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Noteboom Y, van Nassau F, Bosma AR, van der Hijden EJE, Huysmans MA, Anema JR. A roadmap for sustainable implementation of vocational rehabilitation for people with mental disorders and its outcomes: a qualitative evaluation. Int J Ment Health Syst 2024; 18:7. [PMID: 38341601 DOI: 10.1186/s13033-023-00620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 12/11/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND People suffering from mental health disorders have lower work participation compared to people without mental challenges. To increase work participation within this group vocational rehabilitation interventions are often offered. Collaboration between the mental health care and social security sectors is needed to enable professionals to perform optimally when carrying out these interventions. Yet, regulatory and financial barriers often hinder sustainable implementation. To overcome these barriers an experimental roadmap for sustainable funding based on a shared savings strategy was piloted in four regions. The aim of the present qualitative study was to gain understanding of the uses of this roadmap and the factors that were important in the experiment's process. METHOD The roadmap consisted of five steps based upon insights from shared savings strategies and implementation science knowledge, and was initiated by a national steering board. The roadmap aimed to make sustainable funding agreements (based on shared savings) for the implementation of a vocational rehabilitation intervention. In four regions, stakeholders from the mental health care and social security services sector followed the roadmap. We conducted interviews (n = 16) with involved participants and project leaders of the experiment and collected 54 sets of field notes and documents to evaluate the roadmap process. A thematic analysis was used to analyse the data. RESULTS Regions perceived improved stakeholder collaboration around vocational rehabilitation after they were guided by the roadmap. Three regions made, or intended to make, agreements on collaboration and funding, yet not based on shared savings. Moreover, going through the roadmap took more time than anticipated. Stakeholder collaboration depended on factors like personal and organizational interests and collaboration conditions and values. Financial legislation and politics were regarded as barriers and personal motives were mentioned as a facilitator in this process. CONCLUSIONS Our study showed that the roadmap supported stakeholders to establish a more sustainable collaboration, even though no sustainable financial agreements were made yet. Although participants acknowledged the function of financial insights and the need for financial resources, the driver for collaboration was found to be more on improving clients' perspectives than on solving unfair financial distribution issues. This suggests modifying the focus of the roadmap from financial benefits to improving clients' perspectives.
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Affiliation(s)
- Yvonne Noteboom
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Femke van Nassau
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Astrid R Bosma
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Eric J E van der Hijden
- Faculteit Der Sociale Wetenschappen, Talma Institute Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Maaike A Huysmans
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Johannes R Anema
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Olofsdotter G, Giritli Nygren K, Bergström G, Bolin M, Klockmo C, Nyhlén S, Sjöberg I, Tjulin Å. Study protocol: Local labour market programs-institutional structures, organizational forms and lived experiences. PLoS One 2024; 19:e0296242. [PMID: 38265987 PMCID: PMC10807781 DOI: 10.1371/journal.pone.0296242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/09/2023] [Indexed: 01/26/2024] Open
Abstract
In this programme, we map and examine local labour market programmes (LLMPs) at the municipal level in Sweden. This includes their institutional structure and organisation, as well as the experiences of participants in the programmes, using a longitudinal approach with the aim to improve LLMPs. The long-term goal is to increasing the inclusion of LLMP participants in working life. To answer the programme's questions, data will be collected and analysed within the four work packages. In each work package, a mixed-method approach is applied with a combination of quantitative and qualitative methods. The programme is informed by three overarching general theoretical approached, tying together institutional ethnography, intersectional studies of structural inequalities on different levels, and the role of emotions in everyday work. At the organisational level (WP 1), we will investigate the circumstances under which LLMPs are performed and negotiated by those involved. Here, the internal organisation, activities and methods are the focus. This approach will result in knowledge about the characteristics of these organisations and the factors promoting the inclusion of underrepresented groups in working life. By examining the activities in LLMPs (WP 2), we will be able to determine how their institutional structure differs between regions in Sweden, how the different municipalities work with labour market policy, how they translate national policy into the local context, how they organise their work and which initiatives they choose to adopt. By examining the individual experiences of those who are directly affected by such incentives (WP 3), knowledge and understanding will be obtained of the connections between experiences and labour market policies. This will give important insights into the functioning of local programmes and of the opportunities to create entry into the labour market. Furthermore, in WP4 we will develop and test an effect evaluation of work methods used in LLMPs and their effect on clients' progress over time.
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Affiliation(s)
- Gunilla Olofsdotter
- Department of Humanities and Social Sciences, Mid Sweden University, Sundsvall, Sweden
| | | | - Gunilla Bergström
- Research & Development, The Region of Gothenburg, Gothenburg, Sweden
| | - Malin Bolin
- Department of Humanities and Social Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Carolina Klockmo
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Sara Nyhlén
- Department of Humanities and Social Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Ida Sjöberg
- Department of Humanities and Social Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Åsa Tjulin
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Kwan A, Berinstein S, Morris J, Barbic S. Perspectives on implementing Individual Placement and Support (IPS) within primary health care settings for adults living in British Columbia, Canada. BMC Psychiatry 2023; 23:919. [PMID: 38062406 PMCID: PMC10704795 DOI: 10.1186/s12888-023-05395-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Individual placement and support (IPS) is an evidence-based practice (EBP) designed to help people with severe mental illness re-enter the labour market. Implementing an IPS program within a new context (e.g., primary health care setting) to support populations that are complex and multi-barriered presents a set of unique challenges and considerations. This paper provides community-based perspectives that identify implementation strengths and challenges and highlights potential strategies aimed at addressing emergent barriers. METHODS A case study was conducted across three community health centres in British Columbia (BC), Canada, where a novel IPS program was embedded within primary care services. Data collection consisted of open-ended surveys and focus groups with service providers directly involved in program implementation and their associated clinical and managerial support teams (n = 15). Using the updated Consolidated Framework for Implementation Research (CFIR) as a guide, we performed deductive thematic analysis to identify key areas impacting IPS implementation. RESULTS Integration with existing health care systems and primary health care teams and support from leadership across all levels were identified as both key facilitators and barriers to implementation. Facilitators and barriers were identified across all domains, with those within innovation and process most easily addressed. Four cross-cutting themes emerged for promoting more integrated and sustainable program implementation: investing in pre-implementation activities, supporting a dynamic and flexible program, building from community experiences, and developing a system for shared knowledge. CONCLUSIONS Implementing an IPS program embedded within primary health care settings is complex and requires extensive planning and consultation with community-based service providers and decision-makers to achieve full integration. Future practice and policy decisions aimed at supporting employment and well-being should be made in collaboration with communities.
