Supported employment (IPS) and vocational rehabilitation

1. Introduction

Version followed: IPS supported employment as the IPS Employment Center (Robert E. Drake, Gary R. Bond, Deborah R. Becker) publishes it: the eight practice principles (IPS Practice and Principles, Valerie Noel, page updated June 2024; PDF revision 6.2024) and the IPS Practice Principles presentation dated 28 January 2026; the 25-item IPS fidelity scale as given in the Centre for Mental Health UK version adapted by IPS Grow and the Connect to Work Expert Reference Group (which references the Supported Employment Fidelity Review Manual, Fourth Edition), checked against the US Supported Employment Fidelity Scale (IPS Employment Center, revised January 2008) and that manual (Becker, Swanson, Reese, Bond and McLeman, IPS Employment Center, December 2019); NICE CG178 and quality standard QS80 for UK guidance. Where the UK adaptation differs from the US scale this is flagged.

What it is. Individual Placement and Support (IPS) is a model of supported employment for people with serious mental illness (and, increasingly, other behavioural health conditions) who want to work. It was developed by Deborah Becker and Robert Drake (first described in A Working Life, 1993, per the IPS Employment Center), and its research base was built largely by Gary Bond with them; the three set out the model in Individual Placement and Support: An Evidence-Based Approach to Supported Employment (Oxford University Press, 2012). [source: IPS Practice Principles presentation 2026; OUP and IPS Employment Center book pages]

It is a service model, not a psychotherapy. IPS is delivered by employment specialists (also called IPS specialists) embedded in mental health teams, not by therapists. This guide is written for the psychotherapist working inside, or alongside, such a team: section 4 describes how IPS is delivered as its developers publish it (part A) and then the psychotherapist's own work (part B).

How change happens. IPS reverses the traditional "train, then place" logic: it places people rapidly in ordinary paid jobs in the community that match their preferences, then trains and supports them in the job for as long as they want. Work is treated as part of recovery and treatment, not as a reward for having recovered. [source: IPS Practice and Principles; Sainsbury Centre for Mental Health Briefing 37, 2009, which calls IPS "place-then-train"]

Who delivers, and regulation. The employment specialist is the core role; the IPS Employment Center offers an "IPS Certification" for practitioners [source: IPS Employment Center product page]. Employment specialist does not appear to be a statutorily registered profession in the UK or US [uncertain]. In the US, state Vocational Rehabilitation (VR) counsellors are partners; in the UK, Jobcentre Plus is the partner named in the UK fidelity scale. In England, referrals typically come from clinicians such as occupational therapists, advanced nurse practitioners and community mental health team staff [source: NHS England IPS page]. Occupational therapy, a registered profession in its own right, is covered in tab 056 Occupational therapy; read the two together, because OTs often hold the vocational brief in mental health teams.

2. Framework

Status (as of October 2026, per the sources named)

UK.

NICE CG178 Psychosis and schizophrenia in adults: prevention and management (2014), recommendation 1.5.8.1: offer supported employment programmes to adults with psychosis or schizophrenia who wish to find or return to work. NICE quality standard QS80, statement 5, turns this into a quality measure. QS80 defines supported employment programmes as "also called" IPS: any vocational approach that aims to place people in competitive employment immediately, with any preparation period under one month and no sheltered placements, training or transitional employment. For people unable to work or find work, services should consider other occupational or educational activities, including pre-vocational training. [source: NICE QS80 statement 5]
NHS England: the NHS Long Term Plan aimed for 55,000 people a year to access IPS by 2023/24; over 14,500 accessed it in 2020/21; delivery is by local IPS providers, often NHS trusts [source: NHS England IPS page].
IPS Grow: set up by Social Finance in 2019 as the national support system for the rollout of IPS into NHS mental health teams in England; it offers implementation support, training (including free e-learning), independent fidelity reviews with action plans, communities of practice and a quality mark; it reports supporting over 200 IPS teams to mobilise (page updated December 2025) [source: Social Finance IPS Grow page].
Centre for Mental Health publishes the UK IPS fidelity scale adapted by IPS Grow and the Connect to Work Expert Reference Group, and runs two-day IPS training for employment specialists in Connect to Work programmes (covering the eight principles, the 25-item fidelity scale, integration with treatment teams, benefits advice, vocational profiling, disclosure, employer engagement and in-work support) [source: Centre for Mental Health CtW fidelity scale; CMH training page]. The organisational relationship between IPS Grow and Centre for Mental Health is [uncertain: not verified]. Connect to Work extends IPS-style support beyond secondary mental health care to priority groups named in the scale (people with health conditions, care leavers, veterans, refugees, people experiencing homelessness); the programme's commissioning details are [uncertain: not verified].

