Impaired cognitive functioning in people with severe mental illness (SMI) is an important illness-related factor that limits their ability to benefit frm supported employment (SE), an evidence- based practice for improving competitive work in this population. The Thinking Skills for Work (TSW) program is a cognitive remediation program, including computer-based cognitive exercises and teaching compensatory strategies for managing cognitive difficulties, that was designed to be integrated with vocational rehabilitation services, including SE. Two randomized controlled trials (RCTs) of the TSW program provided to consumers with cognitive impairment receiving SE services, including one study from the parent R01 that the current application is a competing renewal for, have shown that TSW significantly improves cognitive functioning and competitive work compared to when SE services alone are provided. However, before widespread dissemination of the TSW program can occur, it is important to evaluate whether a more streamlined and efficient version of the program is equally effective, or whether some consumers require the full TSW program whereas others benefit equally from the briefer version. The most time consuming part of TSW is the computer-based cognitive exercises, yet it is unknown whether simply teaching strategies for compensating for cognitive difficulties is sufficient for overcoming the effects of cognitive impairment on work outcomes. This competing renewal is aimed at addressing this question. The proposed research will examine the importance of the cognitive exercises in the TSW program by comparing it to a briefer version of the program (the Cognitive Skills for Work (CSW) program) that omits this component (45-65 hours for TSW vs. 20-30 hours, for CSW). To compare the effectiveness of the TSW program with the streamlined CSW program, we propose to conduct a RCT at the same two sites and SE programs as our parent R01. We will randomize 200 unemployed consumers with cognitive impairment who are receiving SE to one of two programs: TSW or CSW. All consumers will continue to receive SE services throughout the study period. Cognitive and clinical assessments will be conducted at baseline, post-cognitive training, and 1- and 2-year post-randomization. Work will be tracked weekly for the 2-year study period. The results of this study could lead to a more efficient version of the TSW program (the CSW program), thereby facilitating its dissemination. The findings could also result in the identification of which consumers most benefit from the full TSW program (e.g., such as those with more severe cognitive impairments, or with schizophrenia-spectrum disorders) and which consumers benefit equally from the streamlined CSW program (e.g., consumers with less impaired cognitive functioning, or with other diagnoses). This research has significant promise for reducing the disability, costs, poor quality of life, and social stigma associated with unemployment in SMI; for increasing the potency of SE, the only evidence- based practice for improving work in this population; and for making the dream of competitive work a real possibility for consumers with cognitive impairment.

Public Health Relevance

Cognitive impairment in people with severe mental illness is a major obstacle to obtaining and keeping competitive jobs in supported employment programs, an evidence-based practice for improving work outcomes. The Thinking Skills for Work is a cognitive remediation program, including both computer- based cognitive exercises and teaching compensatory strategies, that has been demonstrated in two randomized controlled trials to improve cognitive functioning and competitive work in consumers with cognitive impairment receiving supported employment, compared to supported employment alone. The goal of this project is to evaluate whether a streamlined version of the Thinking Skills for Work program, requiring approximately one-half the time to implement, is just as effective as the full program, for some or all consumers. The findings could lead to a more efficient cognitive remediation program designed to enhance the effectiveness of supported employment that could facilitate its widespread dissemination, and the identification of which consumers benefit most from the full Thinking Skills for Work program compared to the streamlined version, thereby personalizing the delivery of cognitive remediation. The ultimate goal of this research is to help consumers with cognitive impairment achieve their dreams of competitive work in the community.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Interventions Committee for Adult Disorders (ITVA)
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Juliano-Bult, Denise M
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Boston University
Other Health Professions
Sch Allied Health Professions
United States
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