Errorless Learning and Social Cognition Training for Work Rehabilitation

描述（由申请人提供）： 一个主要的心理健康问题是患有严重精神疾病的退伍军人的劳动力参与率极低，再加上他们在联邦残疾名册上的代表性过高。审查 文献表明，大约65%至90%患有严重精神疾病的退伍军人长期失业。考虑到就业对个人和临床福祉的重要性，这些数字尤其令人沮丧。为了在这个问题上取得进展， 必须找到解决工作成果关键决定因素的治疗方法。有证据表明，神经认知和社会认知缺陷是精神分裂症患者功能结局的关键决定因素之一，这一发现强调了当前提案的基础。该项目包括两个行为训练干预：（a）无错学习，（B）社会认知训练。无错学习是一种训练方法，可以补偿阻碍或限制技能获得的神经认知障碍，例如学习新工作的方法。社会认知训练解决与感知，理解和对社会情境的反应相关的神经认知过程中的障碍，例如与工作中的同事和主管互动。将在支助就业的个人安置和支助模式的背景下审查这些干预措施的综合使用的效力，这是支助严重精神疾病患者就业的主要循证方法。本研究有两个主要目的：（a）测试综合培训方法在就业安置和工作成果方面的功效;（B）研究就业安置和工作成果的决定因素。这项研究将招募108名有精神分裂症或情感障碍的退伍军人，他们有兴趣获得有竞争力的就业机会。研究参与者将在神经认知和社会认知功能水平上进行匹配，并随机分配到两个培训组之一：（a）无错学习+社会认知培训+IPS支持的就业（EL+SCT+IPS），或（B）支持的就业+对照条件，以在培训接触的持续时间和频率（IPS+）方面与实验组匹配。基线评估将包括神经认知、社会认知、临床症状、动机、生活事件、酒精和物质使用、药物依从性和个人幸福感的测量。随机分配到EL+SCT+IPS的退伍军人将在求职期间接受12次社会认知培训。就业安置后，分配到EL+SCT+IPS的退伍军人将接受关于其主要工作任务的无错学习培训，然后接受第二阶段的社会认知培训，以解决工作中的社会困难。随机分配至IPS+组的退伍军人将接受症状管理培训，并在EL+SCT+IPS组接受与培训接触的持续时间、频率和类型相匹配的一对一支持。第二次基线评估将在工作安排后两周进行，使用与第一次基线评估相同的测量方法，加上工作绩效、工作成果和与工作相关的个人幸福感（例如，工作满意度、工作压力）。然后，退伍军人将被跟踪12个月，每三个月进行一次评估，以检查短期和长期训练效果。成果评估将包括工作业绩、工作任期、工作成果和与工作有关的个人福祉的衡量标准。主要分析将检查：（a）无错学习加社会认知培训对就业安置和工作成果的总体功效，以及（B）就业安置和工作成果的预测因素。

DESCRIPTION (provided by applicant): A major mental health problem is the extremely low labor force participation of veterans with severe mental illness coupled with their overrepresentation on federal disability rolls. Reviews of the literature indicate that approximately 65% to 90% of veterans with severe mental illness are chronically unemployed. These figures are particularly discouraging given the importance of employment to personal and clinical well-being. To gain traction on this problem, it will likely be necessary to find treatments that address key determinants of work outcome. Evidence indicates that neurocognitive and social cognitive deficits are among the key determinants of functional outcome for persons with schizophrenia, a finding that underscores the basis for the current proposal. The proposed project includes two behavioral training interventions: (a) errorless learning, and (b) social cognition training. Errorless learning is a method of training that compensates for neurocognitive impairments that impede or restrict skill acquisition such as those involved in learning a new job. Social cognition training addresses impairments in neurocognitive processes associated with the perception, understanding, and response to social situations such as those involving interactions with co-workers and supervisors on the job. The efficacy of the combined use of these interventions will be examined within the context of an Individual Placement and Support (IPS) model of supported employment, the leading evidence- based approach to supported employment for persons with severe mental illness. The study has two primary aims: (a) to test the efficacy of the combined training methods on job placement and work outcome, and (b) examine determinants of job placement and work outcome. The study will recruit 108 veterans with schizophrenia or schizoaffective disorder who are interested in attaining competitive employment. Study participants will be matched on level of neurocognitive and social cognitive functioning, and randomized to one of two training groups: (a) errorless learning plus social cognition training plus IPS supported employment (EL+SCT+IPS), or (b) supported employment plus control conditions to match the experimental group on duration and frequency of training contact (IPS+). Baseline assessment will include measurement of neurocognition, social cognition, clinical symptoms, motivation, life events, alcohol and substance use, medication adherence, and personal well-being. Veterans randomized to EL+SCT+IPS will receive 12 sessions of social cognition training during the period of job search. After job placement, veterans assigned to EL+SCT+IPS will receive errorless learning training on their primary job assignment and then a second phase of social cognition training to address social difficulties on the job. Veterans randomized to IPS+ will receive symptom management training and one-on-one support matched for duration, frequency, and type of training contact in the EL+SCT+IPS group. A second baseline assessment will be conducted two weeks after job placement using the same measures administered at the first baseline plus measures of work performance, work outcome, and work-related personal well-being (e.g., job satisfaction, work stress). Veterans will then be followed for 12 months with assessments conducted every three months to examine short- and longer-term training effects. Outcome assessments will include measures of work performance, job tenure, work outcome, and work-related personal well-being. The primary analyses will examine: (a) the overall efficacy of errorless learning plus social cognition training on job placement and work outcome, and (b) predictors of job placement and work outcome.