Centre for Mental Health

Fidelity to the IPS approach

IPS has been shown to be more effective the more closely it follows the eight principles:

1. It aims to get people into competitive employment
2. It is open to all those who want to work
3. It tries to find jobs consistent with people's preferences
4. It works quickly
5. It brings employment specialists into clinical teams
6. Employment specialists develop relationships with employers based upon a person's work preferences
7. It provides time unlimited, individualised support for the person and their employer
8. Benefits counselling is included.

The source of these principles is the Dartmouth IPS Supported Employment Center website.

A fidelity review is a way of checking the extent to which a service is faithful to the Individual Placement and Support (IPS) approach to supported employment. They are designed to support the continuous improvement and development of services.

How is fidelity measured?

A fidelity review uses the Supported Employment Fidelity Scale of 25 items against which services are 'scored' - the higher the score, the higher the fidelity. The Scale was developed over a number of years with Dartmouth Medical School in the United States. Although not yet 'anglicised' and, despite some need for contextualisation, it is proving to be a robust tool that translates across countries.

What happens during a fidelity review?

A fidelity reviewer, often two, visits a service over the course of one or two days and talks to staff and clients of the service. The reviewer will be trying to capture a snapshot of the current practices and they will be taking into account only what they observe and what they see evidence of, as opposed to what is intended or planned for the future. The reviewer will talk to everyone involved in the service, such as:

• the clients (and families if appropriate)
• the clinicians in the clinical team
• the employment specialist who works with that team

What happens next?

The reviewer will pull together their findings into a report, with comments from the service, and decide a fidelity score. They will give detailed feedback to the service.

The fidelity scale, as a tool for development, can and should be incorporated into a service's regular processes of internal review including supervision of employment specialists. A service actively using the fidelity scale on a regular basis is likely to score more highly in a fidelity review.