8. Support, cross-sectoral and coordinating efforts

In order to help vulnerable unemployed people into employment, it may be relevant to help them deal with various challenges they have that hinder their participation in employment (for example, dealing with everyday life, family problems, or health problems). Often, but not always, this involves a cross-sectoral collaboration between the employment service and social and/or health services. Ongoing support for the vulnerable individuals (and their employers), who have entered a job after a period on benefits, is also sometimes used as an employment instrument. Such support is based on a principle of place, then train and is used in, e.g., IPS. In this chapter, we investigate the effectiveness of such efforts.

The chapter is organised in two parts, each presenting the most recent Nordic literature on the topic:

8.1 Support, mentoring, and relationship to the caseworker

8.2 Cross-sectoral coordination and ongoing support

We present perspectives from caseworker interviews in section 8.3. and end the chapter with some concluding remarks in section 8.4. The literature from the systematic review is summarised in Table 8.1 at the end of the chapter.

8.1 Support, mentoring, and relationship to the caseworker

In this section, we describe mentoring schemes and efforts to help vulnerable individuals deal with issues in their everyday life that constitute barriers to employment and which affect their employment opportunities. Further, this section also contains evidence on the importance of the caseworker’s role when it comes to supporting vulnerable individuals. The purpose of the instruments described in this section is to support vulnerable unemployed persons in getting a job or at least increasing their employability.

Description of the instrument

Mentor support is a relationship between an experienced mentor and a less experienced protégé or mentee that aims to help the mentee develop and acquire some skills (professional or social) and with the further aim of achieving an end goal, e.g., obtaining or maintaining employment. The mentor typically has both a guiding and advisory function and a psychological and social function. The latter means that the mentor must build a confidential and trusting relationship with the mentee, thereby supporting the mentee’s commitment and belief in themselves. After that, the mentor can more easily fulfil a guidance and advisory function, for example on how to apply for a job and how to join a workplace (Albæk et al., 2012).

Experience from Denmark shows that when the mentoring scheme is used with vulnerable unemployed persons who are far from the labour market and have complex social or personal problems, the mentor support typically focuses on how to cope with everyday matters (Albæk et al., 2012; Albæk et al., 2015). However, there are also other types of efforts aimed at addressing everyday challenges. One example is a goal-setting intervention in Norway targeted at unemployed youth, which will be described further below.

The effectiveness of the instrument

The systematic literature review identified one study on the effect of a mentor programme (Månsson & Delander, 2017). The purpose of this mentor programme was to help unemployed newly arrived refugees establish themselves in the labour market or start a business. During the short follow-up period, the programme only had a positive effect for men in the outcome variable “income from work above SEK 42,800”, not for the other outcomes: (1) unsubsidised full-time job or education and (2) atypical employment (temporary or part-time employment or subsidised employment) (Månsson & Delander, 2017). The authors argue that most of the refugees participating in the mentor programme were at some distance from the labour market and that the effect on employment might change (become positive) if they have a longer follow-up period in the effect study.

That the effects on employment are seen only in the longer run is also emphasised in other publications not identified in the systematic literature review. According to Albæk et al. (2015), one cannot expect the disadvantaged groups targeted with mentor support to experience employment effects in the short term, but that the mentor support will contribute in the long term, e.g., that the unemployed persons will be able to participate in activation, take a job, or take an education. Literature reviews show that the number of high-quality studies on the effect of mentor programmes targeted at vulnerable unemployed people is limited. However, systematic literature reviews from 2012 conclude that there is an indication that mentoring support given in connection with other efforts has positive effects on employment for certain vulnerable unemployed groups (e.g., long-term unemployed persons and released prisoners). But the number of studies is too limited to show anything definite about the effects (Albæk et al., 2012; Albæk et al., 2015).

High-quality studies on the effect of mentor programmes are also limited for other target groups (see, e.g., Underhill (2006)).

The systematic literature review identified one study on the employment effects of helping unemployed persons deal with conditions in their everyday life. Bjorvatn et al. (2021) examine a goal-setting intervention which focuses on habits (sleep, exercise, and substance use) toward a better lifestyle in terms of its positive employment effect. The intervention was structured in three steps. First, participants reported their habits regarding bedtime, exercise, and substance use over the past week. Second, they reflected on their satisfaction with these habits and set future goals for a typical week. Third, the participants received a summary of their goals and were encouraged to take a screenshot for future reference. The intervention increased the probability of employment, improved general life satisfaction, and strengthened the locus of control for the participants. These results are in line with research that has shown that a lack of structure and stability in everyday life can be a challenge for some unemployed persons in terms of achieving attachment to the labour market. These everyday challenges can be poor finances, unstable housing conditions, problems with family and networks, or lack of coping with everyday life, i.e., lack of resources for buying food, paying bills, cleaning, cooking, laundry, etc., and problems with circadian rhythms (Væksthusets Forskningscenter, 2012).

