The trend toward evidence-based practice has lead to an increased use of internationally tested programs. This development has been questioned because of translation problems, including the lack of fit with national welfare systems and local organizations. This study has followed the implementation process of 14 Individual Placement and Support (IPS) programs that have received national stimulus startup grants.
The overarching aim was to explore whether a high fidelity implementation of IPS in a real life Swedish context is possible. The study’s focus was directed towards implementation components at different organizational levels, program fidelity, and the sustainability of the initiatives.
Fourteen IPS programs that started during 2012 were selected. Based on research findings that described essential implementation components, an interview protocol and an analysis scale were developed and used. The Sustainable Implementation Scale (SIS) includes components at organizational level, team level, and continuous support. Representatives from the IPS programs were interviewed at baseline, after 12 and 24 months. The 24-month follow-up was conducted 6 months after the disbursement of stimulus grants had ended; therefore questions about the programs sustainability were included. The Supported Employment Fidelity Scale (SEFS) was used to monitor program fidelity after 12 and 24 months.
Five of the municipalities with IPS programs had shut them down, while 3 municipalities had partly integrated IPS in regular programs.
Six of the programs were fully integrated in the organizations’ regular activities. These 6 programs were characterized by high scores in SIS, primarily on the components concerning recruitment of staff, management, education and access to support structures. There was a significant correlation between the scores on SEFS, SIS, and the sustainability of the program. Collaboration between authorities was a challenge for the programs. An engaged, joint steering group and strategies for local financing were important for the survival of the initiatives.
A high fidelity, real-life implementation of IPS in Sweden is possible, but requires a strong focus on essential implementation components and strategies that address contextual barriers. The SIS is a promising tool for monitoring implementation.
Eleventh International Conference of the European Network For Mental Health Service Research, Malaga, 1-3 october 2015