Supported employment and education in comprehensive, integrated care for first episode psychosis: Effects on work, school, and disability income.
Participation in work and school are central objectives for first episode psychosis (FEP) programs, but evidence effectiveness has been mixed in studies not focused exclusively on supported employment and education (SEE). Requirements for current motivation to work or go to school limit the generalizability of such studies.



FEP participants (N=404) at thirty-four community treatment clinics participated in a cluster randomized trial that compared usual Community Care (CC) to NAVIGATE, a comprehensive, team-based treatment program that included ≥5h of SEE services per week, , grounded in many of the principles of the Individual Placement and Support model of supported employment combined with supported education services. All study participants were offered SEE regardless of their initial interest in work or school. Monthly assessments over 24months recorded days of employment and attendance at school, days of participation in SEE, and both employment and public support income (including disability income). General Estimation Equation models were used to compare CC and NAVIGATE on work and school participation, employment and public support income, and the mediating effect of receiving ≥3 SEE visits on these outcomes.



NAVIGATE treatment was associated with a greater increase in participation in work or school (p=0.0486) and this difference appeared to be mediated by SEE. No group differences were observed in earnings or public support payments.



A comprehensive, team-based FEP treatment approach was associated with greater improvement in work or school participation, and this effect appears to be mediated, in part, by participation in SEE.
Yale Medical School, New Haven, CT, USA. Electronic address: Robert.Rosenheck@Yale.Edu.
Robert
R
Rosenheck
Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston, MA, USA; Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA.
Kim T
KT
Mueser
Yale Medical School, New Haven, CT, USA.
Kyaw
K
Sint
Yale Medical School, New Haven, CT, USA.
Haiqun
H
Lin
Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA.
David W
DW
Lynde
Semel Institute for Neuroscience and Brain Behavior, University of California Los Angeles, Los Angeles, CA, USA.
Shirley M
SM
Glynn
Zucker Hillside Hospital, Psychiatry Research, North Shore, Long Island Jewish Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA.
Delbert G
DG
Robinson
Zucker Hillside Hospital, Psychiatry Research, North Shore, Long Island Jewish Glen Oaks, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA.
Nina R
NR
Schooler
Zucker Hillside Hospital, Psychiatry Research, North Shore, Long Island Jewish Glen Oaks, NY, USA.
Patricia
P
Marcy
Yale Medical School, New Haven, CT, USA.
Somaia
S
Mohamed
Zucker Hillside Hospital, Psychiatry Research, North Shore, Long Island Jewish Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA.
John M
JM
Kane
D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services; D006233:Persons with Disabilities / Q000523:psychology*; D004519:Education, Special / Q000379:methods; D004651:Employment; D016832:Employment, Supported; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007182:Income; D008297:Male; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D012574:Schools; D055815:Young Adult
First episode psychosis treatment; Schizophrenia; Supported employment and education