Absence of conflict of interest.
Citation
Highlights
- The study's objective was to examine the impact of NAVIGATE on employment, earnings, and public benefits receipt.
- The study was a randomized controlled trial that assigned community mental health treatment centers to either the intervention or control group. Using clinical assessments and interviews, the authors conducted statistical models to compare the outcomes of intervention and control group members.
- The study did not find any statistically significant differences between the groups on employment, earnings, or public benefits receipt.
- This study receives a moderate evidence rating. This means we would be somewhat confident that the estimated effects are attributable to NAVIGATE, but other factors might also have contributed. However, the study did not find statistically significant effects.
Intervention Examined
NAVIGATE
Features of the Intervention
NAVIGATE was a comprehensive approach to community-based care for individuals recovering from first-episode psychosis. The program was provided at mental health treatment centers across the United States. NAVIGATE uses a team approach and features medication management; psychoeducation for family members; individual, resilience-focused training (IRT) in illness self-management; and supported education and employment (SEE) services. The SEE services were consistent with the Individual Placement and Support (IPS) model and were integrated with other clinical services provided by the NAVIGATE team. SEE focused on competitive employment or enrollment in mainstream educational programs, guided by patients' preferences for job and school type, and provided follow-up supports and benefits counseling as needed. The intervention served first-episode psychosis patients, ages 15 to 40 years old, that were presented for treatment.
Features of the Study
The study was a randomized controlled trial that randomly assigned 34 community mental health treatment centers to either the intervention or control group (17 in each group). Eligible participants needed to be seen for treatment for first-episode psychosis and had taken antipsychotic medication for less than six months. Of the 404 eligible participants, 223 received treatment from one of the seventeen sites providing the NAVIGATE intervention while the other 181 participants received treatment from one of the seventeen sites providing usual community care (control group). The NAVIGATE participants were predominantly male (78%), had larger proportions of White patients (62%) than African American (28%) or Hispanic patients (25%), and the average age was 23.18 years. Control participants were primarily male (66%), had larger proportions of African American (49%) and White patients (44%) than Hispanic patients (10%), and the average age was 23.08 years.
Data sources included clinical assessments conducted at baseline and every six months during the two-year study, and interviews conducted every month during the two-year period. The authors used statistical models to compare the outcomes of NAVIGATE and control group members.
Findings
Employment
- The study found no significant differences in employment between the NAVIGATE and control groups over the two-year period.
Earnings and wages
- The study found no significant differences between the groups in monthly earned income over the two-year period.
Public benefits receipt
- The study found no significant differences between the groups in receipt of public support income, social security income, or social security benefits over the two-year period.
Considerations for Interpreting the Findings
The study was a randomized controlled trial and although attrition was low for treatment sites, it was high for individual participants at the sites. Therefore, the study was not eligible for a high evidence rating. Also, the authors noted large dissimilarities between the two groups on participation in work or school at baseline. However, the authors accounted for these differences and other baseline characteristics in their statistical models.
Causal Evidence Rating
The quality of causal evidence presented in this report is moderate because it was a randomized controlled trial with high attrition, but the authors accounted for differences in pre-intervention characteristics between the groups. This means we would be somewhat confident that the estimated effects are attributable to NAVIGATE, but other factors might also have contributed. However, the study did not find statistically significant effects.