Abstract
Effectiveness of Supported Employment for Individuals with Schizophrenia: Results of a Multi-Site, Randomized Trial
Author(s): Judith A. Cook , Crystal R. Blyler , Jane K. Burke-Miller , William R. McFarlane ,H. Stephen Leff , Kim T. Mueser, Paul B. Gold , Richard W. Goldberg ,Michael S. Shafer , Steven J. Onken , Kate Donegan , Martha Ann Carey ,Lisa A. Razzano , Dennis D. Grey , Susan A. Pickett-Schenk , Caroline KaufmannBackground: Prior studies of supported employment efficacy for individuals with schizophrenia have yielded mixed results, with some finding poorer outcomes for those with this diagnosis and others finding no differences. Aims: This multi-site effectiveness trial examined the relative impact of diagnosis with schizophrenia and evidence-based practice supported employment on the likelihood of competitive employment. Method: At seven U.S. sites, 1,273 outpatients with severe mental illness were randomly assigned to either an experimental supported employment program or to a comparison/services as usual condition and followed for two years. Data collection involved semi-annual, in-person interviews, and weekly recording of all paid employment by vocational and research staff. Mixed-effects random regression analysis was used to examine the effects of study condition, schizophrenia diagnosis, and their interaction, on the likelihood of competitive employment. Results: Subjects in experimental group programs and those with diagnoses other than schizophrenia (predominantly bipolar disorder and major depression) were significantly more likely to be competitively employed than those in control programs and those with diagnoses of schizophrenia. However, an interaction effect between study condition and diagnosis was observed in which experimental group treatment ameliorated the negative effects of diagnosis on employment outcome. Discussion: Evidence-based supported employment interventions are superior to services as usual/comparison programs in assisting individuals with schizophrenia to attain competitive employment. Given recent evidence of this model’s effectiveness outside the U.S. and interest in its promotion internationally, it has global potential to further the recovery potential of individuals with psychiatric disabilities.