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An issue that we need to remind ourselves about in mental health is that it is important to consider the unique differences in the treatment and rehabilitation of individuals with schizophrenia. This is especially true in the various aspects of vocational and supported work programs. The combined efforts of researchers from Mt. Sinai Medical Center, New York and Dartmouth University, examined the elements in a supported employment program over a two year period. The goal of the study, published in Psychiatric Services, was to establish whether there were predictors of work outcomes and the relationships of the measures of cognitive functioning and various psychiatric symptoms with work outcomes and use of vocational services.
The study first established some baseline measures such as the work environment and the level of cognitive functioning. The authors point out that "the supported employment program was reasonably repesentative of the typical supported work enironment. The clients' symptoms and cognitive functioning did not change significantly over the two-year study period, with all the symptom and cognitive domains that were measured showing moderate to high stability"
Results showed that symptoms and cognitive functioning were, in fact, clearly predictive of work outcomes - most specifically, negative symptoms. The findings reported in this study are consistent with earlier findings but add the capability of predicting work outcomes for clients in a supported employment program. Problem-solving skills and learning and memory were related to work outcomes as job performance relies on these cognitive domains. In a similar fashion to cognitive functioning, clinical symptoms were differentially related to work outcomes and service use. Poorer work outcomes were predicted by more severe negative symptoms, and more service use was predicted by more severe positive symptoms.
The authors suggest that adjunctive treatment, such as cognitive-behavioral therapy could reduce the amount of support required for these clients to sustain work. Although this is preliminary study with some limitations (small sample, mostly male, lack of ethnic minorities), it is important to understand that key dimensions of psychiatric illness such as cognition and symptoms may influence both work outcomes and the use of vocational services for clients participating in supported employment. Psychiatr Serv 54:1129-1135, August 2003
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