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Contextual adaptation, implementation, and outcomes of individual placement and support: a case study

Johanson Sturesson, Suzanne ; Bejerholm, Ulrika LU ; Knutagård, Marcus LU orcid ; Denvall, Verner LU and Carlsson Stylianides, Kristina LU (2026) In Implementation Science Communications
Abstract
Background: Implementing the evidence-based Individual Placement and Support (IPS) model in welfare states like Sweden faces contextual challenges that often necessitate local adaptations to enhance fit and effectiveness. While fidelity assessments aim to ensure effective outcomes, adaptations may lead to unintended drift from core components. The Model for Adaptation Design and Impact (MADI) help analyse the characteristics of adaptations and their ripple effects. This study explores the interplay between implementation, adaptations and fidelity in mental health services using the MADI framework.

Methods: An embedded case study design was used, involving five mental health services in a major Swedish city. Data from 26 key... (More)
Background: Implementing the evidence-based Individual Placement and Support (IPS) model in welfare states like Sweden faces contextual challenges that often necessitate local adaptations to enhance fit and effectiveness. While fidelity assessments aim to ensure effective outcomes, adaptations may lead to unintended drift from core components. The Model for Adaptation Design and Impact (MADI) help analyse the characteristics of adaptations and their ripple effects. This study explores the interplay between implementation, adaptations and fidelity in mental health services using the MADI framework.

Methods: An embedded case study design was used, involving five mental health services in a major Swedish city. Data from 26 key informants, field notes, and meeting protocols were analysed using content analysis and interpreted through the MADI framework. Results The adaptations were both planned and unplanned, some adaptations supported the integration of IPS and others negatively impacted core components, revealing unintended impacts on implementation and intervention outcomes.

Conclusions: To understand adaptations and its pathways when implementing IPS in mental health services, and other stakeholders, the MADI framework is valuable. Excessive adaptations can compromise core values and fidelity assessments must account for adaptations and their consequences. To ensure IPS remains effective, some practices within mental health services and other organisations may need to be revised or adapt to the method itself to support IPS implementation and outcomes. The findings offer valuable insights for professionals and user organisations adopting evidence-based practices in mental health services. (Less)
Abstract (Swedish)
Background: Implementing the evidence-based Individual Placement and Support (IPS)
model in welfare states like Sweden faces contextual challenges that often necessitate local
adaptations to enhance fit and effectiveness. While fidelity assessments aim to ensure
effective outcomes, adaptations may lead to unintended drift from core components. The
Model for Adaptation Design and Impact (MADI) help analyse the characteristics of
adaptations and their ripple effects. This study explores the interplay between implementation,
adaptations and fidelity in mental health services using the MADI framework.
Methods: An embedded case study design was used, involving five mental health services in a
major Swedish... (More)
Background: Implementing the evidence-based Individual Placement and Support (IPS)
model in welfare states like Sweden faces contextual challenges that often necessitate local
adaptations to enhance fit and effectiveness. While fidelity assessments aim to ensure
effective outcomes, adaptations may lead to unintended drift from core components. The
Model for Adaptation Design and Impact (MADI) help analyse the characteristics of
adaptations and their ripple effects. This study explores the interplay between implementation,
adaptations and fidelity in mental health services using the MADI framework.
Methods: An embedded case study design was used, involving five mental health services in a
major Swedish city. Data from 26 key informants, field notes, and meeting protocols were
analysed using content analysis and interpreted through the MADI framework.
Results: The adaptations were both planned and unplanned, some adaptations supported the
integration of IPS and others negatively impacted core components, revealing unintended
impacts on implementation and intervention outcomes.
Conclusions: To understand adaptations and its pathways when implementing IPS in mental
health services, and other stakeholders, the MADI framework is valuable. Excessive
adaptations can compromise core values and fidelity assessments must account for
adaptations and their consequences. To ensure IPS remains effective, some practices within
mental health services and other organisations may need to be revised or adapt to the method
itself to support IPS implementation and outcomes. The findings offer valuable insights for
professionals and user organisations adopting evidence-based practices in mental health
services. (Less)
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author
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organization
alternative title
Kontextuella anpassningar, implementering och utfall: en case-studie
publishing date
type
Contribution to journal
publication status
in press
subject
in
Implementation Science Communications
ISSN
2662-2211
DOI
10.1186/s43058-026-00875-5
language
English
LU publication?
yes
id
2f41d2ea-70d2-449c-b37b-6c4a7ed2b663
date added to LUP
2026-02-06 14:53:20
date last changed
2026-02-11 14:31:13
@article{2f41d2ea-70d2-449c-b37b-6c4a7ed2b663,
  abstract     = {{Background: Implementing the evidence-based Individual Placement and Support (IPS) model in welfare states like Sweden faces contextual challenges that often necessitate local adaptations to enhance fit and effectiveness. While fidelity assessments aim to ensure effective outcomes, adaptations may lead to unintended drift from core components. The Model for Adaptation Design and Impact (MADI) help analyse the characteristics of adaptations and their ripple effects. This study explores the interplay between implementation, adaptations and fidelity in mental health services using the MADI framework. <br/><br/>Methods: An embedded case study design was used, involving five mental health services in a major Swedish city. Data from 26 key informants, field notes, and meeting protocols were analysed using content analysis and interpreted through the MADI framework. Results The adaptations were both planned and unplanned, some adaptations supported the integration of IPS and others negatively impacted core components, revealing unintended impacts on implementation and intervention outcomes. <br/><br/>Conclusions: To understand adaptations and its pathways when implementing IPS in mental health services, and other stakeholders, the MADI framework is valuable. Excessive adaptations can compromise core values and fidelity assessments must account for adaptations and their consequences. To ensure IPS remains effective, some practices within mental health services and other organisations may need to be revised or adapt to the method itself to support IPS implementation and outcomes. The findings offer valuable insights for professionals and user organisations adopting evidence-based practices in mental health services.}},
  author       = {{Johanson Sturesson, Suzanne and Bejerholm, Ulrika and Knutagård, Marcus and Denvall, Verner and Carlsson Stylianides, Kristina}},
  issn         = {{2662-2211}},
  language     = {{eng}},
  month        = {{02}},
  series       = {{Implementation Science Communications}},
  title        = {{Contextual adaptation, implementation, and outcomes of individual placement and support: a case study}},
  url          = {{http://dx.doi.org/10.1186/s43058-026-00875-5}},
  doi          = {{10.1186/s43058-026-00875-5}},
  year         = {{2026}},
}