Absence of conflict of interest.
Highlights
- The study's objective was to examine the impact of an augmented vocation rehabilitation intervention on employment tenure for veterans with schizophrenia or other psychotic disorders. The intervention combined usual Veterans Affairs employment services with social cognition skills training (SCST) and social problem solving skills training (SPSST).
- The study was a randomized controlled trial. Using surveys and statistical models, the authors compared the outcomes of treatment and control group members.
- The study suggested no statistically significant relationship between the augmented vocation rehabilitation intervention and employment tenure.
- The quality of causal evidence presented in this report is low because it was a randomized controlled trial with high attrition and the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that any estimated effects are attributable to the augmented vocational rehabilitation intervention; other factors are likely to have contributed.
Intervention Examined
Features of the Intervention
The Department of Veterans Affairs provides a range of services and programs to support veterans with impairments, disabilities, and challenges due to psychiatric or medical conditions, addiction, and homelessness. However, current services and programs do not address work-related social behavior. Recent research has found that difficulties with social behavior in the workplace have contributed to early job termination among individuals with serious mental illnesses.
The augmented vocation rehabilitation intervention combined the usual Veterans Affairs employment services with social cognition skills training (SCST) and social problem solving skills training (SPSST). The intervention was delivered in multiple phases. During the job search phase, participants received 12 weeks of the SCST intervention. If participants obtained a job, they also received 6 weeks of the SPSST intervention. Participants found jobs through one of three types of veteran work programs: incentive therapy, transitional work, and supported employment.
The intervention served veterans with schizophrenia or other psychotic disorders who were 18 years or older, proficient in English, and enrolled in the Veterans Community Employee Development vocational rehabilitation program in the VA Greater Los Angeles Healthcare System. Veterans also had to have no clinically significant neurological disease, no history of a serious head injury, no substance or alcohol dependence for the past three months before enrollment, and they had to be clinically stable for the past three months before enrollment.
Features of the Study
The study used a randomized controlled trial design. The study recruited veterans participating in the Veterans Community Employee Development vocational rehabilitation program of the VA Greater Los Angeles Healthcare System. Veterans were mostly male, non-White, had completed 12 years of education, and were in their 50s. Participants were first matched in pairs based on their baseline social and nonsocial cognition scores. Participants within each pair were then randomized to the treatment or control group. A total of 91 individuals enrolled in the study, but 13 dropped out before the study began. The randomized sample included 38 individuals assigned to the treatment group and 40 individuals assigned to the control group. The analytic sample included 34 individuals in each condition who made it to the job search phase (SCST intervention) and 20 treatment and 18 control group members who made it to the job obtainment phase (SPSST intervention).
The treatment group participants received the augmented vocation rehabilitation intervention. During the job search phase, treatment group participants received 12 weeks of the SCST intervention. Treatment group participants who obtained a job received 6 weeks of the SPSST intervention. The comparison group received 12 weeks of symptom management skills training during the job search phase. Comparison participants who obtained a job received 6 additional weeks of symptom management skills training.
Study participants completed a baseline assessment of social and nonsocial cognition and clinical symptoms, a pretest on skill areas covered in the trainings, a baseline work behavior assessment, a post-training assessment on social cognition, a posttest on skill areas, and a post-training work behavior assessment. Work outcome data was collected by VA vocational rehabilitation specialists for participants who obtained work. Veterans were followed for 12 months since their job start date if they obtained a job. The authors used a statistical model to compare the outcomes of treatment and control group members.
Findings
Employment
- The study suggested no statistically significant relationship between the augmented vocation rehabilitation intervention and the number of weeks worked.
Considerations for Interpreting the Findings
The authors did not account for preexisting differences between the treatment and control groups before the intervention began. These preexisting differences between the groups—and not the intervention—could explain the observed differences in outcomes.
Causal Evidence Rating
Research Guidelines
Review Protocol: Living Systematic Annual Search and Review Protocol
Review Guidelines: Causal Evidence Guidelines