Implementation of Supported Employment in the Context of a National Canadian Program: Facilitators, Barriers and Strategies

摘要

Objective: To describe facilitators, barriers, and strategies to implementation of the Canadian national At Work/Au travail program. This program funded supported employment services, following some of the principles of the Individual Placement and Support (IPS) model, in 12 sites across Canada. Method: We conducted on-site individual interviews (12) and focus groups (15) with 35 employment support workers, 12 team supervisors or managers. and 10 directors or CEOs. Interview summaries were created and coded using thematic analysis techniques. Codes were then distilled into themes grouping prominent barriers and facilitators to implementation. Results: Four themes emerged: (i) national program structure: Flexible eligibility criteria and flexibility in use of subsidy funds were perceived as generally helpful, although there were difficulties associated with communication around noneligibility decisions and outcome targets; (ii) training and reinforcement: The support provided to sites was generally thought to be an important facilitator, especially when more intensive. Several participants viewed the online IPS training as a facilitator; (iii) external factors: Rules concerning impacts of employment earnings on benefits could be viewed as a barrier; and (iv) internal factors: Facilitators included strong leadership, positive staff attitudes, and larger program size. Several participants reported staff resistance as a barrier. Conclusions and Implications for Practice: Several features of the national program structure and leadership emerged that could be maintained if the program were extended elsewhere. The flexibility allowed for spending of wage subsidy funds, as well as the provision of more intensive training, were both perceived as potential enhancements to an eventual expansion of the program.