Place First, Then Train: An Alternative to the Medical Model of Psychiatric Rehabilitation.

Place First, Then Train: An Alternative to the Medical Model of Psychiatric Rehabilitation.

There are two overarching goals to psychiatric rehabilitation: Help people with disabilities achieve (1) work and (2) independent living goals in the real world. Over the past 30 years, two paradigms emerged to guide rehabilitation professionals in helping people achieve these goals. The traditional paradigm is a medical or clinical model called “train-place,” in which people are thoroughly trained to manage the symptoms and dysfunctions of their mental illness and then placed in a real-world job or home. A recently developed paradigm, called “place-train,” instead promotes rapid placement of people with disabilities in real-world work and housing, followed by in vivo support, resources, and training that help the person successfully remain in those settings. The train-place approach to rehabilitation is dominated by concerns about relapse if a person with mental illness is too quickly placed in a real-world setting with its commensurate demands and stresses. Proponents of this model propose a continuum of care through which a person with a disability cautiously progresses before being placed in a job or an independent living situation. Place-train is consistent with a core value of social work–client self-determination–by recognizing the individual’s desire for independence and providing in vivo assistance (NASW, 1996; Reamer, 2001). In this article, we examine research on the two models. Place-train makes sense in relation to social work’s perspective on psychiatric services; hence, we juxtapose some of the basic assumptions of place-train to fundamental assumptions of social work practice for people with psychiatric disabilities.

Place First, Then Train: An Alternative to the Medical Model of Psychiatric Rehabilitation.



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