Abstract
Introduction A significant proportion of people experiencing psychosis are unemployed, despite a strong desire to work. Current supported employment programs appear effective in helping them obtain employment, yet job tenure remains an arduous challenge. The objective of this study was to review the literature and model the results to inform the development of a new manualized group psychosocial intervention—‘Minds@Work’—aimed specifically at improving job tenure in psychosis. Methods The study was registered on the Open Science Framework platform (https://osf.io/he68z). The literature was searched in Medline, Embase, PsycInfo and Cochrane Library databases for studies examining predictors of job tenure in psychosis and existing occupational psychosocial interventions. Data were extracted using a pre-established form and synthesized using logic models. Results A total of 94 studies were included and their findings were modeled using different categories: intervention typologies, mechanisms of action, predictors of job tenure, outcomes and contextual factors. The ‘Minds@Work’ program was built based on these modeled findings and aimed to target specific predictors of job tenure while addressing some of the limitations of existing interventions. The program uses evidence-based techniques and is divided into 9 modules covering 4 themes: positive psychology (motivation, character strengths, self-compassion), neurocognitive remediation (attention, memory, problem-solving), cognitive biases training (jumping to conclusions, defeatists beliefs, theory of mind, attributional styles) and socioemotional coping skills (emotion regulation, communication). Conclusions Once validated, this new program is meant to be used either as a stand-alone intervention or integrated in supported employment initiatives, by employment specialists or healthcare workers.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Harnois G, Gabriel P. Mental health and work: impact, issues and good practice. Geneva: WHO; 2000.
Westcott C, et al. Interest in employment among people with Schizophrenia. Am J Psychiatr Rehabil. 2015;18(2):187–207.
Statistics Canada, Table 12-10-0051-01 Job tenure by type of work (full- and part-time), annual data 2018. Government of Canada
Suijkerbuijk YB, et al. Interventions for obtaining and maintaining employment in adults with severemental illness, a networkmeta-analysis. Cochrane Database Syst Rev. 2017;9:1–214.
Sauvé G, Lepage M, Corbière M. Impacts of vocational programs integrating cognitive remediation on job tenure in schizophrenia: a meta-analysis. Ann Med Psychol. 2018;177(6):534–543.
Carmona VR, et al. Employment outcomes for people with schizophrenia spectrum disorder: a meta-analysis of randomized controlled trials. Int J Occup Environ Med. 2017;30(3):345–366.
Drake RE, Bond GR, Becker DR. IPS principles. In: Drake RE, Bond GR, Becker DR, editors. Individual placement and support: an evidence-based approach to supported employment. New York: Oxford University Press; 2012. p. 33–46.
McGurk SR, et al. Cognitive remediation for vocational rehabilitation nonresponders. Schizophr Res. 2016;175(1–3):48–56.
Lecomte T, et al. Group cognitive behaviour therapy for supported employment—results of a randomized controlled cohort trial. Schizophr Res. 2020;215:126–133.
Corbière M, et al. Work accommodations in canadian social firms: supervisors’ and workers’ perspectives. Can J Commun Ment Health. 2019;38(1):37–56.
Ergül C, Ücok A. Negative symptom subgroups have different effects on the clinical course of schizophrenia after the first episode: a 24-month follow up study. Eur Psychiatry. 2015;30(1):14–19.
Huff SW, Rapp CA, Campbell SR. “Every day is not always Jell-o”: a qualitative study of factors affecting job tenure. Psychiatr Rehabil J. 2008;31(3):211–218.
Milfort R, et al. Barriers to employment among Social Security Disability Insurance beneficiaries in the Mental Health Treatment Study. Psychiatr Serv. 2015;66(12):1350–1352.
Rajji TK, Miranda D, Mulsant BH. Cognition, function, and disability in patients with schizophrenia: a review of longitudinal studies. Can J Psychiatry. 2014;59(1):13–17.
Rollins AL, et al. Workplace social networks and their relationship with job outcomes and other employment characteristics for people with severe mental illness. J Vocat Rehabil. 2011;35(3):243–252.