We did not identify any literature in the systematic review on the importance of the caseworker’s role in supporting vulnerable individuals. However, evidence beyond the systematic review indicates that caseworkers are crucial for supporting and increasing the employment of vulnerable individuals. For example, the success of the Hjørring model (Hjørringmodellen), which includes individually tailored activation plans and cross-sectoral efforts (when needed), is ascribed to, among other things, 1) a lower caseload among the caseworkers (from 70–80 cases to 35–40 cases per caseworker), 2) upskilling of caseworkers so that they possess the right tools, 3) the possibility of making programmes tailored to the individual citizen, and 4) cross-sectoral collaboration (Ravn, 2019; Ravn & Nielsen, 2019; Ravn, 2022). Danish research also highlights the importance of time when vulnerable individuals engage with the system. It concludes that building a collaborative relationship between the individual and the caseworker requires time to establish presence, offer support, and provide encouragement (Olesen, 2008).

Similarly, an evaluation of the OtO intervention Opgang til Opgang or Staircase to Staircase shows positive effects. OtO is a holistic employment intervention targeting vulnerable families, which focuses on everyday life challenges and a job-first approach. Simonsen & Skipper (2023) found no effect on the number of working hours for parents but noted a lower probability of early retirement and a higher likelihood of being referred to a flex job. This highlights the importance of caseworkers and their relationships with vulnerable individuals. Supporting research suggests that a caseworker’s belief in an individual’s job prospects significantly impacts employment outcomes and that changing caseworkers lowers the probability of obtaining employment (Væksthusets Forskningscenter, 2017). Further, the caseworker’s performance is also important, which is demonstrated in Bech (2015), who demonstrates that moving individuals to better performing caseworkers can improve individual’s employment after six months. While these findings indicate the important role of caseworkers, the research is too limited to draw firm conclusions about their caseloads and relationships with clients (Ravn, 2019).

Key considerations regarding the instrument

Employment effects from support may only be positive in the longer term, which calls for other measures of progress (e.g., employability)

Despite lack of positive effects on employment in the short term, instruments targeting vulnerable unemployed people (e.g., mentor programmes) may be relevant to improve the employability of these people and have positive effects on employment in the longer term, as argued by Månsson & Delander (2017). Measures of progress in employability could support caseworkers in the organisation of employment efforts targeting vulnerable unemployed people. However, we lack research on these measures to assess their impact on employability.

Some of the few studies on measures of employability for vulnerable unemployed people are Arendt et al. (2020), Jakobsen & Thuesen (2024), and Bodilsen et al. (2023)

Potential in focusing on other, less structural causes of unemployment, e.g., by setting goals in relation to daily habits, which has proven successful in increasing employment

While structural causes of unemployment often dominate policy discussions, there is significant potential in addressing less structural factors, such as setting goals related to daily habits. Research indicates that interventions focusing on personal habits and routines can be effective in improving employment outcomes. Bjorvatn et al. (2021) highlight the importance of setting daily habit goals for a quick transition back to employment, emphasising the need for a broad perspective in designing employment services. Additionally, the low-cost and low-threshold nature of such interventions makes them easily applicable as a complement to standard labour market programmes.

The caseworker and the relationship to the caseworker seem to be vital for the success of vulnerable groups in various labour market programmes

There is some evidence of positive employment effects of cross-sectoral efforts and a focus on the relationship between citizens and caseworkers. However, there are certain prerequisites that must be met. For example, the caseworker must have time to build a relationship with the citizen, which requires that the number of cases is not too high. Several of the employment efforts (e.g., the Hjørring model) with positive employment effects described in this section involve extra resources added to the employment services. As emphasised in Ravn et al. (2019), a relevant question is whether the effects of the interventions are worth the additional costs. However, this issue is beyond the scope of this report.

8.2 Cross-sectoral coordination and ongoing support

Many successful instruments for vulnerable groups include elements of cross-sectoral efforts. In this section, we describe the effects of instruments where cross-sectoral efforts and ongoing support are central. This includes SE, an instrument where the citizen is supported while in paid employment (ongoing support), which often includes elements of cross-sectoral efforts.

