Cognitive Remediation and Supported Employment Services
Updated: June 12, 2006
The Center for Rehabilitation and Recovery (formerly the New York Work Exchange) sponsored a research study to evaluate the effectiveness of combining cognitive remediation and supported employment services for consumers of mental health services. The project began in January 2003.
There is considerable evidence that individuals with psychiatric disabilities encounter problems in the workplace due to cognitive difficulties such as trouble concentrating, learning job tasks more slowly, poor memory, and challenging problems that are hard to solve. Cognitive training (also known as cognitive remediation or cognitive rehabilitation) involves the practice of cognitive skills, usually using a combination of computer-based exercises and other strategies for coping with cognitive limitations. Research as shown that cognitive training can improve different areas of cognitive functioning that are important for performing job tasks. Thus, cognitive training has potential to help people improve their work functioning and succeed in accomplishing their vocational goals.
The Principal Investigator for this research was Susan R. McGurk, Ph.D., who has evaluated the role of the cognition in work outcomes in multiple studies of consumers receiving vocational services. Dr. McGurk has developed a cognitive training program specially designed for consumers participating in vocational rehabilitation, the Thinking Skills for Work Program. The research project was aimed at evaluating the effectiveness of this program.
The primary goals of the study were to evaluate the feasibility of integrating the Thinking Skills for Work Program with supported employment services at community-based agencies in the greater New York City area, and to determine the effectiveness of the program at improving work outcomes of participating consumers, including the number of jobs held, hours worked, and wages earned. Consumer eligibility to participate in the study included a severe mental illness (as defined by the state of New York), prior job failure (including either being fired or quitting a job without another one in place), interest in competitive work, and willingness to be randomly assigned to either the Thinking Skills for Work Program + Supported Employment or Supported Employment Only, and willingness to provide written informed consent to participate in the study. Study assessments included completion of a cognitive assessment battery and the Positive and Negative Syndrome Scale (PANSS) at baseline and 3 months later.
The Thinking Skills for Work Program involved an assessment of cognitive contributions to past job difficulties, a cognitive assessment in the areas of attention, memory, problem-solving, and psychomotor speed, followed by structured computerized practice of these cognitive domains (approximately 24 sessions delivered over 12 weeks) using software that consumers have reported to be both challenging and fun, and post computerized cognitive training assessment. These assessments and the cognitive training were conducted by a cognitive specialist, who works in an integrated fashion with the employment specialist to help consumers achieve their work goals. The employment specialist met with the consumer and the cognitive specialist to discuss the consumer's job preferences, cognitive problems that may have contributed to past job difficulties, cognitive skills that might be called upon in the type of job the consumer wants to obtain, and cognitive coping strategies that the employment specialist can teach the consumer to use on the job. The cognitive specialist, employment specialist, and consumer worked together as a team to overcome or compensate for the effects of cognitive difficulties on job performance.
One-year work outcomes were obtained for 44 study participants enrolled at two inner city community mental health agencies. The participants were randomly assigned to receive either the Thinking Skills for Work Program and supported employment (CT + SE) or supported employment only (SE Only). Retention in the CT + SE program was high (91%). Baseline to 3-month assessments showed significantly greater improvements in cognitive functioning and depression for the CT + SE compared to the SE Only group. Employment outcomes over 1 year showed that clients who received CT + SE were significantly more likely to work (69.6% vs 4.8%, respectively), worked more jobs, more hours, and earned more wages than clients with SE Only. The findings provide support for the feasibility of implementing a cognitive training program in the context of supported employment, and its beneficial effects on cognitive functioning and competitive employment in persons with severe mental illness.
Participant ratings of The Thinking Skills for Work Program were very favorable, with consistent endorsement of the utility of the program in improving thinking skills, perhaps contributing to enhanced confidence in work skills.
Questions about the project can be directed to Dr. McGurk at (603) 271-5747 or Alysia Pascaris at (212)-742-1600 x201.
Additional Suggested Readings
McGurk, S.R., Mueser, K.T., Harvey, P.D., Marder, J., and LaPuglia, R. Cognitive and clinical predictors of work outcomes in clients with schizophrenia in supported employment. Psychiatric Services, 58(8): 1129-35, 2003.
McGurk, S.R., & Mueser, K.T. (2004). Cognitive functioning, symptoms, and work in supported employment: A review and heuristic model. Schizophrenia Research, 70:147-173.