Keefe RS, et al. Report on ISCTM consensus meeting on clinical assessment of response to treatment of cognitive impairment in Schizophrenia. Schizophr Bull. 2016;42(1):19–33.
Chan JY, Hirai HW, Tsoi KK. Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials. J Psychiatr Res. 2015;68:293–300.
Rose D, et al. What do clients think of cognitive remediation therapy? A consumer-led investigation of satisfaction and side effects. Am J Psychiatr Rehabil. 2008;11:181–204.
Best MW, et al. Motivation and engagement during cognitive training for schizophrenia spectrum disorders. Schizophr Res Cogn. 2020;19:100151.
Bowie CR, et al. Cognitive remediation for schizophrenia: an expert working group white paper on core techniques. Schizophr Res. 2020;215:49–53.
Baxter SK, et al. Using logic model methods in systematic review synthesis: describing complex pathways in referral management interventions. BMC Med Res Methodol. 2014;14(62):1–9.
Peters MDJ, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119–2126.
Winsper C, et al. How do recovery-oriented interventions contribute to personal mental health recovery? A systematic review and logic model. Clin Psychol Rev. 2020;76:101815.
Glenton C, et al. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database Syst Rev. 2013;2013(10):CD010414.
W. K. Kellogg Foundation Team. Logic model development guide. 2004. https://www.wkkf.org/resource-directory/resource/2006/02/wk-kellogg-foundation-logic-model-development-guide. Accessed 2018.
Tricco AC, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–473.
Kinoshita Y, et al. Supported employment for adults with severe mental illness. Cochrane Database Syst Rev. 2013;2013(9):CD008297.
Butler AS, Gonzalez ML. Psychosocial interventions for mental and substance use disorders: a framework for establishing evidence-based standards. Washington: National Academies Press; 2015.
Nicholson J, et al. Developing the WorkingWell mobile app to promote job tenure for individuals with serious mental illnesses. Psychiatr Rehabil J. 2017;40(3):276–282.
Yamaguchi S, et al. Cost-effectiveness of cognitive remediation and supported employment for people with mental illness: a randomized controlled trial. Psychol Med. 2017;47(1):53–65.
Twamley EW, et al. Compensatory cognitive training for people with severe mental illnesses in supported employment: a randomized controlled trial. Schizophr Res. 2017;203:41–48.
Kern RS, et al. Improving work outcome in supported employment for serious mental illness: results from 2 independent studies of errorless learning. Schizophr Bull. 2018;44(1):38–45.
Ikebuchi E, et al. Does improvement of cognitive functioning by cognitive remediation therapy effect work outcomes in severe mental illness? A secondary analysis of randomized controlled trial. Psychiatry Clin Neurosci. 2017;71:301–308.
McGurk SR, et al. Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial. Am J Psychiatry. 2007;164(3):437–441.
Kern RS, et al. Errorless learning for training individuals with schizophrenia at a community mental health setting providing work experience. Schizophr Bull. 2009;35(4):807–815.
Tsang HW, et al. Three year follow-up study of an integrated supported employment for individuals with severe mental illness. Aust N Z J Psychiatry. 2010;44(1):49–58.
Zhang GF, et al. Integrated supported employment for people with schizophrenia in Mainland China: a randomized controlled trial. Am J Occup Ther. 2017;71(6):7106165020.
Tsang HW, Li SM. Work-related social skills and job retention. In: Lloyd C, editor. Vocational rehabilitation and mental health. New York: Wiley-Blackwell; 2010. p. 157–72.
Pinkham AE, et al. The social cognition psychometric evaluation study: results of the expert survey and RAND panel. Schizophr Bull. 2014;40(4):813–823.
Mervis JE, et al. Addressing defeatist beliefs in work rehabilitation. J Ment Health. 2016;25(4):366–371.
Kukla M, et al. A pilot test of group based cognitive behavioral therapy to augment vocational services for persons with serious mental illness: feasibility and competitive work outcomes. J Nerv Ment Dis. 2018;206(5):310–315.
