Robert S Kern1,2, Roberto Zarate3, Shirley M Glynn1,2, Luana R Turner1, Kellie M Smith1, Sharon S Mitchell1, Catherine A Sugar1,4, Morris D Bell5,6, Robert P Liberman1, Alex Kopelowicz1, Michael F Green1,2. 1. UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA. 2. Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA. 3. San Fernando Mental Health Center, Granada Hills, CA. 4. Department of Biostatistics, UCLA School of Public Health, Los Angeles, CA. 5. Department of Psychiatry, Yale University School of Medicine, New Haven, CT. 6. Department of Veterans Affairs Rehab R & D, Psychology Service, VA Connecticut Healthcare System, New Haven, CT.
Abstract
Background: Heterogeneity in work outcomes is common among individuals with serious mental illness (SMI). Objective: In 2 studies, we sought to examine the efficacy of adding errorless learning, a behavioral training intervention, to evidence-based supported employment to improve SMI work outcomes. Work behavior problems were targeted for intervention. We also explored associations between early work behavior and job tenure. Methods: For both studies (VA: n = 71; community mental health center: n = 91), randomization occurred at the time of job obtainment with participants randomized (1:1) to either errorless learning plus ongoing supported employment or ongoing supported employment alone and then followed for 12 months. Dependent variables included job tenure, work behavior, and hours worked and wages earned per week. For the primary intent-to-treat analyses, data were combined across studies. Results: Findings revealed that participants in the errorless learning plus supported employment group stayed on their jobs significantly longer than those in the supported employment alone group (32.8 vs 25.6 wk). In addition, differential treatment effects favoring errorless learning were found on targeted work behavior problems (50.5% vs 27.4% improvement from baseline to follow-up assessment). There were no other differential treatment effects. For the prediction analyses involving work behavior, social skills explained an additional 18.3% of the variance in job tenure beyond levels of cognition, symptom severity, and past work history. Conclusions: These data support errorless learning as an adjunctive intervention to enhance supported employment outcomes and implicate the relevance of workplace social difficulties as a key impediment to prolonged job tenure. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center 2017.
RCT Entities:
Background: Heterogeneity in work outcomes is common among individuals with serious mental illness (SMI). Objective: In 2 studies, we sought to examine the efficacy of adding errorless learning, a behavioral training intervention, to evidence-based supported employment to improve SMI work outcomes. Work behavior problems were targeted for intervention. We also explored associations between early work behavior and job tenure. Methods: For both studies (VA: n = 71; community mental health center: n = 91), randomization occurred at the time of job obtainment with participants randomized (1:1) to either errorless learning plus ongoing supported employment or ongoing supported employment alone and then followed for 12 months. Dependent variables included job tenure, work behavior, and hours worked and wages earned per week. For the primary intent-to-treat analyses, data were combined across studies. Results: Findings revealed that participants in the errorless learning plus supported employment group stayed on their jobs significantly longer than those in the supported employment alone group (32.8 vs 25.6 wk). In addition, differential treatment effects favoring errorless learning were found on targeted work behavior problems (50.5% vs 27.4% improvement from baseline to follow-up assessment). There were no other differential treatment effects. For the prediction analyses involving work behavior, social skills explained an additional 18.3% of the variance in job tenure beyond levels of cognition, symptom severity, and past work history. Conclusions: These data support errorless learning as an adjunctive intervention to enhance supported employment outcomes and implicate the relevance of workplace social difficulties as a key impediment to prolonged job tenure. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center 2017.
Entities:
Keywords:
errorless learning; serious mental illness; supported employment; work outcome
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