and what they want to spend money on. Well, I think that’s insane.”