Kukla M, Strasburger AM, Lysaker PH. A CBT intervention targeting competitive work outcomes for persons with mental illness. Psychiatr Serv. 2016;67(6):697.
Lecomte T, Corbière M, Lysaker PH. A group cognitive behavioral intervention for people registered in supported employment programs: CBT-SE. Encéphale. 2014;40(Suppl 2):S81–S90.
Lystad JU, et al. Cognitive remediation and occupational outcome in schizophrenia spectrum disorders: a 2year follow-up study. Schizophr Res. 2017;185:122–129.
Au DW, et al. Effects of integrated supported employment plus cognitive remediation training for people with schizophrenia and schizoaffective disorders. Schizophr Res. 2015;166(1–3):297–303.
Choi K-H, Fiszdon JM, Bell MD. Beyond cognition: a longitudinal investigation of the role of motivation during a vocational rehabilitation program. J Nerv Ment Dis. 2013;201(3):173–178.
Bechi M, et al. Exploring predictors of work competence in schizophrenia: the role of theory of mind. Neuropsychol Rehabil. 2017;29(5):691–703.
Allen J, Fonagy P. Handbook of mentalization-based treatment. Chichester: Wiley; 2006.
Catalan A, et al. The relationship between theory of mind deficits and neurocognition in first-episode psychosis. Psychiatry Res. 2018;268:361–367.
Kukla M, Bell MD, Lysaker PH. A randomized controlled trial examining a cognitive behavioral therapy intervention enhanced with cognitive remediation to improve work and neurocognition outcomes among persons with schizophrenia spectrum disorders. Schizophr Res. 2018;197:400–406.
Nuechterlein KH, et al. Individual placement and support for individuals with recent-onset schizophrenia: integrating supported education and supported employment. Psychiatr Rehabil J. 2008;31(4):340–349.
Mueser KT, et al. The effectiveness of skills training for improving outcomes in supported employment. Psychiatr Serv. 2005;56(10):1254–1260.
Dorio J, Marine S. Tying it all together—the PASS to success: a comprehensive look at promoting job retention for workers with psychiatric disabilities in a supported employment program. Psychiatr Rehabil J. 2004;28(1):32–39.
Smith MJ, et al. Mechanism of action for obtaining job offers with virtual reality job interview training. Psychiatr Serv. 2017;68(7):747–750.
Sohn BK, et al. Developing a virtual reality-based vocational rehabilitation training program for patients with schizophrenia. Cyberpsychol Behav Soc Netw. 2016;19(11):686–691.
Roder V, et al. Improving recreational, residential, and vocational outcomes for patients with schizophrenia. Psychiatr Serv. 2001;52(11):1439–1441.
Cameron J, et al. Supporting workers with mental health problems to retain employment: users’ experiences of a UK job retention project. Work. 2012;42(4):461–471.
Cella M, Wykes T. The nuts and bolts of Cognitive Remediation: exploring how different training components relate to cognitive and functional gains. Schizophr Res. 2019;203:12–16.
Kukla M, et al. Subjective experiences of the benefits and key elements of a cognitive behavioral intervention focused on community work outcomes in persons with mental illness. J Nerv Ment Dis. 2017;205(1):66–73.
Sandoval LR, et al. Effects of peer social interaction on performance during computerized cognitive remediation therapy in patients with early course schizophrenia: a pilot study. Schizophr Res. 2019;203:17–23.
Bond GR, Kukla M. Impact of follow-along support on job tenure in the individual placement and support model. J Nerv Ment Dis. 2011;199(3):150–155.
McGuire AB, et al. Service intensity as a predictor of competitive employee in an individual placement and support model. Psychiatr Serv. 2011;62(9):1066–1072.
Bryce SD, et al. The impact of intrinsic motivation on session attendance and reliable cognitive improvement in cognitive remediation in schizophrenia. Schizophr Res. 2018;202:354–360.
Phillips BN, et al. Work-related social skills: definitions and interventions in public vocational rehabilitation. Rehabil Psychol. 2014;59(4):386–398.
