Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study | Knowledge Translation for Employment Research Center

Authors:	Malec, J. F.
Year Published	2010
Publication	Social psychiatry and psychiatric epidemiology
Volume	45
Number	1
Pages	1-8
Publisher	Springer
Background	Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested.
Purpose	The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not.
Setting	The study was conducted within an early intervention service serving two multi-ethnic, socioeconomically diverse inner-city London boroughs.
Sample	The study sample consisted of consecutive new referrals (age 17‚Äì35 years), taken on for case management within the early intervention service between 2003 and 2006, for a period of at least 12 months. Within the service and for the purpose of this study first episode psychosis was as the presence of psychotic symptoms (clinically delusions, hallucinations, passivity experiences or severe thought disorder) that have persisted for at least 1 week and/or resulted in hospital admission or crisis team intervention. Patients were excluded if they had already taken antipsychotic medication at a therapeutic dose for at least 6 weeks, previously been diagnosed with a psychotic illness by a specialist mental health service, were considered to be prodromal, or their symptoms appeared to be secondary to a personality disorder, post-traumatic stress disorder or were clearly drug-induced (narrowly ).
Data Collection	Routine standardized data was collected on all clients at baseline and 12 month follow-up using the MiData (minimum dataset) package. This is a Microsoft Access database that was specifically designed as a clinician friendly tool to be incorporated into routine clinical practice
Control	There was no control or comparison condition.
Findings	The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not.
Conclusions	This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.
URL	http://link.springer.com/article/10.1007/s00127-009-0034-4#/page-1
Disabilities	Emotional disturbance
Populations	Black / African American \| White / Caucasian
Outcomes	Employment acquisition
NIDILRR Funded	No
Research Design	Observational
Peer Reviewed	Yes

Year Published

2010

Publication

Social psychiatry and psychiatric epidemiology

Volume

45

Number

1

Pages

1-8

Publisher

Springer

Background

Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested.

Purpose

The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not.

Setting

The study was conducted within an early intervention service serving two multi-ethnic, socioeconomically diverse inner-city London boroughs.

Sample

The study sample consisted of consecutive new referrals (age 17‚Äì35 years), taken on for case management within the early intervention service between 2003 and 2006, for a period of at least 12 months. Within the service and for the purpose of this study first episode psychosis was as the presence of psychotic symptoms (clinically delusions, hallucinations, passivity experiences or severe thought disorder) that have persisted for at least 1 week and/or resulted in hospital admission or crisis team intervention. Patients were excluded if they had already taken antipsychotic medication at a therapeutic dose for at least 6 weeks, previously been diagnosed with a psychotic illness by a specialist mental health service, were considered to be prodromal, or their symptoms appeared to be secondary to a personality disorder, post-traumatic stress disorder or were clearly drug-induced (narrowly ).

Data Collection

Routine standardized data was collected on all clients at baseline and 12 month follow-up using the MiData (minimum dataset) package. This is a Microsoft Access database that was specifically designed as a clinician friendly tool to be incorporated into routine clinical practice

Control

There was no control or comparison condition.

Findings

The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not.

Conclusions

This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.

URL

http://link.springer.com/article/10.1007/s00127-009-0034-4#/page-1

Disabilities

Emotional disturbance

Populations

Black / African American | White / Caucasian

Outcomes

Employment acquisition

NIDILRR Funded

No

Research Design

Observational

Peer Reviewed

Yes