Neurocognitive Enhancement Therapy and Competitive Employment in Schizophrenia: Effects on Clients with Poor Community Functioning

摘要

Neurocognitive enhancement therapy (NET) has been shown to improve executive function and working memory and to improve work therapy outcomes. The current study applied NET to a vocational program (VOC) in the community that included transitional funds with supported employment. NET + VOC achieved higher rates of competitive employment and more total hours worked during the 12-month follow-up period, This report examines the relationship between community function at intake and vocational outcomes by condition. Method: 72 outpatients with diagnoses of schizophrenia or schizoaffective disorder were evaluated on Heinrich''s Quality of Life Scale and randomized to NET + VOC or to VOC only. Active intervention was 12 months with 12-month follow-up. Follow-up rate was 100% for the intent-to-treat sample. Results: When the sample was divided into higher and lower community functioning, logistic regression found significant effects for level of community function and for condition. Most of the difference between condition was found for poor functioning patients. Only 11.1% of VOC-only clients with poor community function became competitively employed as compared to 60% of NET + VOC clients with poor community function. NET + VOC clients with poor community functioning worked twice as many hours as VOC-only clients with poor community functioning (p < .05). Higher community function clients had competitive employment rates over 60% regardless of condition, and there was no difference in total hours worked. Conclusion: Findings indicate that NET training improved vocational outcomes, but its greatest impact was for clients with poor community functioning. While clients with better community functioning may be able to obtain employment with work services without NET, augmenting conventional services with cognitive remediation may be particularly important to improve vocational outcomes for patients with poor community functioning.