Motivational Determinants of Poor Work Outcome in Supported Employment

支持性就业中工作成果不佳的动机决定因素

• 批准号: 9317064
• 负责人: Robert S Kern
• 金额: $ 18.9万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9317064
• 关键词: Affect; Aphasia; Brain; Categories; Cereals; Client; Cognitive; Complement; Data; Decision Making; Development; Distal; Employment; Enrollment; Environmental Risk Factor; Goals; Heterogeneity; Hour; Impairment; Individual; Individual Differences; Lead; Link; Literature; Measurement; Measures; Mental Health; Motivation; National Institute of Mental Health; Occupations; Outcome; Participant; Performance; Persons; Process; Prospective Studies; Psychotic Disorders; Randomized Controlled Trials; Recording of previous events; Research Domain Criteria; Research Personnel; Retrospective Studies; Rewards; Schizophrenia; Services; Site; Specialist; Support Groups; Supported Employment; Symptoms; Time; Vocational rehabilitation; Wages; Work; affective neuroscience; base; critical period; effective intervention; experience; improved; innovation; insight; interest; meetings; programs; prospective; severe mental illness; social; social stigma; translational approach; willingness

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.

摘要 就业困难是精神分裂症和其他疾病患者的主要心理健康问题 精神错乱。令人鼓舞的是，就业结果在过去有了很大的改善 20年来，通过提供支助就业服务。来自随机对照试验的数据 显示患有严重精神疾病(SMI)的人获得支持就业的人数是 比那些接受传统职业康复的人更有可能获得一份有竞争力的工作。不幸的是， 客户的结果差别很大。纵观研究，20%-60%的SMI客户找不到有竞争力的工作， 平均工作年限从10周到12个月或更长。开发新的有效方法 补充支持就业的好处的干预措施取决于发现潜在的 接受辅助就业服务的参与者工作成果不佳的决定因素。激励是一种 潜在的关键，但在很大程度上还没有被探索/很少被理解，工作结果的决定因素。建立在我们的 实验室最近对情感神经科学和用于精神障碍的适应措施的研究，我们 建议使用基于努力的决策范式来评估动机。这些基于性能的任务 评估NIMH研究领域标准(RDoC)的结构，“努力评估/工作意愿”，它是 定义为一个人在不同的条件下愿意付出的努力(身体上的或认知上的) 奖励。对于当前的提案，我们计划检查工作价值评估与参与度之间的关系 辅助性前瞻性和追溯性就业服务和就业成果 学习。参与者将是患有精神障碍的个人，来自两个当地支持的工作岗位 程序。在前瞻性研究中，我们计划包括50名新登记的辅助就业参与者 (n=每个站点25个)，以检查第一个站点的努力价值和敬业度之间的关系 四个月的辅助就业服务交付。对于回溯性研究，我们计划包括60 在过去两年内接受辅助就业的前受助人填写以下类别(n=20% 小组，每个站点10个)：a)非工人，b)工作6个月，c)工作6个月。在这两项研究中， 参与者将收到基准电池，以评估工作价值以及选定的客户和环境 假定与所支持的就业结果有关的因素(例如，耻辱、工作复杂性)。节目保真度 也将被测量。在前瞻性研究中，我们的重点是检验努力和努力之间的关系 在获得竞争力的关键时期对参与者敬业度的评估和程度 就业、求职过程(近期结果)。对于回溯性研究，我们主要关注的是 考察不同受助就业参与者群体在努力评价上的差异 工作经历(远端结果)。对于这两项研究，我们将检查所解释的独特差异的大小 通过超出客户、计划和环境因素的努力进行估值。