Individual Placement Models

The individual placement model is the most individualized approach to SE. In this model, a job coach works with an individual to identify and achieve the person's vocational goal. The services used to achieve this goal will differ depending on the client's needs and wishes as well as the agencies' approach.

The best-defined examples of the individual placement model for people with mental illness are the individual placement and support approach (IPS) articulated by the New Hampshire-Dartmouth Psychiatric Research Center (Becker & Drake, 1994, 2003) and the Choose-Get-Keep approach articulated by Boston University Center for Psychiatric Rehabilitation (Danley & Anthony, 1987; Danley, Sciarappa, & MacDonald-Wilson, 1992; MacDonald-Wilson, Mancuso, Danley, & Anthony, 1989). Both of these approaches emphasize competitive employment based on the preferences of the individual and the importance of ongoing support. The IPS approach further emphasizes rapid job search and the integration of vocational and clinical services, whereas the Choose-Get-Keep approach provides skill development in career planning activities. Although the two approaches have many similarities, which are described here, research has consistently found the IPS approach to be superior in achieving employment outcomes (Bond, 2004).

Both IPS and Choose-Get-Keep engage the client and the significant people in the client's life in identifying the person's skills, preferences, interests, resources, and support needs and then match these to a job and work setting. In the Choose-Get-Keep approach, this is done in the choose phase. By examining past experiences, the person is helped to identify and objectify those personal values and skills that will impact on the person's success and satisfaction in employment. Clients are helped to identify the skills they have developed through previous experiences and also their reactions to those experiences to illuminate their likes and dislikes, preferences, interests, and support needs. This leads to the development of a career goal and a plan for developing or acquiring the skills and resources necessary for success. (In some cases, the chosen career requires more credentials than the person has and may lead the person to seek training or education. Supported education, a strategy to provide people with the educational background they need, is discussed in Chapter 10.) Job development, which also occurs in the choose phase, is based on the skills and values of the individual. Significant people in the client's life are engaged in supporting the goal that the client has articulated (MacDonald-Wilson et al., 1989).

In the IPS approach these tasks are accomplished in the engagement and vocational assessment stages. This approach emphasizes rapid entry into employment and the need to do continual assessment after the client has gotten her or his first job, using each job to gain new information about skills, preferences, and personal style. In both the get phase of the Choose-Get-Keep approach and the obtaining employment stage of the IPS approach, the client is given the support needed and desired to obtain a job.

The keep phase of the Choose-Get-Keep approach and the job support stage of the IPS approach involve activities that identify and ensure access to adequate and ongoing support to promote successful and satisfying employment. Some supports may be in the area of learning new skills, learning to use skills in a new setting, accessing needed services, or arranging for environmental modifications. Supports are available on or off the job site and address not only meeting the requirements of the new job or adjusting to the workplace but also coaching and support in the area of interpersonal interactions. In some cases the job coach accompanies the new worker to the job for a period of time. In this case, the job coach may be providing support in mastering the job, negotiating accommodations, and also in fitting into the workplace and developing relationships with coworkers.

If the job coach provides some of the job training for the worker, it is usually because the worker requires more training than the employer typically provides. It is least stigmatizing for the supported employee to access the same training that is available to all workers in that setting. Often the support is provided off the job site. This may include supportive counseling, problem solving, and even role-playing of difficult interactions. Support provided is not limited to work issues but will include any area of the person's life that affects successful employment. For example, a job coach may assist a supported employee in negotiating a different psychiatric appointment schedule if the current one conflicts with his or her work schedule.

Ideally the job coach is not the sole means of support but has worked with the supported employee to identify and develop a support network. The network may include family, friends, counselors, coworkers, or anyone the client chooses. In fact, there has recently been greater emphasis placed on using "natural supports"; that is, those people or things that are naturally present in the setting. Not only is this usually less stigmatizing, but it is also frequently more effective. Most workplaces and workers in that setting have developed ways of supporting each other. The supported employee should be assisted in accessing those supports and in contributing support to others. It is important that the supported employee hold a valued role as a participant and contributor in the work setting. The level, type, and frequency of support needed by the supported employee may change over time and the support provided should change accordingly.

The IPS approach emphasizes the integration of vocational services and clinical services. This means that the vocational counselor or job coach works as part of the clinical team. In this approach, the clinical team then becomes an important part of the supported employees' support network. In fact, studies show that this vocational/clinical integration is one of the critical factors in positive employment outcomes (Drake, Becker, Bond, & Mueser, 2003).

Recently the Choose-Get-Keep approach was changed to the Choose-Get-Keep-Leave approach, recognizing the importance of assisting people in leaving a job in a way that contributes to future successes (http://www.bu.edu/cpr).

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