title: Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study.
abstract: BACKGROUND
  Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested.
  
  
  METHODS
  The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not.
  
  
  RESULTS
  The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not (OR = 3.53, 95% CI = 1.25-10.00).
  
  
  CONCLUSIONS
  This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.
authors.affiliation: EQUIP, 176-178 Clapton Common, Hackney, London, E5 9AG, UK. barnaby.major@eastlondon.nhs.uk
authors.forename: Barnaby S
authors.initials: BS
authors.lastname: Major
authors.forename: Mark F
authors.initials: MF
authors.lastname: Hinton
authors.forename: Amy
authors.initials: A
authors.lastname: Flint
authors.forename: Anna
authors.initials: A
authors.lastname: Chalmers-Brown
authors.forename: Katharine
authors.initials: K
authors.lastname: McLoughlin
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004651:Employment / Q000706:statistics & numerical data*; D016832:Employment, Supported / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009788:Occupational Therapy; D009790:Occupations; D015397:Program Evaluation; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000534:rehabilitation* / Q000628:therapy; D012050:Rehabilitation, Vocational / Q000379:methods* / Q000592:standards; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy; D012565:Schizophrenic Psychology; D016896:Treatment Outcome