Dissemination of IPS in ItalyProblems and opportuinities

A. Fioritti, R. Sabatelli, Manchisi D., Piegari D., Dell’Alba N., Trono V.

WPA Congress, Buenos Aires, 21.9.2011

Content• Background

– Italy and work– Italian community psychiatries and work

• Strategies and policies for employment by MI– Current approaches and outcomes– Innovative approaches and IPS

• Experiences of IPS in Italy– EQOLISE in Rimini and after– TIPS in Bologna and Emilia-Romagna

• Future developments

Italy and work

• “L’Italia è una repubblica democratica fondata sul lavoro”, Costituzione della Repubblica, art. 1.

• Work as a citizens’ right (and “due”)• Social responsibility in ensuring work to

individuals• High level of protection for workers• How long will it last?

Italian Community Psychiatries

• 1904: law on mental hospitals• 1965: pilot CMHC (secteurs)• 1968: pilot experiences (Gorizia, Trieste,

Reggio)• 1978: National Health System – Psychiatric

Reform Law n.180• 1995: MH plan, standards for CMHTeams• 1999: Devolution• 2009: Regional MH Plan (DGR 313/09)

1978 1993 2008Mental Hs beds 5.191 1.077 0GHPW beds 103 175 237Private clin. Beds 438 438 87Residential short 258 344 802Residential medium

331 676 340

Supported housing

307 312 1.050

CMHC N. 41 /129 41/136 43/140MH staff ? 3.036 ?Day care /PHC 4 46 58

Strategies for employment

Personal initiativeMainstreamingResponsibilizationEmpowermentSupportMotivation

Place and support

• Social responsibility– Specialization– Institutional– Reservation– Welfare– Protection

– Train and place

Strategies for employment

Personal initiativePersonal researchCounsellingTransient job

agencies (Adecco) Supported

EmploymentIndividual Placement

and SupportMicrocredit

Social responsibilityTEG (A, B, C…)Free attendance,

training contractsCooperative BSimulazione e

creazione d’impresaCollocamento

obbligatorio (l. 68)

Currently• Most resources dedicated to social

responsibility programs• Prevalence of pre-vocational, vocational

training and cooperatives programs• Increase in less disabled population with higher

expectations• Trends of:

– Deregulation of labour market– Decommodification of social services

Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM

Percorsi d’inserimento formativo - lavorativo

2002 2003 2004 2005 2006 2007 2008 2009 2010

Utenti in carico per progetti d’inserimento formativo e lavorativo 567 696 749 795 853 901 954 966 986ITR Borse lavoro 433 412 445 541 594 642 703 728 844

Inserimenti in Formazione prof.le 63 78 122 93 107 66 65 46 87

Percorsi L.68/99 28 50 59 72 74 63 73 62 56

Inserimenti in Coop. Soc. B (ITR Borse Lavoro e Assunzioni)

138 117 142 208 228 258 286 314 318

Assunzioni 58 70 64 75 74 57 59 50 45

Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM

Percorsi d’inserimento formativo - lavorativo

0100200300400500600700800900

1000

2002 2003 2004 2005 2006 2007 2008 2009 2010

Utenti in carico per progettid’inserimento formativo elavorativo

ITR Borse lavoro

Inserimenti in Formazioneprof.le

Percorsi L.68/99

Inserimenti in Coop.Soc. B(ITR BL e Assunzioni)

Assunzioni

Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM

Inserimenti lavorativi in Cooperative Sociali di tipo B

ITR Borse Lavoro e Assunzioni

2002 2003 2004 2005 2006 2007 2008 2009 2010

ITR Borse lavoro in Coop. Soc. B

121 111 128 189 203 243 269 297 307

(ITR BL) di cui occupazionali a retta in Coop.Soc. B

- - - 93 90 122 101 198 146

Assunzioni in Coop. Soc. B

17 6 14 19 25 15 17 17 11

Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM

Inserimenti lavorativi in Cooperative Sociali di tipo B

ITR Borse Lavoro e Assunzioni

307

11

297269

243203189

128111121

171715251914617

0

50

100

150

200

250

300

350

2002 2003 2004 2005 2006 2007 2008 2009 2010

Borse Lavoro in Coop.Soc. B Assunti in Coop. Soc. B

Totale complessivo (6 regioni) = 3.273 persone inserite

Progetto Inserimento Lavorativo 16/40

4.294 persone sostenute nei PilDSM

EQOLISE• 6 centers:

