Youth in rural and remote regions around the globe face persistent and multifaceted barriers to meaningful and sustained employment [1, 2]. These challenges are often shaped by a lack of access to integrated mental health and social services, geographic isolation, economic precarity, and limited pathways for skill development [1]. The result is that unemployment rates for youth are often two to three times higher than those of adults [3, 4]. Furthermore, rural youth have higher unemployment and lower education rates compared to urban youth [5]. Supported employment (SE) models, particularly those grounded in person-centered, recovery-oriented principles, have emerged as promising interventions to address these barriers, especially for individuals with mental health and psychosocial challenges [6]. Among them, Individual Placement and Support (IPS) stands out as a well-established model designed to provide timely, integrated employment and mental health services [7].

Research has been conducted to understand the implementation of SE programming, such as IPS, in rural settings. Al-Adbulmunem [8] found that challenges to implementing IPS in rural communities in the United States included a lack of employment and workforce options. Moe [9] found that, when examining the implementation of IPS in rural Norwegian communities, employment specialists were heavily car-dependent, driving long distances in between seeing clients and returning to the office, with some employment specialists using their vehicles as office spaces, limiting their flexibility. A systematic review of peer-delivered employment interventions in rural Australian communities found that employment outcomes can not only offer economic, cultural, and social boosts to the community but can also improve the mental health and wellbeing of those who successfully obtain employment [10].

While some work has been done internationally to understand the implementation of SE programs in rural areas, there is still a need to understand cross-regional and local needs at a global level. As SE programs in Canada expand into rural areas, our study aims to understand the strengths and limitations of implementing SE programs for youth in rural Canadian regions that reflect many of the social, geographic, and infrastructural dynamics shared by rural regions worldwide [2].

In Canada, income support for unemployed youth is provided through federal and provincial programs. In British Columbia (BC), youth experiencing financial hardship may be eligible for Income Assistance or Disability Assistance through the Ministry of Social Development and Poverty Reduction (MSDPR). However, Income Assistance benefits have been criticized as insufficient to meet the cost of living and remain well below poverty thresholds and living wage estimates in BC [11–13]. These challenges may be amplified in rural and remote communities, where youth often face limited employment opportunities, transportation barriers, and reduced access to education, health, and social services. Consequently, income support alone may be insufficient to promote labor market participation, particularly for youth experiencing mental health challenges. This underscores the potential value of supported employment programs, such as IPS, which integrate employment services with broader health and community support.

We interviewed 10 participants. The majority of the respondents identified as women (n = 9; 90%) and white (n = 9; 90%). The participants’ ages ranged from 28 to 58 years old (n = 8; mean = 38.63; median = 35.5), and their years of experience ranged from 5 to 25 years (n = 8; mean = 11.44; median = 9.0). Two participants did not report their age or years of experience. Their role titles ranged from employment counselors and consultants to specialists to program coordinators and job developers. They will henceforth be described as “employment specialists.” The participants’ work experiences varied from school settings to community-based or WorkBC employment programs (a government-funded employment service in BC). Two participants reported using the IPS model as a guiding model of care; others named principles such as strength-based approaches and competitive employment opportunities that guided their work. Others reported that they did not utilize any guiding frameworks when working with clients.

Through our reflexive thematic analysis, we constructed three themes: Theme 1. Macro Level: Societal factors influencing employment outcomes, Theme 2. Meso Level: Organizational barriers and facilitators, and Theme 3. Micro Level: Employment specialists’ capabilities. These themes represent iterative constructions developed through iterative engagement with the data, capturing how employment specialists made sense of the multi-level influences shaping supported employment practices.

Theme 1

Macro Level: Societal factors influencing employment outcomes.

Theme 1 relates to the societal factors that influence employment outcomes for youth living in Northern BC. Societal factors are factors that cannot be changed by individual employment specialists but have a daily influence on the youth clients and the employment opportunities available to them.

Participants described that in Northern BC there were many opportunities to work in the resource industry, which offers career development and high wages that are not available in southern parts of BC (e.g., Vancouver). However, they noted that these jobs are difficult to maintain and sustain for those facing barriers such as mental health challenges, workplace discrimination, unstable housing, and low socioeconomic status. Participants also expressed that youth’s values differ from those of older generations and that youth are less inclined to work in the resource industry.

