Table 2 Summary of perceived facilitators and barriers
Themes | Facilitators | Barriers |
|---|---|---|
1. Innovation | ||
1.1 IPS | ||
Intervention | Evidence based effectiveness of IPS | Costs of IPS |
Key principles of the IPS model | IPS model fidelity scale and fidelity reviews | |
Compatibility of IPS with existing work procedures | ||
1.2 Collaboration | ||
Between organizations involveda | Regular meetings of stakeholders | Clients’ privacy and medical confidentiality |
Sharing information, knowledge and expertise | Organization of the structural meetings | |
Pre-existing relationships and collaboration between stakeholders | Lack of involvement of practitioners in vocational rehabilitation | |
Shared interests, goals and vision of stakeholders | Lack of communication between decision makers and practitioners | |
Professionals involved | ||
Stakeholders characteristics | Mandate and influence of decision makers | |
Attitude and beliefs | Ownership of IPS and collaboration | IPS not experienced as part of the mental health treatment |
Work not experienced as a achievable goal for people with SMI | ||
1.3 IPS funding | ||
Secured fundingb | Substantial funding for IPS | Fragmented funding |
Lack of clarity with regard to costs of IPS services | ||
Ethics | ||
Pay for performanceb | Pay for performance might encourage IPS specialists | Not appropriate to receive extra payments within health care setting |
Sustainability | Covenant between involved organizations stimulates collaboration and funding | Lack of proven cost-effectiveness of IPS Temporary financial agreements between the organizations involved |
2. Socio-political context | ||
Government | Support and funding of Ministry of Social Affairs and Employment New Participation Act provides sense of urgency regarding participation of people with SMI | Dutch social safety net does not stimulate participation in paid work New Participation Act has unwanted consequences Health insurance act limits IPS funding by health insurance company |