Individual Placement And Support Programs Research Articles

Supporting education with ips: Advancing a career-oriented model for integrating work and study support for young adults in sweden.

Supported education (SEd) provides individualized support to people with mental health problems to achieve their educational goals. Individual placement and support (IPS) has emerged as a model through which SEd may be efficiently delivered. However, the components and characteristics of educational support for these employment-focused services have not been fully explored. Building on earlier studies, we constructed a preliminary model of SEd components that integrated with the IPS model. The SEd model included the eight original principles of IPS, developed to reflect the SEd component, and two new principles were suggested. The aim of the study is to investigate these adapted principles by exploring the feasibility of applying them within established IPS programs providing both employment and educational services. An organizational learning approach was taken, involving five IPS programs providing both employment and educational services to young adults with mental health problems. Data were collected through focus groups, interviews, and workshops with 19 IPS specialists. The results suggest that while the IPS principles provide a feasible and relevant structure for the development and provision of integrated services, adaptations that reflect the educational context were considered valuable when supporting young adults in pursuing their career-related goals. The respondents confirmed that the SEd principles and the focus on support in educational contexts helped them to further develop their knowledge and strategies. While challenging, integrating SEd in IPS models shows good potential for supporting young adults as they struggle to reach longer term career-oriented goals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluation of Individual Placement and Support at Three Community Mental Health Centers in California.

Individual Placement and Support (IPS) has been shown to effectively help people with serious mental illness obtain competitive employment, and IPS programs have been established in over 40 U.S. states and at least 20 other countries. As this expansion continues, the field needs data describing IPS implementation, clients, fidelity, and outcomes in real-world, non-research settings, specifically regarding racial and ethnic disparities and young adults. The goal of this study was to observe the initial three years of IPS implementation, measuring fidelity, client characteristics, and employment outcomes in three mental health agencies in one California county.In 2018, officials in one California county contracted with the IPS Center to provide training and measure IPS program fidelity at three mental health agencies in a large urban area. The goal was to establish and maintain IPS programs with good fidelity and effectiveness. After an initial year of preparation, three mental health programs recruited unemployed clients with interest in employment and implemented IPS. An IPS trainer provided initial training, ongoing consultation, and measured program fidelity. The program clinicians documented client characteristics, IPS service use, and quarterly employment throughout 13 quarters.The project followed 351 mental health clients as they participated in three new supported employment programs over a three-year period. The average client age was 36 years, including 107 (31%) young adults (ages 18-25) and 244 older adults (ages 26+); 177 (50%) identified their gender as female, 173 as male, and 1 as other or declined to answer; 119 (36%) identified as Hispanic, 116 (35%) as non-Hispanic White, 42 (13%) as non-Hispanic Asian, 35 (11%) as non-Hispanic Black, and 20 (6%) as other non-Hispanic. Most clients (78%) had diagnoses of non-psychotic conditions such as anxiety or depression, and 22% had diagnoses of schizophrenia, schizoaffective, or other psychotic disorder. During the project, 312 (87%) engaged in supported employment services, 206 (58%) attained competitive employment, and 177 (50%) found their first job within nine months of enrolling. Hispanics (64%), Asians (57%), and non-Hispanic Blacks (77%) achieved higher employment rates than non-Hispanic Whites (49%). Young adults (73%) achieved higher employment rates than older adults (51%).Engaging in new IPS supported employment programs over several months led to high rates of competitive employment across all groups in real-world, non-research settings, typically within nine months. Hispanics, Asians, and non-Hispanic Blacks achieved higher rates of competitive employment than non-Hispanic Whites, and young adults achieved higher rates than older adults. Further research may explain these differences.

Individual placement and support: History, current status, and future directions

AbstractOver the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence‐based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost‐effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta‐analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high‐income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high‐income countries and spreading slowly to middle‐income countries. IPS is an evidence‐based practice for people with serious mental illness in high‐income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.

Influence of multi-aspect job preference matching on job tenure for people with mental disorders in supported employment programs in Japan.