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Affiliation(s)
- Amanda Kwan
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | - Jonathan Morris
- Canadian Mental Health Association BC Division, Vancouver, BC, Canada
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Providence Research, Vancouver, BC, Canada
- Centre for Health Evaluation Outcome Sciences, Vancouver, BC, Canada
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Harkko J, Sipilä N, Nordquist H, Lallukka T, Appelqvist-Schmidlechner K, Donnelly M, Kouvonen A. External context in individual placement and support implementation: a scoping review with abductive thematic analysis. Implement Sci 2023; 18:61. [PMID: 37946209 PMCID: PMC10636871 DOI: 10.1186/s13012-023-01316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Context including the external context may considerably affect the adoption, implementation, sustainment, and scale-up of evidence-based practices. We investigated external contextual features by conducting a scoping review of empirical research regarding the implementation of an evidence-based psychiatric or mental health vocational rehabilitation service called Individual Placement and Support (IPS). METHODS The protocol for the scoping review was registered with the Open Science Framework. We used the methodology by Joanna Briggs Institute for conducting the scoping review and reported it according to the PRISMA-ScR checklist. We searched 12 databases for research regarding 'Individual Placement and Support' or 'Evidence-Based Supported Employment'. We retained peer-reviewed empirical studies investigating external contextual factors and their impact on IPS implementation outcomes. We extracted data from the eligible articles and conducted descriptive and thematic analyses. RESULTS Fifty-nine original research papers met our eligibility requirements and were retained after reviewing 1124 titles and abstracts and 119 full texts. The analysis generated two main themes: (1) external contextual determinants of service delivery and (2) external systems influencing the evidence-to-practice process. The first main theme encompassed policies and laws, financing, and administratively instituted support resources, and organizational arrangements associated with external stakeholders that may facilitate or hinder the local implementation. The second main theme comprised strategies and actions used by different stakeholders to facilitate implementation locally or scale-up efforts at a system level. DISCUSSION Our scoping review illustrates the important role that external contextual factors play and how they may facilitate or hinder the implementation and scale-up of the IPS model across mental health services in different countries. Consideration of these factors by decision-makers in mental health and welfare services, planners, providers, and practitioners is likely to facilitate the development of effective strategies for bridging the evidence-practice gap in implementing the EBPs. Finally, the scoping review identified gaps in knowledge and offered suggestions for future research. TRIAL REGISTRATION Open Science Framework.
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Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
| | - Noora Sipilä
- The Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
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Engdahl P, Svedberg P, Bejerholm U. Acceptability of a digital return-to-work intervention for common mental disorders: a qualitative study on service user perspectives. BMC Psychiatry 2021; 21:384. [PMID: 34344327 PMCID: PMC8336332 DOI: 10.1186/s12888-021-03386-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 07/15/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is an evident discrepancy between need and provision of evidence-based return-to-work (RTW) interventions in existing mental health services. Online dissemination of evidence-based interventions is presumed to reduce this gap. However, there is almost no knowledge available on perceived acceptability of digital RTW interventions among service users, which are factors that might influence the development and implementation of future interventions. The aim of this study was to develop knowledge of service user acceptability of mWorks, a proposed digital RTW solution. METHODS Participants (n = 18) with experience of common mental disorder and sick leave were recruited with a purposive snowball sampling method. Semi-structured interviews (n = 12) and one focus group interview (n = 6) were conducted. A deductive thematic analysis was performed according to the Theoretical Framework of Acceptability. RESULTS Digital RTW interventions were perceived as acceptable and aligned with participant value. Participants expressed positive attitudes toward having access to support, regardless of time and place. A certain ambiguity between a decline in social interactions and opportunities to RTW in a safe space was reported. Participants were confident in their ability to use digital RTW solutions, but reported the need to reduce stressful elements of using smartphones. Overly demanding digital solutions, i.e. ones requiring high cognitive effort, were described as burdensome. CONCLUSIONS For digital RTW solutions to be acceptable, they need to complement traditional services by providing accessible and person-centred support throughout the RTW process. They should be designed to reduce the need for cognitive effort. Future research should explore how to balance user autonomy with other support components in digital interventions.
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Affiliation(s)
- Patrik Engdahl
- Lund University, Department of Health Sciences/Mental Health, Activity and Participation, Lund University, P.O BOX 157, SE-22100, Lund, Sweden.
| | - Petra Svedberg
- grid.73638.390000 0000 9852 2034Halmstad University, School of Health and Welfare, Halmstad, Sweden
| | - Ulrika Bejerholm
- grid.4514.40000 0001 0930 2361Lund University, Department of Health Sciences/Mental Health, Activity and Participation, Lund University, P.O BOX 157, SE-22100 Lund, Sweden
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Andreassen TA, Solvang PK. Returning to work or working on one's rehabilitation: Social identities invoked by impaired workers and professionals in health care and employment services. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:575-590. [PMID: 33635577 DOI: 10.1111/1467-9566.13241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 11/23/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
For persons with a long-term illness or impairment, return-to-work decisions involve considerations about work capacity, opportunities in the labour market, the impact of injuries, further treatment requirements, physical and cognitive rehabilitation, and mental health recovery. These considerations are undertaken by the affected individuals as well as by professionals in health care and employment services. Drawing upon institutional theories of organisations, especially the understanding that institutional logics provide different social identities to injured individuals, we study rehabilitation processes following multi-trauma or traumatic brain injury (TBI) within the Scandinavian welfare model. We identify which social identities are activated in professionals' considerations and in the stories of the injured individuals. The aim is to understand how professionals' reasoning about the clients' problems influences return-to-work processes. Our primary finding is that the wageworker identity, invoked by the injured individuals themselves, is subordinated by the professionals to the logic of profession and the associated patient identity. Consequently, not only is impaired people's anti-discrimination right to reasonably adjusted work ignored, ignored is also a possible resource in the rehabilitation process. Additionally, individuals who view themselves as wageworkers tend to be left unserved.
