BU Sargent College Researcher Awarded $2.7M NIMH Grant
Aims to improve employment opportunities for those with severe mental illness
(Boston) — Boston University researchers at Sargent College and the Center for Psychiatric Rehabilitation (CPR) in partnership with the Dartmouth Psychiatric Research Center (Dartmouth PRC) have received a $2.7 million grant over five years from the National Institute of Mental Health (NIMH) to study the effect of cognitive skills enhancement technology on the existing supported employment model. The goal of this project is to increase the ability of individuals with severe mental illness to secure and maintain employment by participation in a cognitive remediation program, Thinking Skills for Work (TSW), which is integrated with supported employment.
Developed by faculty at the Dartmouth PRC, the Individual Placement and Support model of supported employment is a client-centered approach that helps individuals with severe mental illnesses find competitive jobs in the community that match their own interests. While many individuals with severe mental illness benefit from supported employment, others experience challenges due to cognitive impairments, including difficulties sustaining attention, learning and remembering information, and solving problems.
In order to address the cognitive obstacles to achieving employment goals, Associate Professor of Occupational Therapy at BU Sargent College and senior researcher at BU’s CPR, Susan McGurk along with her team, developed TSW, which integrates supportive employment services with “strategy coaching” from a cognitive specialist who provides:
- Assessment of cognitive impairments interfering with getting or keeping a job
- Computer-based cognitive drill and practice exercises and teaching coping/ compensatory skills
- Assistance in job search planning
- Ongoing consultation to address cognitive challenges
The research team – headed by McGurk, in collaboration with co-investigators Dr. Kim Mueser, Executive Director of CPR, and Dr. Robert Drake and Deborah Becker, researchers from the Dartmouth PRC – will evaluate whether the computer-based drill and practice exercises increase the efficacy of the TSW program at improving cognition. One randomized controlled trial has demonstrated that TSW was more effective than usual supportive employment services alone at improving cognitive functioning and competitive work in those with severe mental illness, and a second recently completed two-site study has shown that TSW was more effective than enhanced supported employment services for individuals who had failed to benefit from usual supportive employment services.
“People with severe mental illness have high rates of unemployment despite wanting to work,” says McGurk. “One of the most significant barriers to work is this cognitive difficulty common in mental illnesses like schizophrenia, which can get in the way of their search for, and retention of, jobs.”
The study aims to lift these barriers by teaching strategies for workplace success, including improving cognitive skills by utilizing the COGPACK software and teaching people strategies for handling cognitive challenges more effectively. For example, in someone with memory problems, the cognitive specialist might teach the individual strategies to help remember people’s names, such as repeating the person’s name back immediately after they have heard it, using mnemonics, or just writing the person’s name down. Additionally, the cognitive specialist works with the vocational team to enhance their ability to detect cognitive impairments and arm them with the skills to respond.
“The cognitive specialist sets the stage for work,” says McGurk. “Many people we work with have tried and failed at work and have not had a job in a while. The cognitive training lab provides the opportunity to practice useful work skills, such as asking for direction in tasks, and accepting suggestions and feedback, in addition to the practice of cognitive skills. Our primary focus is improving employment so participants are receiving work services while they complete the cognitive practice. Every aspect of the intervention is geared towards achieving participants’ work goals.”
Set to begin this summer, the research will be a step towards improving competitive work in individuals with severe mental illness by examining how a cognitive remediation program that improves outcomes in supported employment works, and determining whether a more efficient version of the program produces similar benefits. The two-site study with a planned enrollment of 244 participants, will take place at Thresholds in Chicago, IL, and The Mental Health Center of Greater Manchester, NH, both comprehensive outpatient mental health agencies that provide the full range of psychiatric and rehabilitative services. The effects of the program on cognitive functioning, employment, and other areas of functioning will be evaluated over a two year study period for each participant.
“Those with severe mental illness often have complex problems in a range of areas of functioning. So we approach improving employment with a variety of strategies,” says McGurk. “We are integrating the TSW with a ‘place and train’ model – we don’t impose pre-vocational training on participants because there’s little evidence to support that approach. Through a structured, monitored intervention, we help the person to be as independent as possible.”