Motivational Determinants of Poor Work Outcome in Supported Employment

摘要 就业困难是精神分裂症患者和其他 精神障碍令人鼓舞的是，就业结果比过去有了很大改善 20年来，通过提供辅助就业服务。随机对照试验数据 严重精神疾病患者（SMI）接受支持性就业的人数是其他人的2-3倍。 比那些接受传统职业康复的人更有可能获得有竞争力的工作。不幸的是， 客户的结果差异很大。在各项研究中，20-60%的SMI客户未能获得有竞争力的工作， 平均任期从10周到12个月或更长时间不等。开发新的有效 采取干预措施，以补充支持性就业的好处，取决于发现潜在的 接受辅助就业服务的参与者工作成果不佳的决定因素。动机是 潜在的关键，但在很大程度上未探索/理解不足，工作成果的决定因素。充分发挥两国 实验室最近对情感神经科学和适应性措施在精神障碍中的应用进行了研究， 建议使用基于努力的决策范式来评估动机。这些基于绩效的任务 评估NIMH研究领域标准（RDoC）结构，“努力价值/工作意愿”，这是 定义为一个人在不同的条件下愿意付出的努力（身体或认知）的量。 奖励对于目前的建议，我们计划研究努力价值与参与的关系， 辅助就业服务和就业成果，互补的前瞻性和回顾性 问题研究参与者将是来自两个当地支持就业的精神病患者 程序.在前瞻性研究中，我们计划纳入50名新登记的辅助就业参与者， （每个研究中心n=25），以检查第一阶段工作量评估与参与程度之间的关系 提供四个月的辅助就业服务。在回顾性研究中，我们计划纳入60名 在过去两年内曾接受辅助就业的受助人，以填补下列类别的空缺（每 组，每个站点10个）：a）非工人，B）工作< 6个月，c）工作> 6个月。对于这两项研究， 参与者将收到一个基准电池，以评估工作价值和选定的客户和环境 因素（例如，耻辱，工作的复杂性）与支持就业的结果。程序保真度 也将被测量。对于前瞻性研究，我们的重点是检查努力之间的关系 在获得竞争力的关键时期，参与者的参与程度和评价 就业，求职过程（近端结果）。对于回顾性研究，我们的主要重点是 研究不同类型的受支持就业参与者之间的努力评价差异， 工作历史（远端结果）。对于这两项研究，我们将检查解释的独特方差的量 超越客户、项目和环境因素的努力评估。

ABSTRACT Employment difficulties pose a major mental health problem for individuals with schizophrenia and other psychotic disorders. It is encouraging that employment outcomes have substantially improved over the past two decades through the provision of supported employment services. Data from randomized controlled trials show that individuals with serious mental illness (SMI) who receive supported employment are 2-3 times more likely to obtain a competitive job than those who receive traditional vocational rehabilitation. Unfortunately, client outcomes vary considerably. Across studies, 20-60% of SMI clients fail to obtain a competitive job and mean job tenure ranges anywhere from 10 weeks to twelve months or more. Development of new effective interventions to complement the benefits of supported employment is dependent on discovering the underlying determinants of poor work outcome in participants receiving supported employment services. Motivation is a potentially critical, yet largely unexplored/poorly understood, determinant of work outcome. Building on our lab’s recent studies into affective neuroscience and adapting measures for use in psychotic disorders, we propose to assess motivation using effort-based decision making paradigms. These performance-based tasks assess the NIMH Research Domain Criteria (RDoC) construct, “effort valuation/willingness to work,” which is defined as the amount of effort (physical or cognitive) one is willing to exert under differing conditions of reward. For the current proposal, we plan to examine the relationship of effort valuation with engagement in supported employment services and employment outcomes in complementary prospective and retrospective studies. Participants will be individuals with psychotic disorders drawn from two local supported employment programs. For the prospective study, we plan to include 50 newly-enrolled supported employment participants (n=25 per site) to examine the relationship between effort valuation and degree of engagement over the first four months of supported employment service delivery. For the retrospective study, we plan to include 60 former recipients of supported employment within the past two years to fill the following categories (n=20 per group, 10 per site): a) non-workers, b) worked < 6 months, c) worked > 6 months. For both studies, participants will receive a baseline battery to assess effort valuation and selected client and environmental factors (e.g., stigma, job complexity) putatively related to supported employment outcomes. Program fidelity will be measured as well. For the prospective study, our focus is on examining the relationship between effort valuation and degree of participant engagement during the critical period for obtaining competitive employment, the job search process (a proximal outcome). For the retrospective study, our primary focus is on examining differences in effort valuation between groups of supported employment participants with divergent work histories (a distal outcome). For both studies, we will examine the amount of unique variance explained by effort valuation beyond client, program, and environmental factors.