Emotional disturbance

Populations:

Outcomes:

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:

Outcomes:

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:

Outcomes:

Increase in hours worked

Wages

NIDILRR Funded:

Research Design:

Quasi-experimental

Peer Reviewed:

Yes

The impact of bipolar disorder upon work functioning: A qualitative analysis

Authors:

Migliore, A., Timmons, J., Butterworth, J., & Lugas, J.

Year Published:

2007

Publication:

Bipolar Disorders

Volume:

Number:

Pages:

126-143

Publisher:

John Wiley & Sons, Inc.

Background:

One important but sometimes poorly-captured area of functioning concerns an individual's ability to work. Several quantitative studies have now indicated that bipolar disorder (BD) can have a severe, and often enduring, negative impact upon occupational functioning. While this data indicates that employment rates are relatively low in this patient population, it throws little light on the specific ways in which this complex psychiatric condition can affect work, or upon how these effects are subjectively interpreted by individuals with BD.

Purpose:

In order to further explain the relationship between bipolar disorder (BD) and work, the authors report here on a series of exploratory qualitative interviews undertaken to develop a disease-specific measure of quality of life in BD.

Setting:

Most of this initial sample consisted of outpatients with BD. The second stage of the study actively recruited patients with BD from the University of British Columbia hospital in and outpatient departments.

Sample:

To be eligible to participate, affected individuals had to be 18 years or older and fluent in English; no limitations were placed on the type of BD they had been diagnosed with. Demographic and diagnostic details were recorded on a standardized report form at the onset of each interview, but no confirmation of diagnosis was made. More females than males responded to our recruitment advertisements, resulting in there being more interviews with females (67%). Also, more interviews were conducted with people (64%) with a diagnosis of BD type I than BD type II or not otherwise specified/spectrum.

Data Collection:

All of the interviews were tape recorded, transcribed verbatim and coded by the first author using basic qualitative research methods which included the following steps: (i) the transcripts were initially read through (without coding) in order to gain an overview of the main issues and themes raised by participants; (ii) the transcripts were read again several times, with all pertinent references to work being highlighted and detailed memos being made concerning emerging themes;?(iii) the number of participants describing a particular theme, and the frequency with which themes were mentioned, was recorded, as were instances where opposing viewpoints were apparent; and (iv) themes for discussion were selected on the basis of how many participants mentioned them, and how frequently they were mentioned.

Intervention:

The interviews lasted approximately 1 hour(range 20‚Äì90 min). It is important to note that the primary aim of conducting the interviews was to generate the items for the QoL.BD scale. The researchers wished to give participants as much freedom as possible to describe their own experiences, and in turn, to generate the items and domains of QoL that would eventually be included in the scale. Thus, the interviews began and finished the interviews according to a standard script, but otherwise left them unstructured, and no standardized direct probes were used.

Control:

There was no control or comparison condition.

Findings:

Respondents described the different ways in which the symptoms of depression and hypomania presented in the workplace. Five main themes emerged from the data: lack of continuity in work history, loss, illness management strategies in the workplace, stigma and disclosure in the workplace, and interpersonal problems at work.

Conclusions:

The qualitative data obtained through this study highlights the often complex, varied and intermittent effects of an episodic condition such as BD upon work functioning, and points to the importance of developing more sophisticated and precise measures of occupational functioning for this population.

URL:

http://www.pubfacts.com/detail/17391356/The-impact-of-bipolar-disorder-upon-work-functioning-a-qualitative-analysis

Disabilities:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

The durability of supported employment effects

Authors:

Mclellan, A.T., Gutman, M., Lynch, K., Mckay, J.R., Ketterlinus, R., Morgenstern, J., & Woolis, D.

