Work Rehabilitation For Older Adults With Schizophrenia

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DESCRIPTION (provided by candidate): The primary goal of this five-year training award is to further develop Dr. Elizabeth Twamley's expertise in the following areas: 1) work rehabilitation for individuals with schizophrenia and related disorders; 2) applied neuropsychological research, focusing on the relationships between neuropsychological test performance and everyday functioning, particularly work abilities; and 3) clinical trials research design, methodology, and statistical analysis that can be used to evaluate these relationships. Her overarching career goal is to bridge neuropsychological and interventions research for persons with severe mental illness. The proposed career development plan builds on her doctoral training in clinical psychology, her specialty training in clinical neuropsychology, and her research background in neuropsychology and schizophrenia. The proposed training plan will include structured coursework and regular mentoring from experts in the fields of psychiatric work rehabilitation, neuropsychology, geriatric psychiatry, and schizophrenia research. The training plan is complemented by a research project designed to evaluate the efficacy of a work rehabilitation program for middle-aged and older individuals with schizophrenia. Few of these individuals work, yet about 40% desire paid employment or volunteer work. A type of work rehabilitation called Individualized Placement and Support (IPS), which has achieved the status of evidence-based practice for younger individuals, will be prospectively studied for the first time in a randomized controlled trial for middle-aged and older patients. Retrospective data comparing older schizophrenia patients in IPS programs with those in conventional work rehabilitation programs have shown rates of paid employment to be 69% vs. 29%, respectively. The proposed research will address the IPS program's differential effects on work activity, psychiatric symptoms, functional capacity, and quality of life, as well as cognitive, demographic, and clinical predictors of successful work outcomes. The results of the study will be useful not only in establishing the efficacy of IPS for middle-aged and older consumers, but also in illuminating the relationships between neuropsychological performance, work-related functional capacity, and ultimate work outcomes in this population. Together, the training and research plan will allow Dr. Twamley to transition from a postdoctoral research fellow to an independent investigator in the UCSD Department of Psychiatry, and will provide the foundation for a research career focused on cognition and work rehabilitation for individuals with severe psychiatric disorders.