Individual Placement Research Articles

Effectiveness of a three-component intervention supporting unemployed individuals with mental health issues in their job search and mental health recovery (3for1): study protocol of a non-randomized controlled study.

There is a vicious cycle between unemployment and mental health issues. Unemployed individuals with mental health issues require individualized support at multiple levels in order to promote their mental health, and obtain and retain employment. The 3for1-intervention program aims to provide such support with three components (short-term psychotherapy, job coaching based on the Individual Placement and Support approach, and peer support). This study protocol outlines how the effectiveness of this three-component intervention program in terms of re-employment, mental health, and psychosocial outcomes will be evaluated. The 3for1-intervention program will be evaluated with a non-randomized controlled trial design in a multi-center study. 500 eligible participants aged between 18 and 60 years from six job centers in Southern Germany will be allocated to a control group or an intervention group. Allocation is time-based, with the control group being recruited first, followed by recruitment of the intervention group. The control group will receive treatment as usual, whereas the intervention group will receive treatment as usual as well as access to the three intervention components over a period of 12 months. Assessment will be conducted at baseline (t0), and 12 (t1) and 18 (t3) months later. The primary outcome will be the proportion of participants who are in employment subject to social insurance contributions at t1. Differences between control and intervention group will be tested with logistic regression analysis, controlling for relevant covariates. Analyses of secondary outcomes will relate to group differences regarding re-employment, health and well-being, social integration, help-seeking, and self-stigma at t1 and t2, applying logistic regression analysis or analysis of covariance. Additionally, usage of health services will be measured to evaluate the intervention program's cost effectiveness. The 3for1-intervention aims to improve employability and mental health outcomes of a vulnerable population with high need for assistance. Improvements for this population would benefit the German welfare state as well. This study could provide valuable insights into the feasibility, implementation, and sustainability of this individualized, multi-level support program within German job centers. This trial is registered with the German Clinical Trials Register: DRKS00029002 (registered on 11 May 2022).

External Validation of Accelerometry-Based Mechanical Loading Prediction Equations

Accurately predicting physical activity-associated mechanical loading is crucial for developing and monitoring exercise interventions that improve bone health. While accelerometer-based prediction equations offer a promising solution, their external validity across different populations and activity contexts remains unclear. This study aimed to validate existing mechanical loading prediction equations by applying them to a sample and testing conditions distinct from the original validation studies. A convenience sample of 49 adults performed walking, running, and jumping activities on a force plate while wearing accelerometers at their hip, lower back, and ankle. Peak ground reaction force (pGRF) and peak loading rate (pLR) predictions were assessed for accuracy. Substantial variability in prediction accuracy was found, with pLR showing the highest errors. These findings highlight the need to improve prediction models to account for individual biomechanical differences, sensor placement, and high-impact activities. Such refinements are essential for ensuring the models’ reliability in real-world applications, particularly in clinical and biomechanical research contexts, where accurate assessments of mechanical loading are critical for designing rehabilitation programs, injury prevention strategies, and optimizing bone health interventions.

"Without IPS I Think I Would Really Fall Apart": Individual Placement and Support as Experienced by People With Mental Illness-Phenomenological Peer Research Study.

Having a job is an important component of recovery from mental illness and a source of economic, social, and health benefits. Most people experiencing severe mental illness (SMI) want to work but are excluded from employment opportunities. Employment specialists (ESs) working in individual placement and support (IPS) teams help persons struggling with SMI obtain competitive employment. This study is a qualitative phenomenological study of 10 IPS participants in the Norwegian context, serving to develop a deeper understanding of the IPS phenomenon as it is experienced in the everyday life of IPS participants. The study was designed as a peer research project including four members of a competence group with experience in IPS and SMI. The results, analyzed using the reflective lifeworld research approach, revealed four constituents: "Having a safety net along the way toward employment," "Feeling more like a person, not just a patient," "Brighter future," and "Going above and beyond employment support." IPS functions as an anchor in participants' journey toward employment. Strong and meaningful relationships with an ES seem crucial for IPS participants to gain the strength and confidence essential to engage in the job search. IPS participants experience various challenges in everyday life, resulting in ESs exceeding their vocational role to cover the unmet needs that health services seem unable to fully address. Closer coordination between vocational and health services, as well as a deeper focus on everyday life issues, will positively affect IPS participants' vocational outcomes and quality of life.

