Motivational Interviewing to Improve Work Outcomes in Schizophrenia
Condition: Schizoaffective Disorder; Schizophrenia
MeSH terms: Schizophrenia; Psychotic Disorders
Study type: Interventional
Phase: Phase 3

Summary: 
      Many persons with schizophrenia have difficulty getting and keeping a job. This study is
      designed to compare the benefits of four sessions of motivational interviewing or illness
      education in increasing employment rates accruing from participation in supported employment.
    

Detailed description: 
      Many individuals with serious psychiatric illnesses wish to work, and yet employment rates
      for this population are lower than the general population (Cook & Razanno, 2000). IPS is a
      type of supported employment intervention designed to assist individuals with serious
      psychiatric illnesses return to work. Over 20 randomized trials demonstrate that, in
      comparison to control conditions such as group therapy or referrals to traditional vocational
      rehabilitation services, IPS participants are three more times more likely to obtain a job
      during the study, and at least twice as likely to be competitively employed at any point in
      the study. Just as with the general population, the rewards of work for individuals with
      serious mental illness include considerably more than the financial remuneration. For
      example, employment appears to confer higher self-esteem, greater life satisfaction, and
      perhaps even better treatment compliance, symptom improvement, and insight in persons with
      psychiatric illnesses (Bell et al, 1996; Lysacker et al, 1995; Mueser et al, 1997; Bond et
      al, 1997; Kashner et al, 2002). Despite its demonstrated effectiveness, these IPS results
      could be improved. Most IPS participants are not competitively employed at any point in time,
      it takes an average of about four months to obtain a first job, a typical job lasts only
      approximately 20-25 weeks, and employment rates across the sample asymptote at about month 8
      or 9 of participation in the trials. Furthermore, obtaining a first job seems to be an almost
      insurmountable impediment for approximately 35-40% of individuals in the trials, and these
      findings may be worse in individuals iwth schizophrenia (Twamely et al, 2003) . Motivational
      deficits may play a prominent role in explaining the limited benefits accruing from IPS in
      persons with serious and persisting psychiatric illnesses, especially in those with
      schizophrenia. Building a successful work life requires sustained effort over months and
      years (Palmer, 1989). After a period of unemployment, individuals must obtain their first
      reemployment position, and then transition to others as circumstances arise. Many persons
      with schizophrenia experience high degrees of negative symptoms, demoralization, and
      ambivalence, which likely all interfere with the persistent efforts required to initiate and
      maintain a successful vocational adjustment. Enhancing already validated vocational
      rehabilitation programs, such as IPS, with specific techniques to address motivational
      deficits may be essential to increasing employment rates among persons with schizophrenia. In
      this study, we tested a novel strategy designed to improve motivation for positive behavior
      change, motivational interviewing, adapted for work-related problems, in persons with
      schizophrenia. With the objective of improving work outcomes, we assigned 38 outpatients with
      schizophrenia or schizoaffective disorder to one of two 18 month psychosocial treatment
      groups, traditional Individual Placement and Support (IPS) with the addition of illness
      education (IE) about schizophrenia/schizoaffective disorder, as appropriate, or with the
      addition of Vocationally-oriented Motivational Interviewing (VOMI). We hypothesized that: 1)
      clients with schizophrenia who participated in IPS+VOMI would better vocational outcomes than
      IPS+IE clients. 2) If they are separated from their first job, clients with schizophrenia who
      participate in IPS+VOMI would be more likely to obtain a second job than clients who receive
      IPS+IE; and 3) Regardless of their treatment condition, working clients with schizophrenia
      would have greater social adjustment, symptoms, and life satisfaction than those who are not
      working.
    

Intervention name(s): IPS; IE; VOMI
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Individual Placement and Support Evidence based supported employment; Four sessions of manualized illness education about schizophrenia/schizoaffective disorder (tailored to the participant diagnosis) prior to each course of a job search; Four sessions of manualized motivational interviewing oriented to employment goals and concerns prior to each course of a job search
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: clinical trial; employment; schizoaffective disorder; schizophrenia