Evidence-based activation work and service individualisation: client and frontline worker experiences with a standardised intervention

ABSTRACT

Evidence-based interventions standardise frontline social services, but may also promote policy ideals like service individualisation and client involvement. This article examines how clients and frontline workers experience activities within an evidence-based intervention known as Individual Placement and Support (IPS) in the Norwegian Labour and Welfare Administration. The article draws on interviews and fieldwork conducted in one frontline office from 2017 to 2019. The findings show how clients developed relationships with frontline workers, were given time to follow individual trajectories and received tailored support when facing challenges. Intervention activities were characterised by flexibility, a relational approach to clients and detachment from normal organisational procedures. The findings illustrate how evidence-based interventions can enable service individualisation in frontline organisations, but also indicate a need for additional professional resources due to the complexity of the work.

SAMMENDRAG

Evidensbaserte intervensjoner standardiserer sosiale tjenester, men kan også fremme idealer som tjenesteindividualisering og involvering av brukere. Denne artikkelen undersøker hvordan brukere og aktiveringsarbeidere opplevde aktiviteter innenfor en evidensbasert intervensjon kalt Individual Placement and Support (IPS) i ett NAV-kontor. Artikkelen er basert på intervjuer og feltarbeid fra 2017-2019. Funnene viser hvordan brukere utviklet relasjoner med aktiveringsarbeiderne, fikk tid til egen utvikling, og mottok tilpasset støtte når de møtte utfordringer. Intervensjonsaktiviteter var fleksible, relasjonelle og avkoblet fra vanlige prosedyrer i organisasjonen. Funnene illustrerer hvordan evidensbaserte intervensjoner kan muliggjøre tjenesteindividualisering i førstelinjeorganisasjoner, men indikerer også et behov for profesjonelle ressurser på grunn av kompleksiteten i arbeidet.

KEYWORDS:

• Supported employment
• standardisation
• personalisation
• employment
• individual placement and support

NØKKELORD:

• Supported employment
• standardisering
• personalisering
• aktiveringstjenester
• individuell jobbstøtte

1. Introduction

Standardisation and individualisation can be viewed as two opposing trends in social service organisations (Nordesjö et al., 2020; Ponnert & Svensson, 2016). The provision of individualised activation services, understood as services tailored to individual needs and circumstances, has been emphasised as a central condition for promoting social and labour market integration, especially for the long-term unemployed and people with complex problems (Rice, 2017; Van Berkel, 2018). Implementing individualised services is challenging for frontline organisations, often characterised by rigid organisational frameworks and standardised ‘one-size-fits-all’ approaches that limit attention to individual client needs (Heidenreich & Rice, 2016).

Evidence-based practices (EBPs) and standardised interventions have become increasingly important in activation services, being implemented in frontline organisations as new service delivery models and practices (Dall & Danneris, 2019). On the one hand, these interventions standardise frontline practices, as research knowledge is embedded in systems, processes and standards, e.g. in the form of manuals, guidelines or checklists for frontline workers to follow (Nutley et al., 2009). On the other hand, many EBPs promote individualisation to client needs and other welfare ideals like user involvement and empowerment (Ponnert & Svensson, 2016), ideals that correspond with core themes in social work like the helping relationship, therapeutic alliances and dialogical relations (Payne, 2014). The diffusion of EBP and standardised interventions across welfare sectors has led to polarised and ongoing scholarly debates. Critical authors have argued that evidence-based interventions are rigid and limit frontline workers’ ability to individualise services (Jacobsson & Meeuwisse, 2020; Lauri, 2016; Petersén & Olsson, 2014), while other authors have added nuance by emphasising how interventions can improve client follow-up and empowerment by enabling reflective practices and strengthening professional capacity (Barfoed & Jacobsson, 2012; Natland & Malmberg-Heimonen, 2016; Skillmark, 2018). However, few studies have focused on how such interventions affect service individualisation and the relationship between frontline workers and clients.

The aim of this article is to contribute to the literature by studying frontline worker-client relationships within an evidence-based intervention promoting individualised employment support for vulnerable clients. The research question is: How do clients and frontline workers experience intervention activities? A relational analytical framework is applied to examine how the intervention is made to work in practice through situated interactions between clients and frontline workers (Dall & Danneris, 2019; Koivisto, 2007). The article draws on an in-depth case study from one office in the Norwegian Labour and Welfare Administration (NAV) that implemented the manual-based intervention Individual Placement and Support (IPS; Drake et al., 2012). In the intervention, frontline workers with diverse professional backgrounds known as employment specialists assist unemployed citizens with complex service needs to find ordinary paid employment through personalised follow-up and workplace support.

2. Evidence-based interventions and individualised services

A dominant view in the social work literature has been that evidence-based interventions are part of managerialist trends that promote efficiency and effectiveness (Jacobsson & Meeuwisse, 2020), marginalise informal, relational aspects of practice (Skillmark & Oscarsson, 2018) and subvert practitioners’ ability to personalise services (Dall & Danneris, 2019). A core concern is that clients’ individual needs and circumstances are too complex to be handled merely by following standardised manuals (Gray et al., 2009). Lauri (2016) contends that evidence-based interventions promote ‘rigid methods over a flexible and holistic approach’ (Lauri, 2016, p. iii) to clients. Documentation requirements limit time with clients, and standardised work templates lead to routinised and procedural client interactions. Interventions are often combined with austerity measures and heavy workloads, creating stress and detachment for frontline workers.

However, other authors have argued that evidence-based interventions can promote ‘more service-and client-oriented work where the rights of clients and their needs are in focus’ (Ponnert & Svensson, 2016, p. 594). Empirical studies have found evidence-based interventions strengthened service individualisation by improving frontline practitioners’ competencies and capabilities (Barfoed & Jacobsson, 2012; Malmberg-Heimonen, 2015; Robinson, 2003; Skillmark, 2018; Soydan & Palinkas, 2014), and enabled client empowerment, involvement and resource-oriented perspectives (Natland & Malmberg-Heimonen, 2016). Authors have noted the need for more nuances regarding the diverse local consequences of different interventions and tools (Björk, 2016; Skillmark, 2018).

Although service individualisation is a central topic in the literature on frontline delivery of activation services (Heidenreich & Rice, 2016), few studies have investigated evidence-based interventions and individualised services. Recent studies have highlighted the nonlinear complexity of client trajectories over time, necessitating follow-up approaches characterised by responsiveness and client influence (Danneris, 2018; Danneris & Caswell, 2019; Nielsen et al., 2021). In the literature on the IPS intervention, studies have shown that interpersonal dynamics are central to building client motivation and facilitating employment (Bonfils et al., 2017; Moen et al., 2020b; Nygren et al., 2016). However, this work is challenging and requires experienced and skilled practitioners (Bonfils et al., 2017). Nygren concluded that IPS is based on ‘specialized relationship-based work that includes advanced problem solving’ (2016, p. 49). Studies have shown high work pressure and considerable turnover among employment specialists (Vukadin et al., 2021), and collaboration problems with other professionals (Moen et al., 2020a).

While previous studies have mainly investigated evidence-based interventions in other domains, such as social work departments and child protection services, there is a need for more knowledge about evidence-based interventions and individualised activation services. Like other social services, activation workers are situated in organisations with many rules, laws and procedures, limited resources and high demand for services (Van Berkel & Aa, 2012). Across social services, there is increasing emphasis on client empowerment and involvement to participate in inter-organisational networks and develop outward-oriented, boundary-spanning practices (Heidenreich & Rice, 2016), all of which are features of the IPS intervention. Compared to professional fields like nursing, education and social work, however, activation work is characterised by educational diversity and a lack of a common knowledge base, although the work is also complex and requires considerable knowledge and skills (Van Berkel, 2018). This mix of factors makes it interesting to study the interactions between activation workers and clients within IPS as an evidence-based intervention. There is a need for more knowledge about whether and how evidence-based interventions can contribute to individualised services and a specific need for knowledge about client experiences within such standardised interventions.

3. Analytical framework

The article draws on a relational approach to analyse practices and interactions within a frontline service intervention (Dall & Danneris, 2019; Koivisto, 2007). In this framework, service interventions are conceptualised as situated, local activity and interaction involving different actors, such as frontline workers, clients, employers and broader social networks (Koivisto, 2007). A policy or intervention contains a ‘script’ (Akrich, 1992) that defines the actors and the activities and processes they are to perform to achieve given goals (e.g. a manual or methods book).