Individual placement and support (IPS) – a time-out from modernity: an investigation on the relationship between IPS specialists and clients

ABSTRACT This study examines how evidence-based individual placement and support (IPS) interventions can be perceived to go beyond their constituent principles and fidelity scale to foster a relationship between IPS specialists and clients guided by three principles that promote deceleration and resonance, concepts put forward by Hartmut Rosa. This article is based on a case-study involving two municipalities in Denmark where the IPS method was implemented, resulting in high fidelity and good job outcomes. This study shows that when IPS specialists adhere to the IPS model, their relationship with their clients was seemingly guided by three values, namely, patience in securing sustainable employment, persistence in experimenting with employment and accepting and dealing with barriers to employment. These values originate from the evidence-based IPS approach and principles, but they can be interpreted to supplement the IPS model and form a professional practice. This practice promotes deceleration of social life as well as the immersion of clients in a resonant relationship with job opportunities, with their own mental health and with IPS specialists. The IPS intervention is in sharp contrast to the regular employment service wherein clients are pressured into taking jobs they do not want before they are ready to work. In this sense, the relationship IPS clients establish with IPS specialists is a time-out from modernity.

Measuring Fidelity to Individual Placement and Support for Transition Age Youth: Psychometric Findings.

Individual Placement and Support (IPS), an evidence-based supported employment model for working-age adults with serious mental illness, also serves transition age adults (TAY; ages 16-24). The IPS-Y is a new IPS fidelity scale tailored to this younger population. Although adopted worldwide, it lacks research on the psychometric properties of its two components (employment and education). Six IPS programs serving TAY were assessed on IPS-Y (Employment) in an initial review (Time 1) and on both components in a second review one year later (Time 2). We examined scale calibration, reliability, and validity for the IPS-Y in this sample. Fidelity reviewers use the full range of ratings, from "not IPS" to "exemplary," on both IPS-Y components. On the employment component, item calibration was excellent; internal consistency reliability was good at Time 1 (r = .81) and test-retest reliability was fair (r = .63). The IPS-Y (Employment) showed excellent sensitivity to change, with the mean scale score increasing from 88.3 to 105.5. IPS-Y (Employment)item ratings at Time 2 were similar to corresponding items in a sample of conventional IPS programs using the standard IPS fidelity scale. Predictive validity was promising for both components, with fidelity scale ratings positively correlated with site-level competitive employment rates (r = .57) and education enrollment rates (r = .69). IPS can be implemented to good fidelity for programs serving TAY. Preliminary findings regarding the psychometric properties of the IPS-Y Employment are encouraging, but replication in larger samples is needed.

Individual placement and support (IPS): duration of employment support and equity of access and outcome in routine clinical practice.

To explore the duration of support, reach, effectiveness and equity in access to and outcome of individual placement and support (IPS) in routine clinical practice. A retrospective analysis of routine cross-sectional administrative data was performed for people using the IPS service (N = 539). A total of 46.2% gained or retained employment, or were supported in education. The median time to gaining employment was 132 days (4.3 months). Further, 84.7% did not require time-unlimited in-work support, and received in-work support for a median of 146 days (4.8 months). There was a significant overrepresentation of people from Black and minority ethnic communities accessing IPS, but no significant differences in outcomes by diagnosis, ethnicity, age or gender. Most people using IPS services do not appear to need time-unlimited in-work support. Community teams with integrated IPS employment specialists can be optimistic when addressing people's recovery goals of gaining and retaining employment.

Comparative Analysis of Independent Reviewer-Rated and Self-Rated Fidelity Scores in Individual Placement and Support Programs: Repeated Cross-Sectional Surveys.

