Applicability of IPS principles to job inclusion of vulnerable youth

2.1 Analysis

I developed matrices to display relevant data from each pilot relating to each IPS principle. I also defined themes that were relevant to the assessment of each IPS principle and to data selection. The themes are listed in Table 2. Data were then searched for in each pilot. Selected data were coded using a concept-driven approach (Gibbs, 2007). Finding the relevant information was not very difficult, since the data had been organized by topics in semi-structured interview guides. In addition, I read the rest of the data twice, which led to the discovery of relevant information “hiding” under other headings.

I analyzed the coded data from each pilot by writing short summaries on each theme for every pilot. The summaries also contained direct quotes, researcher explanations and divergent information and areas where there was little or no information. The process of reading and writing summaries was repeated three times, and it led to several changes and the rephrasing of themes and summaries.

This process showed that there were many similarities across pilots. The process of comparing the information across pilots was thus a parallel process. However, I have not performed a case-oriented, cross-case analysis (Miles, Huberman, & Saldaña, 2014). My aim was not to perform an explicit pilot-to-pilot comparison, but to find patterns of needs, situations and experience related to job inclusion across the pilots (cases). It is more correct to say that the analysis resembles a variable-oriented, cross-case analysis, focusing more on themes than variables, however, and therefore also resembling theme-oriented analysis (Thagaard, 1999). In variable-oriented approaches, “generality is given precedence over complexity’ (Ragin, 1987, p.54), and the details of any specific case ‘reside behind the broad patterns found across a wide variety of cases, and little explicit case-to-case comparison is done” (Miles et al., 2014, p.102). My approach can perhaps be labeled “theme-oriented, cross-case analysis”. I wrote summaries of findings across pilots. They are shown in Table 2.

Theme-centered analysis has been criticized for separating the data from its original context (Thagaard, 1999), and variable-oriented, cross-case analysis for being poor at handling the real complexities and sometimes producing very general or even “vacuous” findings (Miles et al., 2014, p.102). Several authors suggest combinations of variable-oriented and case-oriented, cross-case analysis (Miles et al., 2014; Ragin, 1987; Thagaard, 1999). Descriptions and analyses of each pilot already existed prior to my writing this article. This made it possible to combine my theme-oriented, cross-case analysis with knowledge about the context and complexities of eachpilot.

None of the pilots had implemented IPS, which is not surprising since none of them worked solely with what is usually the target group for IPS: persons with severe mental illness enrolled in treatment. My aim was to assess the applicability of IPS principles to a somewhat different target group than is normally included in IPS programs. However, three of the pilots had implemented the five-stage process of SE, which has much in common with IPS (EUSE, 2014). In addition, the pilots had much in common with the IPS approach, for instance in aiming for employment, performing job development, paying attention to user preferences, and providing individualized long-term follow-up. I argue that qualitative knowledge about vulnerable youth, their needs and situation can provide relevant information for an assessment like the one I have carried out. The data are not suitable for statistical generalization, however. The article aims to produce analytic generalizations based on an assessment of qualitative data.

2.2 Findings

Table 2 shows summaries of major findings. Since there were more similarities than differences across pilots and informant groups, I present the summarized findings in one column, and then address observed differences between pilots or informant groups in the other columns. The first column refers to the IPS principle of relevance.

Interviews with youth, employers, and support givers show that vulnerable youth may need support and counseling on a broad spectrum of issues. Challenges differ, ranging widely from minor difficulties related to how to fill in applications for school courses for the coming year to major problems such as severe mental challenges, drug problems orcriminal activity. Frøyland and Fossestøl reported from project A and found that around 40% of this population of vulnerable youth had mental challenges, while around 20% had health problems and around 15% had alcohol or drug problems (2014). Close to 20% had been followed up by the child welfare services, and approximately 10% had been involved with the police (Ibid.). Common problems described were limited networks, lack of an apartment, financial problems, and challenging relationships with their families, and – for immigrants – reduced language skills. Pilot workers also reported social anxiety, withdrawal from social activities, loneliness, and internet gaming/dependence among youth. It was relatively common among these young people to fall into a pattern of staying awake at night and sleeping during the day.

Interviews with support givers and aggregated data show that some vulnerable youth were still students in school, while others had dropped out, and yet others had completed school with poor results. While some of these youth expressed a motivation to work and were eager to start doing something other than school, others seemed to have no interest, “drive”, or hope. While some of these young people came from resourceful families, a large proportion of them had parents and siblings with similar challenges as themselves.