Description of the instrument

SE is one method for supporting vulnerable groups, including individuals with disabilities. The aim is to assist the persons in finding and maintaining paid employment in the open labour market, and the general idea is place, then train. Although there are slightly different definitions of SE, three fundamental elements are included in all definitions (according to the European Union of Supported Employment):

Paid work: Individuals should receive commensurate pay for work carried out. If a country operates with a national minimum wage, then the individual must be paid at least this rate or the going rate for the job.
Open labour market: People with disabilities should be regular employees with the same wages, terms, and conditions as other employees who are employed in businesses/organisations within the public, private, or voluntary sectors.
Ongoing support: This refers to job support while in paid employment in its widest concept. Support is individualised and on a need basis for both the employee and the employer.

The most well-known type of SE is probably IPS, where there is an additional emphasis on the co-location of employment and clinical staff (European Union of Supported Employment, 2024). IPS is a manual-based intervention that was originally developed for people with severe mental illness. IPS builds on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and time-unlimited individualised support (Hellström et al., 2017). The three studies on SE which we have identified in our systematic literature review all include elements of cross-sectoral efforts.

The rehabilitative efforts described in section 5.2 also typically include cross-sectoral cooperation between employment and health services, but the target group for these efforts is limited to sick-listed workers.

The effectiveness of the instrument

In the systematic literature review, we identified three studies on the effect of SE, and two of these studies are evaluated within the framework of IPS.

Evaluations within the framework of IPS include rating the intervention using the IPS fidelity scale.

An international literature review shows that IPS has been expanded to help people with challenges beyond severe mental illness in many cases and that change of the target group often implies that the IPS principles are modified (Bond et al., 2019). The international literature review concludes that IPS with modifications is a promising employment intervention for several populations, in addition to people with serious mental illnesses. The strongest evidence was found for veterans with PTSD, while the IPS intervention for other populations (e.g., people with anxiety, depression, substance use disorder, or musculoskeletal or neurological conditions) needs further development (Bond et al., 2019).

In the two studies of IPS we have found in our literature review, the IPS principles have been modified to match the target groups and contexts. The first IPS study is a Norwegian study of the effect of using IPS to help young adults (18–29) who are at risk of early work disability (in the NEET group, receiving temporary benefits from NAV, and considered eligible and expected to participate in the TVR intervention traineeship in a sheltered business). The participants had various social and health-related challenges that did not necessarily involve mental illness. Hence, the IPS principle of integrating employment services with mental health treatment was not implemented, although health personnel were involved in cases where it was applicable and accepted by the participant. The study finds positive effects of IPS on employment for young adults (18–29 years) who are at risk of early work disability (Sveinsdottir et al., 2019). Similar results are found in brand-new Norwegian research on IPS among young people (Brinchmann et al., 2024).

The second IPS study is a Danish study, where the target group were people on sick leave with mood or anxiety disorders (Hellström et al., 2017). Here, the IPS principle was also modified with respect to the integration of services, since people with mood and anxiety disorders are treated in many different settings in Denmark, which hampered the integration with mental health services. Furthermore, the participants had to find jobs themselves, but with support. Hellström et al. (2017, 2023) do not find any statistically significant effects of IPS on return to work or education for people on sick leave with mood or anxiety disorders.

Studies on IPS for people with severe mental illness typically find positive effects on employment, also in welfare states like the Nordic countries (Christensen et al., 2019).

The third study on the effect of SE identified in our literature review is an example from Sweden, where SE was not conducted in the framework of IPS. Here, the target group were young adults between 19 and 29 on disability pension (Fogelgren et al., 2023). The intervention was the responsibility of PES and consisted of assisted job search and placement assistance, follow-along support, and job development. Caseworkers handled problematic situations and served as backup in situations where the individual faced unexpected negative health shocks. This meant that the caseworker sometimes had to step in and do the participant’s job. Fogelgren et al. (2023) find a significant positive effect of SE on the employment outcome of young adults on disability pension and underline that the instrument of SE has the potential to be successful for a broad group of individuals. The authors made a cost-benefit analysis by comparing SE and regular rehabilitation. Both costs and benefits are higher for SE. The costs are higher due to personnel costs and costs for a personal assistant at the workplace. Since the effects tend to remain in the long run, the intervention has the potential to be cost-effective for young individuals with disabilities (Fogelgren et al., 2023).

Fogelgren et al. (2023) notice that most jobs assigned to individuals with disability pensions involve government-provided employer wage subsidies administered by the PES. When minimum wages are high, it can be difficult for a person with reduced work capacity to obtain a job without a wage subsidy which covers the discrepancy between the market wage level and the productivity level of the worker.

