Older adults with schizophrenia got more – and better – jobs using an individualized employment support program than with conventional job counseling, a study has shown.
Within a year after beginning each program, more than half of those in the individualized program had worked, compared with less than a third of those who received the typical counseling, Elizabeth W. Twamley, Ph.D., and her colleagues wrote in the March issue of Schizophrenia Research (2012;135:100-4).
The 12-month study randomized 58 middle-aged and older adults with schizophrenia to the programs. The individualized placement and support (IPS) program used counselors with a caseload of no more than 25 clients. Caseworkers made an effort to integrate employment counseling with psychiatric treatment. The program also emphasized obtaining competitive work (that is, jobs not reserved for disabled workers) and offered all clients unlimited support during their job search and subsequent employment.
Caseworkers in the conventional vocational rehabilitation (CVR) arm had 35 clients. The study staff provided extra support with job-readiness and prevocational coaching classes and with making appointments. For the three job appointments, the staff provided reminders and transportation.
The clients’ mean age was 51 years; their average duration of illness was 24 years. About half had a diagnosis of schizoaffective disorder; the remainder had schizophrenia. Most (79%) had been without paid work for 2 years, although 86% had at one time held the same job for at least 12 months.
The study had a 21% attrition rate (12 clients). These participants were significantly less likely to be taking atypical antipsychotics (42% vs. 80%), were more likely to have a diagnosis of schizophrenia (67% vs. 33%), and had been unemployed for a significantly longer period (13 vs. 5 years).
Those involved in the IPS program had significantly better employment outcomes by the end of 12 months. More than half (57%) held competitive jobs, compared with 29% in the conventional arm. Most of the IPS clients (70%) obtained any kind of paid work, whether competitive or reserved, compared with 36% of CVR clients.
Those in the IPS group also worked for a significantly longer period (mean, 12 weeks, vs. 5) and earned significantly more money (mean, $2,047, vs. $607).
"The [number needed to treat] for competitive work (3.56) indicated that providing IPS to about three people would result in one more competitive job than would CVR," wrote Dr. Twamley of the University of California, San Diego, and her coauthors.
Several factors significantly affected employment outcomes. In the IPS group, longer prior unemployment was associated with a lower chance of obtaining employment and with a lower income when working. The higher the baseline functional measures, the better the chance of competitive employment and higher earnings.
In the conventional group, higher depression scores on the Hamilton Rating Scale for Depression predicted worse employment outcomes, "perhaps due to lack of integration between CVR and psychiatric treatment."
The National Institute of Mental Health and the National Alliance for Research of Schizophrenia and Depression funded the study. None of the authors reported any relevant financial conflicts.