Support givers from most pilots had also experienced that some vulnerable youth tend to withdraw from assistance, leading to a risk of marginalization (they are often referred to as NEETs (Not in Education, Employment or Training)). Withdrawal from support can, but does not always mean a wish not to receive support. Focus group interviews describing youth progress contain several examples of successful motivation of withdrawn youth after contact with outreach services or home visits. Thus, interpreting withdrawal as the client’s choice can lead to the non-inclusion of youth with huge supportneeds.

The descriptions of the needs and situation of vulnerable youth from these Norwegian pilots echoes findings from a large body of research literature from other European countries and the U.S. (Johansson & Höjer, 2012; Mascherini et al., 2012; Munford & Sanders, 2014; Noble-Carr et al., 2015; Osgood, Foster, & Courtney, 2010; Sanders & Munford, 2014; Van Parys & Struyven, 2012; Xie, Sen, & Foster, 2014). I believe that the findings can thereby also be relevant to vulnerable youth in other countries than Norway.

3.1 IPS principle 1: Competitive employment

“Agencies providing IPS services are committed to competitive employment as an attainable goal for clients with serious mental illness seeking employment,” writes Drake et al. (2012, p.33). This means that IPS employment specialists help clients to enter competitive jobs directly, and that they do not assist clients to obtain non-competitive jobs such as “volunteer jobs, unpaid internships, sheltered work, and set-aside jobs” (Ibid, p.33). For further elaboration, I define competitive employment as jobs at ordinary wages in the open labor market.

Interviews with youth and support givers indicate that most vulnerable youth want ordinary jobs, some in the short term, and many in the longer term. For example, all youths who took part in a group session in one of the pilots had work as part of their dream for the future. Because vulnerable youth often have a history of lack of success, many of them have lost motivation and “drive”. They often have little work experience and knowledge, and have low self-esteem. Examples from several pilots underline the importance of facilitating mastery and participation among these youth, and interviews with employers show that the workplace is an arena that can contribute to this, given a good job match, sufficient support, and an inclusive work environment.

Support through clear messages, positive feedback and caring support from colleges are often mentioned as important elements by support givers. Interviews with support givers and youth show that work experience in the form of job exploration, job tasters, internships, apprenticeships, summer jobs, or work practice can be good short-term ways of facilitating mastery, motivation, learning, and inclusion.

Work experience seems to be an important cue, giving youth the experience that someone needs them, that they can contribute, and that it is achievable. It also represents an opportunity for them to learn about their own skills, potential, and interests.

Interviews with youth and support givers indicate that sheltered work can also facilitate mastery and socialization, and that it can function well for some vulnerable youth for a period. A young boy in one of the pilots first got a job at a local factory assisted by the local job specialist, but he did not master it. For some time after that, he attended a local sheltered workshop and took part in the activities going on there. His support givers followed him up closely all the time. According to them, he seemed to need close follow-up, secure relations and time to “mature”. They described him as a happy and “full of pranks”, more like a boy than a youth, and with a family that did not care. A year later, something had happened; he had made friends who encouraged him to exercise and lose weight. He appeared motivated, and the job specialist encouraged him to visit and attend an upper secondary school where it was possible for him to study only those subjects he had a particular interest in. This turned out to be a success. He was able to perform very well at exams and was provided with a proper education.

However, none of the youth interviewed state that they want sheltered work. They want to be “normal” and have permanent jobs and wages. In combination with the evidence that, for employment outcomes, rapid entry into the regular labor market is superior to stepwise entry (Drake et al., 2012; Markussen & Røed, 2014), these data support the view that ordinary workplaces should be prioritized over sheltered ones. Cimera indicated that what is learned in a sheltered workshop is not always transferable to ordinary work (2011). I therefore suggest that work experience for vulnerable youth should primarily take place in ordinary workplaces. This is also the most common view among support givers in pilots.

Field notes and interviews with support givers suggest that it is not just the wishes and needs of vulnerable youth that are relevant to the applicability of the IPS principles to this target group. The context in which they find themselves can also influence what kind of approach it is possible to implement. In most pilots, competitive employment is not the main aim in the short term. The portfolio of this school advisor is one example:

Return to ordinary school, work practice as part of school (for example an apprenticeship), in combination with school or as an alternative to school for a short period, is seen as more relevant by support givers in a short-term perspective.

