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Pay and participation in work activity: Clinical benefits for clients with schizophrenia (Bell & Milstein 1993)

Absence of conflict of interest.

Citation

Bell, M.D., & Milstein, R.M. (1993). Pay and participation in work activity: Clinical benefits for clients with schizophrenia. Psychosocial Rehabilitation Journal, 17(2), 173-176.

Highlights

  • The study’s objective was to examine the impact of a paid supported work program for veterans diagnosed with schizophrenia or schizoaffective disorder on their employment, earnings, wages, and health outcomes.
  • The authors used a randomized controlled trial to compare outcomes of veterans assigned to the paid supported work condition with those assigned to the unpaid work condition using data collected through interviews at baseline and five months later.
  • The authors found that the paid group had higher employment and earnings and fewer depressive symptoms five months after random assignment compared with the unpaid group.
  • The quality of causal evidence presented in this report is low because it was based on a randomized controlled trial in which the analytic sample sizes are unknown, and the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to paid supported work; other factors are likely to have contributed to the findings.

Intervention Examined

The Paid Supported Work Program

Features of the Intervention

The paid supported work program was designed to support veterans diagnosed with schizophrenia or schizoaffective disorder. For 26 weeks, participants were offered work at several sites and were paid $3.50 per hour for 20 hours of work per week. Most worked at a hospital. The program also included weekly support group meetings.

Features of the Study

The authors used a randomized controlled trial to examine outcomes associated with a paid supported work program. They recruited veterans diagnosed with schizophrenia or schizoaffective disorder from a Veterans Affairs Medical Center to participate in the study. In all, 77 people were randomly assigned: 44 to the treatment group, which was offered supported paid employment, and 33 to the control group, which was offered the same supported work opportunities without any pay. In general, the sample was predominantly male and White, with an average age around 40 years old. The authors collected data on employment, earnings, symptoms as rated on the Positive and Negative Symptom Scale and any return to intensive inpatient treatment through interviews with participants at baseline and five months later. The study did not specify how many people completed the five-month surveys.

Findings

Employment

  • The study found that the treatment group was more likely to be employed and on average worked more total weeks after five months compared with the control group. The treatment group worked 248 hours and 14 weeks more than the control group.

Earnings and wages

  • The study found that the treatment group earned $631 more than the control group five months after random assignment.

Health

  • The study found the treatment group had fewer depressive symptoms than the control group after five months, but there were no differences between the groups on rate of return to inpatient treatment and other mental health symptoms.

Considerations for Interpreting the Findings

The authors did not report the number of people that responded to the five-month survey, so it is not clear how large the analytic sample sizes were for each group. In addition, the authors did not account for gender, age, race, or pre-intervention employment or earnings in their analysis. Therefore, it is not clear whether the groups were similar before the introduction of the intervention.

Causal Evidence Rating

The quality of causal evidence presented in this report is low because it was based on a randomized controlled trial in which the analytic sample sizes are unknown, and the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to paid supported work; other factors are likely to have contributed to the findings.

Reviewed by CLEAR

May 2020

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