From efficacy to effectiveness: case studies in unemployment research

There have been few attempts to implement and disseminate programmes to address the psychological health impact of unemployment despite the burden of this problem upon public health and health services. One approach that has demonstrated efficacy in promoting both psychological health and employment for this group is based upon the principles of cognitive behavioural therapy (CBT). We have been involved in three interventions based upon CBT to improve the psychological health of people who are unemployed, delivered through existing service structures in Australia: employment support agencies, general practice and mental health services. In this paper, we examine our experiences in conducting research within these service organizations using a framework for collaboration between researchers and services based upon intersectoral action. While effective collaboration can facilitate the implementation of research within systems, poor collaboration can impact upon the integrity of research designs. In our experience, it was the capacity of service organizations to address the psychological health impact of unemployment in particular that had a significant effect upon adoption of the intervention. Service organizations did not have structures to support the rigorous evaluation of interventions nor did they have funding arrangements that facilitated effective collaboration on research to address psychological issues. The dissemination of evidence-based interventions like CBT to populations of people who are unemployed in Australia is hindered by the absence of an accessible and appropriate system through which to address the psychological health impact of unemployment.