Individual placement and support after an initial episode of schizophrenia: impact on school or work recovery, hospitalization, and utilization of disability support

Presentation First Author: 
Keith H Nuechterlein

This presentation focuses on the impact of supported education and supported employment on recovery of school and job participation early in the course of schizophrenia and on its secondary effects on rates of hospitalization and disability support. We examined the impact of Individual Placement and Support (IPS) in an 18-month randomized controlled trial with 69 patients with a recent first episode of schizophrenia. We combined IPS with a group skills training approach, Workplace Fundamentals Module (WFM), to enhance return to regular school or competitive employment. The enhanced IPS-WFM intervention was compared to clinical treatment and conventional vocational rehabilitation by separate agencies. The IPS worker facilitated a rapid search for schooling or employment, used assertive outreach, and gave ongoing vocational support. The same clinical team provided case management and psychiatric services for all participants. During the initial six months of intensive treatment, 83% of patients who participated in IPS-WFM returned to competitive work or school, compared to 41% in the comparison group (p = .005). Significant differential effects were sustained over 18 months. Schooling showed the most immediate gains with IPS-WFM treatment, followed by gains in employment. Use of disability support appeared to be reduced and one-year hospitalization rates were approximately half with IPS-WFM, although neither was statistically significant with this sample size. The results indicate that an early active, focused work rehabilitation program can lead to a high rate of recovery of school and employment participation and may have broader consequences for use of costly hospital and disability support systems.

Conference Name: 
Presentation Date: 
January, 2013
Additional Authors: 
Keith H Nuechterlein, Kenneth L Subotnik, Luana Turner, Joseph Ventura, Michael J Gitlin, Denise Gretchen-Doorly, Deborah R Becker, Robert E Drake, Charles J Wallace, Robert P Liberman
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