This study examined the association between job tenure and job preference matching for five job preference domains for people with mental disorders enrolled in Individual Placement and Support (IPS) programs in Japan. The domains include occupation type, monthly income, weekly work hours, commute time, and illness disclosure. We conducted secondary analysis of participants who obtained employment in a longitudinal study during the 24-month follow-up period at 16 agencies routinely providing IPS programs. We included 112 participants who expressed job preferences and were employed at least once. A total of 130 employment cases were analyzed. Matches in the five domains were determined using participants' job preferences and employment information. The Match Level (0-5) indicates the number of domains that match the participant's job preferences. Job tenure (weeks worked) was compared between the matched and unmatched groups in each domain and between each match levels using linear regression mixed-effects models. A match for a given domain did not show a significant relationship with job tenure, whereas Match Levels 3 (B = 29.6, 95% CI [10.8, 48.4], p = .003) and 4 (B = 37.0, 95% CI [17.1, 56.9], p < .001) had a significantly longer tenure than those with Match Level 1. A higher match level may be related to a longer job tenure. The results suggest that employment specialists should prioritize clients' preferences in job searches. Further replication studies in other settings and countries should be conducted to verify the findings in this study. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impacts of Individual Placement and Support (IPS) program of supported employment on employment and psychosocial well-being among individuals with severe mental illness

IntroductionMental health problems increase the risk for unstable career paths and often lead to early transition to disability pensions. Individual Placement and Support (IPS) is an evidence-based program integrated into psychiatric care helping individuals with serious mental illness to find competitive employment. It comprises personalized job search as well as individual in-work support for both the employee and the employer.ObjectivesThe Finnish Individual Placement and Support Evaluation Study (2020-2023) aims at investigating the implementation, feasibility as well as perceived benefits and outcomes of the IPS program implemented for the first time broadly in Finland. The present study focuses on the changes observed among program participants in employment status and psychosocial well-being during the 6- and 12-months follow-ups.MethodsBoth quantitative and qualitative data from different stakeholders have been and will be collected. The data collection will be finished at the end of 2022. The presentation focuses on findings from interviews (n=31) and from questionnaire data collected among program participants at baseline and at 6- and 12-months follow-ups. The total sample will comprise approximately 300 program participants (18−64 years of age) diagnosed with a severe mental illness.ResultsFindings on changes in employment status as well as in psychosocial well-being (self-rated health and work ability, mental distress, positive mental health, self-esteem, satisfaction with life, social inclusion, and perceived social support) will be discussed at the congress. The preliminary findings of the study show that about half of the program participants have succeeded in getting employed at least once during the follow-up. However, becoming employed does not always result in increased psychosocial well-being. Work-related stress, meaningless or unsuitable job, problems at the workplace community or fear of being stigmatized may contribute toward decreased psychosocial well-being.ConclusionsMeaningful work can play an important role in the process of recovery from mental illness. However, individuals with severe mental health problems need support with the working life related concerns and stress especially at the beginning of employment.Disclosure of InterestNone Declared

Implementing a combined individual placement and support and vocational peer work program in integrated youth mental health settings.

To describe the implementation and outcomes of a combined individual placement and support (IPS) and vocational peer work program for young people with mental ill-health. This uncontrolled pilot study co-located IPS workers and vocational peer workers within two integrated youth mental health services (provided to clients aged 15-25 years old). Employment outcomes included job placements (working 15 hours or more per week in a paid competitive job in the open employment market) and sustained employment (employed for at least 26 weeks). Participants who required additional assistance also received peer work. Of the 326 young people enrolled, 195 (59.8%) achieved competitive employment, including 157 (48.2%) in funder-approved placements. Among those in approved placements, 87 (55.4%) achieved sustained employment. For the 116 participants additionally receiving vocational peer work, 54 (46.6%) worked in funder-approved placements, of whom 27 (50.0%) achieved sustained employment. Among 210 participants who did not receive peer work, 103 (49.0%) worked in funder-approved placements, of whom 60 (58.3%) achieved sustained employment. The program achieved positive vocational outcomes and good fidelity to the IPS model. Approximately half of young people had employment placements, with a relatively high proportion maintained over time. The similar proportion of placements for those who did and did not receive peer work was encouraging given the IPS team determined that the former group needed additional support. Recommendations include upskilling the workforce, a data linkage system to obtain placement evidence, and using implementation science methodologies to understand how IPS programs are successfully embedded. This demands a coordinated effort between governments and funders, policymakers, services, and professional bodies.

