Journal Article

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

Nuechterlein, Keith H., Becker, Deborah R., Gretchen-Doorly, Denise, Gitlin, Michael J., Wallace, Charles J., Turner, Luana R., Drake, Robert E., Subotnik, Kenneth L., Ventura, Joseph, Liberman, Robert P.

2020

Overview

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. 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. 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). 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.

• Publisher: Cambridge University Press
• Subject: Adolescent / Adult / Antipsychotic Agents - therapeutic use / Antipsychotics / Case management / Clinical trials / Disability / Drug use / Education / Efficacy / Employment / Employment, Supported - methods / Employment, Supported - statistics & numerical data / Female / Government agencies / Humans / Intensive treatment / Intervention / Job training / Los Angeles / Male / Medical treatment / Mental disorders / Mental health care / Patients / Psychiatric services / Psychosis / Psychotropic drugs / Recovery (Medical) / Rehabilitation / Rehabilitation, Vocational - methods / Rehabilitation, Vocational - statistics & numerical data / Return to work / Return to Work - statistics & numerical data / Schizophrenia / Schizophrenia - drug therapy / Schizophrenia - rehabilitation / Schizophrenic Psychology / Schools / Skill development / Social education / Social groups / Social skills / Teams / Training / Treatment programs / Vocational education / Vocational rehabilitation / Work / Workplace / Workplaces / Young Adult