Article Details

Research Database: Article Details

Citation:  Major, B. S., Hinton, M. F., Flint, A., Chalmers-Brown, A., McLoughlin, K., & Johnson, S (2010). Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study. Social psychiatry and psychiatric epidemiology, 45 (1), 1-8.
Title:  Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study
Authors:  Major, B. S., Hinton, M. F., Flint, A., Chalmers-Brown, A., McLoughlin, K., & Johnson, S
Year:  2010
Journal/Publication:  Social psychiatry and psychiatric epidemiology
Publisher:  Springer
DOI:  https://doi.org/10.1007/s00127-009-0034-4
Full text:  http://proxy.library.vcu.edu/login?url=http://link.springer.com/con...   
Peer-reviewed?  Yes
NIDILRR-funded?  No
Research design:  Cross-sectional

Structured abstract:

Background:  Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested.
Purpose:  The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not.
Setting:  The study was conducted within an early intervention service serving two multi-ethnic, socioeconomically diverse inner-city London boroughs.
Study sample:  The study sample consisted of consecutive new referrals (age 17–35 years), taken on for case management within the early intervention service between 2003 and 2006, for a period of at least 12 months. Within the service and for the purpose of this study first episode psychosis was defined as the presence of psychotic symptoms (clinically defined delusions, hallucinations, passivity experiences or severe thought disorder) that have persisted for at least 1 week and/or resulted in hospital admission or crisis team intervention. Patients were excluded if they had already taken anti psychotic medication at a therapeutic dose for at least 6 weeks, previously been diagnosed with a psychotic illness by a specialist mental health service, were considered to be prodromal, or their symptoms appeared to be secondary to a personality disorder, post-traumatic stress disorder or were clearly drug-induced (narrowly defined).
Intervention:  The intervention represents a locally derived modification of the supported employment model. It is consistent with the model in that the service is embedded within the mental health team. Choices are based on individual preference, competitive employment is a major aim, and follow on support indefinite. Where it differs is in the greater emphasis on education (necessary in view of the typical developmental age of onset of first episode psychoses) and use of a broader approach, beyond just rapid job placement, to address specific areas of vocational functioning in the early stages of recovery (for example rebuilding confidence and structuring time).
Control or comparison condition:  There was no control or comparison condition.
Data collection and analysis:  Routine standardized data was collected on all clients at baseline and 12 month follow-up using the MiData (minimum dataset) package. This is a Microsoft Access database that was specifically designed as a clinician friendly tool to be incorporated into routine clinical practice
Findings:  The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for con-founders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not
Conclusions:  This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.

Disabilities served:  Bi-polar
Depression
Schizophrenia
Populations served:  Race: Black / African American
Race: White / Caucasian
Interventions:  Job search and placement assistance
Rehabilitation counseling
Supported employment
Outcomes:  Employment acquisition