Black / African American

Populations:

Urban

Outcomes:

NIDILRR Funded:

Research Design:

Mixed methods

Peer Reviewed:

Yes

The Hartford study of supported employment for persons with severe mental illness

Authors:

Murphy, L., Chamberlain, E., Weir, J., Berry, A., James, D. N., & Agnew, R.

Year Published:

2004

Publication:

Journal of Consulting and Clinical Psychology

Volume:

Number:

Pages:

479-490

Publisher:

American Psychological Association

Background:

High rates of unemployment persist with people with psychiatric disorders despite their desire to work. Moderate evidence suggests that people with psychiatric disorders who do work experience "modest benefits in terms of symptoms and life satisfaction" (p. 479).

Purpose:

Three approaches to vocational rehabilitation were compared for people with psychiatric disorders. This included the Individualized Placement and Support Model(IPS), a psychosocial rehabilitation program (PSR), and standard services.

Setting:

The setting included community mental health center in Hartford, Connecticut. The psychosocial rehabilitation program was located off-site. Standard services were offered off-site.

Sample:

One hundred ninety-eight clients consented to participate (out of 258 who were asked): 86% were Latino(n = 64 consents/74 total), 81% were African-American (n = 91 consented/119 total), and 66% were White (n=43 consented/65 total).

Data Collection:

Several assessments were used: diagnosis,
background information, employment outcomes, and nonvocational outcomes. Interviews were completed by one of three research staff and reliability checks were conducted on 15% of the interviews by having a 2nd person review the interviews.

Job satisfaction was rated by the Indiana Job Satisfaction Scale. PANSS was used for nonvocational outcomes and modified to be entirely client self-report.

Overall functioning was rated by the Global Assessment Scale, while social and leisure functioning was rated using one subscale from the Social Adjustment Scale-II: Social-Leisure subscale, as well as a global rating.

Social network information was rated with a variant of the Social Support and Social Network Interview and was requested at baseline, 12 months and 24 months. Quality of Life was assessed through the Brief Version of Quality of Life Interview. Substance abuse was also tracked using the Alcohol Use Scale and Drug Use Scale.

Statistical analyses were conducted as follows:
- "Intent-to-treat analyses of employment outcomes were conducted on the entire randomized sample" (p. 483).
- A second set of analyses were conducted to determine if clients differed in their vocational outcomes.
- Employment outcomes were collected over the entire 2-year period. The 3 groups on time to job were restricted to clients who obtained any work.
-Changes in non-vocational outcomes used mixed-effects regression models, using the vocational program as the independent variable.

Intervention:

Two interventions were studied: IPS and PSR. The IPS model used "was based on the principles in the IPS manual (D.R. Becker & Drake, 1993)" (p. 481). The PSR program "incorporated transitional employment into its into its vocational rehabilitation approach" (p. 481). Clients focused on clerical and janitorial skills training with transitional jobs and later obtaining competitive employment.

Control:

Standard services that are considered typical of most supported employment services, which included access to all other vocational services available to everyone with severe mental illness, vocational program with substandard wages, or competitive wages under contracts negotiated by the program. Two programs were evaluated: standard-supported and standard-enclave.

Findings:

Fidelity to the IPS model (for each of the programs) was evaluated using the IPS Fidelity Scale. The programs were rated in order from highest to lowest: IPS, standard-supported, PSR, and standard-enclave.

Conclusions:

The Individual Placement and Support model was the most effective at retaining clients and improving employment outcomes.

URL:

http://www.worksupport.com/kter/documents/pdf/TheHartfordStudyofSupportedEmployment.pdf

Disabilities:

Populations:

Outcomes:

Randomized Controlled Trials (RCTs)

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Supported employment, job preferences, job tenure and satisfaction

Authors:

Mueser, K. T., Campbell, K., & Drake, R. E.