US.

Mercer (September 2025) reports that 29 states have implemented IPS, funded through braided Vocational Rehabilitation and Medicaid funding (VR paying for activities such as work planning and employment assistance; Medicaid for rehabilitative skill-building), Medicaid 1915(i) and 1915(c) home- and community-based services options, 1115 SMI/SED demonstration waivers, and in-lieu-of services. H.R. 1 (signed 4 July 2025) requires states to implement Medicaid community engagement requirements for many members aged 19 to 64 in expansion or certain waiver coverage; Mercer describes IPS as one way to help people meet them. [source: Mercer, H.R. 1 Individual Placement and Support, 22 Sept 2025]
The IPS Employment Center runs an IPS Learning Community of participating states and offers training, consultation, certification and fidelity tools [source: IPS Employment Center pages; Learning Community membership details uncertain].

Where IPS sits among vocational rehabilitation models (brief)

Train-then-place models: clubhouse pre-vocational training and sheltered workshops emphasise extended preparation before open employment; the BJPsych meta-analysis argues they can delay the benefits of work and may add to exclusion, though they may suit some individuals [source: BJPsych meta-analysis].
Comparators in the IPS trials included traditional and enhanced vocational rehabilitation, group skills training, psychosocial rehabilitation, diversified placement, in-house vocational training and a graded work-adjusted approach leading to a set-aside job [source: BJPsych meta-analysis].
Transitional employment (time-limited placements, often via clubhouses) is explicitly excluded from NICE's definition of supported employment [source: NICE QS80].
Augmented IPS (IPS combined with cognitive remediation or skills training) is studied in trials [uncertain]; treat as an addition to, not a replacement for, high-fidelity IPS.
Peer specialist jobs count as competitive employment in IPS [source: IPS Practice Principles presentation 2026].

Structure of the service

An IPS unit has at least two employment specialists and one supervisor who meet weekly for client-based group supervision and cover each other's caseloads (fidelity item 7); a full-time specialist carries 20 or fewer active people (item 1) and spends at least 96% of time on employment services (item 2) and at least 65% of scheduled hours in the community (item 24). Specialists are "vocational generalists" who carry each person through all phases from intake to follow-along rather than handing them on (item 3). [source: CMH CtW fidelity scale; IPS presentation 2026]
Each specialist is attached to one or two clinical teams that supply 90 to 100% of their caseload (item 4) and is integrated through weekly person-focused team meetings, co-location and shared records (item 5). [source: CMH CtW fidelity scale] The US manual adds how item 5 is judged: the specialist attends weekly, and takes an active part in shared decisions at, the treatment-team meeting of any team that supplies three or more of their clients (at least twice a month for teams supplying one or two); administrative meetings and meetings about only one or two people do not count; where a team meets daily, one or two meetings a week earn credit [source: Supported Employment Fidelity Review Manual, 4th ed.].

Phases (the sequence a person moves through)

The US fidelity manual names the six phases that each employment specialist carries out as a vocational generalist: intake, engagement, assessment, job placement, job coaching and follow-along supports; only after these may a person step down to less intensive employment support from another mental health practitioner [source: Supported Employment Fidelity Review Manual, 4th ed., item 3]. The UK scale refers to the same "six IPS phases, from intake to follow-along". The stages in the table below group this work using the fidelity items and the practice principles [synthesis of sourced elements]:

Phase	Goal	Typical timing / format	Move on when
1. Referral and engagement	The person says they want to work; no readiness screen	First meeting soon after referral, in the community	The person chooses to continue
2. Career (vocational) profile	Preferences, strengths, work and education history, supports, disability-related factors	Profiling over 2 to 3 sessions, updated with each job (item 14)	Enough is known to start searching; profile keeps being updated
3. Benefits planning and disclosure decisions	Accurate personal information on how earnings affect benefits; a plan about telling employers	Before job start, revisited when hours or pay change (item 12); disclosure revisited at each stage (item 13)	Runs in parallel with search, not a gate
4. Rapid job search and job development	Face-to-face contact with employers matching the person's preferences	First employer contact within about 30 days of entry (item 15); at least 6 person-specific employer contacts per specialist per week (item 17)	A job offer the person wants
5. Job start and follow-along	Keep the job, grow in it	Contact within a week before and within 3 days after start; weekly in the first month; at least monthly for a year or more (item 23)	Steady work; after about a year of consistent work support may pass to the clinical team
6. Job ending, change or career development	Learn from each job; move to better jobs or education	Contact within 3 days of hearing of a job loss (item 23)	New search, education, or ending of IPS support by choice

There is no fixed session count: support is time-unlimited and individual. Format is one-to-one, mostly in the community (homes, libraries, workplaces, schools, parks). [source: CMH CtW fidelity scale; IPS presentation 2026]

3. Guiding principles

The eight principles, with their practical meaning for a therapist in the team [source: IPS Practice and Principles; IPS presentation 2026; meanings for therapists are synthesis]:

Focus on competitive employment. Ordinary paid jobs in the community (at least minimum wage, open to anyone) are a realistic goal; job carving is an accommodation and the job still counts. Meaning: do not steer people towards volunteering or sheltered work "first" as a step to readiness.
Eligibility based on client choice (zero exclusion). Wanting to work is the only criterion; readiness, diagnosis, symptoms, substance use, hospitalisation history, homelessness, disability level, legal involvement, medication choices, missed appointments and presentation are not grounds for exclusion. Meaning: never act as a gatekeeper; your clinical opinion about "readiness" is not a reason to delay referral.
Integration of employment and mental health services. Specialists are part of the clinical team. Meaning: attend and contribute to the weekly employment discussion; share relevant (consented) information.
Attention to worker preferences. Job type, hours, location and disclosure follow the person's choices; the 2026 presentation reports that people keep jobs longer when at least three of their preferences are met. Meaning: help the client articulate preferences rather than judging them realistic or not.
Personalised benefits counselling. Accurate, individual information about benefits (in the US, from a trained work-incentives coordinator; in the UK, from a trained planner using UK benefits rules). Meaning: name the fear about losing benefits, then route to the planner; never give benefits advice yourself.
Rapid job search. No lengthy assessment, training or counselling before searching; employer contact within about a month. Meaning: therapy runs alongside the job search, not before it.
Systematic job development. Specialists build relationships with employers chosen to fit job seekers' preferences. Meaning: this is the specialist's job; the therapist supports the person, not employer contact.
Time-unlimited, individualised support. In-work support lasts as long as the person wants and needs it. Meaning: coordinate on who supports what when work gets hard.

Further stance-shaping principles from the fidelity scale [source: CMH CtW fidelity scale]:

Community-based work (item 24): "life is out there" (2026 presentation); meet people where they are.
Assertive engagement (item 25): no discharge for missed appointments or fixed time limits; outreach is the team's shared job.
Ongoing, work-based assessment (item 14): people learn about themselves from real jobs; a job ending is information, not failure.
Disclosure is the person's decision and is revisited over time (item 13); specialists do not require disclosure to employers (Briefing 37).
Fidelity matters: services are reviewed on the 25-item scale (scored 25 to 125; exemplary 115 to 125, good 100 to 114, fair 74 to 99, 73 or below not IPS); the US scale uses the same 25 items and score bands [source: CMH CtW fidelity scale; US Supported Employment Fidelity Scale; Social Finance IPS Grow]. Higher fidelity is reported to go with better employment outcomes (Drake, Bond and Becker 2012, as summarised by the Mental Elf) [uncertain: secondary]; the BJPsych meta-analysis (Modini et al. 2016) included only moderate-to-high-fidelity IPS studies, so it does not itself test that link [source: Mental Elf summary of Modini et al. 2016].

4. Intervention inventory

Part A describes how IPS is delivered, as the IPS Employment Center and the fidelity scale publish it; these are the employment specialist's and team's tasks, described so the therapist knows what is happening and where to fit in. Part B covers the psychotherapist's own work in the integrated team. Example language is illustrative throughout.