Why so little focus on competitive employment for this target group? First, several studies have produced support for a link between completion of school and better employment opportunities over the life span (Brekke, 2014; Falch & Nyhus, 2011; Kim, 2013; Markussen, Frøseth, Sandberg, Lødding, & Borgen, 2011; Sletten & Hyggen, 2013). In many countries, this has made the authorities take action. In Norway, the Program for Enhanced Completion of Upper Secondary Education and Training, which was launched in 2014, is just one of many initiatives in recent decades. 1 Drop-out youth with rights to upper secondary schooling (normally aged 15–21 according to the Norwegian regulations (Ministry of Education and Research, 1998)) who have lost interest in and motivation for school will thus find that the school and other services will attempt to help them to return to and complete school. Competitive employment is not viewed as a short-term aim, but rather as a long-term aim for these youth. For older vulnerable youth (22+), ordinary work is more often also a short-term aim.

Second, whereas the school system aims to keep youth in school and help drop-outs to return, the implementation of supported employment can produce incentives in the opposite direction, by offering the possibility of paid employment to students with low motivation. Thus, the combination of school and job-oriented services could be problematic. This was clearly the case in one of the pilots where they tried to implement SE at an upper secondary school. They solved the challenge by subordinating the use of ordinary workplaces and work to the schools’ goal of education and school completion.

Third, very few support givers in the pilots knew of SE. Exceptions were found in three pilots. Although several support givers provide job-related follow-up, only a few of them would qualify as job specialists by the standards of IPS or SE (Drake et al., 2012; EUSE, 2014). The data enabled me to compare the support provided in pilots with job specialists to pilots without such specialists. I found that the presence of a job specialist with knowledge of SE or IPS in services for vulnerable youth is likely to increase the ability to see the possibility of work experience or employment, as well as to facilitate it. This was particularly evident in one of the pilots, where a job specialist with long experience of job inclusion nearly always saw ordinary work as a possible option. He knew of an appropriate workplace, and had the experience and the guts to contact the employer and help the youth out so that he got a taste of working.

Both competitive employment and work experience in ordinary workplaces seem to be capable of meeting needs for mastery, motivation, and inclusion. Ordinary employment is important for everyone in the long term, but school completion can be important in the short term for some vulnerable youth, particularly those of school age (15–21). Facilitation of short-time work experience is relevant for all and more compatible with school. In order to meet the needs and address the context of vulnerable youth, I therefore suggest that the IPS principle of competitive employment – if applied to vulnerable youth – should incorporate other forms of work experience than just competitive employment. This seems to be in line with youth needs and will make it easier to avoid conflicts with the schools’ mandate. It is also in line with EUSE’s suggestions on work experience placements for NEETs (EUSE, 2014, p.91), as well as EUSE’s conclusion on work experience placements, which states that such placements should be viewed as “a means to an end and not as the end result” (Ibid., p.26).

3.2 IPS principle 8: Time-unlimited and individualized follow-up

Continuous follow-along supports meet the needs described by several authors who address the challenges of the transition into adulthood for vulnerable populations (Johansson & Höjer, 2012; Osgood et al., 2010; Xie et al., 2014). This has been one of the pillars of supported employment. The IPS fidelity scale suggests that supports are provided by a variety of people, “including treatment team members, family, friends, co-workers (natural support), and employment specialists” (Drake et al., 2012, Appendix, p.14). However, the intensity and content of such ongoing follow-up has received little attention in the research so far (Ibid.p.41). Drake et al. conclude that there is a need to develop “empirically based standards for what supports are needed, for how long, at what intensity, and for which kinds of clients” (p.42). My analysis did not fully answer all these questions, but provided some clarification.

Interviews with youth, employers and support givers demonstrated that vulnerable youth can profit from support at work both in relation to private and practical issues, such as getting up in the morning and transportation to work, and to other issues such as finances, housing, health, or treatment. One support giver’s reflections show that transportation does not just mean transportation, it is also an opportunity for vital conversations:

The time spent in the car to and from work is used for preparations, de-briefings, advice on issues such as how to dress, reasons to stay home, and how to understand what happened at work that day. Some youth lack family or friends who can participate in such reflections. According to support givers, all the pilots had experienced a need for close individualized, long-term follow-up of vulnerable youth:

In the pilot referred to above, almost 50% of the participants had received support for more than two years, and quite a lot for five to six years or longer. The experience was similar in most pilots, suggesting that close and individualized follow-up delivered by a youth worker, job specialist, or “the right employer” can be an important factor contributing to successful employment.

