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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 the Department of Rehabilitation’s Employment Services (DOR), a conventional vocational rehabilitation program. The data from this study come from program records.
  • The study found no statistically significant relationships between participation in WAVE and volunteer or paid work, or between participation in WAVE and competitive work or compensated work therapy.
  • 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 individuals who were offered WAVE and individuals who were offered DOR. 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 DOR participants did not have to be veterans.

DOR is a conventional vocational rehabilitation program in which participants receive training and then receive a work placement. DOR includes four stages: (1) three to five weeks of vocational evaluation and exploration delivered in a classroom; (2) an additional three to five weeks of classroom work focused on job readiness; (3) working with a job developer while applying to jobs; and (4) working in a job with up to 90 days of support from a job coach. Data from the 36 WAVE participants were collected retrospectively from charts for eligible participants who received services between 1999 and 2001. Data from the 14 DOR 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 no statistically significant relationships between participation in WAVE and volunteer or paid work, or between participation in WAVE and competitive work or compensated work therapy.

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

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