Organizing for Outcomes: Links between service integration and transitions to employment for citizens with complex service needs

For people who need help from multiple services, coordination will presumptively make it easier to enter or return to the labour market. Work-oriented efforts should therefore be combined with, for example, treatment, rehabilitation, housing, or education. In the project Organizing for outcome (O4O), we examine whether such assumptions are supported by empirical research. We try out different methodological approaches and research designs that take into account that similar outcomes may result from different ways of organising the services, and that conditions in the environment can be important. In collaboration with Aalborg University and Stockholm University, we compare Norway with Sweden and Denmark that have organized their services differently. The first published study from O4O analysed the trajectories of young recipients of a temporary incapacity benefit (the Work Assessment Allowance, WAA) from 2010 to 2014. Results showed that some entered employment and earned a decent income, although the paths were neither straightforward nor without setbacks such as periods of sickness absence. Some pathways led to permanent disability pension. Other pathways were characterized by shifts between low paid jobs, benefit recipience, and job-seeking. For more than half of the WAA recipients, the entire four-year period was marked by stable receipt of WAA, for some in combination with labour market measures, for others without any work-oriented activity, possibly with some form of treatment in the health service. For most, these trajectories do not seem to bring them closer to working life. Given their complex problems – poor health, low education and weak attachment to working life – there might have been coordination problems involved. Another article from the project used register data to compare Bergen municipality that in 2020 raised its social assistance rates above governmental guidelines, with nine other cities that did not raise the rates accordingly. The results showed that the increase in social assistance rates had no effect on the social assistance recipients' participation in work. The increase also did not lead to an increase in the number of social assistance recipients or an increase in the duration of receipt of social assistance, as one might assume given that the recipients could receive more support. For some groups, however, the outcome was reduced activity in the labour market and reduced incomes. This applied to families with children, non-Western immigrants and non-Western immigrant families with children. These groups have few real choices as their situation is characterized by health problems, language barriers, care tasks, lack of qualifications, little work experience, and weak opportunities in the labour market. Their complex challenges indicate that comprehensive and coordinated efforts are needed if alternatives to social assistance are to be realistic. We analyse service coordination in a study of the local organization around vulnerable young people who are at risk of dropping out of education and work (NEETs). The study is designed to be comparable to a similar study in Sweden. Based on register data, we have selected municipalities with relatively more or relatively fewer young people at risk of being in a NEET situation than the known risk factors would indicate. In these municipalities we have interviewed employees from organisations providing services to young people, such as the Labour and Welfare Service (NAV), municipal health services and the Follow-up Service in upper secondary schools. The first analysis, based on interviews with managers in local NAV offices, showed that there are differences in how the managers assess the NAV office's role in working with young people, including which age group they target and whether they work preventively or not. The analysis showed that some offices took a proactive approach and engaged with the young people at an early stage in order to prevent exclusion. Other offices took a reactive approach and engaged with the young people only when they were old enough to be entitled to financial benefits or labour market measures. Ongoing analyses indicate that outcomes for the young people are affected by what role the NAV office takes, and how the services collectively handle the fact that they represent different regulations, tasks and measures, and whether they manage to establish a common ground despite these the differences. A similar study from Sweden showed that, in addition to paying attention to all groups of vulnerable young people, it was crucial that the services had a common understanding of the young people's problems and how the services should work to resolve them.

Service integration is assumed to enhance employment outcomes for citizens with multiple service needs because to this group employment services must be provided in conjunction with other services. So far, research on service integration has mainly studied factors, activities and processes of integration and collaboration. The outcomes of service integration tend to be “under-evidenced” because of its complexity and context dependability. The O4O project aims to investigate causal links between organizing of service delivery and employment outcomes among groups with complex service needs, taking into consideration that varying configurations of service integration can contribute to outcomes, and that contextual conditions can affect which service configurations that are put into operation. To study the impact of service integration the project includes comparisons with Sweden and Denmark with different organizational setup of services. The project comprises researchers from OsloMet - Oslo Metropolitan University, and partners from University of Stockholm, University of Aalborg and University of Stockholm. Studying the links between organizing of service delivery and employment outcomes represents a challenging innovation, as does the project’s linking and combination of high-quality data pertaining to different levels, across time and from a variety of sources, and application of a variety of methodological approaches. Though revealing the link between organizing and outcomes, the project will provide valuable knowledge for present and future organizations to create more effective and sustainable public services and strengthening the international orientation of services research. Ultimately, if successful, the project will improve welfare and employment outcomes of individual service users.