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

Train-place programs make up the traditional paradigm for addressing the vocational and independent living goals blocked by psychiatric disabilities; the strategy is to train persons in the necessary skills to manage their disability, only then placing them in settings where they might accomplish work and residential goals without the fear of relapse. Place-train services, which consist of placing persons on the job or in their apartments and then training them in the skills they immediately need to succeed in these settings, describe an alternative paradigm that challenges many of the notions of traditional services. In particular, place-train approaches contest a basic assumption of traditional services—namely, using a carefully mapped continuum 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 word. Place-train approaches also contest other assumptions of the traditional service delivery system: assessing readiness for specific services, contrasting readiness with adherence to treatment; and defining relapse and recovery. The implication of these challenges for clinical services is discussed.