McGurk SR, KiT M. Strategies for coping with cognitive impairments of clients in supported employment. Psychiatr Serv. 2006;57(10):1421–1429.
Koren D, et al. Real-world cognitive–and metacognitive–dysfunction in schizophrenia: a new approach for measuring (and remediating) more “right stuff.” Schizophr Bull. 2006;32(2):310–326.
Matthewson M, Langworthy J, Higgins D. Psychological predictors of vocational success for people with psychotic illness. Aust J Rehabil Couns. 2015;21(1):29–64.
Williams AE, et al. Work participation for people with severe mental illnesses: an integrative review of factors impacting job tenure. Aust Occup Ther J. 2016;63(2):65–85.
Nygren U, et al. Predictors of vocational outcomes using individual placement and support for people with mental illness. Work. 2013;45(1):31–39.
Corbière M, Charette-Dussault É, Villotti P. Predictors of job acquisition and job tenure for people with severe mental disorders. In: Siegrist J, Bültmann U, editors. Handbook of disability, work and health. Cham: Springer; 2020. p. 1–26.
Corbière M, et al. Disclosure of a mental disorder in the workplace and work accommodations: two factors associated with job tenure of people with severe mental disorders. Encephale. 2014;40(Suppl 2):S91–S102.
Graham JR, Jones ME, Shier M. Tipping points: What participants found valuable in labour market training programmes for vulnerable groups. Int J Soc Welf. 2010;19(1):63–72.
Kukla M, Davis LW, Lysaker PH. Cognitive behavioral therapy and work outcomes: correlates of treatment engagement and full and partial success in schizophrenia. Behav Cogn Psychother. 2014;42(5):577–592.
Pachoud B, et al. How to improve practices and interventions for work integration of people with schizophrenia in France? Encephale. 2015;41(6):507–514.
Fortin G, Lecomte T, Corbiere M. Does personality influence job acquisition and tenure in people with severe mental illness enrolled in supported employment programs? J Ment Health. 2017;26(3):248–256.
Cunningham K, Wolbert R, Brockmeier MB. Moving beyond the illness: factors contributing to gaining and maintaining employment. Am J Community Psychol. 2000;28(4):481–494.
Lord SE, et al. The potential of technology for enhancing individual placement and support supported employment. Psychiatr Rehabil J. 2014;37(2):99–106.
Bégin É, Corbière M. Les compétences perçues de la personne ayant un trouble mental grave: un facteur significatif de maintien en emploi. Can J Commun Ment Health. 2012;31(2):35–50.
Saperstein A, Fiszdon J, Bell M. Intrinsic motivation as a predictor of work outcome after vocational rehabilitation in schizophrenia. J Nerv Ment Dis. 2011;199:672–677.
Kirsh B. Client, contextual and program elements influencing supported employment: a literature review. Community Ment Health J. 2016;52(7):809–820.
Evans JD, et al. Cognitive and clinical predictors of success in vocational rehabilitation in schizophrenia. Schizophr Res. 2004;70(2–3):331–342.
Sumiyoshi C, et al. Predicting work outcome in patients with schizophrenia: Influence of IQ decline. Schizophr Res. 2018;201:172–179.
Allott KA, et al. The relative contribution of neurocognition and social cognition to 6-month vocational outcomes following individual placement and support in first-episode psychosis. Schizophr Res. 2013;150(1):136–143.
Caruana E, et al. The relationship between cognition, job complexity, and employment duration in first-episode psychosis. Psychiatr Rehabil J. 2015;38(3):210–217.
Dickerson FB, et al. The association between cognitive functioning and occupational status in persons with a recent onset of psychosis. J Nerv Ment Dis. 2007;195(7):566–571.
Franck N. Cognitive remediation and work outcome in schizophrenia. Encephale. 2014;40(Suppl 2):S75–S80.
McGurk SR, Mueser KT. Cognitive and clinical predictors of work outcomes in clients with schizophrenia receiving supported employment services: 4-year follow-up. Adm Policy Ment Health. 2006;33(5):598–606.
