“I've actually surprised myself at what I can do”: Understanding the longer-term experiences of individual placement and support (IPS) embedded within primary healthcare

Persons with persistent and multiple barriers (PPMB), including mental health and substance use (MHSU) and other disabilities, often experience inequitable challenges obtaining and sustaining competitive employment opportunities. Specialized employment services, such as Individual Placement and Support (IPS), embedded within primary healthcare settings is one approach being trialed to address these inequities. Little is known about the medium and longer-term experiences of PPMB enrolled in IPS programs integrated within primary healthcare. We conducted a longitudinal qualitative study using semi-structured interviews with program clients. We analyzed interviews (12- and 24-months) sequentially and collectively using a reflexive thematic approach. We developed, defined, and named themes iteratively, using annotations throughout the process to record personal reflections and assumptions. Thirty-one participants were enrolled in the study, with 31 interviews conducted at 12 months and 20 interviews at 24 months after program enrollment. Four key themes and one subtheme were generated: (1) negative work experiences have lasting and cyclical impacts, (subtheme) positive work experiences help break negative employment cycles, (2) health remains a significant barrier across the employment journey, (3) social connection is a foundation for health and employment, and (4) growth takes time: progress through self-discovery and support. Continuous access to integrated specialized health and employment services are necessary for PPMB to achieve sustainable progress towards health, recovery, and employment. As such, integrated and multi-sector programs need to receive sustained funding and cross-ministerial support to ensure equitable employment opportunities for those with MHSU, PPMB, and other disabilities. • Integrated employment and primary healthcare services support overall well-being. • Service users with complex health and social barriers perceive IPS as impactful. • Previous setbacks and ongoing health challenges continue to impact employment. • Time, social connection, and integrated supports are key factors for progress. • Sustaining progress towards long-term health, recovery, and employment is possible.