– Londra (UK)– Rimini (I)– Ulm (D)– Zurich (CH)– Groeningen (NL)– Sofia (BUL)

Worked at least for one dayWorked for at least one day

0

10

20

30

40

50

60

70

80

90

London Ulm Rimini Zurich Groningen Sofia

Perc

enta

ge

IPS Vocational Service

15(34.9%)

5(45.5%)

3(42.9%)

0(.0%)

7(87.5%)

0(.0%)

0(.0%)

Vocational

16(18.8%)

8(36.4%)

1(11.1%)

0(.0%)

6(37.5%)

1(7.1%)

0(.0%)

IPS

Totaln=128

Sofian=33

Groningenn=16

Zurichn=14

Riminin=24

Ulm n=25

Londonn=16

Service

Table 16: Worked in informal labour market n (%) of those who obtained employment

EQOLISE in Rimini

• Continuously effected by three IPS specialists since 2003

• More than 180 clients treated• Replication of standard outcomes (>40%

of clients in treatment work)• Seminars across Italy• Preparing TIPS project

PROGETTO TIPS

TRAINING ON INDIVIDUAL PLACEMENT SUPPORT

IPS Training

SEDIFORMATO

RIOPERATO

RI OPER AUSL OPER AUSL REF.AUSL REF.ENAIP

  IPS ENAIP obbligatorio facoltativo    

FORLI Sabatelli 1 1 1 1 1CESENA Sabatelli 1 1 1 1  RAVENNA Sabatelli 1 1 1 1  BOLOGNA Fioritti 2 2 2 1 1IMOLA Fioritti 1 1 1 1  FERRARA Fioritti \ \ 2 1  MODENA Piegari 1 1 1 1  REGGIO Piegari 1 1 1 1 1PARMA Manchisi 1 1 1 1 1PIACENZA Manchisi 1 1 1 1 1

tot   10 10 12 10 5

Time schedule

• 9/6/2010 – Start-up meeting• 16-18/9/2010 – Full immersion residential

training in Rimini• 1/10/2010 – Starting recruitment. Monthly

meetings of supervision and sharing of experiences.

• 31/12/2010 – End of recruitment• 30/6/2011 – Midterm evaluation• 1/12/2011 – Final evaluation workshop

SITES 

Clients enrolled

Job interviews Clients employed

Informal employm.

Interruptions

Piacenza 16 12 5 5 2Parma 14 12 3 + 2 3 1Reggio E. 12 12 6  Modena 14   4 + 3   1BO SG 12 8 3   2BO Zanolini

10 10 5 1  

Imola 10 8 4 + 2   3Ravenna 10 7 1+1 3 2Forlì 19 10 4+2 1 6Cesena 15 10 1 3 4BO Casa 8 4 1 +1   1

BO Nani 13 8 2 2 2Ferrara 8 5 3 2 2Portomagg 4 4 2 2  TOTAL 165  110

(66.7%) 44 +11(33.3%)

22(13.9%)

26(15.7%)

Regional Policies

Regional Policies and IPS

• Regione Emilia-Romagna (DGR 313/09)• Sicily Region (2011)• Rome Province• Some Veneto Departements

IPS in Italy - Opportunities

• Users’ dissatisfaction with traditional vocational rehabilitation

• Awareness among professionals of more empowering opportunities (self help, supported accomodation, IPS…)

• Social welfare cuts, labour market «deregulation»

• Interest in evidence based practices (FEP, ACT, Psychoeducation…)

IPS in Italy - Problems• IPS specialist: project vs. program.

– What is «team approach»? – Are we bound to instability?

• IPS and informal work. – Are we supporting workers exploitation by

blackmarket employers?• PseudoIPS: the «we are already doing this»

issue. – Ensuring fidelity and reasonable adaptation

Dartmouth-J&J Int’l learning coll.

• Good opportunity for:– Linking with international network of

experiences– Access to training and research material– Improving training and fidelity locally– Better coordination of local practice– Provide training to other centers/regions– Participating in international research and

training activities

Thank You!