Year Published:

2001

Publication:

Journal of Mental Health

Volume:

Number:

Pages:

411-417

Publisher:

Informa Health Care

Background:

Brief job tenure is problematic because it often reflects client dissatisfaction with work, and it prevents advancement and the potential to earn higher wages. Relatively few client or situational factors have been consistently correlated with job tenure, with the exception of work experience. However, the role of client job preferences has been examined in only a few studies.

Purpose:

The relationships between job preferences, job satisfaction and job tenure were examined in a sample of 204 unemployed clients with severe mental illness randomly assigned to one of three vocational rehabilitation programs and followed for 2 years.

Setting:

The study was conducted at the Capitol Region Mental Health Center (CRMHC) in Hartford, Connecticut. All clients were receiving standard care for severe mental illness, including medication, case management, housing assistance, and access to psychiatric rehabilitation programs.

Sample:

The study participants were 204 clients with severe mental illness. Criteria for participation included: (1) not currently employed in competitive work ( by US Department of Labor); (2) interest in competitive employment; (3) attendance at two research introduction groups designed to inform clients about the study.

Data Collection:

Throughout the 2 years of the study information on work, including the type of job, wages, and hours worked, was obtained weekly through brief interviews with clients and vocational staff. In addition, job satisfaction was rated using the Indiana Job Satisfaction Scale 2 weeks after beginning a new job and bi-monthly thereafter as long as clients remain on the job.

Intervention:

Individual Placement and Support (IPS) is a systematic approach to helping people with severe mental illness achieve competitive employment. It is based on eight principles: eligibility based on client choice, focus on competitive employment, integration of mental health and employment services, attention to client preferences, work incentives planning, rapid job search, systematic job development, and individualized job supports. Systematic reviews have concluded that IPS is an evidence-based practice

Control:

The condition was a psychiatric rehabilitation program (PSR) and standard services (Standard).

Findings:

For clients in the IPS program, those who obtained jobs that matched their pre-employment preferences for type of work desired reported higher levels of job satisfaction and had longer job tenures than clients who obtained jobs that did not match their preferences. For clients in the PSR or Standard programs, job preferences were not related to job tenure or satisfaction.

Conclusions:

The findings replicate previous research in this area, and suggest that helping clients obtain work that matches their job preferences is an important ingredient of success in supported employment program.

URL:

http://www.tandfonline.com/doi/abs/10.1080/09638230123337

Disabilities:

Populations:

Randomized Controlled Trials (RCTs)

Outcomes:

Increase in tenure

NIDILRR Funded:

Yes

Research Design:

Peer Reviewed:

Yes

The effectiveness of skills training for improving outcomes in supported employment

Authors:

Mueser, K. T., Becker, D. R., & Wolfe, R.

Year Published:

2005

Publication:

Psychiatric Services

Volume:

Number:

Pages:

1254-1260

Publisher:

Psychiatryonline.org

Background:

Supported employment for individuals with mental illness is recognized as an evidenced based practice. Although this approach is more successful at assisting individuals with mental illness with gaining and maintaining work, than other traditional means, better outcomes related to job retention is needed.

Purpose:

The purpose of this study was to evaluate the impact of a supplementary skills training program on employment outcomes for individuals who were receiving supported employment services.

Setting:

The study took place at an employment support organization that is funded by State vocational rehabilitation.

Sample:

Thirty five individuals who were enrolled in a supported employment program and had a diagnosis of severe or persistent mental illness participated in the study. Among these individuals, the majority or 80% were men and 97% were non-Hispanic white. About a third or 30% had graduated from secondary education. The mean age was 38 years.