Year Published:

1998

Publication:

Psychiatric Rehabilitation Journal

Volume:

Number:

Pages:

55-61

Publisher:

American Psychological Association

Background:

The original New Hampshire Supported Employment Study was a two-site, controlled, clinical trial with random assignment to Group Skills Training (GST) or Individual Placement and Support (IPS) (within site) and 18-month follow-up. Both the GST and IPS programs were implemented in two New Hampshire cities and surrounding regions with populations of 166,000 and 119,000. Implementation data supported the fidelity of both interventions, and clients received approximately the same number of direct contact hours and amount of service costs in the two interventions. Following 18 months in the experimental phase, clients were allowed to leave their assigned vocational condition and were asked to participate in a 2-year extension phase. Guided by advice from providers, they pursued additional vocational services at their own discretion. Those who gave written informed consent were reassessed after 1 and 2 years (30 months and 42 months from original baseline) with a composite interview that was administered by a research interviewer who was independent of the clinical or vocational programs.

Purpose:

The purpose of this study was to examine the persistence of supported employment outcomes and the influence of continuing vocational services following the experimental phase of the New Hampshire Supported Employment Study. In the original study, one form of supported employment, Individual Placement and Support (IPS), was found to be more effective than another form, Group Skills Training (GST), in improving clients' competitive employment. IPS clients worked approximately twice as much and earned twice as many wages

Setting:

The original New Hampshire Supported Employment Study was a two-site, controlled, clinical trial with random assignment to GST or IPS (within site) and 18-month follow-up. Both the GST and IPS programs were implemented in two New Hampshire cities and surrounding regions with populations of 166,000 and 119,000.

Sample:

The original study included 143 unemployed adults with severe mental illness from two community mental health centers in New Hampshire. Of the 140 participants who completed 18 months in the original study (experimental phase), 126 (90.0%) consented to participate in the 2-year extension phase. At the start of the original study, the 126 extension phase participants had an average age of 36.8 years (SD = 9.5); 50% were female; 52.4% were never married, and 8.7% were currently married; 27.8% had not completed high school or received a GED; and 96% were Caucasian. Their primary psychiatric diagnoses were heterogeneous: schizophrenia and related psychotic disorders, 46.8%; bipolar and other severe mood disorders, 44.4%; and other disorders (primarily severe personality disorders), 8.7%. During the 18-month experimental phase, 61.1% of the extension phase clients (77/126) worked in at least one competitive job, and they worked an average of 430.8 (SD = 716.5) hours.

Data Collection:

Competitive employment was as work in the competitive job market at prevailing wages that was supervised by personnel employed by the business. Employment was assessed regularly by employment specialists in GST and IPS during the 18 months of the experimental phase and by direct interviews with clients at the 1-year and 2-year points of the extension phase (30-month and 42-month interviews) using the Employment and Income Review. To assess vocational services during the extension phase, clients reported on the vocational services received in the previous 2 months, including type of service, the provider, number of days, and the average amount of time each day. Consequently, estimates of vocational service utilization during the extension phase are based on 4 of the 24 months.
Other variables reported in this paper derived from the structured interview that was conducted with clients at regular intervals throughout the study period. This interview, which is described more fully elsewhere contained measures from the following domains: demographics, psychiatric symptoms, income and benefits, quality of life, drug and alcohol use, self-esteem, recent work and school history, and residential history. This hour-long interview was conducted by research staff members, who had been trained in standardized research interviewing and who were supervised throughout the study.

Intervention:

GST was a vocational rehabilitation program located in a private agency outside the mental health centers that offered individualized intake, 8 weeks of pre-employment skills training in a group format, individualized job placement, liaison with mental health providers, and follow-along supports. During the pre-employment training, clients were encouraged to explore values, preferences, strengths, and weaknesses, as well as to discuss and practice skills in choosing, getting, and keeping a job.

IPS offered an integrated and direct approach in which employment specialists joined the case management teams in the mental health centers and immediately helped clients to begin searching for a job on an individualized basis. The IPS employment
specialists assumed that clients would learn about the job world, and about their skills and preferences, on the job rather than through pre-employment training.

Control:

The comparison conditions were Individual Placement and Support; and the Group Skills Training and other Vocational Rehabilitation Services model; and No Services.

