Overview of Individual Placement and Support (IPS) in the Netherlands

Inaugural European IPS Meeting Inaugural European IPS Meeting 22 22nd June 2021, by Zoom ndJune 2021, by Zoom Netherlands Presenter Details: Cris Bergmans (IPS co rdinator Phrenos (Center of expertise for severe mental illness)/cbergmans@kcphrenos.nl Lars de Winter (IPS data coordinator and researcher Phrenos)/lwinter@kcphrenos.nl

Overview of IPS in the Netherlands IPS implemented in 30 mental health organisations in the Netherlands. In the beginning of January 2021, 5112 people participated in IPS-trajectories. Of these people, 1475 (29%) are working in regular paid jobs. About one in three participants have worked at some point IPS carefully implemented for other cohorts like people with Common Mental Disorders (CMD) Of the se, 1013 (32.3%) werg. IPS in the Netherlands Scale of IPS provision 2

Overview of IPS in the Netherlands (3.. IPS carried out by specialised mental health organisations on national scale. IPS is integrated in early psychosis teams and in (flexible) assertive community treatment teams (F)act, and also in housing services for people with SMI (8 providers) Leaders: Phrenos center of expertise for severe mental illness Important stakeholders; Ministry of Social Affairs, Employee Insurance Agency (UWV) some municipalities and universities Health and welfare landscape IPS funded mainly by a national Employee Insurance Agency (UWV) for people with a disability benefit (started 2014) for people with SMI. New IPS funding in 2017 by UWV (IPS research regulation). 20million for 5 years. For people with SMI. In 2019 1,5million subsidy for IPS and Common Mental Disorders. From 2022 structural funding for IPS by national Employee Insurance Agency (UWV) Municipalities are responsible for people on social welfare municipalities are responsible. More and more municipalities contract IPS services Health care insurance is paying for an average of eight conversations 2021-2024: National upscaling of IPS. Dutch government is allocating 18million to increase job opportunities for people with mental illness. Funding for 2300 IPS trajectories available (SMI/CMD) Funding 3

Development of IPS in the Netherlands A multisite study was conducted to determine the feasibility of IPS in the Netherlands (conducted in 2000). IPS introduced in the Netherlands in 2003 in 4 Mental health organisations. Randomized Controlled trial in the Netherlands (start 2005-2010). Known as Scion study (Van Busschbach et al., 2014). Developing a central implementation program for implementing IPS, training IPS employment specialists, and conducting IPS Fidelity reviews coordinated by Phrenos center of expertise (national approach) The Netherlands member of the International learning community (2012) Breakthrough project in the Netherlands and IPS introduced in a lot of early psychosis teams (2014) 2017 New regulation for subsidy (from ministry of social affairs) for improvement of labour market participation and the cooperation between mental health organizations and municipalities (with responsibility for social welfare benefits) 2019 1,5 million subsidy for IPS and people with Common Mental Disorders 2021-2024: Dutch goverment is allocating 18 million to increase job opportunities for people with mental ilness. Money for 2300 IPS trajectories available (SMI/CMD). From 2022 Structural funding for IPS by national Employee Insurance Agency (UWV 4

Development of IPS in the Netherlands Growth of IPS in the Netherlands Number of IPS programs 28 30 27 26 25 19 20 15 11 9 10 5 5 0 2014 2015 2016 2017 2018 2019 2020 5

Phrenos Center of expertise Phrenos center of expertise member of International Learning Collaborative (IPS Center, RockvilleWestat) Providing IPS implementation for mental health services that want to start with IPS (Kick-off meeting, training professionals as employment specialists 6 IPS trainers concerned with training professionals as IPS employment specialists Organising IPS network meetings for managers, policymakers and IPS employment specialists (three times a year) IPS fidelity reviews by 8 trained reviewers Collect IPS outcome data quarterly and provide feedback reports to IPS providers Websitewww.werkenmetips.nl 6

