Cook Judith A, Leff H Stephen, Blyler Crystal R, Gold Paul B, Goldberg Richard W, Mueser Kim T, Toprac Marcia G, McFarlane William R, Shafer Michael S, Blankertz Laura E, Dudek Ken, Razzano Lisa A, Grey Dennis D, Burke-Miller Jane
Department of Psychiatry, University of Illinois at Chicago, IL 60603, USA.
Arch Gen Psychiatry. 2005 May;62(5):505-12. doi: 10.1001/archpsyc.62.5.505.
National probability surveys indicate that most individuals with schizophrenia and other severe mental illnesses are not employed. This multisite study tested the effectiveness of supported employment (SE) models combining clinical and vocational rehabilitation services to establish competitive employment.
We randomly assigned 1273 outpatients with severe mental illness from 7 states in the United States to an experimental SE program or to a comparison or a services-as-usual condition, with follow-up for 24 months. Participants were interviewed semiannually, paid employment was tracked weekly, and vocational and clinical services were measured monthly. Mixed-effects random regression analysis was used to predict the likelihood of competitive employment, working 40 or more hours in a given month, and monthly earnings.
Cumulative results during 24 months show that experimental group participants (359/648 [55%]) were more likely than those in the comparison programs (210/625 [34%]) to achieve competitive employment (chi(2) = 61.17; P<.001). Similarly, patients in experimental group programs (330/648 [51%]) were more likely than those in comparison programs (245/625 [39%]) to work 40 or more hours in a given month (chi(2) = 17.66; P<.001). Finally, participants in experimental group programs had significantly higher monthly earnings than those in the comparison programs (mean, US 122 dollars/mo [n=639] vs US 99 dollars/mo [n=622]); t(1259) = -2.04; P<.05). In the multivariate longitudinal analysis, experimental condition subjects were more likely than comparison group subjects to be competitively employed, work 40 or more hours in a given month, and have higher earnings, despite controlling for demographic, clinical, work history, disability beneficiary status, and study site confounders. Moreover, the advantage of experimental over comparison group participants increased during the 24-month study period.
The SE models tailored by integrating clinical and vocational services were more effective than services as usual or unenhanced services.
全国概率调查表明，大多数精神分裂症患者和其他严重精神疾病患者没有工作。这项多地点研究测试了将临床和职业康复服务相结合以实现竞争性就业的支持性就业（SE）模式的有效性。
我们将来自美国7个州的1273名重度精神疾病门诊患者随机分配到一个实验性SE项目、一个对照项目或常规服务组，并进行了24个月的随访。每半年对参与者进行一次访谈，每周跟踪有偿就业情况，每月测量职业和临床服务。采用混合效应随机回归分析来预测竞争性就业的可能性、在给定月份工作40小时或更长时间的可能性以及月收入。
24个月期间的累积结果表明，实验组参与者（359/648 [55%]）比对照项目组参与者（210/625 [34%]）更有可能实现竞争性就业（χ² = 61.17；P <.001）。同样，实验组项目中的患者（330/648 [51%]）比对照项目组中的患者（245/625 [39%]）更有可能在给定月份工作40小时或更长时间（χ² = 17.66；P <.001）。最后，实验组项目的参与者月收入显著高于对照项目的参与者（平均，122美元/月 [n = 639] 对99美元/月 [n = 622]）；t(1259) = -2.04；P <.05）。在多变量纵向分析中，尽管控制了人口统计学、临床、工作史、残疾受益状况和研究地点混杂因素，但实验组受试者比对照组受试者更有可能获得竞争性就业、在给定月份工作40小时或更长时间且收入更高。此外，在24个月的研究期间实验组参与者相对于对照组参与者的优势有所增加。
通过整合临床和职业服务量身定制的SE模式比常规服务或未强化的服务更有效。