Informants used the term “the right employer” quite often, by which they meant employers who were interested in youth, wanted to give them a chance, and had the required patience. These employers could offer work that matched youth interests, and had, according to themselves and support givers, an inclusive work environment that could provide the required level of follow-up at work. When employers describe successful work experiences, they often highlight that youth should be given responsibility and meaningful work tasks that they are able to handle:

The boy referred to above had dropped out of school during the autumn. Then, at his own wish and with help from the employment and welfare service, he was offered a job (3 months’ work practice) at a local business. According to support givers, he completely changed his behavior and appearance – from being unmotivated, aggressive, and hard to cooperate with, to being an interested, friendly, and cooperative young man. He worked at this business for around six months and then decided to return to school, which he completed. Interviews with other employers contain similar stories.

Support at work to master work tasks can be important. However, interviews with support givers and employers show that it is not always the job tasks that are the real challenge. Issues relating to sudden absence, behavior in the workplace, and social inclusion seem to be important for some, for example being part of a work environment, having lunch with others, talking and taking active part:

Support givers mentioned social anxiety as one possible explanation for why some youth found it difficult to socialize and have lunch together with the others. Others are challenged because of low self-confidence and lack of belief in themselves:

The girl referred to in the quote above improved her job quality, and when her closest co-worker became ill, she stepped in and did her job. Prior to work placement in this workplace, the girl had been a student at a special school for youth with disabilities. After this work experience, she decided to return to ordinary school, which she completed.

Support needs do change with time. Focus group interviews contain several examples of challenges arising somewhere along the line, where support is then needed in connection with psychological problems, lack of motivation, self-confidence, or other problems.

Some pilots have successfully attempted to establish natural supports at work for long-lasting and close individual support when the need arises. At one workplace, three colleges agreed to cooperate as mentors for a young boy with severe challenges. He was offered an apprenticeship at their workplace. They made it their aim to help this boy succeed:

After five years of close follow-up, including wake-up calls, home visits, and numerous “talks”, he finally got his certificate. This example is rather untypical as regards the willingness and ability of an employer to provide follow-up, but it shows how intensive support can be needed.

Individualized support from an external service in a workplace can lead to problems of stigmatization and, as such, contribute to social exclusion instead of inclusion (Titmuss, 2006). One important issue is therefore to develop ways of providing support that do not lead to stigmatization. By natural support, I mean support that is activated among colleges already working there. The ability to develop natural support can be vital because, with this kind of support, it is easier to avoid stigmatization. In addition, natural support can be “present and close to the person” for a long time and therefore be ready to be activated when a need arises. This point has already been addressed elsewhere (Drake et al., 2012; Murphy, Mullen, & Spagnolo, 2005) in relation to support for persons with psychiatric disabilities. I interpret the needs of vulnerable youth demonstrated in the pilots as arguments in favor of also implementing natural support for vulnerable youth.

The findings clearly support the IPS principle of individualized and time-unlimited support for vulnerable youth. The data demonstrate a need to focus on facilitation of mastery and social inclusion in work with vulnerable youth, as well as close follow-up in connection with issues not directly relevant to work. This indicates that follow-up at work should not just focus on the job tasks, but also on social issues in the workplace: how to behave, what to say, and so forth. Cato Wadel has elaborated on the concept of incorporation and he finds that the processes of inclusion and exclusion can be rather subtle and difficult to address (Wadel, 2008). This challenges the support givers’ ability to adopt a close enough perspective and follow up closely enough. Natural supports can contribute to that.

3.3 IPS principle 3: Integration of rehabilitation and mental health services

According to Drake et al. (2012), “IPS programs are closely integrated with mental health treatment teams” (p.35). This means that IPS specialists review client progress through participation in treatment team meetings. They help team members think about work and develop ideas for improving client functionalities. According to the IPS fidelity scale, an employment specialist carries out “all phases of employment service, including intake, engagement, assessment, job placement, job coaching, and follow-along supports before step down to less intensive employment support from another MH practitioner” (Mental Health practitioner) (Ibid, Appendix, p.2). This principle has at least two important messages: 1) a team should coordinate the support, and 2) a specialist should be responsible for the entire process of job inclusion.

