Evaluation of Individual Placement and Support (IPS) in community drug and alcohol treatment services

What is the issue?

Individual Placement and Support (IPS) is an evidence-based, highly individualised model of employment support originally developed for people receiving treatment for severe mental illness. IPS was first implemented in community drug and alcohol treatment in England as part of a trial (the IPS-AD trial), which ran from 2018 to 2020. Based partly on the strength of evidence from the IPS-AD trial, the 2021 UK Drug Strategy included a commitment to achieving full coverage of IPS in drug and alcohol treatment services across England by March 2025.

How did we help?

The aim of this study was to evaluate the implementation and delivery of IPS in community drug and alcohol treatment services at a national scale and to inform service improvement, drawing on learnings and knowledge of good practice from more experienced IPS teams. The evaluation examined how IPS had been delivered in the drug and alcohol treatment context, with a focus on identifying barriers and enablers of effective delivery. Taking a realist approach, a Context-Mechanism-Outcome (CMO) framework was developed and tested. This framework outlined a set of expectations about how delivery strategies (mechanisms) and contextual factors (contexts) affect outcomes achieved at the national and local levels. The evaluation findings also informed the development of a practice manual, with a focus on identifying practical lessons for IPS delivery.

The evaluation was informed by workshops, interviews, surveys, case studies and desk research. Data-collection methods were designed to balance breadth and depth of enquiry. All IPS teams in operation for six months or longer were invited to take part in surveys, which were complemented by more in-depth, qualitative research conducted in ten case-study areas. Efforts were made to engage with a range of stakeholders offering different perspectives on IPS delivery. These included IPS clients, IPS team members (Senior Employment Specialists [SESs], who serve as IPS team leaders, and Employment Specialists [ESs]), commissioners of drug and alcohol treatment services, treatment-services staff and wider stakeholders.

What did we find?

• The goal of achieving national coverage of IPS in drug and alcohol treatment services is very close to being met, with 145 out of 151 local authorities in England delivering the programme as of March 2025. The commissioning process was widely regarded as straightforward, supported by clear communication and support from the Office for Health Improvement and Disparities (OHID). The national scale-up was facilitated by the wider expansion of IPS in England, given that some commissioners were able to commission IPS services to experienced providers and/or make use of existing governance structures.
• It takes time to embed IPS in treatment services, but most IPS teams in drug and alcohol treatment report achieving a high level of integration. Integration is widely perceived to be easier if the IPS team is employed directly by the treatment provider.
• IPS teams apply a range of strategies to raise awareness of IPS and challenge misconceptions held by treatment staff about the role of employment in recovery. The IPS model, particularly the zero-exclusion approach, represents a shift in thinking for many treatment staff and it can take time to change attitudes and behaviours. IPS teams undertake various activities to promote and raise awareness of the IPS service, with the sharing of success stories frequently highlighted as one of the most effective strategies.
• Most IPS team members feel confident undertaking employer-engagement activities, although this is more challenging in areas where local labour-market conditions are poor (for instance in those with high unemployment rates) or where the market is oversaturated. Effective strategies for employer engagement include taking a targeted and tailored approach and sharing information about local employers with other (IPS/employment) services in the local area. Strengthening peer-to-peer networking and support with IPS services in mental health and primary care, including sharing information about local employers, could help mitigate the risk of employer fatigue and oversaturation.
• Wider research supports the effectiveness of IPS for achieving job outcomes for clients in drug and alcohol treatment. Nonetheless, various contextual factors affect the ability of IPS teams to help clients secure jobs, including the maturity of the IPS service, previous experience of IPS delivery (for large providers), the local labour market context and factors relating to the institutional set up of IPS in local areas. IPS is widely perceived to have benefits for clients beyond (sustained) employment including improved treatment outcomes, greater confidence and self-belief, and financial independence.
• The attributes, knowledge and skills of IPS team members are crucial to the programme’s success, but time-limited funding makes recruitment and retention more challenging. Time-limited funding means that most IPS team members are employed on fixed-term contracts. Moreover, the commissioning structure of IPS in drug and alcohol treatment results in small team sizes which are less resilient to turnover. Many commissioners and SESs expressed concerns about uncertainty regarding future funding for IPS and what this will mean for delivery.
• The scale of IPS delivery facilitates peer-to-peer networking and support both within and beyond the drug and alcohol treatment context. In some areas, peer-to-peer networking and support is facilitated at the provider and/or local level, the latter bringing together IPS teams embedded in different treatment services. Depending on the institutional set-up, some IPS teams may be better placed than others to benefit from or to provide this kind of peer-to-peer networking and support, reinforcing the importance of networking at the national and local level facilitated by OHID and IPS Grow.

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