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Enhancing return to work or school after a first episode of schizophrenia: the UCLA RCT of Individual Placement and Support and Workplace Fundamentals Module training

Published online by Cambridge University Press:  04 January 2019

Keith H. Nuechterlein Open the ORCID record for Keith H. Nuechterlein [Opens in a new window] ,
Kenneth L. Subotnik ,
Joseph Ventura ,
Luana R. Turner ,
Michael J. Gitlin ,
Denise Gretchen-Doorly ,
Deborah R. Becker ,
Robert E. Drake ,
Charles J. Wallace  and
Robert P. Liberman
Keith H. Nuechterlein*
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA Department of Psychology, University of California, Los Angeles, CA, USA
Kenneth L. Subotnik
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
Joseph Ventura
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
Luana R. Turner
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
Michael J. Gitlin
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
Denise Gretchen-Doorly
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
Deborah R. Becker
Affiliation:
Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
Robert E. Drake
Affiliation:
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
Charles J. Wallace
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
Robert P. Liberman
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
*
Author for correspondence: Keith H. Nuechterlein, E-mail: keithn@ucla.edu
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Abstract

Background

This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling.

Methods

Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication.

Results

The IPS–WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS–WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS–WFM intervention (45 v. 26 weeks, p < 0.004).

Conclusions

The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.

Keywords

first-episode schizophreniafunctional outcomerandomized controlled trialsupported educationsupported employmentwork recovery(Improving Work Outcome in People with Recent-Onset Schizophrenia, NCT00203788, http://www.clinicaltrials.gov)
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 1 , January 2020 , pp. 20 - 28
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

*

Now at Westat.

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