Building Employment Skills Through Therapy for Veterans

Not Applicable

Completed

Interventions: Other: Usual Care
Behavioral: integrated Cognitive Behavioral Therapy
Behavioral: Computerized cognitive remediation (CCR)

Brief Summary: Schizophrenia/Schizoaffective Disorder is associated with serious problems with cognitive skills, social skills, and functional skills (like employment). There is a new form of cognitive behavioral therapy called integrated cognitive behavioral therapy (iCBT) that specifically addresses the cognitive, social, and functional deficits of schizophrenia/schizoaffective disorder. This study compared iCBT to the usual care (UC) that Veteran's receive. The investigators compared iCBT to UC in subjects with schizophrenia/schizoaffective disorder who are enrolled in a Supported Employment (SE) program, and evaluate whether iCBT is more helpful in improving job attainment, and other areas of functioning, both right after treatment, and 6 months after the end of treatment.

Detailed Description: The objective of the current study was to evaluate whether integrated cognitive behavior therapy (iCBT) can improve engagement and success in an existing Supported Employment (SE) program among the most functionally disabled patients with schizophrenia/schizoaffective disorder. The iCBT condition also included computerized cognitive remediation. The primary specific aim was to determine whether iCBT will significantly improve work outcomes at post-treatment to a greater extent than Usual Care (UC) in low functioning patients with schizophrenia/schizoaffective disorder who join the SE program. The secondary aims were to evaluate the whether iCBT will significantly improve work outcomes at 6 month follow-up relative to UC, and whether iCBT will improve functional outcomes post-treatment and at follow-up relative to UC in subjects who join the SE program.

Recruitment & Eligibility

Inclusion Criteria

Diagnosis of DSM-IV schizophrenia or schizoaffective disorder (SCID)
Severe/extreme functional disability [World Health Organization Disability Assessment Scale (WHODAS) score > 50]
Clinical stability (as per primary mental health provider)
Receiving treatment at the Veterans Administration
Minimal engagement in psychiatric rehabilitation services (just psychiatrist and therapist/case management in the last 6 months)
Eligible for and willing to be enrolled in Supported Employment program
Age 18 to 65
Proficient in English
Able to give informed consent

Exclusion Criteria

Neurologic disease or damage that would make the diagnosis of schizophrenia questionable
Current opioid or stimulant dependence (SCID)
Not appropriate due to safety concerns (based on risk assessment)

Arm && Interventions

Group	Intervention	Description
iCBT	Computerized cognitive remediation (CCR)	integrated CBT with computerized cognitive remediation
UC	Usual Care	usual care
iCBT	integrated Cognitive Behavioral Therapy	integrated CBT with computerized cognitive remediation

Primary Outcome Measures

Name	Time	Method
Workforce Participation Measure - Total Number of Jobs Attained	Baseline to post-treatment (18-months)	Measure completed by the support employment specialist that evaluates participation in the workforce: Total number of jobs attained per group across the full length of the study (Baseline to 18 month follow-up, study end)
Overall Job Attainment Proportion	Study start through 18 months of the active portion of the study.	This is the proportion of participants, by group, that attained at least one job during the active portion of the study.
Job Participant Composite-hours Worked	Baseline to study intervention start point (ranging from 1-10 months), then at 6 months after intervention start, 12 months after intervention start, and then 18 months after intervention start.	This is a composite of hours work per week X number of weeks worked, in each assessment period.

Secondary Outcome Measures

Name	Time	Method
Work Behavior Inventory	Baseline, mid-treatment (6-months), end of treatment (12-months), and post-treatment (18-months)	Measure completed by the supported employment specialist that evaluates work quality in an employment setting, based on the job supervisor's report, using the overall impression rating, ranging from 1 (consistently needing improvement) to 5 (consistently superior performance). Only the job supervisor's was used, rather than other options possible with the measure.
Specific Levels of Functioning (SLOF)	Baseline, mid-treatment (6-months), end of treatment (12-months), and post-treatment (18-months)	This is measure designed to assess individual social, work, and interpersonal functioning of individuals with severe mental illness. The possible total score ranges from 30 - 150 with higher scores representing higher levels of functioning.