Part A. How IPS is delivered

A1. Zero-exclusion referral and first meeting

Purpose / when: whenever a person in the team's care says they want to work, now or "some day" [source: IPS Practice and Principles; fidelity item 9].
Steps: (1) Any team member can refer; there is no waiting list or readiness screen (item 9). (2) The specialist meets the person soon, ideally in the community. (3) The two key questions are whether the person wants to work and what they want to do (Briefing 37). (4) Partner services are encouraged to promote competitive work and share employment rates (item 10).
Example language (illustrative, specialist): "You said you'd like a job. Let's start with what kind of work you'd enjoy."
Watch for: team members filtering referrals by who seems "stable"; the fidelity scale scores this down. Working when: referrals reflect everyone who expresses interest.

A2. Career profile and ongoing work-based assessment

Purpose / when: to understand preferences and what helps or hinders work, without a formal test battery; at the start and after every job [source: fidelity item 14; IPS presentation 2026].
Steps: (1) Over two or three meetings, gather preferences (type of work, hours, setting), strengths, skills, past work and education, what went well or badly in earlier jobs, disability-related factors, living situation and supports. (2) Use several sources (the person, the clinical team and records, family with consent). (3) Update it with each new job and analyse job outcomes. The IPS Employment Center publishes its own career profile materials, whose exact content is not reproduced here [uncertain].
Example language (illustrative): "In your last job, what made the good days good?"
Watch for: the profile turning into a prolonged assessment that delays search (breaks principle 6). Working when: the profile directly shapes which employers the specialist approaches.

A3. Personalised benefits counselling (work-incentives planning)

Purpose / when: fear of losing benefits is a major barrier; offered before job start and again when hours or pay change [source: fidelity item 12; principle 5].
Steps: (1) A specially trained planner (in the US a Community Work Incentives Coordinator; in the UK, using UK benefits calculators and Universal Credit rules) gives individual calculations. (2) Written earnings scenarios are kept in the record. (3) Help with using work incentive rules (e.g. US Impairment-Related Work Expenses), attending benefits appointments and reporting earnings. (4) Family can be involved if the person wishes. [source: IPS presentation 2026; CMH CtW fidelity scale]
Example language (illustrative): "Before you decide on hours, let's get a proper calculation of what you'd have each month."
Watch for: generic reassurance instead of personal figures; earnings not reported, leading to overpayments. Working when: the person can explain, in their own words, what happens to their income.

A4. Disclosure planning

Purpose / when: deciding whether, when, how and to whom to share information about a mental health condition with employers [source: fidelity item 13; Briefing 37].
Steps: (1) Discuss benefits and risks of disclosure, including what the specialist may say to employers. (2) The person decides; specialists do not require disclosure. (3) Revisit at each stage (job search, offer, start, difficulties, accommodation requests), whatever was decided before.
Example language (illustrative): "You can decide how much I say about our service when I talk to employers. Here are the options."
Watch for: the decision being treated as made once and for all. Working when: the person's choice is recorded and re-checked.

A5. Rapid job search

Purpose / when: start while motivation is high [source: principle 6; fidelity item 15; IPS presentation 2026].
Steps: (1) Arrange an in-person contact with a hiring manager (by specialist, job seeker or both) within about 30 days of the first meeting; programmes track this. (2) If the person is not yet ready to job search, frame employer contact as career exploration. (3) Education is supported as part of the plan if wanted.
Example language (illustrative): "Would you like to come with me to meet a manager at the garden centre, just to find out what the work involves?"
Watch for: "getting ready" activities (courses, CV polishing) replacing contact with employers. Working when: employer contacts happen within the month.

A6. Systematic job development with employers

Purpose / when: to create opportunities matching preferences, not to sell "any job" [source: principle 7; fidelity items 16 to 18; IPS presentation 2026].
Steps: a three-step process: (1) a short visit to introduce oneself and book a brief appointment with the manager; (2) a meeting to learn about the business, its jobs and the manager's hiring preferences; (3) a return visit to present a suitable candidate or keep building the relationship. Specialists aim for at least six person-specific face-to-face employer contacts a week, reviewed weekly by the supervisor; 90 to 100% of contacts should fit the person's preferences and plan. Job types and employers should be diverse (items 19 and 20), and competitive jobs offered almost always (item 21).
Example language (illustrative, specialist to employer): "I'd like to understand what you look for in a good new hire."
Watch for: reliance on online applications only, or repeated use of the same few employers. Working when: varied jobs with varied employers.