The framework is based on a relational ontology (Dall & Danneris, 2019; Koivisto, 2007). Social structures are understood as socio-material networks that actors continuously perform, produce and maintain. For example, workplaces, families and social communities are understood as heterogeneous networks that include both human and non-human actors, such as tools, conventions, artefacts, values, architecture, goals and norms. This approach seeks to avoid common dualisms, such as distinctions between human action and context, instead viewing context as networks and relations that actors are part of and continuously co-produce.

Most social interventions’ aim to change the client’s life in some way (Koivisto, 2007). In the framework, clients’ life situations are also conceived of as socio-material networks performed and produced through daily activities. Their networks are affected by the intervention network and activities in complex and dialectical ways, creating both intended and unintended changes. Thus, the intervention’s effects cannot be explained by the intervention method alone because the method is performed during situated, interactive activities and processes involving the central actors (e.g. frontline workers and clients).

In this article, the relational approach is used to analyse how the intervention is realised in frontline activities and interactions. More specifically, the analysis aims to examine (1) how clients and frontline workers experience intervention activities and (2) what frontline workers do when interacting with clients. While networks are expansive and complex, the goal is not to produce complete accounts but rather to do a ‘modest analysis’ (Koivisto, 2007, p. 535) by emphasising the most relevant actors, activities and elements in the interaction between frontline workers and clients.

4. Organisational context

The organisational context of this study is a midsized NAV office with fewer than 60 employees located in a rural municipality in Norway. NAV offices provide integrated employment and welfare services, including social assistance, social security and employment follow-up (Minas, 2014). A main goal is to provide holistic and individualised services to cover client’s complex needs and obstacles for labour market integration (Gjersøe, 2020). Norwegian activation services are characterised by enabling policies, emphasising support and training to improve employability, although demanding policy elements with an emphasis on obligations and conditionality have also been introduced (Vilhena, 2021). While standardised tools and procedures like client classification and assessment systems structure the work in NAV offices, frontline work requires professional decision-making and knowledge (Hagelund, 2016).

The office was organised into three departments: the welfare department providing social assistance, the follow-up department and the employment specialist department. The employment specialist department had two teams – the IPS team and the in-house follow-up team – with a total of 13 employment specialists. Counsellors administer welfare benefits, conduct work-health assessment, refer clients to activation measures and provide follow-up, while employment specialists match individual clients to specific employers and provide follow-along support in the workplace.

The NAV office represents a useful organisational setting for exploring the experiences of clients and frontline workers within an evidence-based intervention. The office had several years of experience with the IPS intervention. The IPS service received high fidelity scores in annual quality evaluations and was perceived by managers as a successful innovation. Office managers emphasised service development and innovation. To increase service capacity, office managers acquired funding for employment specialists from the In-house follow-up programme in NAV and from the Norwegian Directorate of Health.

The IPS intervention combines the ideals of individualised services with a rather standardised service model. The intervention promotes comprehensive support to clients based on Supported Employment (SE) principles emphasising social inclusion, empowerment and recovery philosophies (Wehman, 2012). Standardising elements include a 25-point fidelity scale prescribing service organisation and frontline work tasks, performance measures, quality evaluation and strong supervisor roles (Becker et al., 2015). IPS is based on the following core principles: (1) focus on competitive employment, (2) eligibility based on client choice (i.e. client motivation), (3) integration of vocational rehabilitation and mental health services, (4) attention to client preferences, (5) personalised benefits counselling, (6) rapid start of job searching, (7) systematic job development and (8) time-unlimited and individualised support (Drake et al., 2012). The model requires close integration between mental health services and employment services and the parallel treatment of clients. The defined client groups (i.e. clients with moderate to severe mental illness, with or without substance abuse) are referred from mental health services. IPS has been found to elicit better results than comparable services in securing competitive employment in several randomised controlled trials (RCTs) in different countries and service contexts (Brinchmann et al., 2020).