Other impacts on SE programs in the north include systemic challenges such as housing insecurity, limited transportation options, internet accessibility, and the availability of healthcare resources.

Participants reported that they had difficulty engaging with clients who had low motivation and emotional regulation skills, which are often associated with untreated mental health challenges. They advocated for client mental health and substance use challenges to be addressed and prioritized in tandem with employment support, but getting young people access to these services is a challenge of its own due to resource shortages.

Participants agreed that their services are siloed from other healthcare services, and the gap between employment services and specialized mental health services (e.g., counseling) was mentioned frequently. One participant noted that clients must self-refer to counseling instead of being referred by the employment specialist. Participants repeatedly reported long wait times for mental health services, a shortage of mental health workers, youth admittance to the emergency room for psychiatric help, and a lack of variety in therapy modalities in Northern BC that complement employment services.

These participants’ accounts reflect macro-level structural determinants of employment, particularly with regard to the capacity of the broader mental health system within rural and remote communities. The reference to intergenerational trauma, combined with long waitlists and workforce shortages in mental health and addiction services, illustrates how under-resourced systems and historical social inequities shape access to care, including access to both health and social services. These systemic gaps limit individuals’ ability to obtain the timely support needed for employment readiness and stability, thereby influencing employment outcomes at the population level rather than an individual level.

Theme 2

Meso Level: Organizational barriers and facilitators.

The second theme, “Organizational barriers and facilitators,” captures how organizational, service, employer, and support system factors influence SE effectiveness. Participants emphasized that youth often require integrated mental health and social support; however, interdisciplinary collaboration was limited by resource constraints in rural northern communities. When collaboration was possible, participants felt that services were more effective. Family support could facilitate employment when it aligns with the goals of the youth but could become a barrier when it limits the youth’s autonomy.

Another subtheme was bridging the gap between employers’ needs and those of youth. Despite having a shortage of employees, participants reported that employers are often not flexible with the needs of youth, such as accommodations, flexible work hours, and non-customer-facing roles. Participants identified that as an employment specialist, they bridge this gap and advocate for youth.

Participants recognized the importance of on-the-job training and searched for these opportunities for youth. One participant advocated for programs that allow youth to attend school and work at the same time. They agreed that these types of programs could help fill labor shortages in their communities, where many jobs require advanced education:

Participants noted how they had to increase employers’ awareness of the impact these young people could have and the accommodations that would help them thrive. Specifically, they advocated for employers to receive trauma-informed training, gender inclusivity training, and education about youth’s mental health needs. Participants identified a community-level knowledge gap about accessing SE and hiring youth with mental health needs. Stigma exists for youth with mental health challenges, and this was an emphasized challenge within small communities where “everyone knows everyone.” While some employers saw these youth as a risk, the participants saw them as resilient and able to thrive when provided the right environment.

Participants identified wage subsidies as a key strategy to reduce employer hesitation by lowering the perceived risk associated with hiring youth with limited work experience or additional support needs. They also highlighted the importance of transition support, including paid certifications and post-secondary education subsidies, which should be embedded within community-informed strategies that are responsive to rural northern contexts.

Participants further described how externally imposed funding structures and program requirements shaped service delivery, including eligibility criteria, program timelines, and funding constraints. Facilitators included evidence-based models such as IPS and interdisciplinary collaboration. While employment specialists felt they could influence organizational factors, they emphasized that sustainable change requires collective commitment from employers, funders, families, and health systems.

Theme 3

Micro Level: Employment specialists’ capabilities.

The third theme focused on items within the employment specialists’ capabilities, defined as those actions that the participants took on a daily basis to help youth find employment. Within this theme, the responsibilities of the employment specialists were focused on one-on-one interactions with youth and/or employers.

Participants identified the importance of client-centered practice and reported that they enable youth to make their own choices about work and provide unjudgmental support and unconditional positive regard throughout the process. For example, if youth did not show up to appointments, the participants kept them on as clients and waited until the youth were ready. They acknowledged that youth autonomy can sometimes be a barrier to employment, but it can also be a turning point in a young person’s life.

Participants noted that being an employment specialist is more than just helping youth find a job or an education. It also includes addressing their emotional needs by normalizing failure and congratulating them throughout the job process, encouraging them to choose their own direction, and supporting them with instrumental activities of daily living to enable employment, such as taking the bus and learning time management–ultimately teaching skills for them to succeed not just in work, but in life. Several participants described that sometimes they are one of the few trusted adults in a youth’s life:

Making connections with youth, colleagues, and employers was a common theme throughout the data. Participants highlighted the importance of building relationships with youth over time so they can develop trust in employment specialists. Participants also described the need to make connections and build trust with potential employers, as “who you know” heavily impacts employment opportunities for their clients. Participants highlighted the need for more time in their roles to build relationships with employers and learn what resources are available in the community:

Our study aimed to understand the unique strengths and significant barriers of providing employment services in rural northern communities. Employment specialists working in Northern BC communities operate at the intersection of macro-, meso-, and micro-level systems to support youth navigating employment and educational challenges, often alongside mental health and/or substance use concerns.

Our results align with literature that explores IPS-based services for youth aged 16–30 experiencing mental health challenges [19, 20]. Ellison [19] noted that there are complexities in providing employment and education services to this age demographic, including youth-centered care in navigating the transition to adulthood, supporting youth through the development of mental health and life skills, and engaging with employers–these concerns are also captured within our themes. Furthermore, our data highlight critical IPS components, including worker preferences, integrated services, and systematic job development, which require focused implementation efforts for this specific population [7].

Notably, our results indicate that youth in rural northern communities rarely seek employment services with “employment” as their sole presenting concern. Rather, employment services are most effective when integrated with broader health and social supports that address the complex and intersecting needs of young people. Employment specialists in our study emphasized needing dedicated time and resources to cultivate meaningful community and employer relationships. While these elements are fundamental to the IPS model, our findings suggest that their full realization remains challenging in resource-constrained and geographically dispersed settings such as Northern BC. Importantly, this also raises a broader question regarding the contextual fit of IPS: although IPS is an evidence-based model with strong empirical support, its assumptions regarding service intensity, integration, and rapid job development may not be equally feasible across all service environments, particularly those characterized by small, heterogeneous populations, limited workforce capacity, and competing service demands. This highlights the need to consider not only how IPS is implemented, but also where and under what conditions it may require substantial adaptation or complementary approaches.

This finding has global relevance, as youth in rural and underserved regions worldwide often face intersecting challenges related to employment, mental health, and social support. Implementing integrated, relationship-based employment services in low-resource settings is a common struggle internationally, highlighting the need for adaptable, context-driven models across diverse geographies [21, 22].

As IPS expands into varied service settings and populations, it is crucial for communities to carefully assess how adaptations impact fidelity and employment outcomes. We observed variation in the reported use of formal frameworks, which may reflect meaningful differences in how employment supports are structured and operationalized across rural service contexts. While a small number of participants explicitly identified the IPS model as a guiding framework, others described drawing on broader principles such as strengths-based practice and a focus on competitive employment, and several reported not working within any formalized model. This variation may reflect both the absence of standardized implementation structures in rural settings and the need for locally responsive practice adaptations.

Previous research confirms the efficacy of IPS in rural areas, but implementation fidelity is often compromised in under-resourced environments [8, 23]. To address this, systematic documentation, evaluation, and assessment of adaptations are essential [24]. Importantly, many IPS models and related supported employment frameworks were not originally designed for Northern, rural, or Indigenous community contexts. As such, effective implementation requires intentional engagement with local communities, including youth, families, Indigenous leaders, and service providers, to ensure that program delivery reflects local priorities, cultural values, and available resources. Our study, alongside existing literature, therefore, highlights a clear need for a rural, Northern-specific strategy to implement sustained SE programming that considers community context, youth needs, workforce capacity, and system capacity. Furthermore, implementation science frameworks should be used to research the impact, such as the Consolidated Framework for Implementation Research (CFIR) or Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) [25, 26].