A7. Job start and individualised follow-along supports

Purpose / when: keeping and growing in the job [source: principle 8; fidelity items 22 and 23; IPS presentation 2026].
Steps: (1) Meet face to face within a week before the job starts and within three days after. (2) Contact at least weekly in the first month, then at least monthly for a year or more on average once work is steady. (3) Tailor supports to the job, preferences and history: examples given include wake-up calls, regular job check-ins, travel training, help getting tools or clothing, requesting accommodations, on-the-job coaching, supervisor feedback meetings, preparing for raises or promotions, and help reporting income. (4) Support the employer on request (with consent). (5) Support moves to better jobs, education or training. (6) After about a year of consistent work, a counsellor or case manager may take over support.
Example language (illustrative): "What's one thing about the job this week you'd want help with?"
Watch for: contact dropping off just after the job starts, the riskiest period. Working when: problems are spotted early and the person stays in or moves up from the job.

A8. Job loss and job change

Purpose / when: every job ending is a learning opportunity [source: fidelity items 14 and 23].
Steps: (1) Contact the person within three days of hearing of a job loss. (2) Review what was learned (preferences, supports, triggers) and update the profile. (3) Start a new search if the person wishes.
Example language (illustrative): "That job taught us something. What would you want to be different next time?"
Watch for: the team reading job loss as proof of "not ready". Working when: a new search starts promptly.

A9. Integration with the mental health team

Purpose / when: throughout; integration is one of the strongest structural features [source: principle 3; fidelity items 4 and 5; IPS presentation 2026; Briefing 37].
Steps: (1) Specialist attached to one or two clinical teams. (2) Weekly person-focused team meetings about employment, "not only for updates". (3) Shared office space and shared records. (4) Joint work on engagement and re-engagement. (5) The mental health team contributes clinical care such as medication review and social skills training (the 2026 presentation lists these). (6) The specialist is an equal team member who takes part in assessment meetings and referral decisions.
Example language (illustrative, in team meeting): "Three people on our list start jobs this month. What does each need from us?"
Watch for: the specialist working in a separate office or receiving referrals by form only. Working when: employment is a standing agenda item and clinicians bring work goals into care plans.

A10. Collaboration with Vocational Rehabilitation (US) or Jobcentre Plus (UK)

Purpose / when [synthesis]: keep the IPS team and the state or national employment service working to one plan; relevant whenever a person is also known to VR or Jobcentre Plus.
Steps: US: monthly meetings with VR counsellors to solve individual cases; IPS programmes can be VR vendors [source: IPS presentation 2026]; the US scale's top score requires face-to-face meetings with VR counsellors at least monthly plus weekly client-related contacts (US item 6) [source: US Supported Employment Fidelity Scale]. UK version: scheduled face-to-face meetings with Jobcentre Plus at least monthly plus weekly person-related contact (UK item 6) [source: CMH CtW fidelity scale].
Example language (illustrative): "Can we look together at what each of us is covering for her?"
Watch for: duplicated or conflicting job plans. Working when: one shared plan.

A11. Assertive engagement and outreach

Purpose / when: when people miss appointments or drop out [source: fidelity item 25].
Steps: six strategies: no ending of service for missed appointments or fixed time limits; systematic documentation of outreach; outreach by integrated team members; multiple home or community visits; coordinated visits with team members; family contact where appropriate.
Example language (illustrative): "I've missed you the last two weeks. Is a job still something you want?"
Watch for: pressure that feels coercive. Working when: people return without having to "start again".

A12. Family involvement

Purpose / when [synthesis]: bring in family or other supporters for practical job support when the person asks for it.
Steps: only at the person's request; family meetings focus on job matches and job supports, not clinical issues; avoid adding stress on the family [source: IPS presentation 2026].
Example language (illustrative): "Would it help if your sister came, so she knows what the new job involves?"
Watch for: families drawn into clinical discussions. Working when: family support is practical.

A13. Career development and supported education

Purpose / when [synthesis]: support education or training when it serves the person's own career goal, rather than as a hurdle before work.
Steps: education or training linked to a career goal counts as a support; supported education and IPS for young adults are named as current directions [source: IPS presentation 2026; IPS Practice and Principles].
Example language (illustrative): "Is there a course that would get you closer to the job you really want?"
Watch for: education used as a long pre-employment delay against the person's wishes. Working when: education follows the person's career goal.