Fidelity assessments can contribute to maintaining the adherence to the individual placement and support (IPS) model, which enhances vocational outcomes for individuals with mental illness worldwide. While independent reviews are standard, self-assessments could broaden the implementation of IPS. This study aimed to evaluate reviewer-rated and self-rated fidelity assessments using the Japanese version of the Individualized Supported Employment Fidelity Scale (JiSEF), and to compare the two assessment methods in terms of their correlations with employment outcomes in Japan. Over the 3-year research period, fidelity assessments were conducted by independent reviewers and trained program staff members across 26 programs, totaling 58 assessments. Analyses involved kappa statistics for item-level comparison, the intra-class correlation coefficient (ICC) and paired t-testfor the overall fidelity scores, and Pearson's correlations to examine the relationship between the fidelity scores and program-level employment outcomes. Most individual JiSEF items demonstrated fair to good reliability between reviewer-rated and self-rated assessments. The ICC for the overall JiSEF scores between the two assessment methods was 0.756, yet the distribution of self-rated scores was more scattered compared with that of reviewer-rated scores. The mean total scores from self-assessments were significantly lower than those from reviewer assessments (t = 2.072, P = 0.043). While both sets of scores correlated significantly with employment rates (r = 0.640, P < 0.001 for reviewer assessments; r = 0.325, P = 0.013 for self-assessments), the correlation was stronger for reviewer ratings (z = 2.207,P = 0.027). Self-rated fidelity assessments offer several benefits. However, since independent reviews had a more normal distribution and higher correlation with employment outcome, they should remain the priority in fidelity assessments within the Japanese IPS framework.

Institutional work aimed atincreasing employment orientation in mental health services.

The importance of employment in recovery from mental health illness has led to broad recognition of the integration of employment-oriented support into mental health treatment. However, there is variation in the extent to which an employment orientation permeates healthcare services. This article explores how managers and advisors in health and welfare services in Norway function as "change agents", who work to increase an employment orientation in mental health services. The empirical material consists of 20 interviews with change agents in health and welfare organisations. They work to implement a model - individual placement and support - to integrate an employment orientation in healthcare services. The findings are analysed using the framework of "institutional work" to elucidate the strategies used by change agents. The findings underscore a consensus on the health advantages of employment and that employment-oriented support belongs in mental health treatment. However, this concept requires further cultivation within healthcare services, with individual actors playing a key role as change agents. Depending on the stage of the various organisations in the change process and the actors' positions within the institutional context, the actors engaged in both creative and maintenance institutional work. The article´s findings are significant for how health organisations can work to achieve desired changes. This article contributes to the literature on collaboration and implementation of employment-oriented practices in healthcare by directing attention to the dynamics of organisational change processes and the efforts of individual actors to promote change.

Experiences of autistic people in supported employment in France: a participatory research project

Purpose The employment rate of autistic people is low, and they are often employed in low-paying jobs or in jobs involving tasks that fall short of their skills and competence. To address this situation, the individual placement and support method (IPS) offers promising perspectives for personalized and long-term support measures. This evidence-based method has produced positive results in several countries. IPS has been used in France only since 2016. This paper aims to examine the experience of autistic people in France who have benefitted from supported employment measures. Design/methodology/approach Nineteen autistic adults in France took part in semistructured interviews. Interview questions focused on work and measures to support employment. The authors analysed the interviews using reflexive thematic analysis, within the paradigm of critical realism. The authors adopted a participatory approach; the project was led by an autistic researcher and autistic individuals were included at all stages. Findings This study identified six primary themes and three subthemes across the data: (1) The uphill battle to obtain adjustments in the workplace; (2) insufficient knowledge of autism; (2.1) explaining again and again: the educative burden; (3) the challenge of making oneself heard; (3.1) when the entourage steps in; (4) support measures as material assistance and reassurance; (4.1) between benevolence and condescension; (5) organizational factors that affect the quality of support; and (6) personal and professional life are closely intertwined. Originality/value This research provides a better understanding of how autistic people experience supported employment in France and highlights ways to improve it. Job coaches play a crucial role in offering practical help and reassurance, and their efforts to nurture an active personal life are perceived positively. However, supported employment also carries the risk of limiting autistic individuals' capacity for action and causing several difficulties if job coaches are not well-informed about autism, do not reflect on their own attitudes, do not assist in obtaining necessary accommodations and if there are organizational problems leading to a lack of resources.

Experiences of individuals with serious mental disorders in regular employment through the Individual Placement and Support model.

This study shows the perspective, meaning and satisfaction perceived by people with Serious Mental Disorders during their experiences in regular employment. A mixed qualitative-quantitative methodology was used, applying semi-structured interview as qualitative information collection tool and the Indiana Job Satisfaction Scale as quantitative tool. The study period was from January 2021 to December 2022. A purposive sampling was performed with a sample of 24 people with Serious Mental Disorders who had obtained a job through an Individual Placement and Support (IPS) program during the study period. Semi-structured interview and the Indiana Job Satisfaction Scale were applied to this Serious Mental Disorder workers' sample. The Indiana Job Satisfaction Scale was also applied to a group of 24 workers without mental disorders in the same working conditions who served as control group. The results of the analyses of the Serious Mental Disorder workers' narratives show that perception of work experience is conditioned by individual, environmental and social predictors, as well as external factors as determining variables. Quantitative results obtained by the Indiana Job Satisfaction Scale reveal levels of job satisfaction resembling those of the rest of workers without Serious Mental Disorder. These findings reinforce the significance of employment in the recovery process for individuals with Serious Mental Disorders and emphasize the importance of understanding the subjective meaning individuals attribute to their work experiences.

Protocol of a randomized controlled trial on the effectiveness and cost-effectiveness of the PLACES intervention: a supported employment intervention aimed at enhancing work participation of unemployed and/or work-disabled cancer survivors

BackgroundApproximately onethird of cancer survivors encounter challenges reintegrating into the workforce, often experiencing involuntary unemployment and/or partial or full work disability following diagnosis and treatment. Returning to paid employment presents evident challenges due to uncertainties regarding work ability, perceived employer discrimination, and a lack of support, thereby risking social exclusion. However, interventions addressing return to paid employment among unemployed and/or work-disabled cancer survivors are scarce. Here, we describe the protocol of a randomized controlled trial (RCT), including a process and economic evaluation, evaluating the effectiveness and cost-effectiveness of the PLACES (unemPLoyed cAnCEr survivors Support) intervention aimed at supporting unemployed and/or work-disabled cancer survivors returning to paid employment.MethodsA two-armed RCT with a 12-month follow-up period will be conducted. Eligible participants: (1) are of working age (18–65 years), (2) are diagnosed with cancer between 6 months and 10 years ago, (3) are unemployed and/or partially or fully work-disabled, (4) have completed cancer treatment, and (5) are seeking paid employment and are motivated to initiate work immediately. Participants will primarily be identified through the Dutch Social Security Agency and the Netherlands Cancer Registry and recruited via healthcare professionals. Participants randomly allocated to the intervention group (n = 82) will receive the PLACES intervention: a tailored supported employment intervention based on the principles of Individual Placement and Support (IPS). This includes support in seeking, returning to, and maintaining paid employment. Participants allocated to the control group (n = 82) will receive care as usual. All participants will be asked to complete questionnaires, at baseline (T0), and after 3 (T1), 6 (T2), and 12 (T3) months of follow-up. The primary outcome is paid employment [yes/no]. Secondary outcomes are time until paid employment, change in working hours, work ability, quality of (working) life, and self-efficacy regarding return to work. Additionally, process and economic evaluations will be conducted.DiscussionWe hypothesize that the PLACES intervention will be effective in obtaining paid employment, enhancing work ability, and improving quality of life. In addition, we expect the intervention to be cost-effective. If proven effective and cost-effective, actions should be taken to implement the intervention in usual care.Trial registrationNCT06028048.

Individual placement and support in mental health services: evaluation of routine clinical data using aretrospective chart review

People with severe mental illnesses are often excluded from working life and would like support to (re)enter the general labor market as part of the psychiatric treatment. Individual placement and support (IPS) is an effective method of finding and retaining work in the general labor market. The aim of the study was to determine the integration rates of IPS into the general labor market in acute and postacute psychiatric settings, identifying patient, setting and program characteristics associated with (re)entering work. A retrospective chart review (RCR) of routine clinical data between 2016 and 2021 was carried out. The IPS program adherence was rated using the IPS fidelity scale. A total of 375 patients participated in the IPS with at least 4 appointments. The (re)integration rate into the general labor market was 51.7%. A shorter time period to the last working day, diagnosis of F1, F2, F3 (vs. F4), change of treatment setting and IPS in the psychiatric institute outpatient department (PIA), IPS fidelity and the number of IPS coaching sessions were positively correlated with (re)integration into work. The implementation of IPS in clinical mental healthcare is possible and leads to high integration rates in the open labor market. An early start of IPS during the clinical treatment can promote social inclusion.

School placement trajectories of students with special educational needs—A longitudinal analysis of administrative data

AbstractSchool transfers may be particularly challenging for students with special educational needs (SEN), and may negatively impact academic and social outcomes for these students. In countries with multiple placement options for students with SEN, although transfers between different types of placements are plausible, studies on this phenomenon are rare. The current study investigates individual placement trajectories over 11 years of compulsory education, using administrative data from a Swiss canton (i.e. federal state) about students with intensive SEN support. We employed sequence analysis to describe individual characteristics of placement trajectories (type of placements attended, number and timing of transfers), and to identify typical placement trajectories. Findings indicate that students with SEN experience frequent placement transfers, however, high variability between individual placement trajectories exists. Four clusters representing typical placement trajectories emerged. The clusters differed in the placements predominately attended by students, the number of transfers experienced, as well as in the distribution of students' age, gender and first language. These differences may reflect variations between clusters in the type and severity of students' SEN. Our study results underscore the importance of understanding the dynamics of placement trajectories for students with SEN, contributing valuable insights into the complexities of their educational journeys.

Mentally ill people with means-tested benefits at the job center : Diagnosis spectrum and care-First results from the LIPSY project

Although people receiving means-tested benefits are regularly taken care of at the job center, little is known about their mental health situation and mental health care. The aim of the study was to describe the diagnostic spectrum and the functional status as well as the mental health care utilization of individuals with mental illnesses who are receiving means-tested benefits. Mentally ill people with means-tested benefits were recruited at the job center as part of the "Leipzig Individual Placement and Support for Mentally Ill People" (LIPSY) project, where they were initially diagnosed according to ICD-10 and included in the project if they had amental disorder. Mental healthcare utilization was recorded. In the present study, data from n = 583 consecutively included persons were analyzed descriptively and by multivariate statistics. Of the study participants 60.7% (n = 583; 51.5% female; average age36years; unemployed for an average of 4.8years) suffered from affective disorders, followed by neurotic, stress and somatoform disorders (42.5%). With amean global assessment of functioning (GAF) value of 49.4 (SD 7.7), there was on average aserious impairment. Nearly half of the subjects (48.5%) had never received psychotherapeutic, psychiatric or neurological treatment in the 6 months prior to inclusion in the project. It could be shown that there is abroad spectrum of mental disorders with substantial functional impairment. The data suggest that this group is significantly undertreated and difficult to reach.

The Influence of Individual Characteristics, Training, Employee Performance, and Job Placement on PT. Bank BNI Medan

This study uses work placement at PT. Bank Negara Indonesia Medan as an intervening variable to identify and assess the direct and indirect effects of individual characteristics and training on employee performance. Associative research is the study of associations. Primary data are the kind used. The general population of this study included 150 permanent workers at PT. Bank Negara Indonesia Medan.. Data analysis was done by employing the Path analysis, using the SPSS software. The results of this research indicated that individual traits have a direct, positive, and significant impact on whether an applicant is hired, training has a direct, positive, and significant impact on whether an applicant is hired, and traits have a direct, positive, and significant impact on whether an applicant is hired. Keywords: individual characteristics, training, job placement, employee performance

Integrated MUSIC array for high-precision damage diagnosis in complex composite structures

Guided Wave (GW)-based Multiple Signal Classification (MUSIC) damage imaging presents several advantages, such as high resolution, which makes it a promising technique for localizing damage in composite structures. However, the application of this technology in aircraft is confronted with various challenges. The variability in performance of MUSIC array sensors is attributed to material and manufacturing process dispersion. Additionally, the conventional wiring of MUSIC array sensors adds considerable weight and is not compatible with complex structural configurations. Furthermore, within intricate configurations, the attenuation of scattering signals induced by structural damage impacts the accuracy of imaging. Moreover, the manual and individual placement of sensors on structures, along with structural anisotropy, may introduce phase errors in the signals detected by MUSIC array sensors. This can lead to a reduction in the accuracy of MUSIC imaging and result in compromised long-term sensor reliability. This paper proposes a high-precision integrated MUSIC array for the diagnosis of complex composite damage. This approach aims to address the challenges related to damage imaging in materials with complex structures. Impedance curve screening and surface-mount co-curing technology are utilized to manage the performance variation of MUSIC array sensors, enhance layout uniformity, and improve long-term stability. Subsequently, a focus compensation algorithm is proposed within the integrated MUSIC design to enhance precision, reduce weight, and adapt to complex structures. The effectiveness of the proposed method is confirmed through experimental validation on an actual complex composite wing box segment, demonstrating a maximum error of 2 cm in locating impact damage.

Predictors of return to work in people with major depression: Results from a supported employment program in Germany

BackgroundDepression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with depression in Germany, the aim of this study was to investigate client variables that predict return to work. MethodsThe sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses. ResultsA total of 70 participants (56 %) returned to work within the one-year follow-up period. >100 days of sick leave in the year prior to study entry (vs. <100 days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS. LimitationsThe sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited. ConclusionsPeople with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.

Decision‐chain integrity and sustainment of the individual placement and support model: An embedded single case study in Finland

AbstractThe individual placement and support (IPS) model is an evidence‐based practice proven effective in aiding individuals with mental disorders to achieve and maintain competitive employment. This study examines how policy and structural factors are perceived to influence the model's sustainment as routine practice after a national development project in Finland. We aim to identify critical dimensions related to decision‐making at the national, regional, and local organisational levels. We used a qualitative single‐case approach, analysing 21 stakeholder interviews and nine administrative documents. We conducted abductive thematic analyses. We report the results in compliance with the COREQ guideline. Our analysis identified three main external contextual influences affecting service sustainment: (1) System‐Level Planning—the coherence of formulation and execution of facilitative strategies across different administrative levels; (2) Political Decision Making—the recognition of inception points of policy change and the ability to set the IPS model on a broader policy agenda; and (3) Stakeholder Engagement and Collaboration—the need for mutual goals and collaborative platforms. Strategic planning, governance decisions, and stakeholder involvement affect local‐level decisions on the IPS model's sustained implementation. This research introduces the concept of ‘Decision‐Chain Integrity’, highlighting the alignment of strategies and their implementation across different levels of administration as a pivotal factor in producing sustained change in the service system.

“What I thought was the dream job was a little different than I had expected”: A qualitative study exploring the turnover of IPS employment specialists

BACKGROUND: Individual Placement and Support (IPS) is an evidence-based vocational rehabilitation program that helps people with severe mental problems to obtain and maintain paid jobs. Turnover of IPS employment specialists is a scarcely studied subject that can undermine the effectiveness and implementation of the intervention. OBJECTIVE: This study aimed to explore and describe the experiential factors and processes that shape IPS employment specialists’ decisions to quit. METHODS: Braun and Clarke thematic analysis was used to analyze interviews of former IPS employment specialists, who worked during the early implementation phase in Northern Norway. RESULTS: A number of negative and positive experiential factors and processes were found to shape IPS employment specialists’ decisions to quit their jobs. A single theme captured our findings ‘The decision to quit for IPS employment specialists is a gradual process consisting of draining factors outweighing nourishing factors’. CONCLUSION: To retain IPS employment specialists in the early implementation phase, it is not enough to rely on hiring well-fitting individuals. Instead, prospectively developing interorganizational contexts, timely identifying and addressing work environment problems, while nurturing the strengths of individual workers can be helpful in decreasing turnover rates of IPS employment specialists.

Impact of Individual Budgets on Work and Financial Well-Being of Supported Employment Recipients With Serious Mental Illness.

The authors sought to determine whether providing recipients of supported employment with individual budgets from which they could purchase employment-related goods and services would improve employment and financial outcomes. Sixty study participants were recruited from an individual placement and support (IPS) program and randomly assigned (1:1) to receive IPS services only (N=32) or IPS services with a 12-month $950 flexible fund called a career account (N=28). Participants receiving IPS and a career account met with staff who helped them identify employment goals and create a budget for purchases directly tied to these goals. The primary outcome was competitive employment; secondary outcomes included job tenure, days worked, total earnings, and financial well-being. Outcomes were analyzed by using adjusted generalized linear models (GLMs) with binary logistic, negative binomial, and linear distributions. The proportion of participants who achieved competitive employment was largely similar for those in the career account+IPS group (54%) and in the IPS-only group (47%). However, the GLM analysis revealed that career account+IPS participants had significantly longer job tenure, more total days of employment, and higher total earnings than IPS-only participants. Feelings of financial well-being increased significantly among career account participants, whereas financial well-being declined among control participants. The amount of career account dollars participants spent was positively and significantly associated with longer job tenure, more days employed, and higher total earnings. Combining flexible funds with IPS-supported employment achieved some superior outcomes compared with IPS only. Further research is needed to assess the longer-term effects of this practice and its cost-effectiveness.