Cognitive Training to Improve Work Outcomes in Severe Mental Illness

描述（由申请人提供）：职业残疾是严重精神疾病（SMI）最具破坏性和最昂贵的后果之一。支持就业计划，如个人安置和支持（IPS）是帮助重度精神障碍患者获得竞争性就业（即社区中的“正规工作”）的最有效途径。然而，许多支持就业的客户要么根本不工作，要么没能保住工作。精神疾病的认知障碍和日常功能技能缺陷导致工作结果不佳，但它们是可以通过认知训练来改变的。试点数据支持IPS和认知训练对重度精神障碍患者（包括中老年患者）的有效性。拟议的研究旨在通过一个为期3个月的认知训练计划来评估增加IPS支持的就业服务的有效性，该计划旨在提高注意力、学习、记忆和解决问题的能力。认知训练方法是补偿性的，因为它教授克服认知缺陷的策略，旨在帮助客户养成终身受益的更好的思维和记忆习惯。在这项为期24个月的随机对照试验中，152名重度精神障碍患者将接受IPS +认知训练（IPS- ct）或IPS +增强支持（IPS- es）。IPS职业专家将在客户选择的社区环境中提供认知训练干预，以及标准的IPS服务（求职、职业发展和后续工作支持）。IPS-ES将控制前3个月IPS-CT条件下提供的额外时间和注意力。所有参与者将被跟踪24个月，每周收集就业数据。本研究的主要目的是评估与IPS-ES相比，IPS-CT会改善认知、功能技能、工作成果（如工作周数）和生活质量的假设。次要目标是调查这种改善的机制，并确定就业结果的预测因素。如果发现认知训练可以改善就业支持的结果，精神康复领域将更好地准备帮助各个年龄段的客户实现他们的职业和社区重新融入目标。

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.