Protocol: A mixed methods evaluation of an IPS program to increase employment and well-being for people with long-term experience of complex barriers in Vancouver’s downtown and DTES

BackgroundEmployment improves mental health and well-being by providing financial security, daily structure, a sense of identity and purpose, and social engagement. However, securing and sustaining employment is exceptionally challenging for vulnerable populations who experience persistent and multiple barriers, such as mental illness, homelessness, food and housing insecurity, and marginalization. Evidence-based supported employment programs, most notably individual placement and support (IPS) are becoming a more common approach for addressing the needs of these high-risk individuals. The aim of this paper is to outline the protocol for evaluating an IPS program in Vancouver’s downtown and Downtown Eastside (DTES).Methods and designThis prospective quasi-experimental study of persons with persistent and multiple barriers to employment will use a mixed-methods approach for evaluating a novel IPS program. The evaluation will consist of survey packages and interviews that will capture outcomes related to employment and well-being, as well as the experiential process of receiving individualized and integrated supports through the IPS program. A mixed-methods approach is appropriate for this study as quantitative data will provide an objective assessment of program impacts on employment and well-being outcomes over time, while qualitative data will provide an in-depth understanding of continued barriers and experiences.DiscussionThe results from this evaluation will contribute evidence within a local British Columbian (BC) context that may increase access to meaningful employment for those with long-term experience of complex barriers to employment. Further, the findings will support continued improvements, and guide decision-making around practices and policy for future implementation of IPS and employment supports across BC.

Growth of IPS Supported Employment Programs in the United States: An Update.

Individual placement and support (IPS), an evidence-based supported employment practice, is a core service in community mental health in the United States. Several factors promote the growth of IPS, including a network of 24 states participating in a learning community devoted to expanding IPS services. This study examined growth of IPS in the United States from 2016 to 2019, comparing growth rates for states within and outside the learning community. This national survey included telephone interviews with 70 representatives from state mental health and vocational rehabilitation agencies in 50 states and the District of Columbia, replicating methods of a 2016 survey. The primary outcomes were the number of IPS programs and clients served. The survey inquired about four indicators of state-level support for IPS implementation and sustainment: collaboration between state agencies, independent fidelity reviews, technical assistance and training, and funding. In 2019, 41 (80%) of 50 states and the District of Columbia had IPS services, with 857 IPS programs serving an estimated 43,209 clients. Between 2016 and 2019, the number of programs increased from 272 to 486 in 22 learning-community states and two learning-community counties, and from 251 to 371 in 18 states outside the learning community. State-level support for IPS was significantly greater in learning-community states, compared with non-learning-community states. IPS services expanded substantially in the United States between 2016 and 2019. Learning-community states had more rapid growth and provided greater implementation support, facilitating implementation, expansion, and sustainment of high-fidelity IPS. Nevertheless, access to IPS remains limited.

Evidence-Based Supported Employment in the Rural United States: Challenges and Adaptations.

The authors examined how individual placement and support (IPS), an evidence-based model of supported employment, has been successfully adapted in rural communities across the United States. Interviews with 27 key informants in 15 states with successful IPS programs in rural communities identified challenges that IPS workers faced because of rurality and the work-around methods they used to overcome these challenges. The authors conducted a thematic analysis of interviews. Significant challenges to implementing IPS in rural areas included limited availability of public transportation, Internet connectivity, employment opportunities, and workforce. The work-around strategies used by IPS teams differed in relation to local circumstances and cultures, but effective services generally used natural supports for transportation, provided computer access for job applicants, developed relationships with local employers, and hired IPS workers with local knowledge. The adaptations made to IPS in rural areas are specific to local communities but retain core IPS principles.

