The aim of the multidisciplinary work ability and employment support services for people of working age is to support their ability to continue working, rehabilitation, education and employment. The interventions formed as a result of various components working together, for example, experiments that combine health care, social welfare and employment and economy services, are called complex interventions.
In the assessment of complex interventions, it must be noted that they are implemented in local operating environments and in interaction between different authorities, professionals, service providers, workplaces and individuals. In practice, identifying and analysing the mechanisms of action requires a parallel multi-methodological study of the implementation of activities and their effects from multiple perspectives, for which the following process assessment model (Image 1) is appropriate.
The impact and effectiveness assessment of multidisciplinary services carried out in our study project regarding the co-ordination of the multidisciplinary services for people of working age and their impact assessment (WorkingMIX) is studied with the complex process assessment model. The results of the operating environment, implementation and mechanisms of action presented may have an effect on how the target set for multidisciplinary services is met, i.e. their impact.
Our goal is to introduce the complex intervention assessment framework as a tool for practical actors and researchers for the purpose of assessing and developing the impact of multidisciplinary services.
Multidisciplinary work ability and employment support services – an example of complex intervention
There is a wide variety of presumed cause-and-effect relationships of the effects of multidisciplinary services based on practical experience of different actors in different scientific fields. In addition to presumed cause-and-effect relationships, it is important to note how the operating environment, mechanisms of action and implementation determine the impact: what are the mechanisms of action associated with the operating environment that create results or fail to create results.
Multidisciplinary services are provided on the basis of practical guidelines and local and regional practices. Implementation includes what is done and how it is done. In Finland, there are various city-specific or regional ways of arranging the services, where operations are arranged to fit the client’s current needs and goals. The most important aspects of the assessment of implementation are how and to what extent the services are arranged in comparison with the content plan or what was intended, whether the target group of the operations was reached or not and what factors in the operating environment, for example, the fluidity of co-operation, affected the quality of service.
The mechanisms of action that affect the result of the interventions related to the operating environment are about how the multidisciplinary services produce effects, how the effects were generated and whether the mechanisms that produce effects can be reproduced elsewhere. Is the effect on the target client group of the actions expected or unexpected? Do the operations produce effects on other groups than the clients of the operations? What are the factors and mechanisms that produce the effects? Was the effect produced by the client’s involvement in the multidisciplinary services or was there no effect because there was no co-operation that supported the client’s involvement? Are there any factors that support or inhibit the change between the multidisciplinary services and the client’s change process?
The effects of multidisciplinary services can be roughly assessed at the level of the entire population by using employment register data, for example. The sensitivity of measuring changes and effects can be improved by using more accurate indicators that are suitable for the service provided. In our project, for example, the features of the Abilitator that support generating data related to the impact assessment of services were highlighted.
A functioning combination – multidisciplinary work ability and employment support services as an example
The results of the WorkingMIX study project are applied in the process assessment framework below. The diverse, multi-methodological study project based on an extensive range of materials yielded additional information about multidisciplinary services, their effects and the underlying factors of the effects. The results are divided into different categories depending on whether they are primarily about the national service system, co-operation between local actors or practical work with clients.
|RESULTS (service system)|