Place-then-train: An alternative service paradigm for persons with psychiatric disabilities

Train-place programs make up the traditional paradigm for addressing the vo cational and independent living goals blocked by psychiatric disabilities; the strategy is to train persons in the necessary skills to manage their di sability, only then placing them in settings where they might accomplish wo rk and residential goals without the fear of relapse. Place-train services, which consist of placing persons on the job or in their apartments and the n training them in the skills they immediately need to succeed in these set tings, describe an alternative paradigm that challenges many of the notions of traditional services. In particular, place-train approaches contest a b asic assumption of traditional services-namely, using a carefully mapped co ntinuum of care to slowly progress persons through safe environments until they are able to cope with the demands of working and living in the real wo rd. Place-train approaches also contest other assumptions of the traditiona l service delivery system: assessing readiness for specific services, contr asting readiness with adherence to treatment; and defining relapse and reco very. The implication of these challenges for clinical services is discusse d.