"A welfare recipient may be drinking, but as long as he does as told--he may drink himself to death": a qualitative analysis of project implementation barriers among Danish job consultants

Maja Bæksgaard Hansen, Stine Kloster, Ida Høgstedt Danquah, Anette Søgaard Nielsen, Ulrik Becker, Tine Tjørnhøj-Thomsen, Janne Schurmann Tolstrup, Maja Bæksgaard Hansen, Stine Kloster, Ida Høgstedt Danquah, Anette Søgaard Nielsen, Ulrik Becker, Tine Tjørnhøj-Thomsen, Janne Schurmann Tolstrup

Abstract

Background: This paper is embedded in a randomised controlled trial (Alcohol and Employment) that investigated whether welfare-to-work schemes combined with alcohol treatment were more effective than welfare-to-work schemes alone for helping unemployed welfare recipients with alcohol problems get back to employment and reduce their alcohol problems. The implementation of Alcohol and Employment turned out to be challenging, and fewer welfare recipients than expected were enrolled. The aim of this paper was to identify and investigate obstacles to the implementation of Alcohol and Employment. Our main objective was to study the job consultants' role in the implementation process as they were key personnel in conducting the trial.

Methods: The process evaluation was conducted in four Danish municipalities in 2011-2012. Data for identifying factors important for the implementation were collected through observations and focus group interviews with job consultants. Data were analysed thematically and thoroughly discussed among members of the project team; emerging themes were then grouped and read again repeatedly until the themes were consistent.

Results: Three themes emerged as the main factors influencing the degree of implementation of Alcohol and Employment: (1) The job consultants' personal attitudes toward alcohol were an important factor. The job consultants generally did not consider a high alcohol intake to be an impediment to employment, or they thought that alcohol problems were only symptoms of more profound problems. (2) The job consultants' perception of their own roles and responsibilities in relation to the welfare recipients was a barrier: they felt that addressing alcohol problems and at the same time sustaining trust with the welfare recipient was difficult. Also, they did not consider alcohol problems to be their responsibility. (3) Shortage of time and resources among the job consultants was determined to be an influential factor.

Conclusions: We identified important factors at the individual level among the job consultants who threatened the implementation of Alcohol and Employment. Future studies in similar settings can take advantage of these findings when preparing interventions that are implemented by job consultants or similar professionals.

Trial registration: ClinicalTrials.gov ID: NCT01416103.

References

    1. Mortensen EV. Kommunalreform 2007 - Sundhed. 1. Copenhagen: Forlag Jura og Information; 2007.
    1. Mølgård S, Tolstrup JS, Mortensen NP, Becker U, Nielsen AS. Jobcentres praksis omkring ledige borgere med alkoholproblemer i matchgruppe 4 og 5 - en undersøgelse blandt landets jobcentre. Centre for Intervention and National Institute of Public Health. 2010. . Accessed 30 Jan 2015.
    1. Bach HB, Boll J. De svageste kontanthjælpsmodtagere - barriere for beskæftigelse. The Danish National Centre for Social Research. 2003. . Accessed 30 Jan 2015.
    1. Winding K. Alkoholbehandling i danmark - efter strukturreformen. Dan Med J. 2007;169(14):1329.
    1. O’Donnell A, Anderson P, Newbury-Birch D, Schulte B, Schmidt C, Reimer J, et al. The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews. Alcohol Alcohol. 2013;0(0):1–13.
    1. Kristenson H, Ohlin H, Hulten-Nosslin MB, Trell E, Hood B. Identification and intervention of heavy drinking in middle-aged men: results and follow-up of 24–60 months of long-term study with randomized controls. Alcohol Clin Exp Res. 1983;7(2):203–9. doi: 10.1111/j.1530-0277.1983.tb05441.x.
    1. Nilssen O. The tromso study: identification of and a controlled intervention on a population of early-stage risk drinkers. Prev Med. 1991;20(4):518–28. doi: 10.1016/0091-7435(91)90049-A.
    1. Nilssen O. Long-term effect of brief intervention in at-risk alcohol drinkers: a 9-year follow-up study. Alcohol Alcohol. 2004;39(6):548–51. doi: 10.1093/alcalc/agh095.
    1. Carey KB, Scott-Sheldon LA, Carey MP, DeMartini KS. Individual-level interventions to reduce college student drinking: a meta-analytic review. Addict Behav. 2007;32(11):2469–94. doi: 10.1016/j.addbeh.2007.05.004.
    1. Field CA, Baird J, Saitz R, Caetano R, Monti PM. The mixed evidence for brief intervention in emergency departments, trauma care centers, and inpatient hospital settings: what should we do? Alcohol Clin Exp Res. 2010;34(12):2004–10. doi: 10.1111/j.1530-0277.2010.01297.x.
    1. McQueen J, Howe TE, Allan L, Mains D. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev. 2009;3:CD005191.
    1. Winter SC. Introduction. In: Peters BG, Pierre J, editors. Handbook of public administration. London: SAGA Publications; 2003. pp. 203–11.
    1. Lipsky M. Street-level bureaucracy: dilemmas of the individual in public services. 1. New York: Russell Sage; 1980.
    1. May PJ. Policy design and implementation. In: Peters BG, Pierre J, editors. Handbook of public administration. London: SAGA Publications; 2003. pp. 223–33.
    1. Sundhedsloven - Lov nr. 546 af 24 juni 2005 (§18, §19). Indenrigs- og sundhedsministeriet. 2005. . Accessed 30 Jan 2015.
    1. Durlak A, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41:327–50. doi: 10.1007/s10464-008-9165-0.
    1. Laurence J, O’Toole JR. Interorganizational relations in implemtation. In: Peters BG, Pierre J, editors. Handbook of public administration. London: SAGA Publications; 2003. pp. 234–44.
    1. Meier KJ, Laurence J, O’Toole JR. Public management and performance: the impact of managerial quality. J Policy Anal Manage. 2002;21(4):629–43. doi: 10.1002/pam.10078.
    1. O’Toole JR, Laurence J, Meier KJ. Modeling impact of public management: Implications of structural context. J Public Adm Res Theory. 1999;9(4):505–26. doi: 10.1093/oxfordjournals.jpart.a024421.
    1. Hill CJ. Casework job design and client outcomes in welfare-to-work offices. J Public Adm Res Theory. 2006;16(2):263–88. doi: 10.1093/jopart/mui043.
    1. Nielsen K. Opening the black box: a framework for evaluating organizational-level occupational health interventions. Eur J Work Organ Psychol. 2013;22:601–17. doi: 10.1080/1359432X.2012.690556.
    1. Damschroder LJ, Aron AC, Keith RE, Kirsh SR, Alexander JA, Lowery J. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. 2009;4(50).
    1. Meyers MK, Vorsanger S. Street-level bureaucrats and the implementation of public policy. In: Peters BG, Pierre J, editors. Handbook of Public Administration. London: SAGA Publications; 2003. pp. 245–55.
    1. Finansministeriet, Økonomi -og Indenrigsministeriet, Kommunernes Landsforening. God økonomistyring i kommunerne – sammenfatning. 2013; 1-16. . Accessed 13 mar 2015.
    1. Brunsson N, Jacobsson B. A World of Standards. 1st ed. Oxford: University Press; 2000.
    1. Dahl PS, Hansen KM. Diffusion of standards: the importance of size, region and external pressures in diffusion processes. Oxford: Public Administration. 2006;84(2):441–59.
    1. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82:581–629. doi: 10.1111/j.0887-378X.2004.00325.x.
    1. Arbejdsmarkedsstyrelsen. Ny Matchmodel - Sådan og derfor? 2009. . Accessed 30 Jan 2015.
    1. May PJ, Winter SC. Politicians, managers, and street-level bureaucrats: influences on policy implementation. Oxford University Press. 2007;19(3):453–76.
    1. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addict. 1993;88(6):791–804. doi: 10.1111/j.1360-0443.1993.tb02093.x.
    1. Babor TF, Higgins-Biddle TC, Saunders J, Monteiro M. AUDIT - The Alcohol Use Disorders Identification Test. World Health Organization. 2001. . Accessed 30 Jan 2015.
    1. Selin KH. Alcohol Use Disorder Identification Test (AUDIT): what does it screen? Performance of the AUDIT against four different criteria in a Swedish population sample. Subst Use Misuse. 2006;41(14):1881–99. doi: 10.1080/10826080601025532.
    1. Conigrave KM, Hall WD, Saunders JB. The AUDIT questionnaire: choosing a cut-off score: alcohol use disorder identification test. Addict. 1995;90(10):1349–56. doi: 10.1111/j.1360-0443.1995.tb03552.x.
    1. Mertan R, Kendall P. The focused interview. Am J Sociol. 1946;51:541–57. doi: 10.1086/219886.
    1. Patton MQ. Qualitative research & evaluation methods. 3. Thousand Oaks California: SAGA Publications; 2002.
    1. Patton MQ. Utilization-focused evaluation. 4. Thousand Oaks California: SAGA Publications; 2008.
    1. Onwuegbuzie AJ, Dickinson WB, Leech NL, Zoran AG. A qualitative framework for collecting and analyzing data in focus group research. Int J Qualitative Methods. 2009;8(3):1–21.
    1. Corbin J, Strauss A. Basics of qualitative research. 3. Thousand Oaks California: SAGA Publications; 2008.
    1. Winter S. Integrating implementation research. In: Palumbo DJ, Calista D, editors. Implementation and the policy process: opening up the black box. New York: Greenwood Press; 1990. pp. 19–38.
    1. Winter S. Explaining Street-Level Bureaucratic Behaviour in Social and Regulatory Policies. Paper presented at the annual meeting of the American Political Science Association. Boston: The Danish National Centre for Social Research; 2002.
    1. Winter S. Bestemmes kommunernes indsats over for borgerne af politikerne eller sagsbehandlerne? In: Social Forsknings Instituttet, editors, editor. Det kommunale råderum, kvalitet, effektivitet og forskellighed i velfærdsydelserne. Copenhagen: Social Forsknings Instituttet; 2004. pp. 73–9.
    1. Aust B, Rugulies R, Finken A, Jensen C. When workplace interventions lead to negative effects: learning from failures. Scand J Public Health. 2010;38:106–19. doi: 10.1177/1403494809354362.
    1. Schuckit MA. Alcohol-use disorders. Lancet. 2009;373(9662):492–501. doi: 10.1016/S0140-6736(09)60009-X.
    1. Rehm J, Baliunas D, Borges GL, Graham K, Irving H, Kehoe T, et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addict. 2010;105(5):817–43. doi: 10.1111/j.1360-0443.2010.02899.x.
    1. World Health Organization. Alcohol in the European union - consumption, harm and policy approaches. 2012. . Accessed 30 Jan 2015.
    1. Anderson P, Baumberg B. Alcohol in Europe: a public health perspective. Institute of alcohol studies for the European commission. 2006.. Accessed 30 Jan 2015.
    1. Shaw S, Cartwright A, Spratley T. Responding to drinking problems. 1. Baltimore: University Park Press; 1978.
    1. Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health. 2011;33(3):412–21. doi: 10.1093/pubmed/fdq095.
    1. Schulte B, O’Donnell AJ, Kastner S, Schmidt CS, Schafer I, Reimer J. Alcohol screening and brief intervention in workplace settings and social services: a comparison of literature. Front Psychiatry. 2014;5:131. doi: 10.3389/fpsyt.2014.00131.
    1. Taylor C. To follow a rule. In: Taylor C, editor. Philosophical arguments. 1. Cambridge, MA: Harvard University Press; 1995. pp. 165–80.
    1. Pesso T. Lokal welfare offices: managing the intake process. Public Policy. 1978;26(2):305–30.
    1. Brodkin EZ. In the welfare contract: discretion and accountability in state welfare administration. Soc Serv Rev. 1997;71(1):1–33. doi: 10.1086/604228.
    1. Moyer A, Finney JW, Swearingen CE, Vergun P. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addict. 2002;97(3):279–92. doi: 10.1046/j.1360-0443.2002.00018.x.
    1. Babor TF, Grant M. Project on identification and management of alcohol related problems report on phase ii: a randomized clinical trial of brief interventions in primary care. Geneva: World Health Organization; 1992.
    1. Wain RM, Wilbourne PL, Harris KW, Pierson H, Teleki J, Burling TA, et al. Motivational interview improves treatment entry in homeless veterans. Drug Alcohol Depend. 2011;115(1–2):113–9. doi: 10.1016/j.drugalcdep.2010.11.006.
    1. Shakeshaft AP, Bowman JA, Burrows S, Doran CM, Sanson-Fisher RW. Community-based alcohol counselling: a randomized clinical trial. Addict. 2002;97(11):1449–63. doi: 10.1046/j.1360-0443.2002.00199.x.
    1. Peterson PL, Baer JS, Well EA, Ginzler JA, Garrett SB. Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents. Psychol Addict Behav. 2006;20(3):254–64. doi: 10.1037/0893-164X.20.3.254.
    1. Brown TG, Dongier M, Quimet MC, Tremblay J, Chanut TF, Legault L, et al. Brief motivational interviewing for DWI recidivists who abuse alcohol and are not participating in DWI intervention:a randomized controlled trial. Alcohol Clin Exp Res. 2010;34(2):292–301. doi: 10.1111/j.1530-0277.2009.01092.x.
    1. Wells-Parker E, Williams M. Enhancing the effectiveness of traditional interventions with drinking drivers by adding brief individual intervention components. J Stud Alcohol. 2002;63(6):655–64. doi: 10.15288/jsa.2002.63.655.
    1. Watt K, Shepherd J, Newcombe R. Drunk and dangerous: a randomised controlled trial of alcohol brief intervention for violent offenders. J Exp Criminol. 2008;4(1):1–19. doi: 10.1007/s11292-007-9048-7.
    1. Nilsen P, Aalto M, Bendtsen P, Seppa K. Effectiveness of strategies to implement brief alcohol intervention in primary healthcare: a systematic review. Scand J Prim Health Care. 2006;24(1):5–15. doi: 10.1080/02813430500475282.
    1. Kaner E, Lock C, Heather N, McNamee P, Bond S. Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial. Patient Educ Couns. 2003;51(3):277–84. doi: 10.1016/S0738-3991(02)00242-2.
    1. Kaner EF, Lock CA, McAvoy BR, Heather N, Gilvarry E. A RCT of three training and support strategies to encourage implementation of screening and brief alcohol intervention by general practitioners. Br J Gen Pract. 1999;49(446):699–703.
    1. Desy PM, Perhats C. Alcohol screening, brief intervention, and referral in the emergency department: an implementation study. J Emerg Nurs. 2008;34(1):11–9. doi: 10.1016/j.jen.2007.03.019.
    1. Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M, et al. Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol Alcohol. 2004;39(4):351–6. doi: 10.1093/alcalc/agh072.
    1. Nilsen P, Wahlin S, Heather N. Implementing brief interventions in health care: lessons learned from the Swedish risk drinking project. Int J Environ Res Public Health. 2011;8(9):3609–27. doi: 10.3390/ijerph8093609.
    1. Heather N. Implementing routine screening and brief alcohol intervention in primary health care: a Delphi survey of expert opinion. J Subst Use. 2004;4(9):66–85.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa