Cognitive Remediation, Illness Self-Management, and Supported Employment in Severe Mental Illness

 

Funding

NIDRR Field Initiated Research Grant

Dates

9/30/09 – 9/29/12

Contact: Susan McGurk




Description

Chronic unemployment is a major problem faced by many persons with severe mental illnesses (SMI) such as schizophrenia, and is the leading cause of disability in this population. Despite rates of competitive employment in the 10-20% range, most clients with SMI want competitive work in integrated community settings as a personal recovery goal. Although supported employment is an evidence-based practice for improving vocational outcomes in this population, 25-60% clients with SMI do not obtain work in supported employment programs, and many others have difficulty keeping their jobs. The primary obstacles to employment for persons with SMI are cognitive impairments, persistent psychiatric symptoms, and relapses. There is an urgent need to improve the effectiveness of supported employment programs by addressing these obstacles, thereby empowering clients to gain control over their illness and achieve their vocational goals. This project builds on the successful work of our group and others that has demonstrated the benefits of providing cognitive remediation to clients with SMI in vocational rehabilitation by evaluating the additional benefits of training in an evidence-based practice for teaching illness self-management skills—the Illness Management and Recovery (IMR) program. This project is evaluating whether cognitive training operates synergistically with IMR and vocational rehabilitation by improving cognitive functioning and learning illness self-management skills critical to success in getting and keeping competitive employment.

The project is a randomized, controlled trial evaluating the effects of combining cognitive training with the IMR program in clients with SMI receiving vocational rehabilitation services, compared to vocational rehabilitation alone. The cognitive training program is the Thinking Skills for Work program (TSW), developed by Susan McGurk and Kim Mueser at the Center for Psychiatric Rehabilitation, which involves work with a cognitive specialist who engages the client in computerized cognitive skills training (2-3 times per week for 3 months), and works in collaboration with the client and employment specialist to identify jobs, practice newly acquired cognitive skills in work-related settings, and to develop strategies for coping with persistent cognitive impairments. The IMR program, developed by Susan Gingerich and Kim Mueser, is a 9-10 month group intervention in which clients set personally meaningful recovery goals (i.e., work), and then learn illness self-management skills in order to help them achieve their goals. The project is being conducted at Brooklyn Community Services, a large agency that serves a predominantly minority (95%), inner city, SMI population, and has a strong track record for providing supported employment. A total of 61 clients with SMI have been randomized to either cognitive training, IMR, and supported employment (TSW + SE + IMR) or supported employment only (SE only), and are being followed for 18 months. Weekly data on work outcomes and vocational services are being obtained over the study period, as well as interview-based assessments of cognitive functioning, symptoms, illness self-management skills, self-esteem and recovery, and quality of life conducted at baseline, 9-months, and 18-months. Three hypotheses are being tested: 1) clients in TSW + SE + IMR will improve more at 9- and 18-month follow-up assessments of ognitive functioning, illness self-management, symptom severity, and self-perceptions of recovery than clients SE only; 2) clients in TSW + SE + IMR will have better competitive employment outcomes over 18 months (wages earned, hours worked); and 3) clients in TSW +SE + IMR will require fewer intensive vocational services per hour of client work. If the project supports the effectiveness of combining cognitive training with IMR, rehabilitation specialists will have an important new technology for improving the employment outcomes of persons with SMI receiving vocational services.

Investigators

BU Center for Psychiatric Rehabilitation Staff
Susan R. McGurk, Ph.D. Project Director
Kim T. Mueser, Ph.D. Co-Investigator
Susan Gingerich, M.S.W., Independent Consultant Co-Investigator
Dartmouth Medical School, Hanover, NH Staff
Haiyi Xie, Ph.D. Co-Investigator
Rosemarie Wolfe, M.S. Data Manager
Brooklyn Community Services, Brooklyn, NY Staff
Leslie Klein, M.A. Site PI
Karin Feldman, M.A. Co-Investigator
Lori Tannenbaum, M.A. Co-Investigator
Sue Buchanan, M.A. Co-Investigator
Beth Vayshenker, B.A. Cognitive Specialist

Documents

No documents are available at this time. Please use the project contact for specific inquiries.

Contact

Inquiries related to the project should be addressed to:

Susan McGurk
Boston University, Center for Psychiatric Rehabilitation
940 Commonwealth Avenue West, 2nd Floor
Boston, MA 02215
Email:mcgurk@bu.edu