Cognitive Remediation and Supported Employment Services

October, 2003

The New York Work Exchange is sponsoring a research study to evaluate the effectiveness of combining cognitive remediation and supported employment services – for consumers of mental health services.

There is considerable evidence that individuals with psychiatric disabilities encounter difficulties in the work place due to cognitive impairments. Cognitive remediation has been shown to improve areas of cognition that are important for performing job tasks. Thus, cognitive remediation has potential to help people improve work functioning by improving cognitive skills necessary to perform job tasks.

The primary goals of the study are to evaluate the feasibility of integrating a cognitive remediation program in supported employment treatment in community based employment programs, and to determine the effectiveness of cognitive remediation on work by tracking work activity in study participants, including hours worked, wages earned, and job satisfaction. One measure of the program’s effectiveness is that consumers will have an increased employment rate – they will obtain and be able to sustain employment for a longer period of time – as measured against others in the supported employment program that are not participating in the cognitive remediation program.

The principal investigator for this research is Susan R. McGurk, Ph.D., who developed the intervention and oversees all aspects of the project. Dr. McGurk has written extensively on the relationship of cognitive functioning and employment in consumers receiving vocational services.

Four employment programs in New York City providing supported employment services are involved in the study. These sites are the Mental Health Association (MHA), Brooklyn Bureau for Community Service (BBCS), Institute for Community Living, Inc. (ICL) and Goodwill Industries (GI). Consumers receiving work services at these agencies who have had difficulties on the job in the past, and who wish to participate are included. Participants are randomized to one of two conditions: cognitive remediation and supported employment or supported employment services only. Twenty consumers per site are sought for study inclusion. Two staff members at each site are designated as "cognitive remediation specialists" and have received training by Dr. McGurk on the computer- based program. The CRS both delivers the computerized intervention to study participants and serves as a liaison between the cognitive and employment staff involved in the project. The cognitive rehabilitation specialists at the agencies are: Diana Little and William Carr (ICL): Ignatius Low and Karin Abrahamian (BBCS); Lemarr Wheeler and Curtrice Gravitt (MHA); and Christine Anderson and Rhonda Baker (GI).

The intervention involves a brief cognitive assessment in the areas of attention, memory, problem-solving, and psychomotor speed, structured computerized practice of these cognitive domains (approximately 24 sessions delivered over 6-8 weeks) using software that consumers have reported to be challenging and fun, post intervention evaluation of cognition, and involvement of the employment team. The employment team becomes involved when the job search begins. At this time, the consumer, employment team, staff involved in the administration of the software ("cognitive remediation specialists"), and Dr. McGurk meet to discuss the consumer’s job preferences, cognitive problems that may have contributed to past job difficulties, and the cognitive skills that might be called upon in the type of job the consumer is currently seeking. This meeting serves to help anticipate cognitive challenges of the job and to generate compensatory strategies for cognitive challenges that the consumer has concerns about.

Thus far, approximately 8 consumers have been enrolled at MHA, ICL, and GI, and 20 at BBCS. Approximately one-half are receiving cognitive remediation, and several people have finished the intervention. Feedback regarding the treatment is sought from project participants and agency staff and utilized to improve the treatment. Enrollment will end December 31st of this year. Participants will be followed for one year in order to track work activity during this time period.

Questions about the project can be directed to Dr. McGurk at (631) 761-2686 or Alysia Pascaris at (212) 742-1122 x201.

Suggested Readings:

McGurk, S.R., Mueser, K.T., Harvey, P.D., Marder, J., and LaPuglia, R. Cognitive and clinical predictors of work outcomes in clients with schizophrenia in supported employment. Psychiatric Services, 58(8): 1129-35, 2003.

Cohen, B. Can Cognitive Remediation Services Improve Employment Outcomes for Individuals with Psychiatric Disabilities? Mental Health News, Summer 2003, 5(3), 38. www.mhnews.org