The involvement of mental health services will only be directly relevant for vulnerable youth who have mental health challenges. Coordination of services and support is often mentioned, however, as one type of need among vulnerable youth (Luecking, 2009; Osgood et al., 2010; Wehman, 2011). This is also the general experience in all the pilots. According to project workers, in order to achieve success it is vital to have the ability to cooperate with other services such as health services, psychiatric specialists, outreach services, and career consultants, as well as advisors at school and local employment and welfare offices that provide welfare benefits and measures for activation and work inclusion.

The pilots had developed different solutions for the coordination of support. Some adopted team approaches. Others coordinated the support through ad-hoc approaches in individual cases, and some through regular coordination meetings at which representatives of several services discussed challenges in ongoing cases. Some solved coordination issues by assigning responsibility for close follow-up and coordination of the support to ambulant pilots/coaches. Some had integrated several services in such a way that two or more services were located in the same place and collaborated from there.

A few pilots had what resembled employment specialists who were responsible for job development and job inclusion processes. Some pilots had developed more generalized approaches, where the youth workers were responsible for employment services in addition to being responsible for support in connection with other issues.

Comparisons of field reports and interviews with support givers across pilots showed that youth workers with few clients were able to follow up more closely and for a longer time, if necessary. One of them was capable of providing this kind of support: every morning at six o’clock, he called one youth to wake him so that he would get to his work experience placement on time. On mornings when the boy did not answer the wake-up call, he drove home to him and took him to the workplace. The youth eventually got a job.

Youth workers in specialized approaches were able to spend more time on job development and follow-up of employers.

As discussed above, the need for close follow-up of issues such as job mastery, social inclusion, and long-term support, clearly indicates that the presence of a support giver with the competence and capacity to ensure such support in the workplace would be preferable. Several of these support needs were often left to the employer, but only the “right employers” have the knowledge or the competence required to provide sufficient follow-up, while most probably do not. Youth workers in specialized approaches seem better suited to meet the work-related support needs of vulnerable youth and their employers.

Thus, I find that bringing the competence and capacity of a job specialist closer to services and generalist-orientated support givers is likely to improve the quality of employment services for vulnerable youth and should have a potential to contribute to better and more systematic use of work experience. The support team in one of the pilots can serve as example. The team consisted of five persons providing support to students aged 16–25 based at senior high school. The team members were a job specialist, a school advisor, a former employment and welfare advisor, a social worker with experience of outreach service, and a project leader with experience of youth work among immigrants. Although they were experienced support givers, most of them were inexperienced in job inclusion issues for persons with severe needs. The job specialist was assigned the role of tutor, helping and teaching the others on issues such as job development, job finding, and job match. Even though school advisors and teachers in general facilitated work experience for their students as part of their job, the methodological approach of the experienced job specialist meant much more systematic job development and facilitation of work-based learning in this institution.

Being responsible for close follow-up of vulnerable youth with severe needs for several years can be a very challenging task according to interviews with support givers. It can lead to burnout and loss of what Tilson and Simonsen describe as “principled optimism”, which is often associated with successful support (2013, p.125). Shared responsibility in a support team can prevent burnout and loss of motivation among youth workers, according to these interviews.

Drake, Becker et al. have shown that integrated services are more effective than parallel services because “clinicians rather than clients assume the burden of coordination, consistency and coherence” (2003, p.51). This is also the experience in several of the pilots included here. My analysis suggests that the message implicit in IPS principle 3 is also relevant to the target group of vulnerable youth: A team-based approach including the presence of a job specialist seems to be a good way to coordinate and facilitate high-quality, supported employment for vulnerable youth.

3.4 Applicability of IPS principles 2, 4, and 6

IPS principle 2 (Eligibility Based on Client Choice) means that starting IPS is based on client choice: “Clients are not excluded on the basis of readiness, diagnoses, symptoms, substance-use history, psychiatric hospitalizations, level of disability, or legal system involvement” (Drake et al., 2012, p.34). Few pilots practiced this approach. Most had pre-defined target groups and stuck to them. But the data contain examples of youth who were assumed not to be “work-ready” by support givers managing integrated work when provided with close follow-up and “the right employer”.

I interpret this as support for a zero exclusion approach to this target group. Zero exclusion means that “all clients interested in working have access to supported employment services regardless of job readiness factors” (Drake et al., 2012, Appendix, p.6).

Data also show that basing participation on client choice can be difficult to practice, particularly in cases when youth withdraw and start on a rather destructive path. This is particularly relevant for under age youth, but also for NEETs in general (Van Parys & Struyven, 2012). This challenge places heavy demands on competence, service flexibility, and efforts by support givers to reach out to troubled youth, as well as on their ability to motivate and meet youth needs.