A14. Supervision and fidelity review

Purpose / when [synthesis]: keep the service close to the IPS model over time; relevant to you when your team is reviewed or when you attend joint supervision.
Steps: the IPS supervisor leads weekly client-based group supervision, reviews employer contacts and outcomes quarterly and sets goals (items 7 and 8); executive leadership supports the programme (item 11); independent reviews score the 25 items and produce an action plan [source: CMH CtW fidelity scale; Social Finance IPS Grow]. In the US manual, a review uses at least two raters (no more than four) for at least 1.5 days on site: they observe treatment-team and IPS-unit meetings; interview executives, supervisors, IPS specialists, a psychiatrist or medical director, a VR counsellor, clients and family members, and at least three case managers or therapists individually (about 30 minutes each, with open questions about actual rather than intended practice); and review at least 10 client records. Raters score independently, agree scores within a week and send the report within two to three weeks; a new programme's baseline review comes six to nine months after start-up. If you are a therapist on the team, expect to be interviewed and to have your team meeting observed [source: Supported Employment Fidelity Review Manual, 4th ed.; last sentence synthesis].
Example language (illustrative): "Our fidelity review flagged that clinical and employment staff meet less than weekly. Could we put a standing slot in the diary?"
Watch for: fidelity drift as teams grow. Working when: scores and employment rates are shared with clinical teams.

Part B. The psychotherapist's work in an integrated IPS team

The IPS sources define the clinical team's role in general terms (integration, weekly meetings, shared engagement work, helping people manage their mental health at work); the specific therapist procedures below are [synthesis] built on those sourced roles unless a source is tagged.

B1. Asking about work and referring without gatekeeping

Purpose / when: at assessment and at every care-plan review; zero exclusion means the clinician's job is to ask and refer, not to judge readiness [source: principle 2; Briefing 37 on co-location reducing the screening-out of people seen as "not work-ready"].
Steps: (1) Ask every client of working age whether they would like a job, a different job or education. (2) If yes, or "maybe", offer a meeting with the employment specialist now. (3) Record the work goal in the care or therapy plan. (4) Do not make referral conditional on symptom change, abstinence or finishing a therapy phase.
Example language (illustrative): "Some people I see find work is part of getting better, not something that has to wait. Would you like to meet our employment specialist?"
Watch for: your own protective reluctance ("work will stress them"). Working when: clients hear the work question from you early, and referrals are not filtered.

B2. Contributing to the weekly integrated team meeting

Purpose / when: weekly; this is the integration mechanism fidelity reviews look for [source: fidelity item 5; IPS presentation 2026].
Steps: (1) With the client's consent, share what bears on work: strengths, coping strategies that work, early warning signs, what support style helps. (2) Agree who does what (specialist: job search, employer contact, benefits referral; therapist: psychological work on fears, symptom coping, disclosure feelings). (3) Bring problem-solving ideas, not just updates. (4) Record decisions in the shared record.
Example language (illustrative): "He's anxious about interviews but does well when he rehearses the opening. Could you build in a practice run before Thursday?"
Watch for: sharing more than the client agreed to; confidentiality rules for therapy notes apply. Working when: plans are joint and the client recognises them.

B3. Working with ambivalence and fear about work

Purpose / when: when a client wants work but fears failure, stigma, symptom relapse or losing benefits.
Steps: (1) Explore what work would mean to them and what worries them, without arguing for work. (2) Separate practical fears (benefits, travel) from emotional ones (shame, past failures). (3) Route practical ones: benefits to the planner (A3), job fit to the specialist. (4) Work psychologically on the emotional ones with your usual methods (e.g. cognitive work on predictions, compassion-focused work on shame). (5) Respect a decision not to work now; keep the door open.
Example language (illustrative): "Part of you wants this and part of you is braced for it going wrong. Can we hear from both?"
Watch for: turning ambivalence work into a pre-employment "readiness" phase, which conflicts with rapid job search. Working when: fears are addressed while the search goes on.

B4. Supporting disclosure decisions

Purpose / when: alongside A4; disclosure is the person's decision and revisited at each stage [source: fidelity item 13].
Steps: (1) Help the client weigh what they want an employer to know, why, and the feelings attached (shame, relief, fear of discrimination). (2) Help them rehearse wording for whichever choice they make. (3) Hand practical questions about accommodations to the specialist. (4) Revisit after job start and when problems arise. Legal rights to reasonable adjustments differ by country; refer to the specialist or an adviser [uncertain: legal detail varies by country].
Example language (illustrative): "If you did tell your manager something, what would be the least you'd want to say?"
Watch for: your own view on disclosure leaking into the decision. Working when: the client can state their choice and reasons.

