Cover: Process evaluation of the Individual Placement and Support for Alcohol and Drug Dependence (IPS-AD) trial

Process evaluation of the Individual Placement and Support for Alcohol and Drug Dependence (IPS-AD) trial

Final report

Published Jan 25, 2024

by Joanna Hofman, Natalie Picken, Jan Hutchinson, Androulla Harris, Katherine Stewart, Emma Disley

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Research Questions

  1. What barriers and facilitators were there to the implementation of the IPS-AD trial in the context of treatment for alcohol and drug dependence?
  2. What day-to-day activities did IPS involve for participants and staff?
  3. What expectations did participants have of their opportunities to obtain employment before and after the trial?
  4. What were the barriers and facilitators associated with finding employment and to what extent did the trial address these?
  5. What were participants' experiences of contact with existing local employment support services?
  6. What were the organisational processes that enable IPS in the specific context of treatment for alcohol and drug dependence?
  7. Were there participant characteristics that are best suited to IPS?
  8. How can IPS best be implemented for the target population in the specific context of treatment for alcohol and drug dependence?
  9. What are the contexts, mechanisms, and outcomes patterns that describe how IPS works in the context of treatment for alcohol and drug dependence?

Individual Placement and Support (IPS) is an evidence-based intervention that has been developed to support people with severe mental illness attain competitive employment. People with alcohol and drug dependence often struggle to find stable employment and have a very low rate of employment compared to the general population.

In 2018, Public Health England (PHE) was commissioned by the Department for Work and Pensions' (DWP) and Department of Health and Social Care's (DHSC) Work and Health Unit to carry out a randomised control trial of IPS in the drug and alcohol population in seven drug and alcohol treatment centres (IPS-AD). The study participants were service users of the treatment centres who were randomly assigned into the 'intervention' or 'control' group. Participants in the 'intervention' group received IPS support for nine months and in-work support for up to four months. Teams of employment specialists were embedded into the seven centres and worked alongside treatment services staff to support service-users in the 'intervention' group into work.

Between 2018 and 2020, PHE commissioned RAND Europe and the Centre for Mental Health to carry out a process evaluation of IPS-AD. Our evaluation explored the experiences of those involved in the IPS-AD study and documented the lessons learnt about delivering IPS to people with drug and alcohol dependence and implementing IPS in the context of drug and alcohol treatment services. The evaluation used a theory-based and realist approach and drew upon a review of documentation and over 250 interviews with stakeholders and trial participants. 

Key Findings

  • IPS was implemented successfully across all seven treatment services, within diverse contexts and organisational settings. Some services faced context-specific challenges when implementing IPS which were overcome over time. Integration of IPS with alcohol and drug dependence treatment services was generally achieved through IPS teams being co-located with the wider services, able to access the same case management systems, and receiving support from treatment services management.
  • IPS teams faced challenges in ensuring that all eligible service-users were able to be referred onto the trial, including because treatment services keyworkers were sometimes reluctant to refer. The IPS-AD trial laid conditions for wider cultural change about the role of employment in helping with recovery from alcohol and drug dependence in the seven services. Measurable changes, however, in the attitudes and practice of treatment service staff require more time and effort to materialise fully.
  • Employment specialists also faced challenges keeping clients with drug and alcohol dependence engaged with IPS. Better understanding is needed to understand reasons for lack of engagement.
  • Service-users receiving IPS support were overwhelmingly positive about their experience of working with IPS. The flexibility and individualised nature of IPS was felt to make it well-suited to address the complex and fluctuating needs of people with alcohol and drug dependence. However, providing employer engagement and in-work support was felt to be challenging in the alcohol and drug dependence treatment settings because of concerns about perceived employer stigma and reluctance to disclose alcohol and drug dependence.

Recommendations

The report makes a number of recommendations grouped in 4 main areas:

  • Ensuring adequate funding IPS in alcohol and drug dependence treatment services
  • Careful planning for and deciding upon IPS implementation
  • Good practice in recruiting and managing Employment Specialists
  • Practical suggestions for implementing and delivering IPS in alcohol and drug dependence treatment services

Research conducted by

The research described in this report was prepared for Public Health England and conducted by RAND Europe.

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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