Perspectives on implementing Individual Placement and Support (IPS) within primary health care settings for adults living in British Columbia, Canada.

BACKGROUND: Individual placement and support (IPS) is an evidence-based practice (EBP) designed to help people with severe mental illness re-enter the labour market. Implementing an IPS program within a new context (e.g., primary health care setting) to support populations that are complex and multi-barriered presents a set of unique challenges and considerations. This paper provides community-based perspectives that identify implementation strengths and challenges and highlights potential strategies aimed at addressing emergent barriers. METHODS: A case study was conducted across three community health centres in British Columbia (BC), Canada, where a novel IPS program was embedded within primary care services. Data collection consisted of open-ended surveys and focus groups with service providers directly involved in program implementation and their associated clinical and managerial support teams (n = 15). Using the updated Consolidated Framework for Implementation Research (CFIR) as a guide, we performed deductive thematic analysis to identify key areas impacting IPS implementation. RESULTS: Integration with existing health care systems and primary health care teams and support from leadership across all levels were identified as both key facilitators and barriers to implementation. Facilitators and barriers were identified across all domains, with those within innovation and process most easily addressed. Four cross-cutting themes emerged for promoting more integrated and sustainable program implementation: investing in pre-implementation activities, supporting a dynamic and flexible program, building from community experiences, and developing a system for shared knowledge. CONCLUSIONS: Implementing an IPS program embedded within primary health care settings is complex and requires extensive planning and consultation with community-based service providers and decision-makers to achieve full integration. Future practice and policy decisions aimed at supporting employment and well-being should be made in collaboration with communities.

Navigating Supported Employment and Education Services for Youths During COVID-19 and Severe Weather Events.

In 2021, the British Columbia (BC) Interior experienced a series of unprecedented disasters, ranging from extreme heat and wildfires to catastrophic flooding and evacuations. Along with these severe weather events, BC was affected by COVID-19 outbreaks and public health restrictions. Despite these challenges, communities worked to ensure that youths who are at risk for increased mental health challenges continued to have access to services that promote well-being, such as individual placement and support programs for supported employment and education. This Open Forum presents program considerations and adaptations in Foundry Penticton, one of 12 province-wide integrated youth hubs, to ensure service delivery during acute and chronic disasters.

A Plausible Mechanism for the Iridium-Catalyzed Hydrogenation of a Bulky N-Aryl Imine in the (S)-Metolachlor Process.

The hydrogenation of N-(2-ethyl-6-methylphenyl)-1-methoxypropan-2-imine is the largest-scale asymmetric catalytic process for the industrial production of agrochemical (S)-metolachlor. The challenging hydrogenation across the sterically crowded carbon-nitrogen double bond was achieved using a mixture of [IrCl(COD)]2, (R,SFc)-Xyliphos, NBu4I and acetic acid. Acetic acid was critical in achieving excellent productivity and activity. Despite its industrial significance, a mechanism that explains how the sterically hindered bond in the imine is reduced has yet to be proposed. We propose a plausible proton-first, outer-sphere mechanism based on density functional theory calculations that is consistent with the experimentally observed activity and the enantioselectivity of the industrial process. Key findings include transition states involving acetate-assisted dihydrogen splitting, and a hydride transfer from a five-coordinate iridium trihydride directed by a C-H∙∙∙Ir interaction. This article was submitted to a Special Issue in honor of Professor Henri Kagan.

Understanding the Influence of Community-Level Determinants on Children's Social and Emotional Well-Being: A Systems Science and Participatory Approach.

Healthy social and emotional development and longer-term outcomes for children are shaped by factors across the multiple levels (micro, meso, exo, macro) of a child's environment. By employing a novel systems science and participatory approach, we were able to co-produce a series of causal loop diagrams that detail the complex relationships between variables operating at the community or neighborhood environment level (e.g., features of the built environment such as: housing type, access, availability, and location; parks and greenspace, facilities such as community services, and other service infrastructure such as transit), and highlight the individual and collective impacts these relationships can have on the subsystem surrounding a child's social and emotional well-being. Our approach provides a unique lens of knowledge through which communities can identify key leverage points for action and (re)design of community spaces, practices, and policy.

A community-based systems dynamics approach for understanding determinants of children's social and emotional well-being.

We report on our application of a community-based systems dynamics modelling approach to identify key factors affecting children's social and emotional well-being (SEW). Using a group model building process with 31 stakeholders in 2 communities in British Columbia, Canada, we constructed two causal loop diagrams composed of 250 variables, 534 connections and 63 feedback loops. Feedback loops, systems complexity, and prominent systems level variables illustrate the interconnectedness of multilevel determinants influencing children's SEW. The community-based models highlighted areas for place-based intervention planning that require collective community action and intersectoral commitment toward common objectives for practice and policy on SEW.

Protocol: A mixed methods evaluation of an IPS program to increase employment and well-being for people with long-term experience of complex barriers in Vancouver's downtown and DTES.

BACKGROUND: Employment improves mental health and well-being by providing financial security, daily structure, a sense of identity and purpose, and social engagement. However, securing and sustaining employment is exceptionally challenging for vulnerable populations who experience persistent and multiple barriers, such as mental illness, homelessness, food and housing insecurity, and marginalization. Evidence-based supported employment programs, most notably individual placement and support (IPS) are becoming a more common approach for addressing the needs of these high-risk individuals. The aim of this paper is to outline the protocol for evaluating an IPS program in Vancouver's downtown and Downtown Eastside (DTES). METHODS AND DESIGN: This prospective quasi-experimental study of persons with persistent and multiple barriers to employment will use a mixed-methods approach for evaluating a novel IPS program. The evaluation will consist of survey packages and interviews that will capture outcomes related to employment and well-being, as well as the experiential process of receiving individualized and integrated supports through the IPS program. A mixed-methods approach is appropriate for this study as quantitative data will provide an objective assessment of program impacts on employment and well-being outcomes over time, while qualitative data will provide an in-depth understanding of continued barriers and experiences. DISCUSSION: The results from this evaluation will contribute evidence within a local British Columbian (BC) context that may increase access to meaningful employment for those with long-term experience of complex barriers to employment. Further, the findings will support continued improvements, and guide decision-making around practices and policy for future implementation of IPS and employment supports across BC.