Data Collection:

Those who consented to participate, completed a Workplace Fundamentals Knowledge Test. Afterwards they were randomly assigned to receive supported employment services alone or to receive supported employment services and the supplementary skills training about workplace fundamentals. Individuals were assigned to the group on an average of 56 days after obtaining a job. Among the 35 participants, 18 received treatment as usual (supported employment services alone) the rest were assigned to the receive the work fundamentals training too. Chi square test and t test indicated no significant difference in the two groups. Workplace knowledge was measured with the Workplace Fundamental Knowledge Test scores at baseline and at nine month intervals. Rates of employment for each month of the study period for individuals who recently went to work was documented by control group and workplace fundamentals group. These rates were compared using a generalized estimating equations analysis. The researchers also compared cumulative time worked, wages earned and job tenure for the first and subsequent jobs held. Mann-Whitney tests were used because that data was skewed. Vocational services used were also analyzed with Mann-Whitney tests.

Intervention:

The intervention was the supplementary workplace skills training program in SE

Control:

The control group was the participants who only received supported employment services and did not attend the workplace skills training.

Findings:

During the study period, participants held a total of 49 different jobs. Forty three percent of the sample worked in the same job during the study period (18 months), others were laid off, fired or quit their jobs. The majority had disclosed their psychiatric disability to their employers. Individuals who attended the workplace fundamentals program received higher scores on the Workplace Fundamentals Knowledge Test than those who did not. Although more individuals who attended the supplementary training were working during the study period this trend was not significant. Earnings and hours worked was not significant either. Both groups used comparable amounts and intensity of employment services. Job tenures for the first job for participants was 331.6 days for workplace fundamentals group and 288.5 for the control group.

Conclusions:

The workplace fundamentals program may not be an effective addition to supported employment services, but more research is needed.

URL:

https://www.ncbi.nlm.nih.gov/pubmed/16215191

Disabilities:

Populations:

Intellectual disabilities

Outcomes:

Increase in hours worked

Increase in tenure

Wages

NIDILRR Funded:

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

Ex-post-facto analysis of competitive employment outcomes for individuals with mental retardation: National perspective

Authors:

Morgan, L., Leatzow, A., Clark, S., & Siller, M.

Year Published:

2004

Publication:

Mental Retardation

Volume:

Number:

Pages:

253-262

Publisher:

American Association on Mental Retardation

Background:

Employment outcomes have often been used as a benchmark of vocational rehabilitation success. Not until the Rehabilitation Act of 1973, were states required to target individuals with significant disabilities for services using an order of selection process. Because of the functional differences that exist between individuals with mild, moderate and significant cognitive disabilities, rehabilitation counselors must be aware of the types of services most needed and those services that more often result in high quality employment outcomes for each target group.

Purpose:

The purpose of this study was to provide a snapshot to generate new knowledge that rehabilitation counselors can apply to enhance competitive employment outcome placements for individuals of varying abilities. In addition, the purpose of the study was to identify disparities in the proportions of competitive job placements between individuals with mild, moderate, and significant cognitive disabilities.

Setting:

This study included individuals with disabilities served by multiple vocational rehabilitation agencies in various settings.

Sample:

The study sample included all consumers with cognitive disabilities closed into Status 26 during fiscal year 1998 in the RSA-911 national database maintained by the Rehabilitation Services Administration. This included a total of 28,565 consumers: mild (n = 17,033, 60%), moderate (n = 9,784, 34%), severe/profound (n = 1,748, 6.1%).

Data Collection:

The data was obtained from the individual client closure reports and RSA-911 national data tape, provided by the Rehabilitation Services Administration (RSA). The authors used two tests of statistical significance: chi-square and logistic regression analysis. Chi-square analysis was conducted for type of mental retardation and work status at closure. In addition the authors conducted a post hoc pairwise comparisons (2 x 2 chi-square) for mild by moderate, mild by severe/profound and moderate by severe/profound. To guard against Type I errors, the authors used the Bonferroni technique, which resulted in an adjusted alpha of .003. Then, the authors used logistic regression analysis to evaluate the linear relationship between vocational rehabilitation services and work status at closure. Then, chi-square tests were used to evaluate the proportions of significant vocational rehabilitation services received by consumers with mild, moderate, or severe/profound cognitive disabilities. Then, the relationship between type of cognitive disability and work status at closure were evaluated for consumers who received vocational rehabilitation services. Those consumers who had not received VR services were then eliminated from the sample. The desktop version of SPSS for Windows, version 11.5 was used in this analysis.

