Neurocognitive enhancement therapy with vocational services: Work outcomes at two-year follow-up

Authors: 
Berthoud, R.
Year Published: 
2008
Publication: 
Schizophrenia Research
Volume: 
105
Number: 
1
Pages: 
18-29
Publisher: 
Elsevier
Background: 

Neurocognitive enhancement therapy (NET) is a remediation program for the persistent and function-limiting cognitive impairments of schizophrenia. In a previous study in veterans, NET improved work therapy outcomes as well as executive function and working memory.

Purpose: 

The present study aimed to determine whether NET could enhance functional outcomes among schizophrenia and schizoaffective patients in a community mental health center receiving community-based vocational services.

Setting: 

The study setting was a Community Mental Health Center serving individuals with psychiatric disabilities.

Sample: 

Seventy-seven stable outpatients with diagnoses of schizophrenia or schizoaffective disorder were recruited at a large urban community mental health center. Participants met diagnostic criteria based on the Structured Clinical Interview for DSM-IV (First et al., 1996) from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association & Task Force on DSM-IV, 1994), conducted by research psychologists, and were eligible if they were clinically stable (i.e., GAF > 30, no housing changes, psychiatric medication alterations, or psychiatric hospitalizations in the 30 days prior to intake). Exclusion criteria included history of traumatic brain injury, known neurological diseases, developmental disability, and active substance abuse within the past 30 days

Data Collection: 

The statistical consultant compared hours worked by condition across quarters over the course of the two-year study using mixed models, repeated measures ANOVAs. Analyses were performed separately for total hours of community-based work activity (transitional and competitive payment combined), and hours of community-based work activity paid exclusively by the employer (competitive payment). Because of significant skew introduced by non-working participants in each quarter, analyses were repeated using ranked data as a nonparametric check of the results. Except where corrected for multiple comparisons, alpha was set at .05 and all tests were two-tailed.

Intervention: 

Patients (N = 72) participated in a hybrid transitional and supported employment program (VOC) and were randomized to either NET + VOC or VOC only. NET + VOC included computer-based cognitive training, work feedback and a social information information-processing group. VOC only also included two weekly support groups. Active intervention was 12 months with 12 month follow-up. Follow-up rate was 100%.

Control: 

The control condition was VOC only.

Findings: 

NET + VOC patients worked significantly more hours during the 12 month follow-up period, reached a significantly higher cumulative rate of competitive employment by the sixth quarter, and maintained significantly higher rates of employment.

Conclusions: 

NET training improved vocational outcomes, suggesting the value of combining cognitive remediation with other rehabilitation methods to enhance functional outcomes.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/18715755
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Long-term employment trajectories among participants with severe mental illness in supported employment

Authors: 
Bejarano, V., Quinn, M., Conaghan, P. G., Reece, R., Keenan, A.-M., Walker, D., Gough, A., Green, M., McGonagle, D., Adebajo, A., Jarrett, S., Doherty, S., Hordon, L., Melsom, R., Unnebrink, K., Kupper, H., & Emery, P.
Year Published: 
2007
Publication: 
Psychiatric Services
Volume: 
58
Number: 
7
Pages: 
922-928
Publisher: 
American Psychiatric Association
Background: 

The article describes the evidence in support of supported employment for people with psychiatric disabilities. However, most of the studies are limited to a maximum of a 2-year follow-up period.

Purpose: 

The purpose of the study was to evaluate individual work trajectories and generic work patterns over an eight- to 12-year period through a quantitative analysis. Perceived influences by participants of their work-related behaviors were also examined through a qualitative analysis.

Setting: 

A community mental health center in New England was the setting for two studies. One began in 1990. The second began in 1995.

Sample: 

The sample included 38 with severe mental illness eight to 12 years after they enrolled in supported employment studies.

Data Collection: 

Participants in the two original studies who received IPS services were invited to participate in one follow-up interview in 2004.

A modified version of a semi-structured interview developed of a previous study was used. Participants were asked about of all their work activities, including competitive employment, sheltered work, and volunteer work. The pattern of work was coded by the percentage of months worked, excluding recent work history.

Most questions were closed; however, several open-ended questions were included. The analysis was developed using the grounded theory approach developed by Glaser and Strauss.

Intervention: 

The intervention was supported employment services.

Control: 

There was a matched sample of participants who did not receive supported employment services.

Findings: 

During the follow up period, all participants had worked at least one job. Most jobs were competitive, and most participants worked at competitive jobs. Most people worked less than 20 hours per week for any job they held during the follow up period.

Twenty-seven participants had worked more than half of the follow-up period. 71% of the 38 participants were working at the time of the re-interview. The majority of the jobs were in clerical, service, or sales categories.

The majority of participants received some type of benefits at long-term follow-up.

Conclusions: 

The long-term trajectories of participants in supported employment programs, both vocational and non-vocational, appear to be positive.

URL: 
http://www.worksupport.com/kter/documents/pdf/LongtermEmploymentTrajectories.pdf
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Impact of a vocational counselor on employment-related outcomes among methadone patients

Authors: 
Appel, P. W., Smith, R., Schmeidler, J. B., & Randell, J.
Year Published: 
2000
Publication: 
Evaluation and Program Planning
Volume: 
23
Number: 
4
Pages: 
437-448
Publisher: 
Elsevier Science Ltd.
Background: 

There were ongoing concerns from New York state government about the steady decline in the rate of employment among methadone maintenance treatment (MMT) patients. One effort to try and change that trend was the VENUS project. The project was designed to identify obstacles to the provision and use of vocational–educational (v–e) services in MMT programs, and then, to evaluate selected remedial interventions. The VENUS project implemented the role of a vocational integrator‚ to enhance the use of v-e resources in routine MMT clinic operations and removed welfare disincentives for patients. The vocational integrator increased v-e participation by patients while the removal of the welfare disincentive to employment was associated with a small decline in patient v-e involvement. Another initiative was to improve patient v-e participation and employment by placing a full-time vocational rehabilitation counselor (VRC) in an MMT clinic. The objective was to provide on-site v-e services and improve v-e outcomes.

Purpose: 

The purpose of this paper was to summarize results of the intervention. The overall objective was to show how patient involvement in v-e can be enhanced by having a full time on site VRC integrated into daily operations.

Setting: 

The settings were two adjacent methadone treatment clinics affiliated with a hospital in Jamaica, Queens, New York

Sample: 

The sample size in the MM intervention clinic was 364 patients. Earlier admissions comprised 68% of Clinic 1 patients. Two-thirds of this group were male; 57% were Black; and median age was 33 years. Median time in treatment for the early admissions was 33 months. The sample size in the comparison clinic was 358 patients.

Data Collection: 

Aggregate data regarding v-e services offered to patients were obtained from reports submitted monthly state substance abuse office. This provided information on the volume and type of service activities provided throughout the study period. In addition the VRC provided individual service information on each person served. Data on individual service delivery and monthly patient v-e status provided project implementation and outcome data.

In Clinic 1; v-e status data for patients in a comparison clinic (Clinic 2; N=358) allowed assessment of the VRC's impact. Vocational-educational services increased significantly in Clinic 1 and declined in Clinic 2. Logistic regression of factors involved in staying or becoming vocationally involved (vocationally involved refers to working full- or part-time, or being enrolled in education/training) vs. staying or becoming vocationally uninvolved among patients in Clinics 1 and 2 were conducted. Logistic regression showed that pre-treatment/at admission employment heavily influenced positive v-e change and that VRC services contributed significantly to v-e change among patients not working at admission.

For the first and second hypotheses, a repeated measures of motivation to find employment and of eight job-seeking activities for the two intervention groups were compared using linear, mixed-effects models. The third and fourth hypotheses were analyzed using multinomial logistic regression analysis. For the third hypotheses a total motivation score was calculated by summing the motivation scores across the six time points of the 12-week intervention. For the fourth hypotheses, a total job seeking score was calculated by summing the number of job search activities over the 12-week intervention period.

Intervention: 

The intervention was in-house vocational rehabilitation counseling. Intervention and comparison groups were not matched or assigned. One setting delivered the intervention and the other provided standard treatment.

Control: 

Intervention and comparison groups were not matched or assigned.

Findings: 

Having a VRC in a MM clinic increased v-e activity and outcomes. Results show increases in average number of counseling sessions, assessments conducted, v-e plans developed, and in the number of patients involved in counseling and pre-employment groups/workshops each month. Referrals for education, training and employment increased.

Conclusions: 

The examiners concluded that having a VRC in a MM clinic has a positive impact by increasing patient v-e activity and employment outcomes. It is also cost effective. Greater emphasis should be placed on employment and training of MM patients to improve employment outcomes.

URL: 
https://www.researchgate.net/publication/4763062_Impact_of_a_vocational_counselor_on_employment-related_outcomes_among_methadone_patients
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Vocational rehabilitation service patterns and employment outcomes for Hispanics with spinal cord injuries

Authors: 
Arango-Lasprilla, J. C., da Silva Cardoso, Wilson, L. M., Romero, M. G., Chan, F., & Sung, C.
Year Published: 
2012
Publication: 
Rehabilitation Research Policy and Education
Volume: 
25
Number: 
3
Pages: 
149-162
Publisher: 
Elliott and Fitzpatrick Inc.
Background: 

Employment impacts the quality of life for individuals with spinal cord injury. Most studies that look at vocational service patterns for individuals with spinal cord injury focus on European Americans. Ethnic minority groups within the United State are growing. These changes also impact referrals to Model Spinal Cord Injury Systems. This presents new challenges to rehabilitation professionals.

Purpose: 

The purpose of this study was to identify demographic and service related patterns for Hispanics with spinal cord injury receiving services from state vocational rehabilitation agencies and examine similarities and differences in vocational rehabilitation services and employment outcomes between a group of European Americans and Hispanics with spinal cord injury.

Setting: 

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

Sample: 

Data for this study came from the Rehabilitation Services Administration Case Service report (RSA-911) database. There were 4,392 spinal cord cases closed either rehabilitated or not in 2005. Among these 3,119 were European American and 395 Hispanics. There were significant differences in age, education, per-service employment status, employment status, significant disabilities and work disincentives between the two groups.

Data Collection: 

Logistical regression analysis were conducted.

Intervention: 

The intervention uses various types of vocational rehabilitation services. These included: assessment, diagnosis and treatment of impairments, vocational rehabilitation counseling and guidance, college or university training, occupational vocational training, on the job training, basic academic remedial or literacy training, job readiness training, disability related, augmentative skills training, miscellaneous training, job search assistance, job placement assistance, on the job supports, transportation services, maintenance services, rehabilitation technology, technical assistance services, information and referral services and other services.

Control: 

There was no control or comparison condition.

Findings: 

Minor differences in case dollar expenditures and service patterns were noted between the two groups. Vocational rehabilitation services that impacted successful work outcomes included: assistive technology services, basic support services and job placement services.

Conclusions: 

Hispanic status of vocational rehabilitation clients does not affect employment outcomes. Hispanics appear to have more risk factors than European American clients. Vocational rehabilitation counselors were able to support the needs of Hispanic clients.

URL: 
http://www.academia.edu/10786564/Vocational_Rehabilitation_Service_Patterns_and_Employment_Outcomes_for_Hispanics_with_Spinal_Cord_Injuries
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes