Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury

Abstract

Purpose: In a 5-year study, individual placement and support (IPS) significantly increased employment rate of United States Veterans with spinal cord injury (SCI), a historically underemployed population. In a follow-up study, data on barriers and facilitators to IPS implementation were identified.Methods: Over 24 months of implementation, 82 key medical and vocational staff underwent semi-structured interviews (n = 130). Interviews were digitally recorded and qualitatively analyzed (ATLAS.ti v0.7) using a constant comparative method to generate themes.Results: Some barriers to implementation occurred throughout the study, such as Veterans’ lack of motivation and providers’ difficulty integrating vocational and medical rehabilitation. Other barriers emerged at specific stages, for example, early barriers included a large geographic service area and a large patient caseload, and late barriers included need for staff education. Facilitators were mostly constant throughout implementation and included leadership support and successful integration of vocational staff into the medical care team.Conclusions: Implementation strategies need to be adjusted as implementation progresses and matures. The strategies that succeeded in this setting, which were situated in a real-world context of providing IPS as a part of SCI medical care, may inform implementation of IPS for other populations with physical disabilities.Implications for RehabilitationKey facilitators to IPS in SCI implementation are integrating vocational staff with expertise in IPS and SCI on clinical rehabilitation teams and providing leadership support.Ongoing barriers to IPS in SCI include patient specific and program administration factors such as caseload size and staffing patterns.Varying implementation strategies are needed to address barriers as they arise and facilitate successful implementation.