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

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. In 2016 INAMI launched a 5-year pilot project on the effectiveness of IPS in supporting people with mental health issues to find a job. Mental health disorders represent more than 34% of people in work incapacity in Belgium. The project is based on a randomised control trial of 1200 reintegration interventions, 600 through IPS and 600 through traditional return-to-work methodology. There are 3 phases: 

1) stakeholders identification; 

2) 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.

3) monitoring and evaluation. 

Medical advisors select clients based on inclusion criteria and are not aware of which group they will be part of. A key role is played by job coaches who search proactively for employers and communicate with medical advisors to give feedback, while providing support to the client for an undetermined period. 23 job coaches are involved, each one of them following a maximum of 20 clients.

The project ends in 2022, but preliminary results show an employment rate of 39%, with a higher probability to work part-time and higher earnings compared to the control group using traditional vocational rehabilitation, as well as a 6,5% decrease in monthly disability benefits. The part-time jobs haven’t much affected beneficiaries of a disability allowance, since it is combined with income. Moreover, IPS didn’t affect the health and well-being of workers with mental health issues, who have proven able to work. This aspect can help combating stereotypes among employers. In 2021 another study group called IPS 2.0 was added, which so far has led to 35% employment rate for participants. 
EPR member GTB is a partner of the project and applies the IPS methodology to its services in Flanders. GTB implements the zero-exclusion principle, with any jobseeker with mental health issues having the possibility to get support, regardless of the diagnosis and severity. The job search is rapid, with the first meeting with employer within 30 days, and based on a place-then-train approach. The job coaches are trained within GTB and establish networks in the region and have 8 weekly meetings with employers to ask them about their current situations and challenges and find a solution to their problems. For the first time, this project is promoted and coordinated by the Belgian government.
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. 
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

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. 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.

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 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.