Dissemination of IPS in Italy
Problems 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
Mental Hs beds
5.191
GHPW beds
103
Private clin. Beds 438
Residential short 258
Residential
331
medium
Supported
307
housing
CMHC N.
41 /129
MH staff
?
Day care /PHC
4
1993
1.077
175
438
344
676
2008
0
237
87
802
340
312
1.050
41/136
3.036
46
43/140
?
58
Strategies for employment
Personal initiative
• Social responsibility
Mainstreaming
Responsibilization
Empowerment
Support
Motivation
– Specialization
– Institutional
– Reservation
– Welfare
– Protection
Place and support
– Train and place
Strategies for employment
Personal initiative
Personal research
Counselling
Transient job
agencies (Adecco)
Supported
Employment
Individual Placement
and Support
Microcredit
Social responsibility
TEG (A, B, C…)
Free attendance,
training contracts
Cooperative B
Simulazione e
creazione d’impresa
Collocamento
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
567
696
749
795
853
901
954
966
986
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
138
117
142
208
228
258
286
314
318
58
70
64
75
74
57
59
50
45
Utenti in carico per
progetti d’inserimento
formativo e lavorativo
ITR Borse lavoro
Inserimenti in Coop.
Soc. B (ITR Borse
Lavoro e Assunzioni)
Assunzioni
Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM
Percorsi d’inserimento formativo - lavorativo
Utenti in carico per progetti
d’inserimento formativo e
lavorativo
1000
900
800
700
600
500
400
300
200
100
0
ITR Borse lavoro
Inserimenti in Formazione
prof.le
Percorsi L.68/99
Inserimenti in Coop.Soc. B
(ITR BL e Assunzioni)
Assunzioni
2002 2003 2004 2005 2006 2007 2008 2009 2010
Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM
Inserimenti lavorativi in Cooperative Sociali di tipo B
ITR Borse Lavoro e Assunzioni
ITR Borse lavoro
in Coop. Soc. B
(ITR BL) di cui
occupazionali a retta
in Coop.Soc. B
Assunzioni
in Coop. Soc. B
2002
2003
2004
2005
2006
2007
2008
2009
2010
121
111
128
189
203
243
269
297
307
-
-
-
93
90
122
101
198
146
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
350
300
243
250
189
200
150
121
111
269
297
307
203
Borse Lavoro in Coop.Soc. B
Assunti in Coop. Soc. B
128
100
50
0
17
6
14
19
25
15
17
17
11
2002 2003 2004 2005 2006 2007 2008 2009 2010
Totale complessivo (6 regioni) = 3.273 persone inserite
Progetto Inserimento Lavorativo
4.294 persone sostenute nei PilDSM
16/40
EQOLISE
• 6 centers:
– Londra (UK)
– Rimini (I)
– Ulm (D)
– Zurich (CH)
– Groeningen (NL)
– Sofia (BUL)
Worked
at
least
for
one
day
Workedfor at least oneday
90
80
70
Percentage
60
50
40
30
20
10
0
London
Ulm
Rimini
Zurich
Groningen
IPS Vocational Service
Sofia
Table 16: Worked in informal labour market n (%) of those who obtained employment
Service
London
n=16
Ulm
n=25
Rimini
n=24
Zurich
n=14
IPS
0
(.0%)
1
(7.1%)
6
(37.5%)
0
(.0%)
Vocational
0
(.0%)
0
(.0%)
7
(87.5%)
0
(.0%)
Groningen
n=16
Sofia
n=33
Total
n=128
1
(11.1%)
8
(36.4%)
16
(18.8%)
3
(42.9%)
5
(45.5%)
15
(34.9%)
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
SEDI
FORMATO
RI
OPERATO
RI
OPER AUSL
OPER AUSL
IPS
ENAIP
obbligatorio
facoltativo
REF.AUSL
REF.ENAIP
1
FORLI
Sabatelli
1
1
1
1
CESENA
Sabatelli
1
1
1
1
RAVENNA
Sabatelli
1
1
1
1
BOLOGNA
Fioritti
2
2
2
1
IMOLA
Fioritti
1
1
1
1
FERRARA
Fioritti
\
\
2
1
MODENA
Piegari
1
1
1
1
REGGIO
Piegari
1
1
1
1
1
PARMA
Manchisi
1
1
1
1
1
PIACENZA
Manchisi
1
1
1
1
1
10
10
12
10
5
tot
1
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
Piacenza 16
Parma
14
Reggio E. 12
Modena
14
BO SG
12
BO
10
Zanolini
Imola
10
Ravenna 10
Forlì
19
Cesena
15
BO Casa 8
Job interviews Clients
employed
12
5
12
3+2
12
6
4+3
8
3
10
5
8
7
10
10
4
4+2
1+1
4+2
1
1 +1
3
1
3
BO Nani 13
Ferrara
8
Portomagg 4
TOTAL
165
8
5
4
2
3
2
2
2
2
110
(66.7%)
Informal
employm.
5
3
Interruptions
2
1
1
2
1
3
2
6
4
1
2
2
44 +11 22
26
(33.3%) (13.9%) (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!