This study focuses on the IPS team in the office, but also includes interviews with two employment specialists from the in-house follow-up team and two clients receiving services from this team. The work in both teams was structured by the IPS fidelity scale and manuals, but only the IPS team was integrated with mental health services. These employment specialists were part of one or two collaboration teams with mental health professionals, participated in weekly treatment team meetings, and had clients referred from mental health services. They had office space both in mental health services and in the NAV office. The IPS clients had moderate to severe mental health problems (as well as other problems and needs, including substance abuse, unstable housing, language barriers and economic debt) and received mental health treatment. The in-house follow-up team also followed the fidelity scale and manuals except for integration with mental health services. Clients were referred by counsellors in the NAV office and also had varied problems and needs.

5. Study design

This study draws on empirical data from 12 interviews with service participants, 18 interviews with frontline workers and managers and approximately 90 h of fieldwork (15 days) in one NAV office. Data were gathered from 2017 to 2019. The fieldwork took place in November and December 2017. The author observed meetings, work and everyday life within the NAV office, and followed employment specialists when they left the office to meet clients and employers in the local community. The project received ethical approval from the Norwegian Centre for Research Data as part of a larger research project [name omitted for blind review].

Case studies allow for an intensive, in-depth exploration of detail and richness (Stake, 1995). The study focuses on client and employment specialist experiences, activities and interactions within the standardised intervention, situated in a frontline service organisation that emphasised implementing the intervention with high quality under the fidelity framework. This can be viewed as a ‘critical case’ having ‘strategic importance in relation to the general problem’ (Flyvbjerg, 2006, p. 229) being studied – that is, the relation between evidence-based interventions and individualised follow-up practices. As such, the case was chosen not primarily for the representativeness of other NAV offices but for being a useful example of client–worker experiences and activities within a standardised intervention in a public frontline service context.

The purpose of the interviews was to understand the actors’ interpretations of the services and to gain an understanding of the world in which they live (Brinkmann & Kvale, 2014). Interviews with frontline workers and managers (i.e. 8 with employment specialists, 6 with counsellors, 2 with team supervisors and 2 with office managers) were conducted in March 2017, November and December 2017 and December 2018. Clients were interviewed in spring 2019 as part of additional data collection. The interviews were semi-structured, lasted 60–120 min, and all informants provided informed consent. All but one interview was recorded and transcribed. One client consented to participate but not to voice recording. In this interview, handwritten notes were taken. Interviews with the employment specialists involved work tasks and practices, interactions with clients and employers, professional competencies, collaboration and views on service development. These interviews were conducted in the NAV office. The material includes 6 interviews with employment specialists from the IPS team, and 2 from the in-house follow-up team. Interviews with supervisors and managers focused on experiences with service development, staff supervision and organisational processes.

The 12 clients comprised six men and six women, ranging from 20 to 57 years old. Clients were interviewed in their workplaces, in the NAV office and at home. Interview topics covered views regarding NAV services, their relationship with employment specialists, views on IPS services, positive and negative aspects of the services, general life situations and past work-life experiences. Clients were recruited through employment specialists, following the selection criteria provided by the researcher. To ensure variation, clients should have at least six months of service experience, represent varied problems and barriers (e.g. regarding mental and physical health, substance abuse, social issues, or language barriers), be both women and men of various ages, and have different views regarding the service. While most participants held positive views about the service, two participants could be characterised as mostly neutral and one as relatively critical. The participants had varied life situations and problems. At the time of the interviews, seven were unemployed and five were working, either full-time or part-time. Out of the 12 participants, 10 had received mental health treatment and had been referred by mental health services to the IPS. The remaining two informants received support from the in-house follow-up team and had been referred to the service by a counsellor within the office.

The data were examined, then coded and analysed in NVivo. The main focus of the analysis was on interviews with clients and employment specialists, while the other interviews and field notes mainly provided background information. To identify and analyse patterns in the data, the data were coded following the thematic analysis approach (Braun & Clarke, 2006), which involves first becoming familiar with the data, developing initial codes, and searching for and reviewing main themes. The identified codes and themes were developed inductively and bottom-up, as this was an explorative study. For the client interviews, this process led to the development of three main themes, namely ‘time’, ‘relation’ and ‘support’. As for the employment specialist data, the process resulted in the themes ‘flexibility’, ‘building relations’ and ‘organisational detachment’. These six themes are presented in the following results section. Each interview was assigned a code to make the statements attributable to informants while maintaining anonymity (CLI for client and EMP for employment specialist).

6. Findings

6.1. Client experiences with the intervention

6.1.1. Relationships

In line with studies examining client trajectories (Danneris, 2018; Nielsen et al., 2021), clients’ trajectories were nonlinear and characterised by ups and downs. The IPS approach involves a long-term follow-up. While six of the participants had received IPS services anywhere from six months to one year, six had been in the service for two to four years. When discussing the service, clients focused on their employment specialist and the specific relationship they developed. Out of the 12 informants, 10 described this relationship as supportive and empowering. Some informants were very enthusiastic when describing their specialists: ‘Always pleasant, always forthcoming, always about finding solutions. […] She made me believe in myself again, that there wasn’t anything wrong with me’ (CLI3). Many participants emphasised the personal connection as central to their processes: ‘You get a very close relation to the one you work with. […] I feel she has helped build me up again. […] This connection strengthens me, like a support’ (CLI6). Informants emphasised the importance of feeling seen and respected as a whole person with a history.

Informants also indicated that this support gave them increased self-confidence: ‘I was really stuck. […] She made me think in new ways, made me throw away the bad and ugly thoughts, and made me think I am actually good enough’ (CLI3). They mentioned better self-confidence and autonomy: ‘I feel she is a support person that enables me to help myself with those things, that I don’t always need her with me’ (CLI5). Informants also gained the confidence to expose themselves to new situations: ‘She gives me motivation and confidence, and if things don’t work out, that’s OK’ (CLI11). However, some clients preferred to keep this relationship work-oriented and not too casual: ‘We talk about finding work for me; the talk is not very personal’ (CLI1). The informants also distinguished between support and helper roles in their relationships with their specialists. One informant had a more difficult relationship with his employment specialist and felt distrusted.

6.1.2. Time

The clients described the follow-up processes in IPS as allowing patience and developments to unfold over time: ‘My experience (has) been that I control the tempo. […] They didn’t push me’ (CLI5). Informants viewed their employment specialist as understanding their ups and downs: ‘I feel IPS works with you and builds you up, rather than pressure you into something to get rid of you’ (CLI10). Out of the 12 participants, eight had experience receiving follow-up services from NAV. They contrasted IPS follow-up with regular NAV services: ‘The NAV I was used to, everything needed to happen so fast. They wanted me to push so much, when I felt I didn’t have capacity for it’ (CLI5). Informants spoke of processes that were rushed, forced and feeling like a case being processed.

A participant who had been depressed and burned out in previous jobs highlighted the gradual and supportive approach of IPS as central to her positive development:

A person you can trust, that you can talk to, who has time and the tools to bring you back into work. She’s like, ‘If that’s what you have the strength to do now, we do that. And that’s really good’. And what did I do that day? I managed to write two sentences on a paper about what I wanted to do. (CLI3)

One narrative that illustrates this patient, understanding approach can be found in a participant’s account about sitting in a car with his employment specialist and preparing for a job interview she had arranged. However, he was in a tight spot due to personal problems:

My employment specialist said, ‘I see that you’re not OK; do you want to drop this?’ I was like, ‘Well, you have to decide, but I’m not in top shape’. The plan was to have a meeting there [with the employer] for 45 min and drive half an hour back. But she called it off, and instead, we sat there [in the car] talking for two hours, only about me and the challenges I had. [… .] And this helped find solutions. That was so nice and really important for me, as I felt I was taken seriously for the first time. (CLI4)

This example demonstrates the service’s flexible character as the employment specialist rearranged her day to prioritise the situation.

6.1.3. Support

Participants emphasised the crucial support role that employment specialists played when facing challenging situations regarding work and employers. Job-seeking processes can be challenging to navigate, as important decisions must be made quickly under uncertain conditions. The employment specialists were experienced in brokering and negotiating with employers; some had experience as employers, themselves.

One participant was helped during a serious conflict with a manager. To avoid exhaustion after heavy work pressure, the participant took sick leave: ‘All hell broke loose. […] There were threats back and forth. […] He [the boss] was pissed that I had taken sick leave, but to protect my health, I had to do it’ (CLI10). The employment specialist supported the client in several meetings with the manager and made an agreement that ended the dispute:

I was totally exhausted and afraid I would go back to old habits, right. […] The support meant everything to me. For me, when I’ve met battles like that, I would just have said screw this, started taking drugs and made money in other ways. […] To have that support, to be able to deal with the situation and get through that period, it was the biggest and most valuable thing that had happened in my life in a very long time (CLI10).

Another participant had been to a job interview and leaned towards accepting the job to avoid disappointing the people around him, but upon seeing the room where he would work right after the interview, he got a bad feeling:

I got a job offer. […] I asked for some time to think. (Over) the weekend, I had a big relapse; there were many triggers similar to the situation that had gotten me sick in the first place. I felt I wouldn’t handle it. […] I talked with my employment specialist through the weekend, and she was so understanding. […] She helped me make the decision based on what was best for me. I ended up saying no. (CLI6)

Employment specialists also helped participants with NAV-related problems, which could involve taking the participants’ side and questioning the demands imposed by NAV counsellors:

I was very stressed at those collaboration meetings because the [NAV counsellor] constantly reminded me that my benefits would run out. So, I was just sitting there, saying, ‘But what can I do? I can’t work full-time’. I was so stressed, and [the employment specialist] noticed. […] When we finished the meeting, she said, ‘Don’t listen to that stuff right now. Just take things at your (own) tempo. We work the way we’ve done all the time and will continue doing that, and it will work out’. And it did. (CLI5)

Although they had limited knowledge about the NAV system, employment specialists sometimes acted as an advocate, for example trying to hasten processes, ensure that the client received relevant services and connect with other actors in the system that could help.

6.2. Employment specialist experiences with the intervention

6.2.1. Flexibility

Employment specialists helped clients through the challenges of their complex trajectories in and out of work. The intervention prescribed six phases of employment services: intake, engagement, assessment, job placement, job coaching and follow-up support. In practice, the unpredictable work required a flexible approach, moving back and forth between phases. Clients faced distinctive problems and situations: ‘I have 18 individuals and a large variation. […] Some have physical challenges. […] Others are almost ready to work and quite well, physically and mentally. And it’s everything from people with depression, bipolar disorder, some doing self-harm’. (EMP6)

Although the standardised intervention structured frontline work by defining employment service phases and tasks, key principles of the intervention opened a space for personalisation, agency and autonomy (e.g. fidelity scale points of individualised follow-along support, low caseloads and time-unlimited follow-up). The intervention script was translated into activities characterised by comprehensive, personalised follow-up. Employment specialists’ day-to-day work involved matching clients to employers, workplace support and collaboration with other professionals. Employment specialists did various activities with clients: ‘We meet participants where they are, join them in meetings, work with them, pick them up at work, drive them to work, right. We do a lot of things’ (EMP7). Employment specialists juggled many processes simultaneously involving clients and employers in diverse networks and constellations:

There’s so many balls up in the air. […] I have only 20 participants, but need to have a plan for everyone and go out (and) visit employers; this fills up the days. Doing some reporting in between. And suddenly, things happen; we’re dealing with people, right’. (EMP4)

Informants viewed work as varied, intense and demanding: ‘It’s a very intense job. […] I need to be on all the time’ (EMP5). Support activities could reach beyond office hours and into weekends: ‘I genuinely want to help and often stretch it far; sometimes, it feels like we’re on twenty-four-seven’ (EMP4). Because plans and arrangements frequently changed, there was a need to improvise and be flexible: ‘You need to be prepared for the unexpected’ (EMP7). The strong emphasis on client preferences and motivations could increase unpredictability.

‘You find a job that satisfies all the criteria the participant had. It’s served on a silver platter, but then they say no. […] You can get a bit fed up. It’s challenging to motivate yourself and go out there again. But that’s the job, to be able to reset’. (EMP6)

They experienced client follow-up work as demanding and emphasised the importance of motivation to cope: ‘It’s about being genuinely involved in the things I do. […] You need to be really committed to it’ (EMP4). A driver of this intensity was intervention performance measures specifying the use of time and activities (i.e. 65 percent of office hours should be spent in the community, including six face-to-face employer meetings each week, with 96 percent of office hours spent on employment services, limiting time spent on documentation tasks).