Job Programs for People With SMI Continue Through Economic Uncertainty

Job Programs for People With SMI Continue Through Economic Uncertainty

IPS in Supported Housing: Fidelity and Employment Outcomes Over a 4 Year Period

Background: People with severe mental illness have difficulties finding and maintaining competitive employment. This is particularly so for those living in supported housing who, by definition, have significant day-to-day support needs: in the Netherlands only 3 to 5% of people with serious mental health problems who live in supported housing are competitively employed. To support these people in finding and maintaining competitive employment, Individual Placement, and Support (IPS) was introduced within supported housing services in the Netherlands in 2015. As this is the first country that broadly implemented IPS in supported housing settings, this paper will focus on the first results regarding feasibility and effects on employment in clients of IPS in this sector.Methods: We investigated the feasibility and employment outcomes of delivering IPS in supported housing services using fidelity assessments and quarterly employment outcomes on IPS program level within eight supported housing organizations, and compared these with 21 mental health treatment organizations in the Netherlands over a 4 year period. We investigated possible reasons for our findings and their implications through qualitative evaluations of the IPS fidelity assessors' notes and additional focus groups with IPS specialists and coordinators from supported housing services and fidelity assessors.Results: The overall fidelity scores indicated reasonable implementation of the IPS model within both supported housing services and mental health services. However, there were differences between services with regard to specific fidelity items; mental health treatment organizations scored higher for team integration, whereas supported housing services scored higher for rapid job search and caseload size, diversity of jobs, and employers. Our qualitative data suggested that the difference in team integration between the two sectors was due to differences in their organizational and financial structures, as well as in the specific needs of their clients. Conversely, supported housing services had better connections with employers which facilitated more rapid job searching and greater diversity in employment opportunities. The average total client employment rate did not significantly differ; and was 25.8% per quarter in supported housing services and 29.6% in mental health treatment services.Conclusion: Implementing IPS in supported housing settings is both feasible and effective.

Growth and Sustainment of Individual Placement and Support.

Many people with serious mental disorders want to work. Individual placement and support (IPS), an evidence-based program that helps such individuals find and maintain jobs of their choice, has spread steadily across the United States (which has more than 1,000 IPS programs) and to at least 19 other countries during the past 20 years. Four factors explain the program's success. First, IPS is client-centered-IPS specialists follow their clients' preferences regarding issues such as type of employment, style of job search, and type of job support needed. Second, research has undergirded IPS's evolution, helping to refine its effectiveness. Third, support from private foundations and federal agencies has helped to foster implementation, research, and dissemination efforts. Fourth, an international learning community has consolidated cooperation among stakeholders and mental health and vocational rehabilitation agencies and has facilitated continuous quality improvement through data sharing and extensive interactions.

Fidelity and IPS: does quality of implementation predict vocational outcomes over time for organizations treating persons with severe mental illness in the Netherlands?

Individual placement and support (IPS) is an evidence-based supported employment intervention. Quality of IPS implementation is assessed using a validated fidelity scale. Previous studies found a positive association between fidelity and employment outcomes at a single time-point. This study examines the longitudinal associations between IPS fidelity scores and employment outcomes. We examined fidelity and employment outcome data for 27 IPS programs in the Netherlands providing IPS. These programs received at least one fidelity assessment and reported quarterly employment outcomes for at least one year to a central registry between 2014 and 2019. We first examined changes over time for fidelity and employment outcome. Then we analyzed the longitudinal associations between the quarterly employment outcomes and the IPS fidelity assessments on multiple time-points using a mixed-model analysis for the 17 programs with at least two fidelity assessments. Both IPS fidelity and employment outcomes improved over time, with the largest improvement in employment outcomes achieved after 18 months of implementation. We found a significant positive longitudinal association between IPS-fidelity and employment. Improvement of fidelity is associated with improvement of employment outcomes over time. Future research should be focused on the improvement of specific elements of IPS implementation and their influence on employment outcomes.

Working at the interface between science and culture: The enablers and barriers to individual placement and support implementation in Aotearoa/New Zealand.

To identify the factors that help and hinder the implementation of individual placement and support (IPS) practices in the Aotearoa/New Zealand (Aotearoa/NZ) context. An examination of the conceptual and empirical literature on IPS implementation in Aotearoa/NZ and a prospective cohort study of people with mental illnesses and/or methamphetamine addiction participating in a newly established IPS program. IPS programs have been operating in Aotearoa/NZ for more than 10 years, but coverage across the country is patchy and access inequitable. Previous public policy, contracting, and funding systems limited the availability of IPS programs, and in some cases operated as a barrier to the provision of integrated health and employment services. There is an opportunity for change, with a greater focus in government policy on mental health and addiction and achieving equity, a plan for cross-government policy solutions, and a recently established technical assistance organization to support new and existing IPS implementation. Facilitating implementation conditions include technical assistance, service integration, supportive contracting, and attention to culture. In 1 program where these conditions were in place from the outset, IPS fidelity reached 107/125; 41.1% of participants had commenced employment; and the program was achieving equity of engagement and outcomes for indigenous Māori people within 15 months of program establishment. Although IPS programs have been successfully implemented in Aotearoa/NZ, availability and access to them remains limited. Identifying the enablers and barriers to IPS implementation specific to the Aotearoa/NZ context could inform future IPS implementation and national program scale-up. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Consumer, health professional and employment specialist experiences of an individual placement and support programme

Background Individuals with severe mental illness (SMI) are under-represented in the workforce. The Individual Placement and Support (IPS) programme is an evidence-based intervention that co-locates an Employment Specialist in a community mental health team to support individuals with a SMI with their goal of finding work. Previous research predominantly explored IPS programme outcomes rather than stakeholder experiences. Aim To explore programme stakeholder perspectives and experiences during the early stages of IPS programme implementation. Methods Qualitative descriptive methodology explored consumers (n = 11), health professionals and employment specialist (n = 11) perceptions and experiences of the IPS programme. Semi-structured interviews were conducted and thematically analysed. Results Three main themes emerged: enacting core care philosophies, IPS programme process and catalyst for supportive environments and relationships. The combination of IPS programme relationships, enactment of core care philosophies, and programme process promoted development of supportive environments and relationships for consumers participating in the programme. Conclusion Findings suggest IPS processes promoted the enactment of person-centred and recovery-oriented care approaches and positively influenced care planning practices and service culture. Significance IPS directly tackles the compounding disadvantage resulting from unemployment for people with a SMI. At a service level, IPS can foster positive changes to care practices and service culture.

Review of Individual Placement and Support Employment Intervention for Persons with Substance Use Disorder

Objectives: Work is a critical part of recovery for many people with chronic health conditions, including Substance Use Disorders (SUD). Individual Placement and Support (IPS) is an evidence-based practice designed initially for adults with mental illness. Although the evidence for using IPS with individuals with severe mental illness is well documented, less is known about the efficacy of using IPS with consumers with substance use disorders, and the results have yet to be systematically evaluated and organized. Key components of zero exclusion, rapid competitive job search, and incorporation with treatment services as well as benefits are components that make IPS a strong practice to incorporate into substance abuse treatment. This study aims to evaluate and organize the evidence base of using IPS with adults with substance use disorders. Results: A systematic review was conducted of meta-analyses, reviews, and individual studies from 2000 through 2019, measuring the efficacy of IPS with individuals with SUD or comorbid SUD. Databases searched were Scopus, PubMed, and PsychInfo. Experimental and quasi-experimental studies are reviewed and critiqued for their application to a SUD population. Then, barriers and facilitators of IPS implementation with this population are discussed. Conclusions/Importance: There is a high evidence to support to application of IPS for persons with SUD, both singly and when combined with a mental health disorder. Barriers to IPS implementation including episodic treatment, risk of relapse, and housing or criminal justice instability make the IPS program a useful best practice to consider for this population.

Cognitive remediation to improve the vocational outcomes of people with severe mental illness

ABSTRACT The present study investigates the effects of cognitive remediation (CR) training with Individual Placement and Support (IPS) in people suffering from severe mental illness in European population (Spanish). Sixty-five participants (83% with schizophrenia or bipolar disorder) were recruited from community mental health teams. Fifty-seven met the criteria and agreed to participate in the study. The conditions of cognitive rehabilitation were assigned randomly with support employment CR + IPS (n = 28) and IPS alone (n = 29). Two groups were followed at 8 and 12 months after the baseline. Participants in the CR + IPS group improved more than the IPS only group during the follow-up period in measures of cognitive functioning (significantly higher in executive functions, verbal learning and memory) and obtained higher employment percentages during the follow-up period, including people who got a job after 8 months (52.2% versus 29.2%, p = .023) and after 1 year (60.9% versus 37.5%, p = .025), as well as, in the weekly hours worked (37.2 versus 26.7 h, p = .023). Retention in the CR + IPS program was high (82.14%). The calculated global cognitive score showed that the evolution over time differed significantly between groups (p < .001).

Outcomes of an individual placement and support programme incorporating principles of the collaborative recovery model.

Engaging in employment enhances mental health recovery and is therefore of central focus for many occupational therapists working in mental health. Individual placement and support (IPS) is an evidence-based, supported employment model specifically designed for individuals with severe mental illness who have the desire to work. Despite strong support for IPS in Australia, implementation challenges have been encountered. This study evaluates outcomes achieved by participants engaged with WorkWell, an IPS programme delivered by a large Australian non-government organisation. In addition to following IPS principles, WorkWell was informed by principles of the collaborative recovery model (CRM). De-identified outcomes data for each participant were analysed by an independent research team. The proportion of individuals engaged with the programme who achieved a competitive employment placement was calculated. Average employment duration and weekly wages were calculated for individuals who achieved a competitive employment placement. Finally, the proportion of individuals who achieved some form of vocationally relevant outcome was calculated. Ninety-seven participants were engaged with the programme. Forty-eight participants (49.5%) gained a competitive employment position. Average employment duration was 151days (21.6weeks) and average weekly wage was $478. Overall, 62 participants (63.9%) were supported to achieve some kind of vocationally relevant outcome (e.g. competitive employment, education, work trial or voluntary work) as a result of their engagement with the programme. While the addition of CRM principles appears to have supported positive outcomes for participants, especially in terms of employment duration, results for employment placement rates were lower than expected. While the employment placement rate compares favourably to results from the international literature and numerous programmes in Australia, more development is required to increase the proportion of individuals who are supported into competitive employment positions. Future research should focus on the specific elements of CRM that most contribute to enhancing IPS processes.

Evidence for Occupational Therapy Intervention With Employment and Education for Adults With Serious Mental Illness: A Systematic Review.

Many of the estimated 9.8 million American adults with serious mental illness (SMI) want to engage in employment and education, yet the majority report a need for more skills training. This review presents evidence for the effectiveness of interventions that occupational therapy practitioners can provide to help people with SMI improve and maintain performance and participation in employment and education. Citations, abstracts, and full-text articles in databases including MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were reviewed for inclusion and analysis. Fifty-seven articles met criteria for inclusion. For employment, strong evidence was found for the Individual Placement and Support (IPS) model and cognitive interventions. For education, moderate evidence was found for supported education interventions. This systematic review supports the role of occupational therapy practitioners in promoting the implementation of IPS, cognitive-based, and social skills programs to improve vocational and educational outcomes for adults with SMI.

The meaning and experience of stress among supported employment clients with mental health problems.

Many clinicians are concerned that competitive work may cause excessive stress for people with severe mental health problems. Individual Placement and Support (IPS) is acknowledged as the most effective model of supported employment for this population. The manner in which IPS clients define and experience employment-related stress is poorly understood. This qualitative study aims to explore how people with mental health problems receiving IPS services define and experience employment-related stress. We purposively sampled and interviewed 16 clients of an IPS programme, who had been competitively employed for more than 1month. Data were collected between September 2014 and July 2015 in Montreal, Canada. Transcripts of semi-structured interviews were analysed using grounded theory methodology. IPS clients often defined stress similar to its common understanding: the result of experiencing prolonged or/and cumulative strains, or of an incongruence between efforts and rewards, hopes and reality. Stress experienced in this way could exacerbate psychiatric symptoms, especially depression or psychotic symptoms. However, when maintained at a more manageable level, stress stimulated learning and improved planning of tasks. Participants described different coping mechanisms, such as sharing their experiences and difficulties with others, focusing on problem resolution and avoidance. The first two of these helped IPS clients remain at work and bolstered their confidence. Work-related stress has potentially positive as well as negative consequences for IPS clients. In order to maximise the potential beneficial effects of stress, employment specialists can help clients anticipate potential stressors and plan how they might cope with them. Further research on the most effective ways of helping clients cope with stress is needed.