Jabben N, et al. Is processing speed predictive of functional outcome in psychosis? Soc Psychiatry Psychiatr Epidemiol. 2008;43(6):437–444.
Lexen A, et al. Cognitive functioning and employment among people with schizophrenia in vocational rehabilitation. Work. 2016;54(3):735–744.
Tsang HW, et al. Review on vocational predictors: A systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998. Aust N Z J Psychiatry. 2010;44(6):495–504.
Gold JM, et al. Cognitive correlates of job tenure among patients with severe mental illness. Am J Psychiatry. 2002;159(8):1395–1402.
Corbière M, et al. Work accommodations and natural supports for maintaining employment. Psychiatr Rehabil J. 2014;37(2):90–98.
Corbière M. Work integration of people with schizophrenia and other severe mental disorders. Revue Quebecoise de Psychologie. 2008;29(1):95–110.
Johannesen JK, et al. Change in self-perceived barriers to employment as a predictor of vocational rehabilitation outcome. Am J Psychiatr Rehabil. 2009;12(4):295–316.
Tsang HW, et al. A cross-cultural study of employers’ concerns about hiring people with psychotic disorder: implications for recovery. Soc Psychiatry Psychiatr Epidemiol. 2007;42(9):723–733.
Chorpita BF, Daleiden EL, Weisz JR. Modularity in the design and application of therapeutic interventions. Appl Prev Psychol. 2005;11:141–156.
Dunn G, et al. Effective elements of cognitive behaviour therapy for psychosis: results of a novel type of subgroup analysis based on principal stratification. Psychol Med. 2012;42(5):1057–1068.
Forbat L, Black L, Dulgar K. What clinicians think of manualized psychotherapy interventions: findings from a systematic review. J Fam Ther. 2015;37:409–428.
Emmelkamp PM, et al. Advancing psychotherapy and evidence-based psychological interventions. Int J Methods Psychiatr Res. 2014;23(Suppl 1):58–91.
Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain and illness. New York: Bantam Books; 1992.
Ryan RM, Deci EL. Self-determination theory: basic psychological needs in motivation, development, and wellness. New York: Guilford Press; 2017.
Medalia A, Bowie C. Cognitive remediation to improve functional outcomes. New York: Oxford Press University; 2016.
Moritz S, Woodward TS. Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Curr Opin Psychiatry. 2007;20(6):619–625.
Boisvert J-M, Beaudry M. S'affirmer et communiquer. Montréal: Les Éditions de l'Homme; 2012.
Gross JJ. Handbook of emotion regulation. 2nd ed. New York: Guilford publications; 2014.
Roberts D, Penn D, Combs DR. Social cognition and interaction training (SCIT): group psychotherapy for schizophrenia and other psychotic disorders. Clinican guide. New York: Oxford University Press; 2016.
Bowie CR, et al. Action-based cognitive remediation for individuals with serious mental illnesses: effects of real-world simulations and goal setting on functional and vocational outcomes. Psychiatr Rehabil J. 2017;40(1):53–60.
Twamley EW, et al. Compensatory cognitive training for psychosis: effects in a randomized controlled trial. J Clin Psychiatry. 2012;73(9):1212–1219.
Moritz S, Woodward TS, Balzan R. Is metacognitive training for psychosis effective? Expert Rev Neurother. 2016;16(2):105–107.
Linehan M. DBT skills training manual. New York: The Guilford Press; 2015.
Davis LW, et al. Effect of mindfulness on vocational rehabilitation outcomes in stable phase schizophrenia. Psychol Serv. 2015;12(3):303–312.
Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression. 2nd ed. New York: The Guilford Press; 2013.
Lecomte T, Corbière M, Lysaker PH. A group cognitive behavioral intervention for people registered in supported employment programs: CBT-SE. Encephale. 2014;40(Suppl 2):S81–S90.
Mervis JE, et al. Effects of the Indianapolis Vocational Intervention Program (IVIP) on defeatist beliefs, work motivation, and work outcomes in serious mental illness. Schizophr Res. 2017;182:129–134.