Intervention:

The intervention was vocational rehabilitation services.

Control:

There was no control or comparison condition.

Findings:

The majority of the individuals in the population were Caucasian (73%). Assessment, adjustment, counseling, job-finding services, and job-placement services were received by 81%, 34%, 78%, 60% and 58%, respectively. Analysis of the data found that 8%5 of the participants were closed into competitive jobs following vocational rehabilitation intervention. Consumers with mild mental retardation were significantly more likely to achieve competitive jobs when compared to those with moderate or severe/profound cognitive disabilities. In addition, individuals with moderate cognitive disabilities were significantly more likely to be placed into competitive jobs compared to those with severe/profound disabilities. The odds of obtaining competitive employment for consumers who received job placement services was 2.05 times the odds for those not receiving those services. The odds of obtaining competitive employment for consumers who received counseling were 1.52 times the odds of those who did not receive counseling. The odds of obtaining competitive employment for consumers who received business and vocational training were 2.14 times the odds of those who did not. However, consumers with mild mental retardation were provided with business and vocational training at a significantly higher proportion when compared to those with moderate and severe/profound disabilities. Consumers with moderate mental retardation were no more likely to receive counseling services than those with mild cognitive disabilities. However, consumers with severe/profound cognitive disabilities were less likely to receive counseling services than those with mild/moderate disabilities. Consumers who received job placement services with mild cognitive disabilities achieved competitive jobs at a significantly higher proportion than those with moderate or severe/profound mental retardation. In addition, consumers with moderate cognitive disabilities were significantly more likely to achieve competitive jobs than individuals with severe/profound disabilities. Consumers with mild cognitive disabilities who received business and vocational services achieved competitive jobs at a significantly higher proportion than those with moderate and severe/profound cognitive disabilities. Consumers with mild disabilities who received counseling achieved competitive jobs at a significantly higher proportion when compared to those with moderate and severe/profound disabilities. In addition, consumers with moderate cognitive disabilities were more likely to achieve competitive employment when compared to consumers with severe/profound disabilities.

Conclusions:

Consumers with Moderate or severe/profound cognitive disabilities were closed into competitive employment at a significantly lower rate than those with mild cognitive disabilities. Consumers who were provided with business and vocational training, counseling, and job-placement services were significantly more likely to achieve competitive jobs. A significantly lower proportion of these services were provided to consumers with severe/profound cognitive disabilities.

The authors concluded that the significantly higher proportion of consumers with mild cognitive disabilities achieving competitive employment could be related to the specific services they more often receive. Perhaps consumers with mild disabilities are more likely to be provided job-placement services as opposed to those with severe/profound cognitive disabilities. The authors ask the questions: Why do consumers with mild or moderate cognitive disabilities more likely to receive job placement and counseling services compared to those with severe/profound disabilities? They propose that too much attention may be given to assessment/testing results and other nonrelevant dimensions that could prohibit the provision of effective services. They also propose that there may be a subjective belief that places a lesser value on the overall potential of individuals with significant cognitive disabilities. Counselors may believe that consumers with severe/profound cognitive disabilities are more difficult to place. Their expectation of successful employment outcomes may result in less significant placement efforts for this population.

The authors state that their findings raise questions that could not be answered through the RSA-911 database. The database does not provide information on reasons for the provision of certain services to consumers with mild, moderate, or severe/profound cognitive disabilities. The database does not contain information on Counselors' perceptions of service effectiveness or how they provide the specific services. Finally, the small proportion of individuals with severe/profound cognitive disabilities raises an important question about the decision-making process counselors use to determine if a consumer can benefit from vocational rehabilitation services.

