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Many persons with schizophrenia have difficulty getting and keeping a job. This study is designed to compare the benefits of four sessions of motivational interviewing or illness education in increasing employment rates accruing from participation in supported employment.
Many individuals with serious psychiatric illnesses wish to work, and yet employment rates for this population are lower than the general population (Cook & Razanno, 2000). IPS is a type of supported employment intervention designed to assist individuals with serious psychiatric illnesses return to work. Over 20 randomized trials demonstrate that, in comparison to control conditions such as group therapy or referrals to traditional vocational rehabilitation services, IPS participants are three more times more likely to obtain a job during the study, and at least twice as likely to be competitively employed at any point in the study. Just as with the general population, the rewards of work for individuals with serious mental illness include considerably more than the financial remuneration. For example, employment appears to confer higher self-esteem, greater life satisfaction, and perhaps even better treatment compliance, symptom improvement, and insight in persons with psychiatric illnesses (Bell et al, 1996; Lysacker et al, 1995; Mueser et al, 1997; Bond et al, 1997; Kashner et al, 2002). Despite its demonstrated effectiveness, these IPS results could be improved. Most IPS participants are not competitively employed at any point in time, it takes an average of about four months to obtain a first job, a typical job lasts only approximately 20-25 weeks, and employment rates across the sample asymptote at about month 8 or 9 of participation in the trials. Furthermore, obtaining a first job seems to be an almost insurmountable impediment for approximately 35-40% of individuals in the trials, and these findings may be worse in individuals iwth schizophrenia (Twamely et al, 2003) . Motivational deficits may play a prominent role in explaining the limited benefits accruing from IPS in persons with serious and persisting psychiatric illnesses, especially in those with schizophrenia. Building a successful work life requires sustained effort over months and years (Palmer, 1989). After a period of unemployment, individuals must obtain their first reemployment position, and then transition to others as circumstances arise. Many persons with schizophrenia experience high degrees of negative symptoms, demoralization, and ambivalence, which likely all interfere with the persistent efforts required to initiate and maintain a successful vocational adjustment. Enhancing already validated vocational rehabilitation programs, such as IPS, with specific techniques to address motivational deficits may be essential to increasing employment rates among persons with schizophrenia. In this study, we tested a novel strategy designed to improve motivation for positive behavior change, motivational interviewing, adapted for work-related problems, in persons with schizophrenia. With the objective of improving work outcomes, we assigned 38 outpatients with schizophrenia or schizoaffective disorder to one of two 18 month psychosocial treatment groups, traditional Individual Placement and Support (IPS) with the addition of illness education (IE) about schizophrenia/schizoaffective disorder, as appropriate, or with the addition of Vocationally-oriented Motivational Interviewing (VOMI). We hypothesized that: 1) clients with schizophrenia who participated in IPS+VOMI would better vocational outcomes than IPS+IE clients. 2) If they are separated from their first job, clients with schizophrenia who participate in IPS+VOMI would be more likely to obtain a second job than clients who receive IPS+IE; and 3) Regardless of their treatment condition, working clients with schizophrenia would have greater social adjustment, symptoms, and life satisfaction than those who are not working.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| IPS and VOMI | Experimental | Individual Placement and Support (IPS), a form of evidence-based supported employment with 4 sessions of manualized vocationally-oriented motivational interviewing (VOMI) prior to each course of job searching |
|
| IPS and IE | Active Comparator | Individual placement and support (IPS), a form of evidence-based supported employment with 4 sessions of education about schizophrenia/schizoaffective disorder (IE), as appropriate, prior to each course of job searching |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| IPS | Behavioral | Individual Placement and Support Evidence based supported employment |
|
| Measure | Description | Time Frame |
|---|---|---|
| Obtained Employment | Number of participants who obtained a competitive job | 18 months of study |
| Average Number of Days Worked | Average number of total days each participant worked in the study | 18 months of study |
| Average Number of Hours Worked Per Week For Those Who Worked | Average number of hours worked per week among participants who obtained a job | 18 months of study |
| Measure | Description | Time Frame |
|---|---|---|
| Obtained a Second Job if Lost First Job and Still Had at Least 2 Months in the Program | Number of participants who obtained a second or third job if lost his/her first job but still had at least 2 months in the study | 18 months of the study |