Findings:

This 2-year extension of an experimental study of supported employment showed persistence of the experimental effects on competitive employment. Overall, clients experienced no significant deterioration in amount of competitive employment, despite the fact that only 60% continued to receive vocational services. This finding is in contrast to that found in earlier studies of supported employment although it is consistent with the persistence found by Bond and colleagues.
Moreover, differences between the original experimental groups that emerged during the 18-month experimental phase persisted throughout the 2-year extension phase with only moderate attenuation. The evidence indicates a continuation of the momentum gained during the experimental phase of the study despite minimal continued vocational supports overall. This finding was also contrary to expectations, as earlier studies have often found a decrease in group differences following the termination of a formal intervention. The results also showed that receiving services during the extension phase was related to amount of employment for clients in the original IPS group. More than half of the IPS clients received IPS-like services during the extension phase, and together with those few who received other services, they were more than twice as likely to work than clients who received no services.

Conclusions:

It appears that continued vocational services, even if minimal, are critical to the durability of the elevated vocational outcomes from an IPS program. As IPS becomes implemented more widely, it will be important to design and to build in mechanisms that provide continued services in order to maintain the higher rates of competitive employment that IPS provides.

URL:

http://psycnet.apa.org/journals/prj/22/1/55/

Disabilities:

Populations:

Outcomes:

Increase in hours worked

NIDILRR Funded:

Research Design:

Mixed methods

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:

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:

Increase in hours worked

Return to work

Wages

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Cognitive training and supported employment for persons with severe mental illness: One-year results from a randomized controlled trial

Authors:

McGurk, S. R., Mueser, K. T., Harvey, P. D., LaPuglia, R., & Marder, J.

Year Published:

2005

Publication:

Schizophrenia Bulletin

Volume:

Number:

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.

Intervention:

The intervention was cognitive training titled Thinking Skills for Work and supported employment services.

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:

Populations:

Outcomes:

NIDILRR Funded:

Research Design:

Peer Reviewed:

Yes

Service intensity as a predictor of competitive employment in an individual placement and support model

Authors:

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

Year Published:

2011

Publication:

Psychiatric Services

Volume:

Number:

Pages:

1066-1072

Publisher:

Psychiatric Services

Background:

Research has been done on supported employment for people with psychiatric disorders; however, little of it has been focused "on variables that moderate the relationship between service intensity and vocational outcomes" (p. 1067)

Purpose:

The study reviewed "four aspects of service intensity in a supported employment program" (p. 1067):
1. Average level of service intensity
2. Association between service intensity and weeks worked
3. Individual demographics and clinical variables associated with service intensity
4. Individual characteristics that moderate the relationship between service intensity and weeks worked

Setting:

The setting included 2 Psychiatric Rehabilitation Centers located in Chicago, Illinois.

Sample:

The sample was made up of 96 participants in the IPS group and 98 in the diversified placement approach group. Participants were randomly assigned to the two groups, and 5 discontinued IPS services within the first 3 months, which reduced the sample size for IPS to 91.

Data Collection:

The intervention group was enrolled between 1999 and 2002, while data collection continued until 2004. Data were obtained from Threshold PsychServe system and were measured in terms of hours of support. Clients were also completed a survey, which included demographics, as well as a self-report of number of weeks worked and number of years since last employment.

The Positive and Negative Syndrome Scale was administered, as well as the number of lifetime hospitalizations and diagnosis (using DSM-IV). These were collected at baseline.

Data were analyzed using SPSS 11.0 for Windows and Hierarchical Linear Modeling. Zeroes were recorded for participants' IPS contacts for quarters when they dropped IPS.

Hypotheses were tested by totaling variables across the entire study and conducting hierarchical linear modeling regressions, as well as examining the data longitudinally by using the hierarchical linear model.

Intervention:

The intervention was the Individual Placement and Support (IPS) model of supported employment

Control:

The comparison condition was the Diversified Placement Approach.

Findings:

Forty-eight participants continued IPS services for the entire two years. People who dropped out did not differ from those who continued on either demographics or clinical variables.

IPS services and mental health services declined over time; therefore, the intensity of IPS services was positively correlated with mental health services. The number of IPS contacts in one quarter was positively associated with the number of weeks worked in the following quarter.

Conclusions:

Increasing ISP services intensity may improve employment outcomes.

URL:

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

Disabilities:

Populations:

Outcomes: