To Örebro University

I denna rapport presenteras resultat ur en utvärdering av projektet IPS-integrering i vårdteam. Projektet och utvärderingen pågick under perioden 2023-03-01 - 2026-02-28 och finansierades av Europeiska Socialfonden. Utvärderingen är baserad på intervjuer med yrkesverksamma och deltagare i projektet. Syftet med rapporten är att belysa dels möjligheter och hinder som uppstår i implementeringen av IPS, dels deltagares erfarenheter av att vara med i IPS, samt med utgångspunkt i dessa resultat föreslå förbättringsförslag och viktiga områden att ta hänsyn till vid implementering av IPS i Sverige.

Utvärderingens huvudsakliga slutsatser är:

• Det går att implementera IPS inom psykiatriska team i Sverige där arbetsspecialisterna inte är anställda av psykiatrin men dettar tid och kräver kontinuitet.

• Externa faktorer är betydande för möjligheten att implementera IPS för psykosvårdens målgrupp. De inkluderar inte minst ersättningssystemens påverkan samt psykiatrins organisering. Samtidigt är det viktigt att följa förändringar i ersättningssystem då det kan uppstå glapp mellan å ena sidan praktikers och patienters farhågor, exempelvis för indragen ersättning och å andra sidan myndigheters faktiska tillämpning.

• Den långsiktiga implementeringen av IPS inom Region Örebro län är oviss. Det är viktigt att klargöra ansvarsfrågan i relation till frågan huruvida IPS är en rehabiliterande vårdinsats eller en arbetsmarknadsinsats. Fokuset på arbete, och då inte minst det arbetsgivarorienterade arbetssättet, innebär att IPS utmanar synen på hälso- och sjukvårdens arbete.

• De deltagare som intervjuats är i huvudsak nöjda med IPS-insatsen. Arbetet koordineras mellan psykosvården och arbetsspecialister utan större behov av mer deltagarintensiv samverkan. Detta har i huvudsak uppfattas som positivt av deltagare. Dock är en risk att deltagares delaktighet förbises om det uppstår ett glapp mellan den enskildes upplevelse av insatsen och arbetsspecialistens uppfattning om deltagarens deltagande.

• På grund av nedsatt arbetsförmåga har IPS-insatsen i praktiken kommit att erbjuda sysselsättning, med liten eller ingen chans för anställning, åt en stor andel deltagare. Å ena sidan innebär det en avvikelse mot IPS-metoden. Å andra sidan uttrycker de intervjuade deltagarna att sysselsättningen varit stärkande och ett viktigt komplement till socialpsykiatrins dagverksamhet.

Purpose: The purpose of this study is to identify what factors influence user satisfaction with vocational rehabilitation services among service users in a Swedish context.

Methods: In a randomized control trial, ordinal logistic regression was applied to a dataset of 631 completed questionnaires about the support provided in three different vocational rehabilitation programmes in Sweden—Supported Employment, Case Management and Regular Vocational Rehabilitation.

Results: The factors Person-centeredness, Trust in Support Persons, and Experience that the activities help with getting a job were significant factors of satisfaction among service users. The ordinal logistic regression model explained between 34.3% and 49.9% of the variance in the material, depending on the pseudo R2-measure used.

Conclusions: Service users who experience vocational support as person-centered, experienced trust in their support persons and that vocational rehabilitation activities help with getting a job are more satisfied with the vocational rehabilitation services than are other service users, independent of the vocational rehabilitation models used. Therefore, a person-centered approach is relevant to include in models’ development and service design of vocational rehabilitation.

Introduction: Several systematic reviews have found the vocational rehabilitation (VR) intervention of Supported Employment (SE) to be more efficient for persons with disabilities to obtain employment than other interventions within VR. Nevertheless, there is a lack of research on how the intervention works for men and women.

Aim: To explore the influence of gender on access, processes, and employment outcomes in VR, designed according to the SE method, for men and women with psychiatric, neuropsychiatric, or intellectual disabilities.

Methods: Study I was a scoping review to examine what has been reported regarding the influence of different intersecting statuses on the employment rate after participating in an SE intervention. Study II was a focus group study with employment specialists exploring their social representations of gender in relation to disability, VR, and working life .Study III was a qualitative interview study exploring participants’ experiences of SE interventions. Study IV was a mixed method multiple case study using qualitative comparative analysis to explore enabling and barrier conditions in SE interventions.

Results: In the triangulation of the four studies, two superordinate themes evolved. In the material, gendered paths through the welfare system resulted in women having less access to SE interventions, and when participating in an SE intervention, women with disabilities with high responsibilities for home and family struggled to find enough resources to focus on vocational rehabilitation.

Conclusion: For SE to become more equal and better suited for all persons with disabilities interested in employment, regardless of gender, the accessibility to SE and the SE method needs to be developed to better suit the diversified needs of SE participants.

BACKGROUND: In Sweden, gender differences have been found in standard vocational rehabilitation as well as in evidenced-based methods such as Supported Employment (SE). However, these quantitative findings have not been followed up by qualitative research to clarify the issue.

OBJECTIVE: To explore participants’ experiences of participating in an SE intervention and the influence of gender on their experiences.

METHOD: Semistructured interviews with 10 women and 7 men participating in SE in Sweden were conducted. Qualitative content analysis followed by a gender analysis were performed using the material.

RESULTS: The participating men and women had different background characteristics. Overall, the participants shared the same experiences of SE. They valued a trustful relationship with the employment specialist and the diversified and individualized support from the employment specialist. Unlike the men, the women had experienced difficulties receiving SE from authorities, and when receiving SE, they expressed the value of a slow start, being challenged, and whole-life support.

CONCLUSION: The findings might moderate the rapid job principle in SE and indicate the need to acknowledge that the path to employment might look different, depending on the participants’ gendered experiences and living conditions, for SE to be more successful for both men and women.

PURPOSE: Gender differences have been found in the outcomes of vocational rehabilitation (VR) and in Supported Employment (SE), therefore, the purpose of this study was to explore employment specialists' (ES) social representations of gender in relation to work and VR and how these social representations influence the ES's work in the VR process according to SE.

METHODS: The qualitative method of focus group discussions was employed. Ten focus groups were held with 39 ESs from four categories of SE organizations in Sweden. Topic analysis was applied to the transcribed material from the focus groups.

RESULTS: Five themes with different social representations about gender and disability in relation to VR and working life formed in the analysis: (1) differences in personal and health factors among VR-participants, (2) gender norms in society influencing VR, (3) energy-intensive environmental issues influencing VR, (4) gender-specific interactions in VR, and (5) gendered paths in the welfare system.

CONCLUSION: Social representations of higher strains on women with disabilities compared to men with disabilities both in private and working life, which reflect the lived experiences of the ESs, is a possible explanation for gender differences in VR and working life for persons with disabilities.

IMPLICATIONS FOR REHABILITATION: Gender differences in the outcomes of vocational rehabilitation (VR) interventions have been noticed worldwide. In this study, pervasive social representations about gender and disability in relation to VR were found, but also unconsciousness about gender among VR professionals. Therefore, awareness of gender is necessary in VR.Individualized and person-centered approaches to VR like Supported Employment, although considered best practice, might hide structures like gender, which could lead to reproducing discriminating processes and therefore not achieving gender equality in VR. Therefore, knowledge of discrimination is important in VR.Gender-sensitivity in vocational rehabilitation models with a person-centered and individualized approach is needed and there might also be a need to systematically tailor vocational rehabilitation models to reach gender equality in the outcomes of the interventions. Therefore, gender equality indicators are needed for VR models, to evaluate model effectiveness from a gender perspective.

BACKGROUND: Supported Employment (SE) has shown better results in the employment rate for persons with disabilities than other methods within vocational rehabilitation, but how SE affects the employment rate for subgroups in the interventions needs further attention.

OBJECTIVE: To examine previous research regarding the influence of intersecting statuses on the employment rate in SE for people with psychiatric, neuropsychiatric, or intellectual disabilities according to type of diagnosis, sex, race/ethnicity, age, level of education and previous work history.

METHODS: A systematic literature search was conducted in nine databases including peer-reviewed articles from 2000 to April 2021. Articles presenting the employment rate in SE interventions according to the intersecting statuses listed in the objective were included.

RESULTS: The searches identified 3777 unique records, of which 53 articles were included in data extraction. In most of the included articles, intersecting statuses did not affect the employment rate for people in the SE interventions with psychiatric disabilities. Few studies have examined neuropsychiatric and intellectual disabilities. A majority of the studies subjected to full-text analysis were excluded due to a lack of reporting of the effects of intersecting statuses on the employment rate. The studies that reported on the effects of intersecting statuses on the employment rate often had small samples and lacked statistical power.

CONCLUSIONS: Intersecting statuses do not appear to affect the employment rate for people receiving SE interventions, but systematic reviews with pooled samples need to be undertaken because of the low reporting rate and underpowered sample sizes in existing studies.