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Affiliation(s)
- Tone Alm Andreassen
- Centre for the Study of Professions - SPS, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Per Koren Solvang
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Engdahl P, Svedberg P, Lexén A, Bejerholm U. Role of a Digital Return-To-Work Solution for Individuals With Common Mental Disorders: Qualitative Study of the Perspectives of Three Stakeholder Groups. JMIR Form Res 2020; 4:e15625. [PMID: 32936089 PMCID: PMC7527904 DOI: 10.2196/15625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 05/22/2020] [Accepted: 06/25/2020] [Indexed: 01/29/2023] Open
Abstract
Background Although effective return-to-work (RTW) interventions are not widely available for individuals with common mental disorders on sick leave, there is potential for transforming such interventions into a digital solution in an effort to make them more widely available. However, little is currently known about the viewpoints of different stakeholder groups, which are critical for successful development and implementation of a digital RTW intervention in health care services. Objective The aim of this study was to examine stakeholder groups’ perspectives on the role and legitimacy of a digital RTW solution called mWorks for individuals with common mental disorders who are on sick leave. Methods A purposeful snowball sampling method was utilized to recruit respondents. Semistructured individual and focus group interviews were conducted for stakeholder groups of service users, RTW professionals, and influential managers regarding their experiences, needs, and preferences for mWorks. Content analysis generated themes and categories that constituted the main findings. Results The legitimacy of a digital RTW solution was high among all stakeholder groups since such a tool was perceived to enable service users to take control over their RTW process. This was mainly a product of accessible support and promotion of service user decision making, which had the potential to empower service users. All respondents stressed the importance of fostering a positive user experience with usability and emphasis on service user resources and strengths, as opposed to various limitations and shortcomings. Stakeholder groups highlighted critical content to facilitate RTW, such as the need to clarify a back-to-work plan, accompanied by an accessible RTW network and strategies for handling mental health problems. Implementation challenges primarily involved influential managers’ concern of legislation incompatibility with innovative technology, and RTW professionals’ concern of the possibility that digital solutions may replace them to a certain extent. Conclusions This formative research emphasizes the importance of shifting power from RTW professionals to service users. mWorks can play a role in mediating service user control over the RTW process, and thereby increase their empowerment. A digital RTW solution may facilitate the circumvention of implementation barriers associated with introducing evidence-based RTW interventions in a traditional RTW context.
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Affiliation(s)
- Patrik Engdahl
- Mental Health, Activity and Participation, Department of Health Science, Lund University, Lund, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Annika Lexén
- Mental Health, Activity and Participation, Department of Health Science, Lund University, Lund, Sweden
| | - Ulrika Bejerholm
- Mental Health, Activity and Participation, Department of Health Science, Lund University, Lund, Sweden
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Chen N, Lal S. Stakeholder Perspectives on IPS for Employment: A Scoping Review. The Canadian Journal of Occupational Therapy 2020; 87:307-318. [PMID: 32762348 DOI: 10.1177/0008417420946611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. Individual Placement and Support (IPS) has demonstrated effectiveness in achieving competitive employment for people with severe mental illness. Yet limited efforts have been made to synthesize the literature pertaining to the experiences and perspectives of key stakeholders regarding IPS, which could be helpful for occupational therapists, given their role in vocational rehabilitation. PURPOSE. To synthesize qualitative literature to understand how stakeholders (including occupational therapists) experience and perceive IPS and consider the implications for future occupational therapy practice and research. METHOD. A scoping review methodology guided our review. We conducted an electronic search of qualitative and mixed-method studies on IPS. FINDINGS. Twenty-six articles were retrieved. Most studies sought clients' perspectives (n = 15), followed by practitioners (mostly employment specialists; n = 10) and only one with employers. IMPLICATIONS. There is a need for research targeting practitioners and employers which will help improve the nature of the collaboration between mental health teams, vocational teams, and employers.
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Moen EÅ, Walseth LT, Larsen IB. Experiences of participating in individual placement and support: a meta-ethnographic review and synthesis of qualitative studies. Scand J Caring Sci 2020; 35:343-352. [PMID: 32271470 DOI: 10.1111/scs.12848] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/05/2019] [Accepted: 03/10/2020] [Indexed: 11/27/2022]
Abstract
AIM To provide increased understanding about how work applicants, employment specialists, social workers in the welfare service and clinicians in mental healthcare service experience participating in individual placement and support (IPS). METHODS We searched in several databases and identified 17 studies published from 2007 to 2017 in Sweden, USA, Canada, UK, Australia and Denmark, and applied meta-ethnographic reinterpretation and synthesis. RESULTS The employment specialists followed the core ideas of IPS, where work is seen as a way to recover. They saw the work applicants' preferences and needs as important for health and well-being, and crucial for successful work rehabilitation. In order to reach these goals, they offered a personal relationship to the work applicants. Work applicants clearly appreciated this personalised recovery-oriented mindset. Furthermore, work applicants needed the employment specialists as culture brokers between health-related questions and the expectations met in the labour market. Social workers lacked resources to such personalised support, and they were under demand of welfare regulations made for a 'train then place' model, which conflicts with the view that work leads to recovery as IPS sees it in their 'place then train' model. The scarce knowledge of the clinicians' experiences in the present study suggests that they are sceptical to work as a way to recover, which is in conflict with IPS. CONCLUSIONS The work applicants highlighted the significance of the individualised support they received. Social workers and some clinicians found it difficult to provide this important personalised support towards work. Conflicting mindsets between the traditional gradual work rehabilitation paradigm and the IPS approach as a way of recovering might explain these frustrations and distance. Recommendations for practice. An improvement of IPS may depend on more cooperation based on an acceptance of the recovery-oriented mindset, which for some will mean an acceptance of new knowledge.
