Chronic unemployment is a major problem faced by many persons with severe mental illnesses 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 serious mental illness 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 do not obtain work in supported employment programs, and many others have difficulty keeping their jobs. The primary obstacles to employment 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 serious mental illness 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 evaluated 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 was a randomized, controlled trial evaluating the effects of combining cognitive training with the IMR program in clients 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 was conducted at Brooklyn Community Services, a large agency that serves a predominantly minority (95%), inner-city population with severe mental illness and has a strong track record for providing supported employment.
A total of 61 clients with serious mental illness were randomized to either cognitive training, IMR, and supported employment (TSW + SE + IMR) or supported employment only (SE only), and were 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 were being tested: 1) clients in TSW + SE + IMR will improve more at 9- and 18-month follow-up assessments of cognitive 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. This project addressed the question of the effectiveness of combining cognitive training with IMR as an important new technology for improving the employment outcomes of persons with serious mental illness receiving vocational services.
Project Director: Susan R. McGurk, Ph.D.
Co-Investigator: Kim T. Mueser, Ph.D.
Co-Investigator: Susan Gingerich, M.S.W., Independent Consultant (No longer at the Center)
This is a multi-site study. Please contact the Center investigator for additional information.
McGurk, S. R., & Mueser, K. T. (2015). Cognitive enhancement and illness self-management in vocational rehabilitation. Schizophrenia Bulletin, 41, S183.
Inquiries related to the project should be addressed to:
Susan McGurk, Ph.D.
Boston University, Center for Psychiatric Rehabilitation
940 Commonwealth Avenue West, 2nd Floor
Boston, MA 02215