Dissemination of IPS in Italy Problems and opportuinities A. Fioritti, R. Sabatelli, Manchisi D., Piegari D., DellAlba N., Trono V. WPA Congress, Buenos.

Presentazione sul tema: "Dissemination of IPS in Italy Problems and opportuinities A. Fioritti, R. Sabatelli, Manchisi D., Piegari D., DellAlba N., Trono V. WPA Congress, Buenos."— Transcript della presentazione:

1 Dissemination of IPS in Italy Problems and opportuinities A. Fioritti, R. Sabatelli, Manchisi D., Piegari D., DellAlba N., Trono V. WPA Congress, Buenos Aires, 21.9.2011

2 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

3 Italy and work LItalia 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?

4 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)

5 Italian Community Psychiatries National Health System Universal -Tax funded Regional Government Public Health Approach – geographical responsibility, Unità Sanitaria Locale, all community and hospital facilities Psychiatry within NHS –All goods and staff from previous administrations –New mission included

6 197819932008 Mental Hs beds5.1911.0770 GHPW beds103175237 Private clin. Beds438 87 Residential short258344802 Residential medium 331676340 Supported housing 3073121.050 CMHC N.41 /12941/13643/140 MH staff?3.036? Day care /PHC44658

7 Strategies for employment Personal initiative Mainstreaming Responsibilization Empowerment Support Motivation Place and support Social responsibility –Specialization –Institutional –Reservation –Welfare –Protection –Train and place

8 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 dimpresa Collocamento obbligatorio (l. 68)

9 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

10 Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM Percorsi dinserimento formativo - lavorativo 200220032004200520062007200820092010 Utenti in carico per progetti dinserimento formativo e lavorativo 567696749795853901954966986 ITR Borse lavoro 433412445541594642703728844 Inserimenti in Formazione prof.le 63781229310766654687 Percorsi L.68/99 285059727463736256 Inserimenti in Coop. Soc. B (ITR Borse Lavoro e Assunzioni) 138117142208228258286314318 Assunzioni 587064757457595045

11 Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM Percorsi dinserimento formativo - lavorativo

12 Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM Inserimenti lavorativi in Cooperative Sociali di tipo B ITR Borse Lavoro e Assunzioni 200220032004200520062007200820092010 ITR Borse lavoro in Coop. Soc. B 121111128189203243269297307 (ITR BL) di cui occupazionali a retta in Coop.Soc. B ---9390122101198146 Assunzioni in Coop. Soc. B 1761419251517 11

13 Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM Inserimenti lavorativi in Cooperative Sociali di tipo B ITR Borse Lavoro e Assunzioni

14 Totale complessivo (6 regioni) = 3.273 persone inserite

15

16 Progetto Inserimento Lavorativo 16/40 4.294 persone sostenute nei PilDSM

17 EQOLISE 6 centers: –Londra (UK) –Rimini (I) –Ulm (D) –Zurich (CH) –Groeningen (NL) –Sofia (BUL)

18

19 Worked at least for one day

20 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 Total n=128 Sofia n=33 Groningen n=16 Zurich n=14 Rimini n=24 Ulm n=25 London n=16 Service Table 16: Worked in informal labour market n (%) of those who obtained employment

21 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

22 PROGETTO TIPS TRAINING ON INDIVIDUAL PLACEMENT SUPPORT

23 IPS Training SEDI FORMATO RI OPERATO RIOPER AUSL REF.AUSLREF.ENAIP IPSENAIPobbligatoriofacoltativo FORLISabatelli 11111 CESENASabatelli 1111 RAVENNASabatelli 1111 BOLOGNAFioritti 22211 IMOLAFioritti 1111 FERRARAFioritti \\21 MODENAPiegari 1111 REGGIOPiegari 11111 PARMAManchisi 11111 PIACENZAManchisi 11111 tot 10 12105

24 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

25 SITES Clients enrolled Job interviews Clients employed Informal employm. Interruptions Piacenza1612552 Parma14123 + 231 Reggio E.12 6 Modena14 4 + 3 1 BO SG1283 2 BO Zanolini 10 51 Imola1084 + 2 3 Ravenna1071+132 Forlì19104+216 Cesena1510134 BO Casa841 +1 1 BO Nani138222 Ferrara85322 Portomagg4422 TOTAL 165 110 (66.7%) 44 +11 (33.3%) 22 (13.9%) 26 (15.7%)

26 Regional Policies

27 Regional Policies and IPS Regione Emilia-Romagna (DGR 313/09) Sicily Region (2011) Rome Province Some Veneto Departements

28 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…)

29 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

30 Dartmouth-J&J Intl 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

31 Thank You!