Implementing individual placement and support for young people at clinical high risk for psychosis: A qualitative study on clients and clinicians perspectives.

Abstract

Objective: Education and employment play a crucial role in recovery from mental illness, offering purpose, structure, social connection, and financial independence. Nevertheless, many young people at clinical high risk for psychosis (CHR-P) leave education early, underachieve academically, and face difficulties gaining employment. Evidence is limited on which interventions early detection services should implement to address these challenges. This qualitative study examined the acceptability of implementing Individual Placement and Support (IPS), an approach that supports individuals with mental illness to pursue vocational goals, within Outreach and Support in South London (OASIS), a well-established early detection service. Methods: Semi-structured interviews were conducted with 25 clients and 13 clinicians following the intervention. Data were analyzed using framework analysis guided by the Theoretical Framework of Acceptability (TFA). Results: The data mapped to five of the seven TFA constructs (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy). The construct ‘opportunity costs’ was not represented, while ‘intervention coherence’ was relabeled as ‘integration of IPS within OASIS’. An additional construct, ‘therapeutic relationship with IPS specialist’ was also identified. Conclusions and Implications for Practice: Findings indicated that IPS was highly acceptable to clients and clinicians, with both groups expressing a desire for it to be extended and established as a permanent part of OASIS. IPS may therefore offer a promising approach for addressing unmet vocational needs in early detection services. However, large-scale controlled trials are needed to establish its effectiveness. Impact and implications: This study shows that Individual Placement and Support (IPS) is a highly acceptable intervention for individuals at clinical high risk of psychosis and may help address a critical gap in vocational and educational support. The findings also support broader implementation of IPS within early psychosis detection services.