The Use of Skills Training to Augment Compensated Work Therapy (CWT)/VI for Veterans With SMI
Condition: Mental Illness; Schizophrenia
MeSH terms: Schizophrenia; Mental Disorders
Study type: Interventional

Summary: 
      The goal of this study is to evaluate the efficacy of a combined social skills training and
      cognitive-behavioral therapy intervention for seriously mentally ill Veterans as they begin
      employment.
    

Detailed description: 
      In spite of the fact that most individuals with serious mental illness (SMI) express a desire
      to work, some 80% of these individuals in the United States are chronically unemployed or
      under-employed. The VA has long recognized the need for vocational rehabilitation programs to
      facilitate meaningful work for patents with SMI. VA vocational rehabilitation programs
      (Compensated Work Therapy / Veterans Industries; CWT/VI) generally follow a supported
      employment model which has been the most extensively studied type of program and has garnered
      the most empirical support for helping individuals with SMI obtain employment. Nevertheless,
      studies of supported employment programs find that approximately 50% of participants remain
      unemployed and that job retention rates among those patients who do get jobs are quite low.
      In fact, more than half of all clients leave their supported employment positions within 6
      months. The most frequently cited reasons for job terminations among patients with SMI
      include interpersonal problems in the work place and difficulty coping with symptom
      exacerbations.

      The investigators have developed a psychosocial intervention (CBT-SST) that is designed to
      augment CWT/VI by targeting the skills needed for reintegration into community work settings
      and to facilitate job retention among persons with SMI. It is a manualized intervention that
      combines elements of cognitive-behavioral therapy (CBT) with work-related social skills
      training and basic problem solving training (SST). The CBT module of the treatment is
      designed to help reduce residual symptoms of mental illness and help patients develop
      strategies to cope with symptom exacerbations when they occur. The SST social skills and
      problem solving modules are designed to help patients improve their interpersonal functioning
      at work.

      The purpose of this study is to conduct a randomized clinical trial comparing CWT/VI
      augmented with CBT-SST to CWT/VI without augmentation (control condition). The investigators
      will recruit patients for the study as they are beginning jobs through enrollment in the
      CWT/VI program at the VA, as this is the critical time period for them to develop the skills
      needed to perform well and retain employment. Expected outcomes for CBT-SST participants
      relative to controls include improved job retention and earnings, improved social skills (as
      assessed both in the clinic and in the actual work place), better everyday problem solving
      skills / social function, and improvements in quality of life.

      The long term objective of this research is to develop and disseminate an effective skills
      training program that can improve work function and job retention among persons with SMI, and
      thereby enhance: a) their social role functioning; and b) their quality of life.
    

Intervention name(s): Maryland Program for Vocational Effectiveness; Supportive Treatment for SMI
Intervention type(s): Behavioral; Other
Intervention description(s): psychosocial intervention that combines elements of cognitive-behavioral therapy (CBT) with work-related social skills training and basic problem solving training (SST); Sessions are interactive, supportive, flexible, and unstructured, and are intended to help patients adjust to their new jobs and understand how working affects their lives. The therapist stance is non-directive, and there is an emphasis on having patients share with one another, rather than having the therapists dictate the content of group sessions. The primary goals of the therapists are to engage patients in treatment and to generate discussion among members.
Other intervention name(s): M-PROVE; STS
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cognitive behavioral therapy; Social Skills training; Vocational Rehabilitation