6.2.2. Building relationships

Unlike NAV counsellors meeting clients in the institutional setting of the NAV office, the intervention specified that employment specialists should meet clients in the community. Preferred places were cafes, clients’ homes, taking a walk together, in a car visiting employers or clients’ workplaces. These settings made social interaction friendlier: ‘You get a totally different conversation. […] The white walls and red signs [of the NAV office] represent a certain power; you don’t talk on the same level there as when you sit in a car together, listen to music and find some other references’ (EMP8).

Informants viewed a relational approach to clients as crucial for creating positive processes for work and for providing job support. This involved establishing trust, a safe atmosphere, and open communication: ‘Take them seriously and use a lot of humour and show that I’m there, that I understand and achieve this kind of trust-based relationship. I think that’s the key to get that flow’ (EMP7). This relational approach was also goal-oriented: ‘The intention is to get quicker (at) finding a job. To find a job, you got to have the relationship and get a lot of knowledge in a short time about the person’ (EMP8).

Employment specialists worked towards specific employers and workplaces. They worked to integrate their clients into workplace networks by connecting with relevant actors, learning about the workplace and embedding themselves in networks as supportive actors. To illustrate, one employment specialist helped a client with social anxiety and other diagnoses move from unemployment to full-time work. According to the intervention, the specialist started job development by visiting a potential employer several times. After persuading the employer, the client started working a few hours weekly. The employment specialist targeted improving the client’s social skills and working on relationships in the male-oriented workplace: ‘It’s really a boys’ kind of place, right. […] He didn’t understand the jokes’ (EMP5). Gradually, the client shifted to full-time work. The employment specialist emphasised the client’s relationships with colleagues: ‘Now, he’s one of the guys. […] The colleagues have been so good with him. They’ve accepted him for who he is, and that really makes a difference’ (EMP5).

6.2.3. Organisational detachment

While counsellors in the office followed organisational routines, procedures and requirements, employment specialists were exempt from these rules and followed intervention principles. The fidelity scale was central to their work. Informants contrasted their approach with normal ways of working in an organisation: ‘I think we’re experienced as a “breath of fresh air”’. […] We represent something else; we turn the mindset around’ (EMP8). Unlike counsellors, employment specialists in this office had scant experience with social services: ‘We don’t understand NAV tasks from the outset […] I think that’s an advantage in many ways because then you don’t do tasks you shouldn’t’. (EMP8). Regarding professional resources, they used knowledge from business, the private sector and the employer side, as they had backgrounds from these fields. This office’s hiring policy involved external recruitment, not transforming former counsellors into employment specialists.

Employment specialists also assumed an advocacy role on their clients’ behalf, sometimes opposing the counsellors. They problematised normal procedures and promoted an alternative approach: ‘It’s typical for counsellors to make choices for the clients. We focus on making participants choose themselves and give them opportunities’ (EMP6). Informants avoided reading existing documentation in client cases because they wanted to meet clients without pre-conceived notions. Although informants emphasised the importance of collaboration, integration problems occurred between groups of frontline workers. Both counsellors and employment specialists mentioned cultural differences, professional tensions and the IPS team as a separate ‘island in the organisation’.

7. Concluding discussion

This article examines client and frontline worker experiences and activities within a standardised, evidence-based intervention promoting individualised employment support. Clients developed rather strong relationships with their individual employment specialist. They were given time to experience individual processes and received work-oriented support through their difficulties. Clients contrasted these experiences with regular NAV services, which they characterised as stress-inducing, fast-paced and rigid. Generally positive client experiences are contextualised by examining employment specialists’ experiences and activities. They were characterised by flexibility, a strong relational approach to clients and detachment from normal organisational procedures. The case study foregrounds complex relational processes between frontline workers and clients also identified in previous literature (Danneris, 2018; Vukadin et al., 2021). While many service aspects were standardised (i.e. implemented with high fidelity), employment specialists approached individual clients in a flexible, personalised way. There was dynamic interplay between intervention scripts, frontline worker agency and individual clients (Koivisto, 2007).

