dissemination of ips in italy problems and opportuinities a. fioritti, r. sabatelli, manchisi d.,...
TRANSCRIPT
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 2008
Mental Hs beds 5.191 1.077 0
GHPW beds 103 175 237
Private clin. Beds 438 438 87
Residential short 258 344 802
Residential medium
331 676 340
Supported housing
307 312 1.050
CMHC N. 41 /129 41/136 43/140
MH staff ? 3.036 ?
Day care /PHC 4 46 58
Strategies for employment
Personal initiativeMainstreaming
Responsibilization
Empowerment
Support
Motivation
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
1717152519146
17
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
Per
cen
tag
e
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 1
CESENA Sabatelli 1 1 1 1
RAVENNA Sabatelli 1 1 1 1
BOLOGNA Fioritti 2 2 2 1 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
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!