Newswise — (Boston) — Boston University researchers at Sargent College and the Center for Psychiatric Rehabilitation (CPR) in partnership with the Dartmouth Psychiatric Research Center (Dartmouth PRC) have received a $2.7 million grant over five years from the National Institute of Mental Health (NIMH) to study the effect of cognitive skills enhancement technology on the existing supported employment model. The goal of the project is to increase the ability of individuals with severe mental illness to secure and maintain employment by participation a cognitive remediation program, Thinking Skills for Work (TSW), which is integrated with supported employment.
Developed by faculty at the Dartmouth PRC, the Individual Placement and Support model of supported employment is a client-centered approach that helps individuals with severe mental illnesses find competitive jobs in the community that match their own interests, through a combination of rapid job search and the provision of follow-along supports.
Although many individuals with severe mental illness benefit from supported employment, others benefit less due to cognitive impairments, including difficulties sustaining attention, learning and remembering information, and solving problems. In order to address the cognitive obstacles to achieving employment goals, Associate Professor of Occupational Therapy at BU Sargent College and senior researcher at BU’s CPR, Susan McGurk along with her team, developed TSW, which integrates supportive employment services with “strategy coaching” from a cognitive specialist who provides 1) assessment of cognitive impairments interfering with getting or keeping a job, 2) computer-based cognitive drill and practice exercises using commercially available software, COGPACK, and teaching coping/compensatory skills for dealing with cognitive difficulties, 3) assistance in job search planning, and, 4) ongoing consultation to address cognitive challenges to work.
The research team – headed by McGurk, in collaboration with co-investigators Dr. Kim Mueser, Executive Director of CPR, and Dr. Robert Drake and Deborah Becker, researchers from the Dartmouth PRC – will evaluate whether the computer-based drill and practice exercises increase the efficacy of the TSW program at improving cognition and work. Already one randomized controlled trial demonstrated that TSW was more effective than usual supportive employment services alone at improving cognitive functioning and competitive work in consumers with severe mental illness, and a second recently completed large, two-site study, has shown that TSW was more effective than enhanced supported employmemnt services for consumers who had failed to benefit from usual supportive employment services.
“People with severe mental illness have high rates of unemployment despite wanting to work,” says McGurk. “One of the most important barriers to work are these cognitive difficulties that are common in mental illnesses like schizophrenia, which can get in the way of their search for and retention of jobs. For example, it’s a problem if you work in customer service and you have difficulty remembering your customers’ names, or if the tasks your supervisor has asked you to do exceed the capacity of your short-term memory.”
The study aims to lift these barriers by teaching strategies for workplace success, including improving cognitive skills by utilizing the COGPACK software and teaching people strategies for handling cognitive challenges more effectively. For example, in someone with memory problems, the cognitive specialist might teach the individual strategies to help remember people’s names, such as repeating the person’s name back immediately after they have heard it, using mnemonics, or just writing the person’s name down. Additionally, the cognitive specialist works with the consumer’s vocational team to enhance the team’s ability to detect cognitive impairments in their clients and arm them with the skills to respond.
“The cognitive specialist sets the stage for work,” says McGurk. “Many people we work with have tried and failed at work and have not had a job in a while. The cognitive training lab provides opportunity to practice useful work skills, such as asking for direction in tasks, and accepting suggestions and feedback for task completion, in addition to the practice of cognitive skills. It’s important to note that our primary focus is improving employment, and that participants are receiving work services while completing the cognitive practice. The work in the cognitive training lab goes on while they are also pursuing work in the supported employment program. Every aspect of the intervention is geared towards achieving participants’ work goals.”
Set to begin this summer, the research will be a step towards improving competitive work in individuals with severe mental illness by examining how a cognitive remediation program that improves outcomes in supported employment works, and determining whether a more efficient version of the program produces similar benefits. The two-site study with a planned enrollment of 244 participants, will take place at Thresholds in Chicago, IL, and The Mental Health Center of Greater Manchester, NH, both comprehensive outpatient mental health agencies that provide the full range of psychiatric and rehabilitative services. The effects of the program on cognitive functioning, employment, and other areas of functioning will be evaluated over a two year study period for each participant.
“Those with severe mental illness often have complex problems in a range of areas of functioning. So we approach improving employment with a variety of strategies,” says McGurk. “We are integrating the TSW with a ‘place and train’ model (e.g., SE) – we do not impose prevocational training on participants because there’s little evidence to support that approach. Through a structured, monitored intervention, we help the person to be as independent as possible.”
Boston University College of Health and Rehabilitation Sciences: Sargent College is an institution of higher education, which fosters critical and innovative thinking to best serve the health care needs of society through academics, research, and clinical practice. As reported by U.S. News and World Report, its graduate programs in Speech-Language Pathology and Physical Therapy are ranked in the top 8% of all programs while Occupational Therapy is #2 in the nation. For more information and to learn about degree programs in occupational therapy, physical therapy, speech, language and hearing sciences, health science, athletic training, human physiology and nutrition, visit http://www.bu.edu/sargent.
Founded in 1839, Boston University is an internationally recognized private research university with more than 30,000 students participating in undergraduate, graduate, and professional programs. BU consists of 16 colleges and schools along with a number of multi-disciplinary centers and institutes which are central to the school's research and teaching mission.
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