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，加上他们在联邦残疾名册上的比例过高。评论： 文献表明，患有严重精神疾病的退伍军人中约有65%至90%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。要在这个问题上获得牵引力，很可能是 有必要找到解决工作结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果的关键决定因素之一，这一发现强调了当前提议的基础。拟议的项目包括两项行为培训干预：(A)无错误学习；(B)社会认知培训。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损伤，比如那些参与学习新工作的人。社会认知培训针对的是与感知、理解和回应社交情况相关的神经认知过程中的障碍，例如涉及与同事和主管在工作中互动的情况。综合使用这些干预措施的效果将在支助就业的个人安置和支助(IPS)模式的背景下进行审查，这是为严重精神疾病患者提供支助就业的主要循证办法。这项研究有两个主要目的：(A)测试综合培训方法对工作安排和工作结果的有效性，以及(B)检查工作安排和工作结果的决定因素。这项研究将招募108名患有精神分裂症或分裂情感障碍的退伍军人，他们对获得竞争性工作感兴趣。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，并随机分为两个训练组之一：(A)无错误学习+社会认知培训+IPS支持就业(EL+SCT+IPS)，或(B)支持就业+控制条件，以在培训接触的持续时间和频率(IPS+)方面与试验组匹配。基线评估将包括对神经认知、社会认知、临床症状、动机、生活事件、酒精和物质使用、服药依从性和个人幸福感的测量。被随机分配到EL+SCT+IPS的退伍军人将在求职期间接受12次社会认知培训。在安排工作后，被分配到EL+SCT+IPS的退伍军人将在其主要工作分配上接受无错误学习培训，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。被随机分配到IPS+的退伍军人将接受EL+SCT+IPS组中持续时间、频率和培训联系类型相匹配的症状管理培训和一对一支持。第二次基线评估将在安置工作两周后进行，采用与第一次基线相同的措施，加上工作业绩、工作成果和与工作有关的个人幸福感(例如，工作满意度、工作压力)的衡量标准。然后对退伍军人进行为期12个月的跟踪调查，每三个月进行一次评估，以检查短期和长期培训效果。结果评估将包括对工作表现、工作期限、工作结果和与工作相关的个人幸福感的衡量。初步分析将审查：(A)无错误学习加上社会认知培训对工作安排和工作结果的总体效果，以及(B)工作安排和工作结果的预测因素。

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.