Supported employment has been repeatedly demonstrated to improve competitive work outcomes in people with severe mental illnesses such as schizophrenia and bipolar disorder (1). Although strong research supports the effectiveness of supported employment, and efforts are underway to increase access to these programs (2, 3), not all participants benefit from supported employment. Specifically, across most studies between 20% and 40% of patients do not find jobs (4‚Äì8), and of those who do, many have brief job tenures that end unsuccessfully, such as being fired for poor work performance. These findings have stimulated efforts to address illness-related impairments that may limit the effectiveness of supported employment for some individuals with severe mental illness.
To address cognitive impairments that limit the effectiveness of supported employment services for patients with schizophrenia, a cognitive training program, the Thinking Skills for Work Program, was developed and integrated into supported employment services.
The setting was supported employment programs and various places of employment.
The sample included patients with severe mental illness (N=44) and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City. The eligibility criteria was severe mental illness as by the State of New York Office of Mental Health, current unemployment, desire for employment, enrollment in supported employment, history of at least one unsatisfactory job ending (getting fired from a job held less than 3 months or walking off a job without another job in place), and willingness and capacity to provide informed consent.
Employment outcomes were aggregated by computing the total number of jobs, hours worked, and wages earned over the entire follow-up period. Potential interactions between site, treatment group, and work were evaluated by performing an analysis of variance (ANOVA), with site and treatment group (supported employment with cognitive training or supported employment alone) as the independent variables and the total number of jobs worked as the dependent variable. A chi-square analysis was conducted to compare the two treatment groups on percentage of patients who obtained work over the course of the follow-up period. Additional analysis was also done to address a variety of data factors.
Patients with severe mental illness N=44 and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City were randomly assigned to receive either supported employment alone or supported employment with cognitive training. Measures at baseline and 3 months included a brief cognitive and symptom assessment. Work outcomes were tracked for 2‚Äì3 years.
The comparison condition was supported employment only.
Patients in the supported employment with cognitive training program demonstrated significantly greater improvements at 3 months in cognitive functioning, depression, and autistic preoccupation. Over 2‚Äì3 years, patients in the supported employment with cognitive training program were more likely to work, held more jobs, worked more weeks, worked more hours, and earned more wages than patients in the program offering supported employment alone.
The findings support the feasibility of integrating cognitive rehabilitation into supported employment programs and suggest that more research is warranted to evaluate the effects of the Thinking Skills for Work Program.