Breaking barriers to employment: A new approach to young people struggling with substance use in Denmark

The Individual Placement and Support (IPS) method was developed in the United States to help unemployed individuals with severe psychiatric diagnoses gain employment or enter education (Drake & Bond 2023). Over the past decade IPS has been also been implemented in Denmark and other Scandinavian countries with some success (Sadeghi et al 2024).

In 2023, the scope of IPS was nationally expanded in Denmark with support from the Danish Agency for Labour Market and Recruitment. Danish municipalities could apply for funding to support the implementation of the IPS method in their employment services, specifically targeting young people under the age of 30.

In our survey, 27 out of 98 municipalities reported using the IPS method with a focus on young people.  Of these, 19 municipalities have an expanded target group, where other types of municipal services than the psychiatric services can be partners. This includes drug and alcohol treatment centers, and the target group thereby also includes young people with problematic substance use as a barrier to employment or education.

The IPS method is based on a “place- then- train” approach and guided by eight basic principles. Particularly relevant in this context are:

• no exclusion,
• integration of employment and treatment,
• a focus on ordinary employment,
• providing support during employment for as long as needed,
• starting with the participant’s wishes and preferences, and
• cooperation with local employers.

IPS caseworkers should not have caseloads exceeding 20-25 at any time and a high level of flexibility is considered essential for effective support.

High levels of flexibility and stronger relations

Overall, the reported experiences were positive. Although several municipalities had only been able to recruit a few participants at the time of the pilot study, IPS caseworkers and coordinators reported a greater level of flexibility and an enhanced ability to tailor their efforts to the needs and motivations of each enrolled individual, compared to their previous work with this target group. As one IPS-coordinator explained

 “I mean, it’s plain as day that the fewer cases you have, the closer the relation you can have to the person […] The greater the trust, the easier you will be able to carry someone forward”

This improved ability to focus on participants was partly due to the considerably smaller caseloads and the flexibility to prioritize the needs and wishes of the participant over the demands of  the system.

Several interviewees highlighted the flexibility to adapt employment services to the individual’s needs.  One IPS caseworker described a young participant with daily cannabis use:

“And then we can maybe taper out simultaneously [with starting education], but so that you do not smoke weed during school hours. So that we make a plan, that runs on the side, instead of saying, you have to be clean before you can do that […] That has actually made it possible that I have one [participant] who has almost stopped [using cannabis] now”.

Another advantage of IPS is its relatively high level of detail and the clear, practical principles it provides. While some key concepts, such as motivation, may be interpreted differently, the IPS guidelines offer case workers a solid frame to rely on.

Ethical and practical challenges

While some level of alcohol or drug use outside work or school hours can be tolerated in certain types of education or employment, IPS caseworkers sometimes face ethical dilemmas. Several case workers and coordinators mentioned that jobs involving machine operation, driving, or working with children are incompatible with problematic substance use. If a participant expressed interest in such positions, caseworkers felt obliged to advise them not to apply until they were sober. In cases where participants did not follow this guidance, case workers faced the difficult decision on whether to disclose relevant information to potential employers.

Another challenge was that the IPS case workers and coordinators often needed to work across municipal departments and collaborate with regional psychiatric services as well as drug and alcohol treatment centers. For many, a key part of their work was to become “visible” within both their own and external organizations, ensuring that regular case workers, job consultants, treatment staff, and other potential collaborators understood the IPS function and how it operated. In municipalities where IPS caseworkers reported the highest levels of satisfaction, IPS-training had been provided to key employees in municipal treatment centers, which facilitated communication about the methodology’s benefits and made collaboration easier.

A third issue noted was the challenge of sustaining implementation after the project period. As one coordinator explained

“Now there’s been innumerable projects, where it is not really implemented what worked well, and I think that is really unfortunate, because it’s not all elements necessarily, you can take forward, but you implement what actually works as basic elements, because otherwise it’s three years and then it’s back to normal”

A useful concept

While the data we draw on here are very much in the early days, there are indications that IPS offers a toolbox that is considered useful for the caseworkers and coordinators.

Take-aways:

• Lower caseloads and flexibility are important factors for both caseworkers and participants.
• Cooperation with treatment centers is essential.
• Practical and ethical dilemmas, particularly in cases involving substance use, need to be addressed clearly.
• Disseminating knowledge of the methodology to collaborators within and outside the municipality is important.
• Long-term implementation should be considered from the very beginning.

The article is written by

Karoline Vibæk, student assistant,  &

Jonas Strandholdt Bach, assistant professor

Center for Alcohol and Drug Research, Aarhus University