title: The efficacy of supported employment for middle-aged and older people with schizophrenia.
abstract: OBJECTIVE
  Supported employment is the evidence-based treatment of choice for assisting individuals with severe mental illness to achieve competitive employment, but few supported employment programs specifically target older clients with psychiatric illness. The purpose of this study was to evaluate the efficacy of supported employment for middle-aged or older people with schizophrenia.
  
  
  METHODS
  Participants included 58 outpatients with schizophrenia or schizoaffective disorder aged 45 or older who were recruited from a community mental health clinic. Participants were randomly assigned to receive Individual Placement and Support (IPS; the manualized version of supported employment) or conventional vocational rehabilitation (CVR) for one year, and completed assessments at baseline, six months, and twelve months.
  
  
  RESULTS
  IPS was superior to CVR on nearly all work outcome measures, including attainment of competitive employment, weeks worked, and wages earned. Fifty-seven percent of IPS participants worked competitively, compared with 29% of CVR participants; 70% of IPS participants obtained any paid work, compared with 36% of CVR participants. Within the IPS group, better baseline functional capacity (as measured by the UCSD Performance Based Skills Assessment) and more recent employment were modestly associated with better work outcomes.
  
  
  CONCLUSIONS
  Middle-aged and older adults with schizophrenia are good candidates for supported employment services.
authors.affiliation: Department of Psychiatry and Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive 0851, La Jolla, CA 92093, USA. etwamley@ucsd.edu
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Twamley
authors.forename: Lea
authors.initials: L
authors.lastname: Vella
authors.forename: Cynthia Z
authors.initials: CZ
authors.lastname: Burton
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Becker
authors.forename: Morris D
authors.initials: MD
authors.lastname: Bell
authors.forename: Dilip V
authors.initials: DV
authors.lastname: Jeste
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology; D019540:Area Under Curve; D004651:Employment; D016832:Employment, Supported; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000523:psychology / Q000534:rehabilitation; D012050:Rehabilitation, Vocational / Q000379:methods*; D012559:Schizophrenia / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index