URL:

https://www.ncbi.nlm.nih.gov/pubmed/15230653

Disabilities:

Populations:

American Indian or Alaska Native

Asian

Outcomes:

NIDILRR Funded:

Research Design:

Observational

Peer Reviewed:

Yes

One-year outcomes from the CASAWORKS for Families intervention for substance-abusing women on welfare

Authors:

Michalak, E., Yatham, L., Maxwell, V., Hale, S., & Lam, R.

Year Published:

2003

Publication:

Evaluation Review

Volume:

Number:

Pages:

656-680

Publisher:

Sage

Background:

Drug and alcohol addictions continue to pose serious public problems for the nation, particularly in the areas of crime, overutilization of expensive health services, lost productivity, and welfare costs. The percentage of individuals receiving welfare with diagnosable substance-abuse disorders has ranged from 2% to 37% in various studies. There is general consensus that these individuals will be among the last to exit the welfare rolls.

Purpose:

The purpose of this study was to evaluate the CASAWORKS for Families (CWF) intervention, developed by the National Center for Substance Abuse and Addiction (CASA) at Columbia University and implemented in 11 sites across the country. The CASAWORKS demonstration project was designed to reduce alcohol and drug use among substance-abusing women receiving welfare and increase independence through employment.

Setting:

Using a recruitment process, 11 sites were selected from a pool of more than 30 applicants. Three sites were located in California, and one each in the states of Maryland, Missouri, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, and Tennessee. Five sites were located within urban cities, two were located in suburbs, and the others were in small towns.

Sample:

The study sample consisted of 962 women referred to one of the 11 demonstration sites, of whom 673 were determined to be eligible for services. The mean age was 32 years, 38% were white, 48% African-American, and 12% Hispanic.

Data Collection:

Repeated measures included the Addiction Severity Scale, a structured interview related to problem areas (health, transportation, finances, etc.), and six- and 12-month follow-up interviews regarding employment status. Data analysis used mixed-effects models to describe in-treatment change. These models comprise fixed effects, describing the average change over time, and random effects, describing the components of variation about that average pattern of change. For continuously distributed linear mixed-effects models were used, and for binary responses generalized linear mixed-effects models.

Intervention:

The CWF model is a multifaceted integrative intervention strategy designed to assist recipients of TANF achieve stable employment and self-sufficiency by overcoming substance abuse and other major barriers to work. The core services of the intervention were focused on substance abuse, employment (work readiness, vocational training, and basic education), domestic violence, and parenting training. Additional as-needed services were physical health, mental health, and assistance with basic needs such as child care, transportation, shelter, and clothing.

Control:

There was no control or comparison condition. The study used a pre/during/post intervention design.

Findings:

Because of time limits on the evaluation, only the first 529 clients from 10 sites had an opportunity to be followed at least 12 months. Retention was relatively high in comparison to similar programs; 81%of those enrolled were still in the intervention at the 1-month point, 61% were enrolled at 3 months, 51% were enrolled at 6 months, and 38% were enrolled at 9 months. Significant improvements in drug and alcohol use were seen at the 6- and 12-month follow-ups. There were significant improvements in employment and earnings from baseline to 6-month follow-up and from 6-month to 12-month.

Conclusions:

Although the authors note that it cannot be certain that the generally favorable results seen in this formative evaluation were actually caused by the intervention, the findings are quite consistent with the underlying CWF model under which the interventions were conceived, delivered, and evaluated. In addition, there is evidence that the intervention was appropriate for and attractive to the target population. These initial findings offer a compelling rationale for continued development and evaluation of the CWF model.

