Cognitive Training to Improve Work Outcomes in Severe Mental Illness

职业残疾是严重精神疾病（SMI）最具破坏性和代价最高的后果之一。支持就业计划，如个人安置和支持（IPS）是帮助SMI患者获得有竞争力的就业的最有效方法（即，社区中的“正常工作”）。然而，许多接受支助就业的人要么根本不工作，要么无法保住工作。精神疾病的认知障碍和日常功能技能缺陷导致工作成果不佳，但它们可以通过认知训练来改变。试点数据支持IPS和认知训练对SMI客户的有效性，包括中年和老年人。这项拟议的研究旨在评估增强IPS支持的就业服务的有效性，该服务提供为期3个月的认知训练计划，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，旨在帮助客户培养更好的思维和记忆习惯，这些习惯将持续一生。在拟议的24个月随机对照试验中，152名患有SMI的参与者将接受IPS与认知训练（IPS-CT）或IPS与增强支持（IPS-ES）。IPS职业专家将在客户选择的社区环境中提供认知培训干预，沿着标准IPS服务（求职、职业发展和后续沿着工作支持）。IPS-ES将控制IPS-CT条件下前3个月内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。该研究的主要目的是评估与IPS-ES相比，IPS-CT将改善认知、功能技能、工作成果（例如，工作周数）和生活质量。第二个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支持性就业的结果，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返目标。

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.