Approach to quality and innovation Quality assurance Innovation and future direction Training professionals as IPS employment specialists IPS fidelity reviews undertaken by Phrenos center of expertise. Mental Health organisations pay for the reviews. First fidelity review eight months after start implementation, repeat every two years Monitoring of outcomes at national level by Phrenos center of expertise. Feedback reports to each provider Conducting research IPS for people with SMI in housing services (no mental health treatment but mental health support) (2016) Introduction IPS for people with common mental disorders (2019). As of 2022 structural IPS funding for people with SMI by Employee Insurance Agency (UWV) Phd research by Phrenos on cognitive remediation and IPS (Dani lle Van Duin) Research by Phrenos on IPS and people with common mental disorders More focus on IPS and education (however, difficult to get funding!) 7

Phrenos Center of expertise Number of clients receiving IPS each year 6000 5112 5053 5000 3840 4000 2831 3000 1742 2000 1000 0 2016 2017 2018 2019 2020 8

Phrenos Center of expertise Total number of clients with IPS in work or education 1110 1108 1094 1200 1063 1031 1013 1013 1005 902 1000 831 718 800 688 670 643 652 576 600 382 400 225 213 210 209 207 198 195 195 187 182 164 158 154 141 115 110 200 76 0 N work N education In 2020: 1,475 clients employed and 271 clients in education In 2020: 575 clients started a job and 291 clients lost a job 9

Phrenos Center of expertise Fidelity scores and ratings 16 115.00 15 15 14 110.00 109.92 13 12 105.00 104.83 10 100.00 8 95.00 96.93 7 6 6 90.00 5 4 85.00 3 2 1 0 0 0 1 0 80.00 Assessment 1 Assessment 2 Assessment 3 No IPS Fair fidelity Good fidelity Excellent fidelity Fidelity score Quality of implementation improves on the long-term 10

Phrenos Center of expertise Impact of COVID-19 in implementation IPS Caseload (number of clients per IPS program) grows slower than expected Number of new clients are starting to decrease slightly If this trend continues the caseload might shrink! Small decrease in the average number of people that are employed due to IPS Balance between number of people that started and stopped competitive employment remains positive First indications: so far no negative impact of COVID-19 on supporting people into competitive employment 11

IPS Research/Recent publications Michon, H., van Busschbach, J. T., Stant, A. D., van Vugt, M. D., van Weeghel, J., & Kroon, H. (2014). Effectiveness of individual placement and support for people with severe mental illness in the Netherlands: A 30-month randomized controlled trial. Psychiatric Rehabilitation Journal Van Weeghel, J., Bergmans, C., Couwenbergh, C., Michon, H., & de Winter, L. (2019, June 17). Individual Placement and Support in the Netherlands: Past, Present, and Future Directions. Psychiatric Rehabilitation Journal. Advance online publication. http://dx.doi.org/10.1037/prj0000372 Employment in Personality Disorders and the Effectiveness of Individual Placement and Support: Outcomes from a Secondary Data Analysis T. T. Juurlink, F. Lamers, H. J. F. van Marle, H. Michon, J. T. van Busschbach, A. T. F. Beekman, J. R. Anema. Journal of Occupational Rehabilitation (2019) https://doi.org/10.1007/s10926-019-09868-9 De Winter, L., Couwenbergh, C., Van Weeghel, J., Bergmans, C. & Bond, G.R. (2020). Fidelity and IPS: does quality of implementation predict vocational outcomes over time for organizations treating persons with severe mental illness in the Netherlands? Social Psychiatry and Psychiatric Epidemiology. Published online: 28 May 2020. https://doi.org/10.1007/s00127-020-01890-0 Roeg D, de Winter L, Bergmans C, Couwenbergh C, McPherson P, Killaspy H and van Weeghel J (2021) IPS in Supported Housing: Fidelity and Employment Outcomes Over a 4 Year Period. Front. Psychiatry 11:622061. doi: 10.3389/fpsyt.2020.622061 12