Cognitive training and supported employment for persons with severe mental illness: One-year results from a randomized controlled trial | Knowledge Translation for Employment Research Center

Authors:	McGurk, S. R., Mueser, K. T., Harvey, P. D., LaPuglia, R., & Marder, J.
Year Published	2005
Publication	Schizophrenia Bulletin
Volume	31
Number	4
Pages	898-909
Publisher	Oxford University Press
Background	Individuals with severe mental illness have poor unemployment rates. Past research indicates supported employment can help improve employment rates among this group. However, not all person with severe mental illness have benefited from that model. For example, poor job tenure rates have been reported. Therefore, it is important to try to improve the effectiveness of these programs. One possible way to enhance outcomes may relate to improving cognitive functioning through an intervention such as cognitive training.
Purpose	The purpose of this study was to measure the impact of cognitive rehabilitation on employment outcomes among individuals with severe mental illness who had not been successfully employed and were receiving supported employment services.
Setting	The study took place at two mental health centers that provided a wide range of services including supported employment.
Sample	Participants included 44 individuals with severe mental illness who were receiving services from 2 mental health centers in New York. The majority were males (62%), from a minority like African American (59%), followed by Hispanic (24%) and had a diagnosis of Schizophrenia. The mean age of participants was 31 years and most had relatively low levels of education. Participants were assigned to either the cognitive training and supported employment program or supported employment.
Data Collection	Comprehensive employment data were collected the first year. Cognitive and psychological assessments were administered at baseline and three months later. Diagnostic and background information were retrieved from the participants charts, interviews, and staff reports. Employment outcomes were measured through contact with the participants and staff. Seven different tests were used to measure cognitive functions (i.e.. attention and concentration, psychomotor speed, information processing speed, verbal learning and memory, executive functioning and overall cognitive functioning) at baseline and 3 month follow up. Psychiatric symptoms were measured with interviews using the Positive and Negative Syndrome Scale. Efforts were made to get follow up employment data for the one year following randomization. Intent to treat analyses of the employment outcomes were conducted on the entire randomized sample that had some follow up data (n=44). The statistical analysis included: x2, t test and analyses of covariance. Due to skewed data Mann Whitney U tests were also used.
Control	The control was supported employment services without cognitive training.
Findings	The rate of retention of the cognitive training program was high. The program was successfully implemented at two sites that predominantly served inner city minorities. Participant who received cognitive training showed improvements in several areas over the first 3 months of the study as well as a better overall cognitive functioning score as compared to those who received only supported employment services. They also had higher rates of employment. Notably, this group showed improvements on the PANSS depression scale.
Conclusions	The Thinking Skills for Work program may help individuals with severe mental illness with employment. This program was successfully implemented in a challenging inner city setting. More research is needed.
URL	https://academic.oup.com/schizophreniabulletin/article/31/4/898/1877695
Disabilities	Emotional disturbance
Populations	Male & Female \| Hispanic or Latino \| Black / African American \| White / Caucasian \| Urban
Outcomes	Wages \| Other
NIDILRR Funded	Not Reported
Research Design	Randomized Controlled Trials (RCTs)
Peer Reviewed	Yes

Year Published

2005

Publication

Schizophrenia Bulletin

Volume

31

Number

4

Pages

898-909

Publisher

Oxford University Press

Background

Individuals with severe mental illness have poor unemployment rates. Past research indicates supported employment can help improve employment rates among this group. However, not all person with severe mental illness have benefited from that model. For example, poor job tenure rates have been reported. Therefore, it is important to try to improve the effectiveness of these programs. One possible way to enhance outcomes may relate to improving cognitive functioning through an intervention such as cognitive training.

Purpose

The purpose of this study was to measure the impact of cognitive rehabilitation on employment outcomes among individuals with severe mental illness who had not been successfully employed and were receiving supported employment services.

Setting

The study took place at two mental health centers that provided a wide range of services including supported employment.

Sample

Participants included 44 individuals with severe mental illness who were receiving services from 2 mental health centers in New York. The majority were males (62%), from a minority like African American (59%), followed by Hispanic (24%) and had a diagnosis of Schizophrenia. The mean age of participants was 31 years and most had relatively low levels of education. Participants were assigned to either the cognitive training and supported employment program or supported employment.

Data Collection

Comprehensive employment data were collected the first year. Cognitive and psychological assessments were administered at baseline and three months later.
Diagnostic and background information were retrieved from the participants charts, interviews, and staff reports. Employment outcomes were measured through contact with the participants and staff. Seven different tests were used to measure cognitive functions (i.e.. attention and concentration, psychomotor speed, information processing speed, verbal learning and memory, executive functioning and overall cognitive functioning) at baseline and 3 month follow up.
Psychiatric symptoms were measured with interviews using the Positive and Negative Syndrome Scale. Efforts were made to get follow up employment data for the one year following randomization. Intent to treat analyses of the employment outcomes were conducted on the entire randomized sample that had some follow up data (n=44). The statistical analysis included: x2, t test and analyses of covariance. Due to skewed data Mann Whitney U tests were also used.

Control

The control was supported employment services without cognitive training.

Findings

The rate of retention of the cognitive training program was high. The program was successfully implemented at two sites that predominantly served inner city minorities. Participant who received cognitive training showed improvements in several areas over the first 3 months of the study as well as a better overall cognitive functioning score as compared to those who received only supported employment services. They also had higher rates of employment. Notably, this group showed improvements on the PANSS depression scale.

Conclusions

The Thinking Skills for Work program may help individuals with severe mental illness with employment. This program was successfully implemented in a challenging inner city setting. More research is needed.

URL

https://academic.oup.com/schizophreniabulletin/article/31/4/898/1877695

Disabilities

Emotional disturbance

Populations

Male & Female | Hispanic or Latino | Black / African American | White / Caucasian | Urban

Outcomes

Wages | Other

NIDILRR Funded

Not Reported

Research Design

Randomized Controlled Trials (RCTs)

Peer Reviewed

Yes