| Association Between Employment Status and Psychiatric Symptoms as Measured on the Brief Psychiatric Rating Scale |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Shirley M. Glynn, PhD | VA Greater Los Angeles Healthcare System, West LA | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Greater Los Angeles Healthcare System, West LA | West Los Angeles | California | 90073 | United States |
Contact PI for access to data
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| ID | Title | Description |
|---|---|---|
| FG000 | IPS+VOMI | Individual Placement and Support (IPS), a form of evidence-based supported employment with 4 sessions of manualized vocationally-oriented motivational interviewing (VOMI) prior to each course of job searching Individual Placement and Support (IPS): Evidence based supported employment Vocationally-Oriented Motivational Interviewing (VOMI): Four sessions of manualized motivational interviewing oriented to employment goals and concerns prior to each course of a job search |
| FG001 | IPS+IE | Individual placement and support (IPS), a form of evidence-based supported employment with 4 sessions of education about schizophrenia/schizoaffective disorder (IE), as appropriate, prior to each course of job searching Individual Placement and Support (IPS): Evidence based supported employment Illness Education (IE): Four sessions of manualized illness education about schizophrenia/schizoaffective disorder (tailored to the participant diagnosis) prior to each course of a job search |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | IPS+VOMI | Individual Placement and Support (IPS), a form of evidence-based supported employment with 4 sessions of manualized vocationally-oriented motivational interviewing (VOMI) prior to each course of job searching Individual Placement and Support (IPS): Evidence based supported employment Vocationally-Oriented Motivational Interviewing (VOMI): Four sessions of manualized motivational interviewing oriented to employment goals and concerns prior to each course of a job search |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Obtained Employment | Number of participants who obtained a competitive job | Posted | Number | participants | 18 months of study |
|
Length of Study--18 months
Information obtained from routine medical chart review and every 6 month interviews with participants
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | IPS+VOMI | Individual Placement and Support (IPS), a form of evidence-based supported employment with 4 sessions of manualized vocationally-oriented motivational interviewing (VOMI) prior to each course of job searching Individual Placement and Support (IPS): Evidence based supported employment Vocationally-Oriented Motivational Interviewing (VOMI): Four sessions of manualized motivational interviewing oriented to employment goals and concerns prior to each course of a job search |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hospitalization or ER visit | Psychiatric disorders | Non-systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Torn tendon in finger | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
Small sample size reflecting recruitment challenges
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Shirley M. Glynn. Ph.D. | VAGLAHS at West Los Angeles | 310-268-3939 | sglynn@ucla.edu |
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| ID | Term |
|---|---|
| D011618 | Psychotic Disorders |
| D012559 | Schizophrenia |
| ID | Term |
|---|---|
| D019967 | Schizophrenia Spectrum and Other Psychotic Disorders |
| D001523 | Mental Disorders |
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| IE | Behavioral | Four sessions of manualized illness education about schizophrenia/schizoaffective disorder (tailored to the participant diagnosis) prior to each course of a job search |
|
| VOMI | Behavioral | Four sessions of manualized motivational interviewing oriented to employment goals and concerns prior to each course of a job search |
|
Employment status at each major follow-up assessment period and psychiatric symptomatology as reflected in the Total Brief Psychiatric Rating Scale Score (Ventura J, et al., Training and quality assurance with the Structured Clinical Interview for DSM-IV (SCID-I/P). Psychiatry Research, 1998. 79(2): p. 163-173) with scale range from 24 to 168, with higher scores indicating greater symptomatology |
| 6,12, 18 months |
| Association Between Employment Status and Self-reported Life Satisfaction Measured on the Quality of Life Scale (Lehman) | Employment status at each major follow-up assessment period and self-reported Life Satisfaction (range from 1 (terrible) to 7 (delighted)) on the Quality of Life Scale (Lehman A, Kernan E, and Postrado L, Toolkit for Evaluating Quality of Life for Persons with Severe Mental Illness. 1995, Baltimore, MD: The Evaluation Center at HSRI). | 6,12, 18 months |
| Association Between Employment Status and Overall Adjustment as Rated on the Social Adjustment Scale II (Schooler) | Employment status at each major follow-up assessment period and overall adjustment as rated on the Social Adjustment Scale II (Schooler, N., G. Hogarty, and M. Weissman, Social Adjustment Scale II (SAS-II), in Resource Materials for Community Mental Health Program Evaluations, W.A. Hargreaves, C.C. Atkisson, and J.E. Sorenson, Editors. 1979, NIMH: Rockville, MD. p. 290-303), on a 1 (excellent adjustment ) to 7 (severe maladjustment) scale. | 6, 12, and 18 months |
| BG001 | IPS+IE | Individual placement and support (IPS), a form of evidence-based supported employment with 4 sessions of education about schizophrenia/schizoaffective disorder (IE), as appropriate, prior to each course of job searching Individual Placement and Support (IPS): Evidence based supported employment Illness Education (IE): Four sessions of manualized illness education about schizophrenia/schizoaffective disorder (tailored to the participant diagnosis) prior to each course of a job search |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Number | participants |
|
| Education | Number | participants |
|
|
|
|
| Primary | Average Number of Days Worked | Average number of total days each participant worked in the study | Posted | Mean | Standard Deviation | days | 18 months of study |
|
|
|
|
| Primary | Average Number of Hours Worked Per Week For Those Who Worked | Average number of hours worked per week among participants who obtained a job | Only included hours worked for participants who obtained a job (n=19 in the entire study) | Posted | Mean | Standard Deviation | hours/worked per week | 18 months of study |
|
|
|
|
| Secondary | Obtained a Second Job if Lost First Job and Still Had at Least 2 Months in the Program | Number of participants who obtained a second or third job if lost his/her first job but still had at least 2 months in the study | Includes only participants who obtained at least one job and had at least 2 months left if they lost/left that job; 2 individuals in each condition held the same job for almost the whole program and thus could not contribute data here | Posted | Number | participants | 18 months of the study |
|
|
|
|
| Secondary | Association Between Employment Status and Psychiatric Symptoms as Measured on the Brief Psychiatric Rating Scale | Employment status at each major follow-up assessment period and psychiatric symptomatology as reflected in the Total Brief Psychiatric Rating Scale Score (Ventura J, et al., Training and quality assurance with the Structured Clinical Interview for DSM-IV (SCID-I/P). Psychiatry Research, 1998. 79(2): p. 163-173) with scale range from 24 to 168, with higher scores indicating greater symptomatology | Number of individuals working within one month of assessment point varies by follow up point; total n=38 at baseline; total n=23 analyzed at 6 months; total n= 19 analyzed at 12 months; total n = 16 analyzed at 18 months | Posted | Mean | Standard Deviation | units on a scale | 6,12, 18 months |
|
|
|
|
| Secondary | Association Between Employment Status and Self-reported Life Satisfaction Measured on the Quality of Life Scale (Lehman) | Employment status at each major follow-up assessment period and self-reported Life Satisfaction (range from 1 (terrible) to 7 (delighted)) on the Quality of Life Scale (Lehman A, Kernan E, and Postrado L, Toolkit for Evaluating Quality of Life for Persons with Severe Mental Illness. 1995, Baltimore, MD: The Evaluation Center at HSRI). | Number of individuals working within one month of assessment point varies by follow up point; total n=38 at baseline; total n=26 analyzed at 6 months; total n= 19 analyzed at 12 months; total n = 17 analyzed at 18 months | Posted | Mean | Standard Deviation | units on a scale | 6,12, 18 months |
|
|
|
|
| Secondary | Association Between Employment Status and Overall Adjustment as Rated on the Social Adjustment Scale II (Schooler) | Employment status at each major follow-up assessment period and overall adjustment as rated on the Social Adjustment Scale II (Schooler, N., G. Hogarty, and M. Weissman, Social Adjustment Scale II (SAS-II), in Resource Materials for Community Mental Health Program Evaluations, W.A. Hargreaves, C.C. Atkisson, and J.E. Sorenson, Editors. 1979, NIMH: Rockville, MD. p. 290-303), on a 1 (excellent adjustment ) to 7 (severe maladjustment) scale. | Number of individuals working within one month of assessment point varies by follow up point; total n=38 at baseline; total n=25 analyzed at 6 months; total n= 16 analyzed at 12 months; total n = 17 analyzed at 18 months | Posted | Mean | Standard Deviation | units on a scale | 6, 12, and 18 months |
|
|
|
|
| 6 |
| 17 |
| 1 |
| 17 |
| EG001 | IPS+IE | Individual placement and support (IPS), a form of evidence-based supported employment with 4 sessions of education about schizophrenia/schizoaffective disorder (IE), as appropriate, prior to each course of job searching Individual Placement and Support (IPS): Evidence based supported employment Illness Education (IE): Four sessions of manualized illness education about schizophrenia/schizoaffective disorder (tailored to the participant diagnosis) prior to each course of a job search | 5 | 21 | 6 | 21 |
| Increased psychiatric symptoms | Psychiatric disorders | Non-systematic Assessment | Anxiety depression, or suspiciousness, |
|
| Elevated blood pressure | Cardiac disorders | Non-systematic Assessment |
|
| Rectal bleeding | Gastrointestinal disorders | Non-systematic Assessment |
|
| Leg infection | Infections and infestations | Non-systematic Assessment |
|
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| >.05 |
| No |
| Superiority or Other |
| 18 months |
|
time effect F(1,54)=.2.05 |
| .16 |
| No |
| Superiority or Other |
| Mixed Models Analysis | employment status X time effect F (1,54)=.. 24 | .63 | No | Superiority or Other |
| 18 months |
|
time effect F (1,58)=.21 ,. |
| .65 |
| No |
| Superiority or Other |
| Mixed Models Analysis | employment status X time effect F(1,58)=.06 | .81 | No | Superiority or Other |
| 18 months |
|
time effect (1.54)=2.99, |
| .09 |
| No |
| Superiority or Other |
| Mixed Models Analysis | employment status X time effect (F(1,54)=.74 | .39 | No | Superiority or Other |