URL:

http://erx.sagepub.com/content/27/6/656.full.pdf

Populations:

Female

Rural

Outcomes:

Increase in hours worked

NIDILRR Funded:

Not Reported

Research Design:

Single group

Peer Reviewed:

Yes

Assistive technology and computer adaptations for individuals with spinal cord injury

Authors:

Assistive technology and computer adaptations for individuals with spinal cord injury

Year Published:

2004

Publication:

NeuroRehabilitation

Volume:

Number:

Pages:

141-146

Publisher:

IOS Press

Background:

Spinal cord injury (SCI) commonly occurs when individuals are forming their vocational goals, resulting in low post-injury employment rates and higher costs to society. Individuals with SCI who are employed have improved quality of life. Assistive technology, often available at modest cost, can help individuals with SCI to compensate for functional limitations, overcome barriers to employability, enhance technical capacities and computer utilization, and improve ability to compete for gainful employment.

Purpose:

Studies have shown that return to work for individuals after a spinal cord injury are low. Other studies have shown that individuals with SCI who are employed report a better quality of life. One barrier to returning to work is a decreased scope of work skills due to physical limitations from the SCI. The purpose of this study was to demonstrate the successful return to work of three individuals with SCI using assistive technology and computer adaptations.

Setting:

One individual received his evaluation in an acute rehabilitation center. One individual was evaluated at his workplace. The other setting for the third case study was not specified in the article.

Sample:

Three males with SCI ages 23, 27, and 41. All three had cervical level injuries to include C3, C6, and C7.

Data Collection:

Each individual received a computer accommodation evaluation that guided the selection of the assistive technology.

Intervention:

Computer accommodation evaluation by the State Vocational Rehabilitation Department by a rehabilitation engineer and occupational therapist. All individuals were provided with computer accommodations as recommended by the evaluations. Each of the three participants received individualized accommodations.

Control:

There was no control or comparison condition.

Findings:

Assistive technology can help individuals with SCI to compensate for functional limitations, overcome barriers to employability, enhance technical capacities and computer use, and improve ability to compete for employment.

Conclusions:

The authors conclude that an important goal for SCI rehabilitation includes maximizing vocational potential including the evaluation and application of computer and assistive technology.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/15201473

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Work, recovery and comorbidity in schizophrenia: A randomized controlled trial of cognitive remediation

Authors:

McHugo, G., Drake, R., & Becker, Dl.

Year Published:

2009

Publication:

Schizophrenia Bulletin

Volume:

Number:

Pages:

319-335

Publisher:

Oxford University Press

Background:

A common theme that cuts across all definitions of recovery is work. Work is valued by most and it enables on to make a contribution to society and offers the promise of liberating consumers from financial dependence on others. In recent years, a recovery paradigm has emerged that offers a guiding vision for self-empowerment, treatment, and rehabilitation for individuals with schizophrenia and comorbid problems such as: cognitive impairment,9 substance abuse,10 and medical disorders. This study addressed the impact of comorbidity on recovery of work functioning and response to vocational rehabilitation, described strategies for minimizing its effects, and provided data from a new study targeting the problem of cognitive impairment in order to improve employment outcomes.

Purpose:

The purpose of the study is to evaluate the impact of adding cognitive remediation to vocational rehabilitation to determine the impact on comorbid substance abuse and medical disorders on work outcomes and response to the treatment program.

Setting:

The study took place in a vocational rehabilitation program associated with an urban medical center.

Sample:

The study included 34 participants who were 18 years or older, had severe mental illness, expressed an interest in work, had a history of being fired or quitting employment prior to locating new work. Participants received either vocational rehabilitation plus cognitive retraining or Vocational rehabilitation only.
In both groups, the majority of subjects were male (61% and 56%) black (61% and 63%) and had never been married (78% and 75%). The primary diagnosis was Schizophrenia (75% and 60%) and most had a comorbid disorder (67% and 81%). The mean age of the group members was (46 and 42 years).

Data Collection:

Referrals were made by therapists and work services personnel. Those interested had a baseline assessment scheduled. Consumers were not paid for assessments. Following completion of the assessments, consumers were randomized to either vocational rehabilitation alone (VR) or vocational rehabilitation and cognitive remediation (VR and CR)using a computer program. The examiners compared the groups at baseline on the demographic, clinical, and cognitive measures using t-tests (continuous variables) and v2 analyses (categorical variables). Next they computed the percentage of consumers who were exposed to the cognitive remediation program, as completing 6 or more cognitive remediation sessions, the average number of sessions completed, and the number of weeks to complete them.

Then to evaluate changes over the treatment period in cognitive functioning and clinical variables, they performed a series of analyses of covariance (ANCOVAs), with the cognitive/symptom measures at posttreatment as the dependent variables, the cognitive/ symptom measures at baseline as the covariate, and treatment group as the independent variable. Finally they looked at work outcomes. Because continuous work outcomes were highly positively skewed, main treatment effects were evaluated by performing Mann-Whitney U tests comparing the 2 treatment groups on wages earned and hours and weeks worked. To evaluate whether substance abuse directly influenced vocational outcomes or interacted with treatment group, separate analyses were performed for current drug-use disorder and alcohol-use disorder. For these analyses, the work variables were log transformed to minimize skew. For each series of analyses, analysis of variance were performed with current drug-use disorder (or current alcohol-use disorder), treatment group, and their interactions as the independent variables and the work outcomes as the dependent variables. The main effect for drug-use disorder (or alcohol-use disorder) in these analyses was a test of whether the disorder had an overall impact on vocational outcomes, whereas the drug-use disorder (or alcohol-use disorder) by treatment group interaction effect was a test of whether the outcomes of the treatment groups differed significantly as a function of the disorders.

Intervention:

The intervention was adding cognitive remediation to a hybrid vocational rehabilitation program that combined paid internship jobs with supported employment.

Control:

Participants were randomly assigned to either vocational rehabilitation alone or vocational rehabilitation and cognitive remediation using a computer-generated randomization program.

Findings:

Statistical tests comparing consumers assigned to VR only or VR and CR indicated no significant differences in any demographic, diagnostic, or baseline clinical or cognitive performance measures.

The results of the ANCOVAs comparing changes over time in cognitive functioning and symptoms between consumers who received cognitive remediation and those who did not were summarized. Significant improvements favoring cognitive remediation were found for several cognitive measures. Results of the Mann-Whitney U tests comparing work outcomes for the 2 groups indicated that the VR and CR group worked significantly more internship weeks and hours and earned more wages than the VR-only group.

The VR and CR group also worked significantly more weeks than VR only, and there was a trend for them to earn more wages, although hours
worked did not differ between the groups. Number of weeks or hours of competitive work did not differ between the 2 groups nor did wages earned. Overall rates of competitive rates were 39% for the VR and CR group vs 31% for the VR-only group, which did not differ significantly. Analyses of relationship of substance-abuse disorder and medical comorbidity focused on total (log transformed) hours worked for each vocational outcome. Alcohol-use disorder was marginally significantly related to total hours worked with the absence of current alcohol-use disorder associated with more hours worked compared with the presence of an alcohol-use disorder. Drug-use disorder was also related to total hours worked, with absence of current drug-use disorder associated with more hours worked compared with the presence of a drug-use disorder.

There were no interactions between either alcohol or drug-use disorder and treatment group, suggesting that the addition of cognitive remediation to vocational services was just as helpful in the consumers with a substance-use disorder as those without. A similar analysis of total hours worked comparing consumers with high levels of medical comorbidity to those with low levels indicated that both the main effect for medical comorbidity and the interaction with treatment group were not significant. Thus, consumers with higher medical comorbidity burden appeared to have comparable vocational outcomes compared with those with less such burden. For the VR-only group, Spearman correlations between overall cognitive performance at baseline and total work over the study period were significant for total hours worked and wages earned and marginally significant for number of weeks worked, whereas for the VR and CR group, none of these correlations were significant Thus, cognitive performance at baseline was more predictive of work in the study for those in the control group than those in the cognitive remediation group.