B5. Preparing for interviews and the first days at work

Purpose / when: before interviews and job start, the high-risk transition [synthesis aligned with item 23's emphasis on contact around job start].
Steps: (1) Identify the specific feared moments (introductions, questions about gaps in work history, breaks with colleagues). (2) Rehearse in session through role-play; graded rehearsal is an exposure-style method, so explain the rationale, get consent, let the client set the pace and stop on request. (3) Plan coping steps for the day (sleep, travel, what to do if anxiety spikes). (4) Coordinate with the specialist's pre-start and three-day contacts.
Example language (illustrative): "Let's practise the answer to 'tell me about yourself' until it feels more like yours."
Watch for: avoidance increasing as the date nears; panic or dissociation in rehearsal (slow down). Working when: the client attends the interview or starts the job.

B6. Managing symptoms and stress at work

Purpose / when: once working; clinicians help people manage their mental health at work [source: Briefing 37].
Steps: (1) Build a work-specific early-warning plan: signs (sleep change, irritability, hearing voices more at work), what helps, who to tell. (2) Problem-solve concrete workplace triggers (a critical supervisor, shift changes). (3) Agree with the client what the specialist can raise with the employer. (4) Adjust therapy timing to fit working hours.
Example language (illustrative): "What would be the first sign that work is starting to get on top of you, and what would you want us to do then?"
Watch for: the client hiding difficulties to protect the job. Working when: problems are named early and the job is kept or changed by choice.

B7. Benefits worries: naming and routing

Purpose / when: whenever benefits come up [source: principle 5].
Steps: (1) Acknowledge the anxiety. (2) Do not estimate entitlements or give rules. (3) Route to the trained planner and support the client to attend. (4) Work on the anxiety itself if it persists after accurate information.
Example language (illustrative): "That's a real worry, and it deserves exact figures, not guesses from me. Can we book you in with the benefits planner?"
Watch for: informal advice from staff without specialist training. Working when: the client has a personal calculation and acts on it.

B8. Medication, side effects and medical review

Purpose / when: when sedation, side effects or symptom changes affect work; the mental health team handles medication review [source: IPS presentation 2026 lists medication adjustments as a team role].
Steps: (1) Ask how medication and symptoms affect work (mornings, concentration). (2) Pass concerns, with consent, to the prescriber. (3) Never suggest starting, stopping or changing a medicine. (4) Medication choices are not a reason for exclusion from IPS (presentation 2026).
Example language (illustrative): "Feeling slowed down in the mornings is worth raising with your prescriber. Would you like me to let them know?"
Watch for: clients altering medication on their own to cope with work. Working when: the prescriber is informed and the client feels heard.

B9. Crisis and safety planning around work

Purpose / when: when job loss, workplace conflict or rejection raises risk.
Steps: (1) Ask directly about suicidal thoughts and self-harm after setbacks, using your service's standard risk assessment. (2) Update the safety plan with work-related triggers and contacts. (3) Inform the team through usual routes. (4) Coordinate so that the specialist's three-day contact after job loss (item 23) is joined by clinical follow-up.
Example language (illustrative): "Losing a job can hit very hard. Have you had thoughts of harming yourself or ending your life since it happened?"
Watch for: setbacks followed by withdrawal. Working when: risk is assessed and the person re-engages.

B10. Processing job endings and re-engagement

Purpose / when: after a job ends (A8), or when a client drops out of IPS (A11).
Steps: (1) Help the client make sense of what happened without self-blame, drawing out what was learned about preferences and needs. (2) Feed this, with consent, into the updated career profile. (3) Join coordinated outreach visits if appropriate (item 25).
Example language (illustrative): "What did that job tell you about the kind of work that suits you?"
Watch for: the team concluding "not ready". Working when: a new search or education plan begins.

B11. Integrating therapy over the long run and after IPS support ends

Purpose / when: steady work; after about a year of consistent work, support may move to the clinical team (presentation 2026).
Steps: (1) Agree with the specialist which job supports you or the case manager will take over. (2) Shift therapy goals towards longer-term growth (career development, relationships at work, self-esteem). (3) Plan how the client can return to the specialist (support is time-unlimited).
Example language (illustrative): "You've held this job for a year. What would you like work to look like in two years?"
Watch for: abrupt loss of support at handover. Working when: the client knows who to call and keeps progressing.

