Institut national d'assurance maladie-invalidité (INAMI), IPS pilot project

Belgium, Institut national d'assurance maladie-invalidité

Summary
Under the authority of the Belgian Federal Minister of Social Affairs, the INAMI is responsible for administering the country's compulsory national schemes for health insurance and disability benefits and manages a compensation fund for medical accidents. Needs of the target group and the IPS:

  •   Based on a literature review the Individual Placement and Support model (IPS) was identified as a successful methodology abroad. IPS involves intensive, individual support, a rapid job search followed by placement in paid employment, and time-unlimited in-work support for both the employee and the employer.
  •   Mental health disorders represent more than 34% of people in work incapacity in Belgium.
  •   Several tools (e.g. ICF assessment) are used to identify the needs of clients and help determine the procedure that will be followed.
  •   The IPS program uses the “place-then-train” methodology (vs. “train-then-place”)
  •   For the first time, this project is promoted and coordinated by the Belgian government.

8 principles of the IPS model:

  •         Aims to get people into competitive employment
  •         Based on the person's choice
  •         Integrated into the areas of rehabilitation and mental health
  •         Based on the individual's preferences and choices
  •         Quick job searches
  •         Time unlimited individual support
  •         Personalized recommendations
  •         Systematic job development.

Factbox

Mission:To guarantee access to health care for all people covered by the social security system and managing compensation in case of work incapacity (incapacity benefits).

Foundation year: 1964

Legal type: Governmental agency

Principal area of activity:Health care coverage and work incapacity benefits through Social Security

Total number of employees: 1200

Average number of service users in the whole organisation:For health care, all people covered under the social security system (99% of the population in Belgium).

Geographic area of activity of the organization:National level

Target group / service users:  For health care, all people covered under the social security system. For work incapacity benefits, all private sector’s contract employees and self-employed workers.

This study is a pilot project. The design of this research is a Randomised Control Trial (RCT) launched in 2016 and studies 1200 individual reintegration interventions. 600 people are included in IPS methodology (place-then-train) and 600 others follow a usual return to work program (care as usual) (train-then-place, control group). The study is divided in 3 phases: Phase 1. Partner engagement and program construction, in relation to the Belgian context (structurally). Identification of barriers and facilitators. This step was completed in 2017.

Phase 3. Monitoring and evaluation (ongoing).

There are approximately 23 job coaches involved with a maximum of 20 clients per 1 job coach.

With the “care as usual” the medical advisor sends the client to a regional employment service in order to get support. This support is temporary and focuses on the determination of a professional project and the trainings needed. The follow-up is minimal and is time limited.

The IPS methodology is a client-centred approach based on the individual situation of the client. The support is much more intensive and there is no time limit. Job coaches and clients immediately seek competitive employment. Job coaches are proactive in contacting employers and build long-term relationships with them.

This study will help to understand what types of support are most appropriate to help people with mental health problems in finding suitable employment. This will support equal access to employment for all.

Informing /  procedure to become a client

Medical advisors select clients based on inclusion criteria, clients who do not require intensive medical support. To avoid bias, clients cannot choose if they belong to the intervention group or to the group receiving standard care. Medical advisors are not aware if the client will be in the intervention or the control group. Clients cannot apply directly to get this service as now it is a pilot project and therefore not yet implemented.

Service’s start after the disability is acquired

Return to work phase. It can be at any stage of work incapacity. It can be from day 1 but in practice usually these are people that are already a significant period away from the labour market and in need for specialised support. The medical advisor together with the client decide on inclusion (free choice of the client is a basic principle).

Continuity / integration between services

The integration of health and employment services is part of the IPS principles. The articulation and synergy of several actors allow this continuity of services. The NIHDI is responsible for this coordination. Several meetings are organized with the stakeholders (for example regional employment services, medical advisors and job coaches) which allow problem solving, monitoring and coordination. Meetings are organised: - Monthly NIHDI with the supervisors and the job coaches.

- Whenever needed with the supervisors by mail.

Furthermore, fidelity review processes were completed several times to harmonize the process across the country and to check the IPS methodology was effectively and correctly applied.

Staff and Resources

- Steering committee: NIHDI & research team - Research team: Université Libre de Bruxelles - Supervisors: from regional employment services who share guidelines to job coaches

- Resources are adapted based on the project and the needs of clients.

Duration

The duration of support is unlimited, depends on clients’ needs. The research ends in 2022 (duration of 5 years). For follow-up after 2022 discussions will be done in the future.

Budget

State funding. It can only be guaranteed if the study provides conclusive results on whether this pathway helps people with mental health needs. This is one of the merits of the project: accepting that everything isn’t known yet and evaluating whether this type of pathway makes sense in Belgium.

Partners

Partners include, GTB, Article 23, L’équipe, Socrate, regional employment services: VDAB, FOREM, ACTIRIS and the 6 Belgian sickness funds. Employers are not official partners in the project

Other stakeholders

Other partners include medical advisors, general practitioners, vocational practitioners and all other actors involved in the return to work process. Medical advisors are the entry point for the study as they select clients. The job coaches communicate at key moments with the medical advisors to give them feedback. Key moments can be for example when the client starts the project, when the client starts work, the project is on hold due to clinical or social reasons, etc. Contact between job coaches and medical advisors happens at least every 2 months. The doctors such as GP’s and/or psychiatrists can support the client, the job coach and the process. Preferably there is close cooperation between them.

Network

The project allows the employers to learn from the advantages of IPS, which can help a client to obtain and keep a job. The job coaches are searching (pro)actively for employers through formal and informal contacts. The search for interested employers is not only based on specific cases but also more general. The IPS job coaches provide a close follow-up of their clients and support the employers which represents added-values for all.

Repeated service accessibility

The job coach of a client continues his support throughout the return to work for an undetermined period.

Monitoring

Follow-up should normally be of indefinite duration. Currently, the pilot project only exists for 5 years. The IPS methodology could be implemented afterwards.

Direct and wider impact

The first results will be in 2021. The main hypothesis is that the clients with moderate or severe mental health needs having an IPS coaching will have a faster, more sustainable and qualitative return to work. Another hypothesis is that the service user’s quality of life will improve. Macro-economic data will be considered and analysed to understand the impact on the Belgian social security.

Success factors

A sustainable return to work for the client.

Dialogue with policy makers

The steady increase in the number of individuals on sick leave represents an added financial pressure on government and insurers’ expenditures. In a policy-making context, it is therefore important to identify the cohorts more at risk of spending longer periods away from the labour market. Mental health is involved in one third of these cases. That’s why the Belgian government decided in 2016 to take several measures (including research financing) to reverse the trend. Thus, the project is directly linked to the willingness of the public authorities to move forward in this area. Relations also exist with the administrations of other branches of social security.

Adaptation for other countries

Several scientific publications show positive results (cost-effectiveness) in USA, UK, NL, CAN, etc.

Individual Placement and Support (IPS) pilot project

by the Quality & Research Unit (Work Incapacity) of the Disability Benefits department of the NIHDI for people in work incapacity due to mental health disorder (moderate to severe)

Phase 2. Launching. Completed in 2018.

- Monthly NIHDI with the supervisors and if needed the researchers also attend the meeting.

- Job coaches (competences are more important than educational background, therefore several kinds of support are foreseen and coordinated by NIHDI.

Vocational practitioners from the regional employment services can help the job coaches when required to support the need for training and in sharing their employers’ network.

If the results are positive, the aim will be to strengthen this cooperation so that people can be supported throughout their lives, regardless of their social status.
Since the results of the research will be positive, there is a possibility for future developments.