There are also examples of SE targeting immigrants (see, e.g., Maximova-Mentzoni et al. (2019) and Maximova-Mentzoni (2019)). The needs for support are different to some extent from the needs of other groups requiring SE. Among other things, some immigrants need language support, support with regard to cultural differences, and addressing other situations that prevent inclusion in the labour market. But we have not found any studies on the employment effects of SE among immigrants.

Key considerations regarding the instrument

Potential in using IPS for many other target groups (beside people with severe mental illness), but the IPS principles typically need to be modified according to the target group and context

SE, particularly IPS, is utilised across all Nordic countries in various forms and among diverse groups. Some studies of SE, including IPS, report positive employment effects. A key finding from the literature is that SE significantly enhances the likelihood of various target groups obtaining and maintaining employment. However, it is evident that IPS principles often require adaptation to fit the specific needs and contexts of different target groups, thereby maximising their effectiveness. For a discussion of facilitators and barriers when implementing the IPS approach see Bonfils et al. (2017).

8.3 Caseworker interviews

The caseworker interviews provide some knowledge relevant to the instrument topics treated in this chapter, although the prevalence of the use of these instruments varies across the Nordic countries and across municipalities. Summarising the findings from the interviews, both measures, albeit to a varying extent, appear to be built into much of the ordinary work caseworkers are expected to perform, e.g., coaching a client on how to combine everyday life and job search or coordinating with the municipal social services department. Concerning SE, most caseworkers who know about it are relatively positive, but few caseworkers have personal experience.

Support for everyday life challenges

Many caseworkers across the Nordic countries have experience with giving support for handling everyday life challenges that can be an obstacle in maintaining a job, and the support can take many forms. One of the groups who may need it the most are young people who have dropped out of school or just finished school, have no contact to their family (i.e., lack family role models and support), have limited or no social network, and have no idea about how to live their life or what to do with it. A Finnish caseworker relates that they have a psychologist specialised in helping such young people find a career path and potentially sign up for school (again) in his One-Stop Guidance Center Ohjaamo. He says that, after those sessions, the young people are generally more motivated and know more about in which direction to go. However, like other examples mentioned by caseworkers concerning job and life coaching, it is difficult to discern to what extent the caseworkers truly find that these measures have an effect. In relation to some groups, e.g., persons with neurological mental diseases, support for handling everyday life challenges is built into the therapy they receive, and support in that sense is crucial (see also chapter 5 on rehabilitative efforts). Summarising the findings, it can be said that measures that aim at supporting the vulnerable unemployed people in coping with everyday life challenges are relatively common but not necessarily as a tool on its own, rather as one built into interventions like job coaching or rehabilitation.

Supported employment

Supported Employment (SE) or Individual Placement and Support (IPS), which support persons with disabilities and other disadvantaged groups in finding and maintaining paid employment in the open labour market, are also approaches that many caseworkers have heard of and that exist in various shapes in the Nordic employment systems. Still, relatively few of the interviewed caseworkers have personal experience with these types of interventions. Many Swedish caseworkers, when asked about the use of such an approach in Sweden, refer to the Swedish SIUS scheme (Särskild stödperson för introduktions- och uppföljningsstöd)

https://arbetsformedlingen.se/for-arbetssokande/extra-stod/stod-a-o/sarskild-stodperson-for-introduktions--och-uppfoljningsstod---sius

and say that persons with disabilities can be referred to this scheme. Their impression of the functioning and effects of the SIUS scheme is typically positive, but they do not have first-hand experience with the scheme or its effects.

An exception to the lack of personal experience with SE appeared when we interviewed two Icelandic caseworkers who are part of a newly established Icelandic ‘IPS light’ programme aiming at assisting vulnerable youth aged 18–29 years find a job or start an education. They recounted that it was not always easy to provide this support for young people who might not be ready to receive it, although a sizeable number of young people might benefit from their support in practice. In the first place, many young unemployed persons did not want a job, and if they did and might benefit from support, they might not want an IPS consultant to accompany them to the employer or assist them in the workplace for fear of stigmatisation. Still, their overall experience was that a number of young people did benefit from the IPS light approach.

A final example of caseworkers having personal experience with IPS involves a Danish caseworker and an initiative to establish an IPS programme in her municipality, on the basis of a collaboration between the job centre and a regional psychiatric hospital department. However, according to the caseworker, the initiative stranded due to resistance from some of the psychiatric doctors and nurses, who did not see the point in the project, even though the project had backing at a management level. Interestingly, another Danish caseworker told of a similar project in her municipality, where collaboration in psychiatry on an IPS intervention functioned quite well, not least, according to the caseworker, because the IPS consultants were able to support the citizens for a longer period than she could herself.