Outreach services can be important in such situations, as well as communicative skills. I propose that vulnerable youth should not be excluded without support givers making efforts to meet their needs.

Experience from all the pilots supports the view that services targeting vulnerable youth should address client preferences and choices, strengths, and experience (IPS principle 4: Attention to Client Preferences). However, helping youth with low self-esteem and a long history of failure and defeats to define their own preferences and strengths requires some extra effort. Most pilots had developed individual or group-based approaches to help them discover their own interests and preferences. Examples include motivational courses (two or three weeks), peer groups, activities of various kinds, and the use of visual methods and approaches that promote a positive emotional climate and focus on what works (for example Motivational Interviewing and Appreciative Inquiry), as well as individual conversations with youth workers aimed at building close and secure relations. Drake et al. devote much attention to clients’ previous job experience as a source of ideas for future work (2012). This is also relevant for some vulnerable youth, but most of them do not have much work experience and have little knowledge of working life. My analysis suggests that finding a job that suits their interests and abilities will require greater emphasis on exploring and discovering the youths’ interests and skills, in addition to focusing on previous work experience.

IPS principle 6 (Rapid Job Search) underlines that the approach to open employment should proceed at a fast pace in contrast to lengthy pre-employment assessment, training, and counseling. Youth workers in all the pilots report a need to respond quickly to the needs of the youth when they “are motivated”. “If you wait, they might change their mind and disappear” is a common experience.

A quick response can take place in several ways, for instance through frequent dialogues or meetings, participation in courses, or as work experience or employment. My empirical data do not provide information that is suitable for assessing whether the quick response should also be job-related. However, as already mentioned, my data show that vulnerable youth often want normal lives and jobs. Common wishes in my data are education, job, home, family, a car, money, kids, etc. Based on the finding from many studies that rapid job search is superior to stepwise approaches in terms of later employment (Drake et al., 2012; Markussen & Røed, 2014), I find that a rapid job search approach is also reasonable in relation to vulnerable youth. However, since they will not always aim for competitive employment in the short-term, a minor adjustment of principle 6 seems appropriate: from rapid job search for competitive employment to rapid search for work experience in line with user needs and preferences. As previously argued, the work experience should take place in ordinary workplaces and include the possibility of employment if that isdesirable.

4.1 Limitations and implications for future research

There are several limitations to this study. The article is not based on an empirical test of the IPS principles in relation to support for vulnerable youth. I have assessed the applicability of the IPSprinciples to a target group that differs from that normally assigned to IPS, based on knowledge about this target group’s needs, situation, and experience of job inclusion. My study has generated several hypotheses to test. The main hypotheses are 1) the IPS principles are applicable to vulnerable youth, and 2) modifications of the principles as described above is likely to increase their applicability to this target group. An actual test of support in line with IPS for this target group is necessary to produce evidence that such support is actually applicable to vulnerable youth, as well as to check whether my proposals are reasonable. To test my findings, a controlled trial of IPS could be carried out on a group of youth who have dropped out of school or are at risk of dropping out.

Even though I have read and analyzed the data carefully several times, there are many interesting particularities related to youth, employers, and support givers that I have not addressed in this article. Every single youth in any pilot has individual needs and will need individualized support. My aim was not to present all the details and particularities, but to discover and describe major patterns and contents relating to selected themes across this rich material. This approach involves a risk of producing very general findings. In my view, the data I found were not too general and were thus suitable for assessing the applicability of the IPS principles to vulnerable youth in the way I have done.

I have chosen a rather wide and heterogeneous definition of the target group. “Vulnerable youth” can mean youth with severe mental challenges, drug problems, or learning disabilities, or youth with only minor challenges and good work ability if they only find the right class or the right job. This vague definition of the target group can be criticized. However, in local communities, the problem and response seem to be defined more based on the actual situation of youth (dropout, jobless) than on their potential diagnosis. The support givers in the pilots provide follow-up for a wide variety of young people. In the end, the approach always has to be individualized. However, I have not carried out a detailed study of possible systematic differences in needs and approaches related to various sub-groups of vulnerable youth in this article. This is a limitation. IPS has previously been assessed for several “sub-groups” of vulnerable youth with mental challenges (see for instance Bond et al., 2014; Burke-Miller et al., 2012; Ferguson, 2013). More knowledge is needed, however, particularly as regards vulnerable youth with other challenges than severe mental challenges.