A Dismantling Study of Cognitive Remediation for Supported Employment

支持性就业认知矫正的拆解研究

• 批准号: 8295184
• 负责人: SUSAN R. MCGURK
• 金额: $ 66.2万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-05-17 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8295184
• 关键词: Address; Characteristics; Clinical assessments; Cognitive; Cognitive remediation; Communities; Computers; Diagnosis; Disease; Dreams; Educational process of instructing; Effectiveness; Elements; Employment; Enrollment; Evidence based practice; Exercise; Goals; Healthcare; Hour; Impaired cognition; Impairment; Individual; Intervention; Intervention Studies; Lead; Mental Health; Mental disorders; National Institute of Mental Health; Occupations; Outcome; Parents; Persons; Pilot Projects; Play; Population; Preparation; Quality of life; Randomized; Randomized Controlled Trials; Research; Role; Schizophrenia; Services; Site; Specialist; Supported Employment; Symptoms; Testing; Thinking; Time; Unemployment; Variant; Vocational rehabilitation; Work; base; cognitive function; cognitive training; compare effectiveness; cost; design; disability; improved; innovation; programs; rehabilitation service; response; severe mental illness; skills; social stigma; therapy design

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：严重精神疾病 (SMI) 患者的认知功能受损是一个重要的疾病相关因素，限制了他们从支持性就业 (SE) 中受益的能力，支持性就业 (SE) 是一种改善该行业竞争性工作的循证实践。人口。工作思维技能 (TSW) 计划是一项认知补救计划，包括基于计算机的认知练习和管理认知困难的教学补偿策略，旨在与包括 SE 在内的职业康复服务相结合。 TSW 计划的两项随机对照试验 (RCT) 向接受 SE 服务的认知障碍消费者提供，其中一项来自母公司 R01 的研究表明，与当前的申请相比，TSW 显着改善了认知功能和竞争性工作到单独提供 SE 服务时。然而，在 TSW 计划广泛传播之前，重要的是要评估该计划的更简化和更高效的版本是否同样有效，或者某些消费者是否需要完整的 TSW 计划，而其他消费者是否同样从简短版本中受益。 TSW 最耗时的部分是基于计算机的认知练习，但尚不清楚简单的补偿认知困难的教学策略是否足以克服认知障碍对工作成果的影响。此次竞争性更新旨在解决这个问题。拟议的研究将通过将 TSW 计划与省略该组成部分的简短版本（工作认知技能 (CSW) 计划）进行比较来检验 TSW 计划中认知练习的重要性（TSW 为 45-65 小时，而 TSW 为 20 小时）。 -30 小时，CSW）。为了比较 TSW 计划与简化的 CSW 计划的有效性，我们建议在与母公司 R01 相同的两个地点和 SE 计划进行 RCT。我们将随机将 200 名患有认知障碍且正在接受 SE 的失业消费者分配到两个计划之一：TSW 或 CSW。在整个研究期间，所有消费者将继续接受 SE 服务。认知和临床评估将在基线、认知训练后以及随机化后 1 年和 2 年进行。在两年的研究期间，每周都会跟踪工作情况。这项研究的结果可能会导致 TSW 计划（CSW 计划）的更有效版本，从而促进其传播。研究结果还可能导致确定哪些消费者从完整的 TSW 计划中受益最多（例如，患有更严重认知障碍或精神分裂症谱系障碍的消费者），以及哪些消费者同样从简化的 CSW 计划中受益（例如，认知功能受损较轻或有其他诊断的消费者）。这项研究对于减少 SMI 中与失业相关的残疾、费用、生活质量差和社会耻辱具有重大前景；提高SE的效力，这是改善该人群工作的唯一循证实践；以及让有认知障碍的消费者真正实现竞争性工作的梦想。 公共卫生相关性：严重精神疾病患者的认知障碍是在支持性就业计划中获得和保持有竞争力的工作的主要障碍，支持性就业计划是改善工作成果的循证实践。工作思维技能是一项认知补救计划，包括基于计算机的认知练习和教学补偿策略，两项随机对照试验已证明，与接受支持性就业的认知障碍消费者相比，该计划可改善认知功能和竞争性工作仅支持就业。该项目的目标是评估工作思维技能计划的简化版本（需要大约一半的时间来实施）对于部分或所有消费者是否与完整计划一样有效。研究结果可能会导致更有效的认知补救计划，旨在提高支持性就业的有效性，从而促进其广泛传播，并确定与简化版本相比，哪些消费者从完整的工作思维技能计划中受益最多，从而个性化进行认知矫正。这项研究的最终目标是帮助有认知障碍的消费者实现在社区中有竞争力的工作的梦想。