Enhancing return to work or school after a first episode of schizophrenia: the UCLA RCT of Individual Placement and Support and Workplace Fundamentals Module training

• Published in: Psychological medicine Vol. 50; no. 1; p. 20
• Main Authors: Nuechterlein, Keith H, Subotnik, Kenneth L, Ventura, Joseph, Turner, Luana R, Gitlin, Michael J, Gretchen-Doorly, Denise, Becker, Deborah R, Drake, Robert E, Wallace, Charles J, Liberman, Robert P
• Format: Journal Article
• Language: English
• Published: England 01-01-2020
• Subjects: Adolescent; Adult; Antipsychotic Agents - therapeutic use; Employment, Supported - methods; Employment, Supported - statistics & numerical data; Female; Humans; Los Angeles; Male; Rehabilitation, Vocational - methods; Rehabilitation, Vocational - statistics & numerical data; Return to Work - statistics & numerical data; Schizophrenia - drug therapy; Schizophrenia - rehabilitation; Schizophrenic Psychology; Schools; Workplace; Young Adult; Los Angeles; Improving Work Outcome in People with Recent-Onset Schizophrenia, NCT00203788, http://www.clinicaltrials.gov; supported employment; work recovery; functional outcome; supported education; first-episode schizophrenia; randomized controlled trial
• ISSN: 1469-8978
• DOI: 10.1017/S0033291718003860

This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling.
Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication.
The IPS-WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS-WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS-WFM intervention (45 v. 26 weeks, p < 0.004).
The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.