UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA.
Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
Schizophr Bull. 2018 Jan 13;44(1):38-45. doi: 10.1093/schbul/sbx100.
Heterogeneity in work outcomes is common among individuals with serious mental illness (SMI).
In 2 studies, we sought to examine the efficacy of adding errorless learning, a behavioral training intervention, to evidence-based supported employment to improve SMI work outcomes. Work behavior problems were targeted for intervention. We also explored associations between early work behavior and job tenure.
For both studies (VA: n = 71; community mental health center: n = 91), randomization occurred at the time of job obtainment with participants randomized (1:1) to either errorless learning plus ongoing supported employment or ongoing supported employment alone and then followed for 12 months. Dependent variables included job tenure, work behavior, and hours worked and wages earned per week. For the primary intent-to-treat analyses, data were combined across studies.
Findings revealed that participants in the errorless learning plus supported employment group stayed on their jobs significantly longer than those in the supported employment alone group (32.8 vs 25.6 wk). In addition, differential treatment effects favoring errorless learning were found on targeted work behavior problems (50.5% vs 27.4% improvement from baseline to follow-up assessment). There were no other differential treatment effects. For the prediction analyses involving work behavior, social skills explained an additional 18.3% of the variance in job tenure beyond levels of cognition, symptom severity, and past work history.
These data support errorless learning as an adjunctive intervention to enhance supported employment outcomes and implicate the relevance of workplace social difficulties as a key impediment to prolonged job tenure.
严重精神疾病（SMI）患者的工作结果存在异质性。
在两项研究中，我们试图检验在基于证据的支持性就业中增加无错误学习（一种行为训练干预）是否能改善 SMI 的工作结果，以解决工作行为问题。我们还探讨了早期工作行为与工作任期之间的关联。
两项研究（VA：n = 71；社区心理健康中心：n = 91）均在获得工作时进行随机分组，参与者被随机分配（1:1）到无错误学习加持续支持性就业组或持续支持性就业组，然后随访 12 个月。因变量包括工作任期、工作行为、每周工作时间和收入。对于主要的意向治疗分析，数据在研究间进行了合并。
研究结果显示，无错误学习加支持性就业组的参与者在职时间明显长于仅接受支持性就业组（32.8 周比 25.6 周）。此外，无错误学习加支持性就业组在针对目标工作行为问题上的治疗效果存在差异（从基线到随访评估，改善幅度为 50.5%比 27.4%）。无其他治疗效果差异。对于涉及工作行为的预测分析，除认知水平、症状严重程度和既往工作经历外，社交技能解释了工作任期的额外 18.3%的变化。
这些数据支持无错误学习作为一种辅助干预措施，以增强支持性就业的结果，并暗示工作场所社交困难是延长工作任期的关键障碍。
