Skip to main content

Work rehabilitation for middle-aged and older people with schizophrenia: A comparison of three approaches (Twamley et al. 2005)

Absence of conflict of interest.

Citation

Twamley, E. W., Padin, D. S., Bayne, K. S., Narvaez, J. M., Williams, R. E., & Jeste, D. V. (2005). Work rehabilitation for middle-aged and older people with schizophrenia: A comparison of three approaches. Journal of Nervous and Mental Disease, 193(9), 596-601.

Highlights

  • The study examined the impact of the Wellness and Vocational Enrichment Clinic (WAVE), a conventional vocational rehabilitation program with some elements of supported employment, on veterans’ employment outcomes.
  • The study used statistical tests to examine differences between veterans who were offered WAVE and individuals who were offered Individual Placement and Support (IPS), a supported employment program. The data from this study come from program records.
  • The study found that participation in the WAVE program is associated with lower rates of volunteer or paid work, and lower rates of competitive work or compensated work therapy participation compared with participation in the IPS program.
  • The quality of causal evidence presented in this report is low because 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 the WAVE program; other factors are likely to have contributed.

Intervention Examined

Wellness and Vocational Enrichment Clinic (WAVE)

Features of the Intervention

The Veterans Affairs (VA) San Diego Healthcare System’s WAVE is a conventional vocational rehabilitation program with some elements of supported employment. WAVE services are delivered in the following steps: (1) an orientation meeting; (2) an intake appointment; (3) assessments in job skills and career interests; (4) prevocational classes and training; (5) incentive therapy that includes 20 hours per week working at the VA Medical Center; and (6) compensated work therapy.

Features of the Study

The study used statistical tests to examine differences between veterans who were offered WAVE and individuals who were offered IPS. To be eligible for this study, all participants had to be age 40 or older with a schizophrenia or schizoaffective disorder diagnosis; those with an alcohol or substance dependence, dementia, or other major neurological disorder were excluded from the study. WAVE participants had to be veterans, but IPS participants did not have to be veterans.

IPS is a supported employment program in which participants receive job placements and on-the-job training. The IPS program was delivered in the following phases: (1) initial assessment including a discussion of the client’s skills, past employment, and goals; (2) job searching with support from a vocational specialist; and (3) time-unlimited follow-up support during employment with check-ins about once per week. Data from the 36 WAVE participants were collected retrospectively from charts for eligible participants who received services between 1999 and 2001. Data from the 16 IPS participants were extracted from program data beginning in 2002. The study examined whether participation in these programs affected rates of volunteer or paid work, or competitive work or participation in compensated work therapy.

Findings

Employment 

  • The study found that participation in the WAVE program is associated with lower rates of volunteer or paid work, and lower rates of competitive work or participation in compensated work therapy compared with participation in the IPS program.

Considerations for Interpreting the Findings

The authors did not account for differences between groups before the intervention. These preexisting differences between the groups—and not the intervention—could explain the observed differences in outcomes. Additionally, because the data on the two groups were collected from participants at different times, differences in outcomes could be due to time-varying factors (such as overall changes in the economy) and not the intervention.

Causal Evidence Rating

The quality of causal evidence presented in this report is low because 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 the WAVE program; other factors are likely to have contributed.

Reviewed by CLEAR

February 2019

Topic Area