Cognitive Training to Improve Work Outcomes in Severe Mental Illness

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DESCRIPTION (provided by applicant): Occupational disability is one of the most devastating and costly consequences of severe mental illness (SMI). Supported employment programs such as Individual Placement and Support (IPS) are the most effective way to help people with SMI obtain competitive employment (i.e., "regular jobs" in the community). However, many clients in supported employment either do not work at all or fail to keep their jobs. The cognitive impairments and everyday functioning skills deficits of psychiatric disorders contribute to poor work outcomes, but they are modifiable with Cognitive Training. Pilot data support the effectiveness of IPS and Cognitive Training for clients with SMI, including those who are middle-aged and older. The proposed research aims to evaluate the effectiveness of augmenting IPS supported employment services with a 3-month Cognitive Training program that aims to improve attention, learning, memory, and problem-solving abilities. The Cognitive Training approach is compensatory, in that it teaches strategies for overcoming cognitive deficits, and aims to help clients develop better thinking and memory habits that will last a lifetime. In the proposed 24- month randomized controlled trial, 152 participants with SMI will receive either IPS with Cognitive Training (IPS-CT) or IPS with enhanced support (IPS-ES). The IPS vocational specialist will deliver the Cognitive Training intervention in the client's community setting of choice, along with standard IPS services (job searching, job development, and follow-along job supports). IPS-ES will control for the additional time and attention provided in the IPS-CT condition during the first 3 months. All participants will be followed for 24 months, and employment data will be collected weekly. The primary aim of the study is to evaluate the hypothesis that compared to IPS-ES, IPS-CT will result in improved cognition, functional skills, work outcomes (e.g., number of weeks worked), and quality of life. Secondary aims are to investigate the mechanisms underlying such improvements and to identify predictors of employment outcomes. If Cognitive Training is found to improve outcomes in supported employment, the psychiatric rehabilitation field will be better prepared to help clients across the age spectrum meet their vocational and community reintegration goals.