Evaluation of the Individual Placement and Support for alcohol and drug dependence (IPS-AD) trial

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People with drug and alcohol dependence often struggle to find stable employment. Despite employment being identified as a key part of recovery by successive governments’ drug strategies, employment rates for people in both drug and alcohol treatment remain low. Individual Placement and Support (IPS) could be used to help resolve this issue. IPS is an evidence-based approach which supports people looking for employment, using trained employment specialists alongside treatment for substance misuse as part of a multi-disciplinary treatment team.

Public Health England (PHE) was commissioned by the joint Department for Work and Pensions and Department for Health and Social Care Work and Health Unit to run a trial of IPS in substance misuse community treatment services. Working with providers and local authorities in seven areas across England, the trial ran for over two years and was the first large-scale randomised controlled trial of IPS for this client group.

How did we help?

RAND Europe and the Centre for Mental Health (CMH) were commissioned by PHE to conduct a process evaluation of the trial. The 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 review of documentation and over 250 interviews with stakeholders and trial participants.

What did we find?

IPS was implemented successfully across all seven treatment services, within diverse contexts and organisational settings. Some services faced context-specific challenges when implementing IPS that 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, as 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 the 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 challenging in the alcohol and drug dependence treatment settings because of concerns about perceived employer stigma and reluctance to disclose alcohol and drug dependence.

What can be done?

Our recommendations include actions for funders and policymakers and for treatment service managers and commissioners of future IPS-AD services.

Funders and policymakers could:

  • Ensure that there are adequate resources for all stages of setting up an IPS service in drug and alcohol treatment services, including dedicating funding for regular fidelity reviews of IPS services and sharing experiences across a wider community of IPS providers.
  • Develop and disseminate practical IPS material and implementation guidelines, building on experiences of the sites hosting the IPS-AD trial to future services.
  • Commission further research and evaluations to better understand some aspects of IPS in alcohol and drug dependence treatment services (for example, exploring why clients may not engage with IPS services, the impact of not disclosing alcohol and drug dependence on clients’ likelihood to sustain paid employment and the reasons driving stigma among employers about hiring clients with alcohol and drug dependence).

Treatment managers and commissioners could:

  • Draw upon resources and learning from the services that hosted the IPS-AD trial
  • Keep treatment services staff fully involved and informed about the decision to launch an IPS service (for example, running briefing sessions or workshops with IPS experts, future funders, or clients with alcohol and drug dependence who received IPS support) and consider including client employment outcomes as Key Performance Indicators.
  • Demonstrate a consistent commitment to IPS as an integrated part of the treatment services and ensure that IPS team members are embedded into treatment services.
  • Ensure there is sufficient induction training and continuous development opportunities for IPS team members.
  • Draw upon IPS resources to deliver a high-quality service, including focusing on how and when to share personal and health information, employer engagement and in-work support for both clients and employers.
  • Arrange for regular fidelity reviews to improve and maintain the quality of the IPS service.