Evaluating Individual Placement and Support (IPS) and IPS Grow

IPS Grow aims to speed the implementation of high-quality individual placement and support for people with serious mental illness to find employment. A programme evaluation found that the support provided by IPS Grow Regional Leads and networking available through Communities of Practice were particularly helpful.

What is the issue?

Individual Placement and Support (IPS) is an evidence-based model which supports people with serious mental illness into employment. In order to increase access to IPS services nationally, NHS England has allocated funds to specific sustainability and transformation partnership (STP) areas. A proportion of funding has been dedicated to IPS Grow, a national implementation support initiative.

IPS Grow aims to speed up time taken to deliver high quality IPS and ensure sustainable services through providing technical implementation support, workforce development and data tools and performance standards.

How did we help?

Our evaluation used a theory-based approach and a logic model to examine IPS Grow’s impact on funded IPS services. We aimed to answer seven evaluation questions through a combination of methods, including telephone interviews, focus groups, case studies, online surveys and a targeted documentation review (including of reports and plans from services’ IPS fidelity reviews).

The study aimed to examine the uptake of support from IPS Grow by IPS services, explore the perceptions of IPS Grow by key audiences, and examine the impact that different elements of support from IPS Grow had on services, depending on their organisational features.

What did we find?

How did IPS maturity change during the initial two years of receiving support?

High fidelity to the IPS model is associated with better outcomes and fidelity reviews test services’ levels of fidelity. We reviewed reports and action plans from two rounds of fidelity reviews of seven services supported by IPS Grow. By 2020, all examined services delivered IPS to at least fair (or good) fidelity and all had improved over time. Some aspects of good fidelity were in place from the beginning, such as tailored employment support, whereas other aspects of fidelity improved over time, such as integration with clinical teams. Other elements, such as ensuring all clients can take part were not yet fully in place.

How were the IPS services organised within the local healthcare system?

Based on sampling and reviewing 21 funding applications from IPS services, we identified four potential profiles of likely IPS services in terms of funding sought, prior IPS experience and provider type. Considering and developing this model may help predict and provide appropriate levels of support in the future.

What were the activities and outputs of the services that received IPS Grow support?

In good fidelity IPS, clients are supported through six phases of an employment journey: referral to IPS Employment Specialist, engaging with clients for an initial meeting, building a vocational profile, job seeking, job start and supporting a client in work. Data reported by services shows that, throughout the time of support, the number of referrals, caseload sizes, clients with a vocational profile and job starts increased between April 2019 and March 2020

What support did each service receive from IPS Grow?

IPS Grow offered wide-ranging support to services across three key workstreams: technical implementation support, workforce development, data tools and performance standards. Support in the form of workshops, informal advice, coaching and training, and use of online resources were frequently used.

How was IPS Grow perceived by its key audiences?

IPS Grow’s support was perceived positively and considered helpful; 92% of survey respondents rated the quality of IPS Grow support as 4 or 5 (when 5 = excellent) and 86% would recommend IPS Grow support to other services. The support provided by IPS Grow Regional Leads was particularly valued by interviewees and respondents across all workstreams. This was because the Regional Leads helped IPS practitioners to network, learn from others, find out about support and were generally responsive and accessible. Support delivered through the Communities of Practice were also highly valued for learning, networking and support.

How did organisational factors or levels of support account for variation in IPS maturity?

We found that the level of previous experience of service with IPS had an effect on IPS maturity: services that had more experience with IPS were more likely to have good fidelity to the IPS model. However, it was unclear whether the type of provider of a service (ie. whether offered by NHS mental health trusts) affects IPS maturity. Organisational factors, such as the extent to which services are ‘well established’ and the region in which they fall, may make it easier for services to access and benefit from effective IPS Grow support.

What were the key elements of the IPS Grow that allowed new services to reach good fidelity to the IPS model?

We identified three elements of IPS Grow support that were emerging as most valuable in terms of improving services’ fidelity based on stakeholder feedback and evaluation team assessment. These included:

• IPS Grow Regional Leads: in particular, their support and knowledge about IPS
• Communities of Practice: their ability to facilitate learning and sharing resources to increase fidelity
• IPS Grow online resources (including templates, the forum, e-learning, training): these supported services to understand and show evidence of good fidelity.

The evaluation team concludes that IPS Grow has

1. helped with a faster implementation of IPS across the funded services
2. improved the consistency of IPS implementation, and
3. contributed to improving the quality of IPS offered by these services.

What do we recommend?

We set out a number of recommendations for NHS England and DWP:

1. We recommend that there is separate funding ensured to maintain IPS Grow or a similar central support initiative in the future.
2. We recommend that (i) future IPS Grow supports both expanding IPS to new services and IPS in existing services, and (ii) NHS England / DWP examine which stream offers a better value for money.
3. We recommend that funding is ensured for IPS fidelity reviews (and follow-up action plans) for all supported services, given that these are shown to lead to service quality improvements.
4. We recommend evaluating IPS Grow over a longer period of time.

We also set out a number of recommendations for implementers of IPS Grow:

1. We recommend that IPS Grow (i) continues to offer (and indeed expands) regular fidelity reviews with services and routine completion of (and updates to) action plans and (ii) monitor action plans, findings patterns in the findings and adjusting their support accordingly.
2. We recommend that IPS Grow uses data from the regular fidelity reviews to map and identify strengths and weaknesses across services.
3. We recommend that IPS Grow considers different ways in which CoP could operate (including cross-regionally with a focus on specific challenges faced by types of services or on particular fidelity items).
4. We recommend that IPS Grow (i) improves the awareness and accessibility of available resources, so that more services know where to find these, when and how to use them (e.g. by developing a communication and dissemination plan for tools and resources and a better utilisation of IPS Grow Regional Leads in helping services make use of these tools) and (ii) better harmonises the tools used for monitoring and evaluation used locally.
5. We recommend that IPS Grow (i) reviews how the regions are defined and how IPS Grow Regional Leads are allocated between these, (ii) together with NHS England and DWP set expectations for an optimum ‘reach’ for this role, and (iii) continues to consider the support needs of services with different organisational setups when providing support and developing resources in future.
6. We recommend that IPS Grow considers providing different levels of support in order to ensure that support is as tailored as possible to services’ needs.

---

Read the full study