The Use of Skills Training to Augment Compensated Work Therapy (CWT)/VI for Veterans With SMI

Not Applicable

Completed

Conditions: Mental Illness
Schizophrenia

Interventions: Other: Supportive Treatment for SMI
Behavioral: Maryland Program for Vocational Effectiveness

Registration Number: NCT00272168

Lead Sponsor: VA Office of Research and Development

Brief Summary: The goal of this study is to evaluate the efficacy of a combined social skills training and cognitive-behavioral therapy intervention for seriously mentally ill Veterans as they begin employment.

Detailed Description: In spite of the fact that most individuals with serious mental illness (SMI) express a desire to work, some 80% of these individuals in the United States are chronically unemployed or under-employed. The VA has long recognized the need for vocational rehabilitation programs to facilitate meaningful work for patents with SMI. VA vocational rehabilitation programs (Compensated Work Therapy / Veterans Industries; CWT/VI) generally follow a supported employment model which has been the most extensively studied type of program and has garnered the most empirical support for helping individuals with SMI obtain employment. Nevertheless, studies of supported employment programs find that approximately 50% of participants remain unemployed and that job retention rates among those patients who do get jobs are quite low. In fact, more than half of all clients leave their supported employment positions within 6 months. The most frequently cited reasons for job terminations among patients with SMI include interpersonal problems in the work place and difficulty coping with symptom exacerbations.

The investigators have developed a psychosocial intervention (CBT-SST) that is designed to augment CWT/VI by targeting the skills needed for reintegration into community work settings and to facilitate job retention among persons with SMI. It is a manualized intervention that combines elements of cognitive-behavioral therapy (CBT) with work-related social skills training and basic problem solving training (SST). The CBT module of the treatment is designed to help reduce residual symptoms of mental illness and help patients develop strategies to cope with symptom exacerbations when they occur. The SST social skills and problem solving modules are designed to help patients improve their interpersonal functioning at work.

The purpose of this study is to conduct a randomized clinical trial comparing CWT/VI augmented with CBT-SST to CWT/VI without augmentation (control condition). The investigators will recruit patients for the study as they are beginning jobs through enrollment in the CWT/VI program at the VA, as this is the critical time period for them to develop the skills needed to perform well and retain employment. Expected outcomes for CBT-SST participants relative to controls include improved job retention and earnings, improved social skills (as assessed both in the clinic and in the actual work place), better everyday problem solving skills / social function, and improvements in quality of life.

The long term objective of this research is to develop and disseminate an effective skills training program that can improve work function and job retention among persons with SMI, and thereby enhance: a) their social role functioning; and b) their quality of life.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 88

Inclusion Criteria

Diagnosis of schizophrenia or schizoaffective disorder, or other severe mental disorder including bipolar disorder, major depression, or severe anxiety disorder
Enrolled in vocational rehabilitation program or working
Age between 18 and 65 years
Ability and willingness to attend treatment sessions for 3 months
Judged by their treating clinician to be able to participate and provide informed consent
Ability and willingness to provide informed consent to participate

Exclusion Criteria

Documented history of severe neurological disorder or head trauma with ongoing cognitive sequelae
Inability to effectively participate in the baseline assessments due to intoxication or psychiatric symptoms on two successive appointments

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm 2: Control	Supportive Treatment for SMI	Supportive Treatment for SMI (control)
Arm 1: MPROVE	Maryland Program for Vocational Effectiveness	The Maryland Program for Vocational Effectiveness (MPROVE)

Primary Outcome Measures

Name	Time	Method
Employment Status	Post Treatment (approximately 3 months after completion of the baseline assessment)	Data collected included from participants: weekly wages earned
Work Performance (Work Behavior Inventory)	Post Treatment	This measure is completed with participants' supervisors and assesses current work behavior and vocational function. The WBI yields six scores related to fundamental work requirements: social skills, cooperativeness, work habits, work quality personal presentation, and a general score of overall work performance. Each of these is rated between 1-5: 1. Consistently an area Needing Improvement 2. Occasionally an area Needing Improvement 3. Performance Adequate in this area 4. Occasionally an area of Superior Performance 5. Consistently an area of Superior Performance. The global impression of work behavior (overall rating of work functioning using the same 1-5 scale) was used for the purpose of reporting results for this study.
Social Functioning	Post Treatment	This was assessed using the Maryland Assessment of Social Competence (MASC), which assesses participants social problem solving skill abilities in both work-related and non-work related situations. Using three scenes, the participant is rated on the following scale for each scene. Overall score is then averaged to arrive at a final score. 1. Very Poor 2. Poor 3. Neither good nor poor 4. Somewhat good 5. Very good

Secondary Outcome Measures

Name	Time	Method
Cognitive Insight	Post Treatment	Cognitive insight was assessed using the Beck Cognitive Insight Scale, a 15-item questionnaire developed to evaluate patients' self-reflectiveness and their overconfidence in their interpretations of their experiences. Participant responses to each of these items were as follows: 1. Do not agree at all 2. Agree slightly 3. Agree a lot 4. Agree completely Total score for the self-certainty scale could range from 6 to 24. Total score for the self-reflectiveness scale could range from 9 to 36. Total score for the composite score was calculated by subtracting the summed score for the self-certainty scale from the summed score of the self-reflectiveness scale and could range from 3 to 12, lower composite scores are an indicator of lower psychiatric functioning.
Psychiatric Symptoms	Post-Treatment	Psychiatric Symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS), a widely used instrument for assessing the positive, negative, and affective symptoms of individuals who have mental illnesses. The BPRS consists of 20 symptom constructs scored from 1 (not present) to 7 (extremely severe). BPRS total score could range from 0 (not present) to 140 (extremely severe).