Evidensbaserad metod eller praktisk verksamhet?

Abstract

Evidence-based method or practical support for users? – Supported Employment without IPSSince the Mental Health Reform of 1995, the social service in Sweden is required to offer ”meaningful activities” to persons with mental health impairments. This requirement has usually been met by the social service’s ”daily activities” centres, which do not have contact with the competitive labour market. ”Supported Employment” (SE) is a method which can be used to help people with mental health, neuropsychiatric or intellectual impairments to regular work places. Based on international research, the SE model ”Individual Placement and Support” (IPS) is recommended in national guidelines as an evidence-based method. However, IPS can be difficult to implement, since the model requires integrated teams, while in the Swedish system health care, social service and vocational rehabilitation belong to different sectors. Another reason is that subsidized forms of employment and internship are more usual in Sweden than in many other countries. This study investigates SE practices in three municipalities which do not follow all of the IPS model’s eight ”basic principles”. The results show that after 18 months many persons who had been totally without regular activities, or had access only to a daily activities centre, had some form of work or internship at regular workplaces. Twenty per cent had paid employment. The author interprets IPS as a ”packaging” of SE which the municipalities have ”translated” locally to offer SE activities which benefit users. This can also be seen as evidence-based practice (EBP), in which the best available research has been combined with the wishes of users and the professionals’ judgement of what is possible to offer in practice. Further research is needed concerning the value for users of prolonged internships which do not lead to paid employment.