Conclusions:

Providing cognitive remediation in addition to vocational rehabilitation can improve cognitive functioning and employment outcomes for individuals with severe mental illness. Comorbid substance abuse impacts work outcomes while medical comorbidity does not. More research is needed to evaluate the impact of comorbidity and their interaction on treatment. More research is needed to evaluate the impact of comorbidity on work functioning in VR and its interaction with cognitive remediation.

URL:

http://www.ncbi.nlm.nih.gov/pubmed/19269925

Disabilities:

Populations:

American Indian or Alaska Native

Asian

Outcomes:

Randomized Controlled Trials (RCTs)

Return to work

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment

Authors:

McGurk,S., R., Mueser, K. T., DeRosa, T., J., & Wolfe, R.

Year Published:

2003

Publication:

Psychiatric Services

Volume:

Number:

Pages:

1129-1135

Publisher:

American Psychiatric Association

Background:

Although previous research has indicated that symptoms and cognitive functioning are related to employment outcomes for clients with severe mental illness, few studies have examined the relationship between these client factors and outcomes in supported employment programs.

Purpose:

This study examined the relationships of measures of cognitive functioning and psychiatric symptoms with work outcomes and use of vocational services for clients with schizophrenia in a supported employment program.

Setting:

Study sample received outpatient services at a state hospital. Research team was based at Mount Sinai School of Medicine, New York, New York.

Sample:

The study participants were 30 clients with schizophrenia or schizoaffective disorder who are receiving outpatients services at a state hospital. The clients diagnoses were made by a member of the research team on the basis of clinical interviews with the Comprehensive Assessment of Symptoms and History and information form the clients charts.

Data Collection:

Data for the study included work outcomes, an analysis of demographic and other background predictors of work outcomes, the degree of change in clients' symptom severity and cognitive functioning over the year follow up period, and an analysis of symptom and cognitive predictors of work outcomes. Final analysis was on the relationship of symptoms and cognitive functioning with utilization of supported employment services by the clients who obtained competitive employment.

Intervention:

The program provided at the hospital's outpatients clinics was based on the individual placement and support employment model. At entry into the program, each client was assigned an employment specialist who provided all components of supported employment, including assessment, assistance with job search, and job support. Each employment specialist functioned as a member of the client's interdisciplinary team. The supported employment program provided follow along as needed for an unlimited time, including both on- and off-site support, depending on the client's needs or preferences.

Control:

There was no control or comparison condition.

Findings:

Predictors of clients' work outcomes included previous work history, amount of government entitlement income received, severity of negative symptoms, involvement in sheltered work activity at baseline, and level of cognitive functioning, including scores on measures of executive functioning and verbal learning and memory. The amounts of on-job support and contact with employment specialists were predicted by the cognitive domains of executive functioning, verbal learning, attention, and psychomotor speed as well as by the severity of psychotic symptoms.

Conclusions:

Clients with schizophrenia who have higher levels of cognitive impairment may require greater amounts of vocational support than those with lower levels of impairment. A variety of rehabilitation strategies may be required to improve vocational outcomes and reduce the amount of supported employment services needed by clients with schizophrenia.

URL:

http://schizophreniabulletin.oxfordjournals.org/content/31/4/898.short

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

Cognitive training for supported employment: 2-3 year outcomes of a randomized controlled trial

Authors:

McGurk, S. R., Mueser, K. T., & Pascaris, A.

Year Published:

2007

Publication:

American Journal of Psychiatry

Volume:

164

Number:

Pages:

437-441

Publisher:

American Psychiatric Publishing

Background:

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.

Purpose:

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.

Setting:

The setting was supported employment programs and various places of employment.

Sample:

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.

Data Collection:

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.

Intervention:

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.

Control:

The comparison condition was supported employment only.

Findings:

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.

Conclusions:

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.

URL:

http://www.coalitionny.org/the_center/resources/cognitive_remediation/documents/CogTrainingAmJPsychiatry0307.pdf

Disabilities:

Populations:

Asian

Outcomes: