Supported employment (SE) is firmly established as an evidence-based practice for clients with severe mental illness (SMI). However, a significant proportion of clients in SE programs either fail to work or have great difficulty maintaining their jobs, and new strategies are urgently needed to improve the effectiveness of these programs. Cognitive impairment is a major contributing factor to these poor work outcomes and an important target for rehabilitation efforts. The proposed research will evaluate the effectiveness of a cognitive training program for improving the outcomes of clients enrolled in SE programs. The intervention (The Thinking Skills for Work Program) is a cognitive training program that is fully integrated into SE services and combines computer cognitive exercises with cognitive assessment, job planning, and job support consultation provided by a cognitive specialist. The program has been manualized and pilot tested in a small (n=44) randomized controlled trial in 2 inner-city SE programs, and found to improve cognitive functioning and work compared to SE only. This randomized controlled trial will evaluate the effectiveness of The Thinking Skills for Work Program by comparing it to enhanced SE services in clients with SMI who are participants in a high fidelity supported employment program, but who have difficulty getting or keeping jobs. A total of 80 clients will be randomized to either cognitive training and supported employment (CT+SE) or enhanced supported employment (E-SE), with cognitive, symptom, and quality of life assessments performed at baseline, 3 months (post-computer cognitive training), 12 months, and 24 months, and employment data gathered over the full 2-year period. For the E-SE condition, SE services will be enhanced by training employment specialists how to recognize cognitive problems related to work performance, and how to teach clients coping strategies for managing these problems. Primary analyses will focus on testing the hypotheses that The Thinking Skills for Work program leads to better cognitive functioning and better competitive work outcomes over the 2-year follow-up period compared to the E-SE program. If the results of this study support the added effects of the cognitive training program to SE outcomes, the field will have a valuable hew tool for helping clients with SMI and cognitive impairment achieve their vocational goals, and become more integrated members of their communities. ? Relevance: This controlled study will evaluate the effects of a promising cognitive training program for clients with severe mental illness who have difficulty benefiting from customary supported employment. If found to be effective, this cognitive training program will enable many people with severe mental illness to work and live more productive lives. ? ? ?