5. Handling problems

Sourced responses are tagged; the rest is [synthesis].

Clinician says the client is "not ready". IPS sources reject readiness criteria (principle 2; fidelity item 9) and Briefing 37 notes that co-location reduces this screening-out. Response: refer anyway; bring specific concerns to the weekly meeting as support needs (e.g. "needs help with mornings"), not as reasons to wait. [source: IPS Practice and Principles; Briefing 37]
Client keeps missing appointments. Do not discharge; use the team's outreach strategies (item 25): home or community visits, coordinated visits, family contact if the person wants. In therapy, ask what makes attending hard and whether the job goal is still theirs. [source: CMH CtW fidelity scale; synthesis for the therapy part]
Stuck in preparation. If months pass in CV work or courses, check whether the client is avoiding employer contact. Name it gently and work with the avoidance; ask the specialist to arrange a low-stakes employer visit framed as career exploration (presentation 2026). [synthesis + source]
Overwhelm after starting work. Increase contact early (the first month is the period of weekly contact in item 23); break problems into one or two actionable steps; ask the specialist about accommodations or a temporary change of hours via the employer, with consent; route symptom changes to the prescriber. [synthesis + source]
Benefits panic. Stop guessing; arrange a personal calculation (A3). If anxiety persists after accurate figures, treat it as anxiety. [synthesis]
Client chooses a job the team thinks unrealistic. Preferences drive the search (principle 4); work-based assessment means the job itself teaches. Explore what draws them to it and look for related jobs with the same appeal. [source + synthesis]
Client wants to work but family is opposed. Offer a family meeting focused on job match and supports, only if the client wishes, avoiding clinical topics (presentation 2026); in therapy, explore the client's own wishes and the family's fears. [source + synthesis]
Rupture over the therapist's stance. A client who senses you doubt them may stop sharing work problems. Acknowledge it openly, restate that the choice is theirs, and separate your clinical concern from any judgement of their ability. [synthesis]
Disclosure regret. If a client disclosed and now feels exposed, or did not and now struggles to ask for adjustments, revisit the decision (item 13); help them decide the next step rather than relitigating the past. [source + synthesis]
Job loss followed by low mood or risk. Assess risk directly; update the safety plan; coordinate with the specialist's three-day contact (item 23) and start a new search when the client wants. [source + synthesis]
Active substance use or housing crisis. Neither excludes the person (principle 2; presentation 2026). Work on substance use and housing alongside job search, coordinating through the team. [source + synthesis]
Low-fidelity service (specialist in a separate building, no weekly meetings, long waits): raise it with team leadership; the 25-item scale gives concrete targets, and IPS Grow (England) or the IPS Employment Center (US) provide fidelity reviews. [source: CMH CtW fidelity scale; Social Finance IPS Grow; IPS Employment Center]
Confidentiality tension between therapy notes and shared IPS records: agree in advance with the client what is shared, in what form, and keep detailed therapy content in the therapy record as your service's rules require. [synthesis]
Client not eligible for an NHS IPS service (e.g. not under secondary mental health care in England): look for local IPS in primary care or Connect to Work programmes, or other employment support [uncertain: local eligibility rules vary].

For the occupational therapy perspective on work and occupation, and on vocational assessment by a registered profession, see tab 056 Occupational therapy.

Sources

Books and guidance cited:

Drake, R. E., Bond, G. R., and Becker, D. R. (2012). Individual Placement and Support: An Evidence-Based Approach to Supported Employment. Oxford University Press. DOI 10.1093/acprof:oso/9780199734016.001.0001.
Becker, D. R., and Drake, R. E. (1993). A Working Life (as cited by the IPS Employment Center; publication details [uncertain]).
NICE (2014). CG178 Psychosis and schizophrenia in adults: prevention and management, recommendation 1.5.8.1 (as cited in QS80).
Becker, D. R., Swanson, S. J., Reese, S. L., Bond, G. R., and McLeman, B. M. (2019). Supported Employment Fidelity Review Manual (4th ed.). IPS Employment Center, The Rockville Institute, Westat.

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