A multisite study of implementing supported employment in the Netherlands.

Authors: Varekamp, I., Verbeek, J. H., de Boer, A., & van Dijk, F. J. H.
Year Published 2007
Publication Psychiatric Services
Volume 58
Number 11
Pages 1421-1426
Publisher American Psychiatric Association

In the Netherlands, a small western European country with 16 million inhabitants,persons with severe mental illnesses consistently have the worst employment outcomes of all disability groups; only 12% are enrolled in competitive jobs. The Dutch approach to vocational rehabilitation for this group has been a cautious one, mainly encompassing prevocational training,sheltered employment, volunteer work, or trainee placements in regular businesses (8). Many clinicians in the Netherlands believe that competitive employment is too ambitious or too stressful for clients with severe mental illnesses. Clients are offered work tasks in segregated settings to prepare them for competitive employment,but the progression from sheltered to competitive jobs is not substantial (9).Another feature of Dutch practice is the parallel organization of mental health services and vocational services,based on the belief that this segregation enables employment specialists to focus solely on vocational issues without causing any stigma.


This article reports on the implementation of the individual placement and support model of supported employment in four Dutch regions.The main objective of the Dutch Study was to determine whether the individual placement and support model of supported employment could be implemented in the Netherlands.Study sought to answer the following questions: what is the level of fidelity of the implementation, what are the employment outcomes in the four sites (client outcomes and job characteristics), what are the barriers to implementation, and what strategies to overcome these barriers are successful.


In 2003 four Dutch mental health agencies began to implement individual placement and support programs of supported employment. Employment Specialists from vocational services(such as generic vocational agencies, sheltered workshops, and rehabilitation centers) were assigned to mental health teams delivering comprehensive treatment and care for persons with severe mental illnesses. Sites were selected on criteria including a case manager client ratio of at most 1:30, a client population of at least 240, regular contacts with vocational services, and willingness to provide funding.


The study group was predominantly male, the mean age was 35±10, and most clients were living independently. At intake 107 participants (46%) did not perform any vocational activities. The most common diagnoses were schizophrenia and related psychotic disorders. On average, participants had received 8±7 years of mental health services.

Data Collection

The authors used structured site visits, employment data, and semi-structured interviews to assess fidelity, employment outcomes, and facilitators of and barriers to successful implementation.


There was no control or comparison condition.


At 24 months, the four sites reached a mean±SD fidelity score of 4.1±.3 (possible scores range from 1 to 5, with higher scores indicating closer adherence to the model). Of the 316 persons with mental illnesses, 57 (18%) obtained competitive jobs. Barriers to implementation included lack of organizational standards, loss of vocational staff, funding problems, insufficient time for program leaders, and inadequate cooperation between the involved organizations. Important facilitators were the skills and commitment of the vocational team members and the integration of vocational and mental health staff.


To implement evidence-based supported employment in the Netherlands will require changes in financing, organizational structures, attitudes, cultural beliefs, and labor and disability regulations.

URL http://ps.psychiatryonline.org/doi/abs/10.1176/ps.2007.58.11.1421
Disabilities Emotional disturbance
Populations Male & Female
Outcomes Employment acquisition
Research Design Mixed methods
Peer Reviewed Yes