Cross-sectoral efforts

Finally, cross-sectoral efforts and collaboration also stand out as central in many of the interviews with caseworkers. However, these efforts appear rather as (more or less) well-functioning practices than specific tools and are built into much ordinary work that the caseworkers perform. Hence, it is very common that caseworkers in a municipal employment service have to collaborate with a municipal social services department taking care of family and child-related matters. A sick or disabled child in a family can represent a major obstacle to one parent’s labour market participation. Most caseworkers who recount experiences with this collaboration regard it as relatively well-functioning. Much cross-sectoral coordination also revolves around collaboration with doctors and hospitals, especially psychiatrists, but also many other specialists. Experiences among the caseworkers concerning this topic are relatively diverse. Most caseworkers recount that such collaboration is relatively well-functioning, but many add that there is a (very) long waiting time before some of their clients can be diagnosed and receive treatment. It is beyond the scope of this report to investigate the functioning of the psychiatric health-care systems in the Nordic countries. Still, several interviews bear witness to employment barriers affecting vulnerable youth, disabled persons, and others who cannot receive timely treatment due to lack of resources within those systems.

8.4 Concluding remarks

In this chapter, we have described the effects of instruments that aim to help vulnerable unemployed people deal with conditions in their everyday life that affect their opportunities to get into employment, as well as the effects of instruments where cross-sectoral efforts or other dimensions of the working methods of the caseworkers are central. We have also described the effects of SE, an instrument where the citizen is supported while in paid employment (follow-up). SE often, but not always, includes elements of cross-sectoral efforts.

We find that interventions supporting the vulnerable unemployed persons in coping with everyday life challenges may have positive employment effects and may be easily applicable as a complement to standard labour market interventions. Caseworkers explain that they commonly apply such support measures in their work as a part of more extensive interventions. There is some evidence of positive employment effects of cross-sectoral efforts and a focus on the relationship between citizens and caseworkers. Not all but some of the studies of SE (including IPS) find positive effects on employment. An important learning point from the literature is that SE can have a positive impact on the probabilities of obtaining and maintaining employment for many target groups. Another learning point, however, is that the IPS principles typically need to be modified according to the target group and context. Only a few of the interviewed caseworkers had first-hand experiences with SE measures, but those who did generally had a positive impression of the tool. See Bonfils et al. (2017) for a discussion of facilitators and barriers when implementing the IPS approach.

Instruments targeting vulnerable unemployed people may only have positive effects on employment in the longer term, and measures of progress in employability could support caseworkers in the organisation of employment efforts targeting vulnerable unemployed people. However, we lack research on these measures to assess their impact on employability.

Table 8.1 Identified literature in the systematic review related to support, cross-sectoral and coordinating efforts

Study	Instrument	Target group	Time perspective	Effect	Method
Bjorvatn et al. (2021) Norway	Goal-setting intervention	Young people (16–29 years old)	12 months after intervention	Intervention increased the probability of employment and decreased the probability of receiving unemployment benefits 12 months after the intervention	RCT
Månsson & Delander (2017) Sweden	Mentoring programme	Refugees (newly arrived)	1 year after intervention	No effect on employment outcomes. Positive effects on income for men	CEM
Fogelgren et al. (2023) Sweden	SE. Utilises a caseworker as backup for the individual during training to reduce the risks of employers when hiring an individual with unclear productivity	Young adults between 19 and 29 years of age with disability pension	The follow-up period is 18 months	18 months after the start of the project, participants with SE have work rates that are approximately 10 percentage points higher than participants who received regular rehabilitation	RCT
Hellström et al. (2017); Hellström et al. (2023) Denmark	IPS	People on sick leave due to mood or anxiety disorder (for more details, see p. 718 in the 2017 article)	24 months after treatment	After 24 months, 44.4 pct. of the participants receiving IPS was in employment or education, while 37.8 pct. of the participant receiving services as usual was in employment or education. The difference is, however, not significant. No differences in weeks of employment	RCT and logistic regression
Sveinsdottir et al. (2020) Norway	IPS	Young adults (18–29 years) who not are in employment or education are receiving temporary benefits from NAV and are considered eligible and expected to participate in the TVR intervention traineeship in a sheltered business by the caseworker	6- and 12-month follow-ups	48% of IPS participants obtained employment after 12 months compared to 8% of participants in traditional vocational rehabilitation (TVR)	RCT

Note: RCT is an abbreviation for Randomized Control Trial. CEM is an abbreviation for Coarsened Exact Matching.