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Affiliation(s)
- Ellen Å Moen
- Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
| | - Liv T Walseth
- Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
| | - Inger Beate Larsen
- Department of Psychosocial Health, University of Agder, Kristiansand, Norway
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Johanson S, Markström U, Larsson ME, Bejerholm U. Implementation of a novel return-to-work approach for persons with affective disorders in a traditional vocational rehabilitation context: a case study. Int J Ment Health Syst 2020; 14:22. [PMID: 32206085 PMCID: PMC7079353 DOI: 10.1186/s13033-020-00355-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background The person-centred Individual Enabling and Support (IES) model is a novel return-to-work (RTW) intervention for people with affective disorders that was developed from evidence-based supported employment for persons with severe mental illness. Typically, supported employment is integrated into mental healthcare and provides a network around the service user and close collaboration with employment and insurance services and employers. Introducing integrated models into a highly sectored welfare system that includes traditional mental healthcare and vocational rehabilitation is challenging. Greater knowledge is needed to understand how facilitating or hindering factors influence this introduction. The aim of this study was to investigate essential components in implementation of the IES model. Methods A case-study was conducted and included four mental healthcare services. Data collection was comprised of semi-structured interviews with 19 key informants, documentation from meetings, and reflection notes. Analyses were performed according to directed content analysis, using the components of the Consolidated Framework of Implementation Research (CFIR) as a guiding tool. Fidelity assessments were performed at 6 and 12 months. Results Anticipating RTW support for the target group, and building collaborative relationships and a network with employment specialists that engaged staff in every organization were components that resulted in the greatest facilitation if IES implementation. Barriers consisted of difficulty in integrating employment specialists into the mental healthcare teams, insufficient engagement of first line managers, reorganization and differing perceptions of the IES model fit into a traditional vocational context. Delivery of the IES model had good fidelity. Conclusions The IES model can be implemented with good fidelity, several model advantages, and context adaptation. Team integration difficulties and negative perceptions of model fit in a traditional vocational rehabilitation context can be overcome to a certain degree, but this is insufficient for sustainable implementation on a larger scale. Policy and guidelines need to promote integrative and person-centred RTW approaches rather than a segregated stepwise approach. Further implementation studies in the traditional vocational rehabilitation context are needed.
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Affiliation(s)
- Suzanne Johanson
- 1Department of Health Sciences/Mental Health, Activity and Participation, Medical Faculty, Lund University, Lund, Sweden
| | | | - Maria E Larsson
- 3Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Ulrika Bejerholm
- 1Department of Health Sciences/Mental Health, Activity and Participation, Medical Faculty, Lund University, Lund, Sweden
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Khalifa N, Hadfield S, Thomson L, Talbot E, Bird Y, Schneider J, Attfield J, Völlm B, Bates P, Walker DM. Barriers and facilitators to the implementation of individual placement and support (IPS) for patients with offending histories in the community: The United Kingdom experience. Br J Occup Ther 2019. [DOI: 10.1177/0308022619879334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction We aimed to identify the barriers and facilitators to the implementation of a high fidelity individual placement and support service in a community forensic mental health setting. Method In-depth interviews were conducted with clinical staff ( n = 11), patients ( n = 3), and employers ( n = 5) to examine barriers and facilitators to implementation of a high fidelity individual placement and support service. Data was analysed using thematic analysis, and themes were mapped onto individual placement and support fidelity criteria. Results Barriers cited included competing interests between employment support and psychological therapies, perceptions of patients’ readiness for work, and concerns about the impact of returning to work on welfare benefits. Facilitators of implementation included clear communication of the benefits of individual placement and support, inter-disciplinary collaboration, and positive attitudes towards the support offered by the individual placement and support programme among stakeholders. Offences, rather than mental health history, were seen as a key issue from employers’ perspectives. Employers regarded disclosure of offending or mental health history as important to developing trust and to gauging their own capacity to offer support. Conclusions Implementation of individual placement and support in a community mental health forensic setting is complex and requires robust planning. Future studies should address the barriers identified, and adaptations to the individual placement and support model are needed to address difficulties encountered in forensic settings.
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Affiliation(s)
- Najat Khalifa
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
- Nottinghamshire Healthcare NHS Foundation Trust, Wells Road Centre, Nottingham, UK
| | | | - Louise Thomson
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, UK
| | - Emily Talbot
- DOCS contracted partner of Amgen, Amgen Ltd, Cambridge, UK
| | - Yvonne Bird
- Nottinghamshire Healthcare NHS Foundation Trust, Wells Road Centre, Nottingham, UK
| | | | - Julie Attfield
- Nottinghamshire Healthcare NHS Foundation Trust, Duncan Macmillan House, Nottingham, UK
| | - Birgit Völlm
- Department of Forensic Psychiatry, University of Rostock, Germany
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Liljeholm U, Bejerholm U. Work identity development in young adults with mental health problems. Scand J Occup Ther 2019; 27:431-440. [DOI: 10.1080/11038128.2019.1609084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Ulrika Liljeholm
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - Ulrika Bejerholm
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
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13
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Hasanpoor E, Siraneh Belete Y, Janati A, Hajebrahimi S, Haghgoshayie E. Nursing Managers' Perspectives on the Facilitators and Barriers to Implementation of Evidence-Based Management. Worldviews Evid Based Nurs 2019; 16:255-262. [PMID: 31155846 DOI: 10.1111/wvn.12372] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evidence-based health management is defined as a new approach to improve the quality of hospital decisions by systematic application of the best available evidence. To use that, facilitators and barriers to implementation of evidence-based management (EBMgt) in the decision-making process need to be identified. AIM The purpose of this study was to assess nursing managers' perspectives on the facilitators and barriers to implementation of EBMgt in Tabriz hospitals, northwest Iran. METHODS A cross-sectional study design was used in 2017. The study was conducted in one state in Iran (Tabriz). A total of 276 nursing managers (e.g., matrons, supervisors, & head nurses [HNs]) were invited to participate from the Tabriz hospitals (N = 20); 212 completed and returned the survey, yielding a response rate of 76.81%. The EBMgt assessment questionnaire was used to collect data. The questionnaire consists of two parts. The first part includes barriers to EBMgt (five main domains and 46 questions). The second part includes the facilitators of EBMgt (five main domains and 42 questions). Data entry and analysis were carried out using SPSS-21 software. RESULTS Highest mean scores of barriers were observed for "training and research systems" (64.65 ± 12.42). "Lack of communication between knowledge producers and hospital decision-makers" (68.19 ± 17.32) had highest mean scores among all 46 barriers. Also, the results showed that mean scores for all the barriers were higher than 55. The highest mean scores were observed for "social/interpersonal factors" (65.84 ± 17.07). "Interest and willingness to scientific management principles" (68.62 ± 20.17) had highest mean scores among all 42 facilitators. LINKING EVIDENCE TO ACTION The aim of EBMgt is to provide the most effective healthcare outcomes. Identifying barriers and facilitators is essential for implementing EBMgt in hospitals. Building the facilitators and eliminating barriers are foundation of EBMgt. Filling the gap between knowledge producers and nursing managers can be a starting point for improvement of the decision-making process in nursing care.
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Affiliation(s)
- Edris Hasanpoor
- Department of Healthcare Management, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Yibeltal Siraneh Belete
- Department of Health Economics, Management and Policy, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ali Janati
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elaheh Haghgoshayie
- Department of Healthcare Management, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
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Esteban E, Coenen M, Ito E, Gruber S, Scaratti C, Leonardi M, Roka O, Vasilou E, Muñoz-Murillo A, Ávila CC, Kovačič DS, Ivandic I, Sabariego C. Views and Experiences of Persons with Chronic Diseases about Strategies that Aim to Integrate and Re-Integrate Them into Work: A Systematic Review of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1022. [PMID: 29783671 PMCID: PMC5982061 DOI: 10.3390/ijerph15051022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 12/18/2022]
Abstract
The effectiveness of strategies targeting professional integration and reintegration strongly depends on the experiences of participants. The aim of this systematic literature review is to synthesize European qualitative studies exploring views and experiences of persons with chronic conditions regarding strategies for integration and reintegration into work. The systematic search was conducted in Medline, PsycINFO, CDR-HTA, CDR-DARE and Cochrane Systematic Reviews. Overall, 24 studies published in English between January 2011 and April 2016 were included. Most studies were carried out in Nordic countries or in the UK, and most participants were persons with either mental or musculoskeletal disorders. Ten themes emerged: individual and holistic approach, clarity of strategy and processes, timing of rehabilitation processes, experience with professionals, at the workplace and with peer groups, changes in the understanding of health and work, active involvement in the process, competencies development and motivating aspects of work. Findings highlight, among others, the need to actively involve participants in the return to work process and to provide timely and clearly structured processes and interventions. This review provides stakeholders key information to develop, plan, implement and evaluate interventions to integrate and re-integrate persons with chronic conditions into work in Europe.
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Affiliation(s)
- Eva Esteban
- Department of Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | - Michaela Coenen
- Department of Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | - Elizabeth Ito
- Department of Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | - Sonja Gruber
- Disability and Diversity Studies, Carinthia University of Applied Science (CUAS), 9020 Klagenfurt, Austria.
| | - Chiara Scaratti
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, 20133 Milan, Italy.
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, 20133 Milan, Italy.
| | - Olga Roka
- Department of Special Education, University of Thessaly, 38221 Volos, Greece.
| | - Evdokia Vasilou
- Department of Special Education, University of Thessaly, 38221 Volos, Greece.
| | - Amalia Muñoz-Murillo
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, 08830 Barcelona, Spain.
| | - Carolina C Ávila
- Department of Psychiatry, Universidad Autónoma de Madrid and Institute of Health Carlos III, CIBER of Mental Health (CIBERSAM), 28038 Madrid, Spain.
| | - Dare S Kovačič
- Development Center for Vocational Rehabilitation, University Rehabilitation Institute, Republic of Slovenia, 1000 Ljubljana, Slovenia.
| | - Ivana Ivandic
- Department of Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | - Carla Sabariego
- Department of Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
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Abstract
Purpose Despite the importance of evidence-based practice, the translation of knowledge into quality healthcare continues to be stymied by an array of micro, meso and macro factors. The purpose of this paper is to suggest a need to consider different - if not unconventional approaches - like the role of positive emotion, and how it might be used to promote and sustain knowledge translation (KT). Design/methodology/approach By reviewing and coalescing two distinct theories - the broaden-and-build theory of positive emotions and the organisational knowledge creation theory - this paper presents a case for the role of positive emotion in KT. Findings Theories pertaining to positive emotion and organisational knowledge creation have much to offer KT in healthcare. Three conceptual "entry points" might be particularly helpful to integrate the two domains - namely, understanding the relationship between knowledge and positive emotions; positive emotions related to Nonaka's concept of knowledge creation; and the mutual enrichment contained in the parallel "upward spiralling" of both theories. Research limitations/implications This is a conceptual paper and as such is limited in its applicability and scope. Future work should empirically explore these conceptual findings, delving into positive emotion and KT. Originality/value This is the first paper to bring together two seemingly disparate theories to address an intractable issue - the translation of knowledge into quality healthcare. This represents an important point of departure from current KT discourse, much of which continues to superimpose artefacts like clinical practice guidelines onto complex healthcare context.
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Affiliation(s)
- Michael Hodgins
- School of Business, Western Sydney University , Parramatta, Australia
| | - Ann Dadich
- School of Business, Western Sydney University , Parramatta, Australia
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16
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Svensson B, Hansson L, Lexén A. Outcomes of clients in need of intensive team care in Flexible Assertive Community Treatment in Sweden. Nord J Psychiatry 2018; 72:226-231. [PMID: 29373933 DOI: 10.1080/08039488.2018.1430168] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Flexible Assertive Community Treatment (Flexible ACT) has been implemented in Sweden during recent years due to increasing interest in integrated services for people with severe mental illness. To date, few studies have been done on Flexible ACT effectiveness. AIMS The overall aim of this study was to explore the extent to which clients assigned to the Flexible ACT board for ACT intensive care were stabilized with improved everyday functioning, social outcomes, and changes in healthcare use. METHODS Ninety-three participants with psychosis, in need of ACT from six newly started Flexible ACT teams, were included. Data were collected using the Social Outcome Index scale (SIX), Practical and Social Functioning Scale, and a healthcare usage questionnaire. RESULTS There was a significant positive change in everyday functioning and in the SIX-item 'friendship' at 18-months follow-up. A positive correlation was also found between everyday functioning and the SIX-item 'friendship' and a negative correlation between duration of ACT and everyday functioning. A significant increase in number of inpatient hospital days and psychiatric outpatient visits also occurred. CONCLUSION Clients with psychosis who need ACT may benefit from Flexible ACT through improved social functioning. Being involved in meaningful activities and supported by others are key aspects of recovering from mental illness and are enhanced by Flexible ACT.
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Affiliation(s)
- Bengt Svensson
- a Department of Health Sciences/Mental Health and Mental Health Services Research , Lund University , Lund , Sweden
| | - Lars Hansson
- a Department of Health Sciences/Mental Health and Mental Health Services Research , Lund University , Lund , Sweden
| | - Annika Lexén
- a Department of Health Sciences/Mental Health and Mental Health Services Research , Lund University , Lund , Sweden
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17
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Watson DP, Adams EL, Shue S, Coates H, McGuire A, Chesher J, Jackson J, Omenka OI. Defining the external implementation context: an integrative systematic literature review. BMC Health Serv Res 2018; 18:209. [PMID: 29580251 PMCID: PMC5870506 DOI: 10.1186/s12913-018-3046-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/20/2018] [Indexed: 11/27/2022] Open
Abstract
Background Proper implementation of evidence-based interventions is necessary for their full impact to be realized. However, the majority of research to date has overlooked facilitators and barriers existing outside the boundaries of the implementing organization(s). Better understanding and measurement of the external implementation context would be particularly beneficial in light of complex health interventions that extend into and interact with the larger environment they are embedded within. We conducted a integrative systematic literature review to identify external context constructs likely to impact implementation of complex evidence-based interventions. Methods The review process was iterative due to our goal to inductively develop the identified constructs. Data collection occurred in four primary stages: (1) an initial set of key literature across disciplines was identified and used to inform (2) journal and (3) author searches that, in turn, informed the design of the final (4) database search. Additionally, (5) we conducted citation searches of relevant literature reviews identified in each stage. We carried out an inductive thematic content analysis with the goal of developing homogenous, well-defined, and mutually exclusive categories. Results We identified eight external context constructs: (1) professional influences, (2) political support, (3) social climate, (4) local infrastructure, (5) policy and legal climate, (6) relational climate, (7) target population, and (8) funding and economic climate. Conclusions This is the first study to our knowledge to use a systematic review process to identify empirically observed external context factors documented to impact implementation. Comparison with four widely-utilized implementation frameworks supports the exhaustiveness of our review process. Future work should focus on the development of more stringent operationalization and measurement of these external constructs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3046-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dennis P Watson
- Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA.
| | - Erin L Adams
- Department of Psychology, Indiana University Purdue University-Indianapolis, 420 N Blackford St, Indianapolis, IN, 46202, USA
| | - Sarah Shue
- Indiana University-Purdue University Indianapolis, School of Health and Rehabilitation Sciences, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Heather Coates
- Indiana University-Purdue University Indianapolis, University Library, Center for Digital Scholarship, 755 W. Michigan St, Indianapolis, IN, 46202, USA
| | - Alan McGuire
- Richard L. Roudebush VA, 1481 W. 10th St, Indianapolis, IN, 46202, USA
| | - Jeremy Chesher
- Department of Environmental Health Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Joanna Jackson
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Ogbonnaya I Omenka
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
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Markström U, Svensson B, Bergmark M, Hansson L, Bejerholm U. What influences a sustainable implementation of evidence-based interventions in community mental health services? Development and pilot testing of a tool for mapping core components. J Ment Health 2017; 27:395-401. [PMID: 29252043 DOI: 10.1080/09638237.2017.1417544] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND An important aspect of research regarding the implementation of evidence-based practice is the sustainability and long-term stability of a programme. There is a need to measure these critical components for establishing successful programmes. AIM The aim was to develop and pilot test the sustainable implementation scale (SIS) for measuring the critical components in the sustainable implementation of community mental health services. METHOD The scale was based on implementation research and consisted of three subscales regarding (1) the organisational level, (2) the team level and (3) continuous support. Data from interviews and documents were collected from 14 programmes implementing the Individual Placement and Support model of supported employment. RESULTS Internal consistency was acceptable for all subscales and for the scale as a whole. Regarding the scale, an analysis of the differences between fully established programmes and the programmes that were not established or were or only partially established after three years showed statistically significant differences, indicating that a greater number of implementation components were present in the fully established programmes. CONCLUSIONS SIS showed both good reliability and acceptable internal consistency as well as the ability to predict programme survival.
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Affiliation(s)
- Urban Markström
- a Department of Social Work , Umeå University , Umeå , Sweden and
| | - Bengt Svensson
- b Department of Health Sciences , Lund University , Lund , Sweden
| | - Magnus Bergmark
- a Department of Social Work , Umeå University , Umeå , Sweden and
| | - Lars Hansson
- b Department of Health Sciences , Lund University , Lund , Sweden
| | - Ulrika Bejerholm
- b Department of Health Sciences , Lund University , Lund , Sweden
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19
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Johanson S, Markström U, Bejerholm U. Enabling the return-to-work process among people with affective disorders: A multiple-case study. Scand J Occup Ther 2017; 26:205-218. [PMID: 29078724 DOI: 10.1080/11038128.2017.1396356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Individual Enabling and Support (IES) model is an adapted, supported employment program developed to meet motivational, cognitive and time-use needs of people with affective disorders. Vocational programs for this target group have been developed but more knowledge is needed about the important characteristics and perceived usefulness of the programs. The aim of this study was to illustrate the IES model and process from multiple perspectives. METHODS Five participants were included in this multiple-case study. The material comprised interviews with participants, intervention documents, memos and interviews with employment specialists. Within and cross-case analyzes and an analytical generalization were performed. RESULTS The cases illustrated different IES processes, and the theme; Enabling engagement in return to work (RTW) was formulated. Continuous support from the employment specialist and a focus on personal resources and motivation were essential to overcome low self-confidence regarding RTW. Motivational, cognitive and time-use strategies gave an opportunity to learn new behavior and coping strategies for job seeking, getting employed and working. CONCLUSION Providing a combination of these strategies integrated with supported employment could promote self-efficacy and engagement in the RTW process among people on sick leave due to an affective disorder.
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Affiliation(s)
- Suzanne Johanson
- a Department of Health Sciences/Mental Health, Activity and Participation, Medical Faculty , Lund University , Lund , Sweden
| | - Urban Markström
- b Department of Social Work , Umeå University , Umeå , Sweden
| | - Ulrika Bejerholm
- a Department of Health Sciences/Mental Health, Activity and Participation, Medical Faculty , Lund University , Lund , Sweden
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20
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Svensson B, Hansson L, Markström U, Lexén A. What matters when implementing Flexible Assertive Community Treatment in a Swedish healthcare context: A two-year implementation study. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2017. [DOI: 10.1080/00207411.2017.1345041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bengt Svensson
- Department of Health Sciences/Mental Health and Mental Health Services Research, Lund University, Lund, Sweden
| | - Lars Hansson
- Department of Health Sciences/Mental Health and Mental Health Services Research, Lund University, Lund, Sweden
| | | | - Annika Lexén
- Department of Health Sciences/Mental Health and Mental Health Services Research, Lund University, Lund, Sweden
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21
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Eklund M, Bejerholm U. Staff ratings of occupational engagement among people with severe mental illness - psychometric properties of a screening tool in the day center context. BMC Health Serv Res 2017; 17:338. [PMID: 28482841 PMCID: PMC5422941 DOI: 10.1186/s12913-017-2283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 05/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background Staff who plan and organize day center activities may need to observe the attendees’ performance and progression. This led us to develop a tool for that purpose, termed General Occupational Engagement in people with Severe mental illness (GOES). The aim was to investigate its psychometric properties in terms of factor structure, internal consistency, corrected item-total correlations (CITC), convergent and discriminant validity, and test-retest stability. Methods Ninety-three day center attendees were assessed by the GOES and instruments addressing constructs hypothesized to be either similar to (activity level, motivation for day center attendance, perceptions of the worker role, hours spent in the day center) or divergent from the GOES (attendees’ ratings of engagement in specified occupations, self-rated health, psychosocial functioning, psychiatric symptoms). A second sample of 41 attendees were included for the test-retest analysis. Exploratory factor analysis, Cronbach’s alpha analysis, Pearson correlations and paired-samples t-tests were performed. Results Exploratory factor analysis indicated one factor, which was in line with the intentions of the scale. The alpha value was 0.85 and all CITC were above 0.30. The tests for convergent validity resulted in correlations ranging between 0.23 and 0.47, most of which were moderately strong and mainly confirmed the hypotheses. Discriminant validity was clearly indicated, since all correlations with the selected constructs were <0.20. GOES also showed preliminary test-retest stability (r = 0.32). Conclusions The GOES is ready for use in rehabilitation services and research where productive and other types of activities are of interest. It may serve as an important supplement to attendees’ self-reported occupational engagement.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences/ Mental Health, Activity and Participation, Lund University, Box 157, SE 221 00, Lund, Sweden.
| | - Ulrika Bejerholm
- Department of Health Sciences/ Mental Health, Activity and Participation, Lund University, Box 157, SE 221 00, Lund, Sweden
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22
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Lyon AR, Koerner K. User-Centered Design for Psychosocial Intervention Development and Implementation. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016; 23:180-200. [PMID: 29456295 PMCID: PMC5812700 DOI: 10.1111/cpsp.12154] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The current paper articulates how common difficulties encountered when attempting to implement or scale-up evidence-based treatments are exacerbated by fundamental design problems, which may be addressed by a set of principles and methods drawn from the contemporary field of user-centered design. User-centered design is an approach to product development that grounds the process in information collected about the individuals and settings where products will ultimately be used. To demonstrate the utility of this perspective, we present four design concepts and methods: (a) clear identification of end users and their needs, (b) prototyping/rapid iteration, (c) simplifying existing intervention parameters/procedures, and (d) exploiting natural constraints. We conclude with a brief design-focused research agenda for the developers and implementers of evidence-based treatments.
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Bejerholm U, Areberg C, Hofgren C, Sandlund M, Rinaldi M. Individual placement and support in Sweden - a randomized controlled trial. Nord J Psychiatry 2015; 69:57-66. [PMID: 24983382 DOI: 10.3109/08039488.2014.929739] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden. AIMS To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect. METHODS A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024. RESULTS One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18-54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this. CONCLUSIONS IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.
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Affiliation(s)
- Ulrika Bejerholm
- Ulrika Bejerholm, Ph.D., Associate Professor, Department of Health Sciences/Work and Mental Health, Medical Faculty, Lund University , Sweden
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Mueser KT, McGurk SR. Supported employment for persons with serious mental illness: current status and future directions. Encephale 2014; 40 Suppl 2:S45-56. [PMID: 24929974 DOI: 10.1016/j.encep.2014.04.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/29/2014] [Indexed: 11/27/2022]
Abstract
The individual placement and supported (IPS) model of supported employment is the most empirically validated model of vocational rehabilitation for persons with schizophrenia or another serious mental illness. Over 18 randomized controlled trials have been conducted throughout the world demonstrating the effectiveness of supported employment at improving competitive work compared to other vocational programs: IPS supported employment is defined by the following principles: 1) inclusion of all clients who want to work; 2) integration of vocational and clinical services; 3) focus on competitive employment; 4) rapid job search and no required prevocational skills training; 5) job development by the employment specialist; 6) attention to client preferences about desired work and disclosure of mental illness to prospective employers; 7) benefits counseling; and 8) follow-along supports after a job is obtained. Supported employment has been successfully implemented in a wide range of cultural and clinical populations, although challenges to implementation are also encountered. Common challenges are related to problems such as the failure to access technical assistance, system issues, negative beliefs and attitudes of providers, funding restrictions, and poor leadership. These challenges can be overcome by tapping expertise in IPS supported employment, including standardized and tested models of training and consultation. Efforts are underway to increase the efficiency of training methods for supported employment and the overall program, and to improve its effectiveness for those clients who do not benefit. Progress in IPS supported employment offers people with a serious mental illness realistic hope for achieving their work goals, and taking greater control over their lives.
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Affiliation(s)
- K T Mueser
- Departments of Occupational Therapy, Psychology, and Psychiatry; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, United States.
| | - S R McGurk
- Departments of Occupational Therapy, Psychology, and Psychiatry; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, United States
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Abstract
PURPOSE OF REVIEW Individual Placement and Support (IPS) is an effective intervention for helping people with severe mental illness obtain competitive employment, yet it has not been widely implemented. This review will examine and summarize the latest research on IPS. RECENT FINDINGS As the effectiveness of IPS has been well established in the literature, newer research is exploring nonvocational outcomes, such as quality of life and mental health services utilization and expanding the reach of IPS to include different countries and different population groups. There is also a growing literature exploring the cost-effectiveness of IPS compared with traditional vocational services, which has favored IPS. By far, the area of research that has expanded the most is aimed at enhancing IPS outcomes, at both the intervention level and the client level. Researchers are exploring the variance in IPS outcomes as a means of increasing competitive employment rates with IPS. SUMMARY Although the field of research continues to expand, it is clear that many barriers remain to broad implementation of IPS. The solution goes beyond further research and involves policies and practices that support a recovery oriented mental healthcare system.
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Schön UK, Rosenberg D. Transplanting recovery: research and practice in the Nordic countries. J Ment Health 2013; 22:563-9. [PMID: 24205790 DOI: 10.3109/09638237.2013.815337] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The conceptual framework which describes recovery from mental illness is based primarily on studies conducted in English-speaking countries. Knowledge and development of recovery orientation within other cultures and mental health systems is still limited. AIM The aim of this study was to compile, describe and discuss the research on personal recovery and recovery-oriented practice within the psychiatric and social fields in the Nordic countries. METHOD A systematic literature review of Nordic research on recovery from mental illness. RESULTS The research literature is limited, and primarily replicates designs and confirms findings first presented in studies conducted in the USA and Great Britain. The majority of the studies are qualitative, and point to the importance of social relations, environmental factors and peer support. CONCLUSIONS There is a need to identify and describe factors in Nordic mental health systems that may influence the recovery process. A corresponding challenge will be to translate and further develop outcome indicators that can promote a recovery-oriented health system.
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Affiliation(s)
- Ulla-Karlin Schön
- School of Health and Social Studies , Dalarna University , Falun , Sweden
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Eklund M, Tjörnstrand C. Psychiatric rehabilitation in community-based day centres: motivation and satisfaction. Scand J Occup Ther 2013; 20:438-45. [PMID: 23721255 DOI: 10.3109/11038128.2013.805428] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study investigated attendees' motivation and motives for participation in day centres and their satisfaction with the rehabilitation, while also addressing the influence of day centre orientation (work- or meeting-place orientation), gender and age. METHODS Ninety-three Swedish day centre attendees participated in a cross-sectional study and completed questionnaires about motivation, motives, and satisfaction with the rehabilitation. Data were analysed with non-parametric statistics. RESULTS The participants were highly motivated for going to the day centre and set clear goals for their rehabilitation. Female gender, but not age, was associated with stronger motivation. The strongest motives for going to the day centre were getting structure to the day and socializing. Attendees at work-oriented day centres more often expressed that they went there to get structure to the day and gain social status. Satisfaction with the rehabilitation was high, and the most common wishes for further opportunities concerned earning money and learning new things. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The rehabilitation largely seemed to meet the attendees' needs, but the findings indicated that further developments were desired, such as participation in work on the open market and more work-like occupations in the day centre, accompanied by some kind of remuneration.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, Occupational Therapy and Occupational Science, Lund University , Sweden
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Lexén A, Hofgren C, Bejerholm U. Reclaiming the worker role: Perceptions of people with mental illness participating in IPS. Scand J Occup Ther 2012; 20:54-63. [DOI: 10.3109/11038128.2012.693946] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bond GR, Drake RE, Becker DR. Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US. World Psychiatry 2012; 11:32-9. [PMID: 22295007 PMCID: PMC3266767 DOI: 10.1016/j.wpsyc.2012.01.005] [Citation(s) in RCA: 232] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While reviews of controlled studies of the Individual Placement and Support (IPS) model of supported employment for clients with severe mental illness have documented its effectiveness in the US, its generalizability to other countries has not been systematically evaluated. This is the first review to compare US to non-US studies. We identified 15 randomized controlled trials of IPS programs, 9 in the US and 6 outside the US. We examined competitive employment outcomes, including employment rate, days to first job, weeks worked during follow-up, and hours worked. We also considered noncompetitive employment, program retention, and nonvocational outcomes. IPS programs had significantly better outcomes across a range of competitive employment indicators and higher retention in services than control groups. The overall competitive employment rate for IPS clients in US studies was significantly higher than in non-US studies (62% vs. 47%). The consistently positive competitive employment outcomes strongly favoring IPS over a range of comparison programs in a group of international studies suggest that IPS is an evidence-based practice that may transport well into new settings as long as programs achieve high fidelity to the IPS model, but further research is needed on international adaptations.
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Affiliation(s)
- Gary R Bond
- Dartmouth Psychiatric Research Center, Rivermill Commercial Center, 85 Mechanic Street, Lebanon, NH 03766, USA
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