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）的认知功能受损是与疾病有关的重要因素，它限制了他们使FRM支持的就业受益的能力（SE），这是一种基于证据的实践，可改善该人群中的竞争性工作。工作技能（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补偿策略，该策略旨在与包括SE在内的职业康复服务集成。 TSW计划的两项随机对照试验（RCT）提供给具有认知障碍的消费者，接受了SE服务，其中包括来自父母R01的一项研究，当前申请是竞争性的续订，表明TSW显着提高了与单独提供SE服务相比，TSW显着提高了认知功能和竞争性工作。但是，在可能发生TSW计划的广泛传播之前，重要的是要评估该程序的更简化和高效的版本是否同样有效，或者有些消费者是否需要完整的TSW程序，而其他人则从Briefer版本中同样受益。 TSW最耗时的部分是基于计算机的认知练习，但是尚不清楚仅仅教授补偿认知困难的策略是否足以克服认知障碍对工作结果的影响。这种竞争的更新旨在解决这个问题。拟议的研究将通过将其与该计划的Briefer版本（工作的认知技能（CSW）计划）进行比较，从而研究了TSW计划中认知练习的重要性，该计划省略了该组件（TSW vs. 20-30小时，CSW）。为了将TSW计划的有效性与简化的CSW计划进行比较，我们建议在与父母R01相同的两个站点和SE计划中进行RCT。我们将将200名患有认知障碍的失业者随机，他们将SE接收到两个程序之一：TSW或CSW。在整个研究期间，所有消费者都将继续获得SE服务。认知和临床评估将在基线，后认知训练以及两年期随机化后进行。工作将在2年学习期内每周进行跟踪。这项研究的结果可能导致TSW计划（CSW计划）的更有效版本，从而促进其传播。这些发现还可能导致确定哪些消费者最大的TSW计划受益（例如，具有更严重的认知障碍或精神分裂症 - 谱系疾病的消费者），而消费者也从流线的CSW计划中受益（例如，具有较小的认知功能障碍的消费者，或与其他诊断相同）。这项研究具有减少与SMI失业相关的残疾，成本，生活质量差和社会污名的巨大希望；为了增加SE的效力，SE的效力是改善该人群工作的唯一基于证据的实践；对于有认知障碍的消费者来说，使竞争性工作的梦想成为真正的可能性。 公共卫生相关性：患有严重精神疾病的人的认知障碍是在支持就业计划中获得和保持竞争性工作的主要障碍，这是改善工作成果的循证实践。工作的思维技巧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，这在两项随机对照试验中已得到证明，以改善认知功能和竞争性工作，而在获得支持的就业的认知障碍的消费者中，与仅支持的就业相比。该项目的目的是评估工作计划的简化版本是否需要大约一半的时间来实施，对于某些或所有消费者而言，是否与完整程序一样有效。这些发现可能会导致更有效的认知补救计划，旨在提高支持就业的有效性，从而有助于其广泛的传播，并且与流线型版本相比，消费者的识别最大的识别从全面的工作思维技巧中受益，从而个性化认知补救的交付。这项研究的最终目标是帮助患有认知障碍的消费者实现社区中竞争性工作的梦想。