Corbière M, Charette-Dussault É, Villotti P. Factors of competitive employment for people with severe mental illness, from acquisition to tenure. In: Bültmann U, Siegrist J, editors. Handbook of disability, work, and health. Cham: Springer; 2020. p. 525–550.
Pachoud B, et al. How to improve practices and interventions for work integration of people with schizophrenia in France? Encéphale. 2015;41(6):507–514.
Johannesen JK, et al. Change in self-perceived barriers to employment as a predictor of vocational rehabilitation outcome. Am J Psychiatric Rehabil. 2009;12(4):295–316.
Bleijenberg N, et al. Increasing value and reducing waste by optimizing the development of complex interventions: enriching the development phase of the Medical Research Council (MRC) Framework. Int J Nurs Stud. 2018;79:86–93.
Bartholomew L, et al. Planning health promotion programs: an intervention mapping approach. 4th ed. San Francisco: Jossey-Bass; 2016.
Subirana M, et al. A realist logic model of the links between nurse staffing and the outcomes of nursing. J Res Nurs. 2014;19(1):8–23.
Hagler M, et al. Working for well-being: uncovering the protective benefits of work through mixed methods analysis. J Happiness Stud. 2016;17:1493–1510.
Gibbons BJ, Salkever DS. Working with a severe mental illness: estimating the causal effects of employment on mental health status and total mental health costs. Adm Policy Ment Health. 2019;46(4):474–487.
Bio DS, Gattaz WF. Vocational rehabilitation improves cognition and negative symptoms in schizophrenia. Schizophr Res. 2011;126(1–3):265–269.
Martin B. Benefits of work for people with psychosis. Perspect Psy. 2018;57(2):115–120.
Ogden L. “To fill the emptiness”: the importance of work in life history narratives of older adults with schizophrenia-spectrum diagnoses. Qual Soc Work. 2018;17(4):556–76.
Davidson L. Recovering a sense of self in schizophrenia. J Pers. 2020;88(1):122–132.
Bejerholm U, Eklund M. Occupational engagement in persons with schizophrenia: relationships to self-related variables, psychopathology, and quality of life. Am J Occup Ther. 2007;61(1):21–32.
Dewa CS, et al. A comparison of healthcare use and costs for workers with psychiatric disabilities employed in social enterprises versus those who are not employed and seeking work. Community Ment Health J. 2019;55(2):202–210.
Czajkowski SM, et al. From ideas to efficacy: the ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol. 2015;34(10):971–982.
McGorry P, et al. Clinical staging: a heuristic and practical strategy for new research and better health and social outcomes for psychotic and related mood disorders. Can J Psychiatry. 2010;55(8):486–497.
Bond GR, Drake RE, Campbell K. Effectiveness of individual placement and support supported employment for young adults. Early Interv Psychiatry. 2016;10(4):300–307.
Acknowledgements
We would like to thank Karyne Anselmo, MSc, for her assistance in data analysis.
Funding
No funding was received for conducting this study.
Author information
Authors and Affiliations
Contributions
Authors GS, ML and MC contributed to the study conception and design. Authors GS and GB performed the literature search and data analysis. Author GS drafted the manuscript and all authors critically revised, read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors GS, GB and MC declare no conflicts of interest. Author ML reports grants from Otsuka Lundbeck Alliance, personal fees from Otsuka Canada, personal fees from Lundbeck Canada, grants and personal fees from Janssen, and personal fees from MedAvante-Prophase, all outside the submitted work. Salary awards include: Doctoral scholarships from the Université du Québec À Montréal for author GS; James McGill Professorship from McGill University and Research Chair from the FRQS for author ML.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Sauvé, G., Buck, G., Lepage, M. et al. Minds@Work: A New Manualized Intervention to Improve Job Tenure in Psychosis Based on Scoping Review and Logic Model. J Occup Rehabil 32, 515–528 (2022). https://doi.org/10.1007/s10926-021-09995-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10926-021-09995-2