These findings contribute to nuance discussions of evidence-based interventions and service individualisation. Previous studies have emphasised how evidence-based interventions limit service individualisation through proceduralism, formalisation and routinised interactions with clients (Dall & Danneris, 2019; Lauri, 2016; Petersén & Olsson, 2014). The findings suggest how interventions can promote personalised frontline practices responsive to individual needs and preferences. This aligns with IPS studies emphasising supportive relationships characterised by client engagement (Moen et al., 2020b; Nygren et al., 2016; Vukadin et al., 2021). Interventions differ concerning content, the detail of prescribed actions, how they balance fidelity and adaptation and how they are implemented (Ponnert & Svensson, 2016). While some interventions restrict individualisation, others promote it. The study also adds to the literature by illustrating how interventions can surpass organisational barriers constraining service individualisation identified in the literature (Fuertes & Lindsay, 2016; Hansen, 2020; Howard, 2012). Interventions can specify the necessary organisational conditions to enable one-on-one engagement. In this case, these conditions included low caseloads, task specialisation and detaching employment specialists from existing organisational procedures, mindsets and norms.

An implication of these findings concerns evidence-based interventions and professionalism in activation work (Van Berkel & Aa, 2012). While standardised interventions can be a professionalisation strategy in semi-professional fields like activation work (Nothdurfter, 2016; Ponnert & Svensson, 2016), findings indicate a need for additional professional resources when working within evidence-based interventions. Supporting clients with non-linear trajectories to gain employment was challenging, as studies have demonstrated (Danneris & Caswell, 2019; Nygren et al., 2016; Vukadin et al., 2021). Frontline workers used their employer and labour market knowledge extensively, but their lack of professional social work resources intensified the challenges of client follow-up work. There were struggles in establishing professional boundaries. Performance measures accentuated the high-intensity, high-pressure character of the work situation.

Different organisational contexts and policy settings can influence implementation processes (Bonfils et al., 2017). The organisational context of this study was public welfare services. The midsized NAV office was characterised by a community-oriented, trust-based organisational culture. Managerial authority was not strongly emphasised. Funding was sufficient because the office had acquired additional resources for employment specialist teams. Other governance structures and resource situations may influence service individualisation in varying ways, for example, by constraining frontline workers’ abilities to tailor to individuals’ needs and circumstances (Howard, 2012; Rice, 2017). Policy contexts may also influence implementation. Norway’s welfare system is characterised by enabling activation policies emphasising support and skills training to improve employability. However, interventions may be interpreted and implemented differently by actors in welfare settings with demanding policies, conditionality and sanctions.

Overall, this study provides an in-depth account of client experiences and interactions with frontline workers within a standardised intervention promoting service individualisation in a particular setting. A limitation is that only one standardised intervention in one setting was examined. However, this enabled an in-depth investigation into local dynamics and interactions. The findings related to detachment between the employment specialists and other frontline workers warrants further research. It would be interesting to examine how NAV offices cope with tensions caused by detachment. Further research could also examine how the demands related to additional professional resources and competence are handled in practice. Finally, an interesting avenue for further research would be to compare follow-up practices and client experiences with evidence-based interventions implemented in disparate organisational contexts and policy settings.

Ethics approval statement

Approval for the research project was granted by the Norwegian Ombudsman for Research at the Norwegian Centre for Research Data (NSD). Ref 52008.

Acknowledgements

The author would like to thank the editor and the anonymous referees, as well as Eric Breit, Tone Alm Andreassen, Chris Rønningstad, Gudrun Rudningen and Kjetil Frøyland for valuable comments on earlier drafts of the article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Research data are not shared in order to ensure anonymity of research participants and due to privacy restrictions.

Additional information

Funding

The study was financed by the project “Front line innovations in the welfare services” (INNOWEL), funded by the Research Council of Norway (project no. 256706).

Notes on contributors

Vidar Bakkeli

Vidar Bakkeli is a PhD fellow in social work and social policy at Oslomet – Oslo Metropolitan University in Norway. His PhD study focuses on activation work and implementation of evidence-based services. His research interests include innovation and development in social services, the relationship between knowledge and professional practice, and street-level bureaucracy.