ABSTRACT Employment difficulties pose a major mental health problem for individuals with schizophrenia and other psychotic disorders. It is encouraging that employment outcomes have substantially improved over the past two decades through the provision of supported employment services. Data from randomized controlled trials show that individuals with serious mental illness (SMI) who receive supported employment are 2-3 times more likely to obtain a competitive job than those who receive traditional vocational rehabilitation. Unfortunately, client outcomes vary considerably. Across studies, 20-60% of SMI clients fail to obtain a competitive job and mean job tenure ranges anywhere from 10 weeks to twelve months or more. Development of new effective interventions to complement the benefits of supported employment is dependent on discovering the underlying determinants of poor work outcome in participants receiving supported employment services. Motivation is a potentially critical, yet largely unexplored/poorly understood, determinant of work outcome. Building on our lab?s recent studies into affective neuroscience and adapting measures for use in psychotic disorders, we propose to assess motivation using effort-based decision making paradigms. These performance-based tasks assess the NIMH Research Domain Criteria (RDoC) construct, ?effort valuation/willingness to work,? which is defined as the amount of effort (physical or cognitive) one is willing to exert under differing conditions of reward. For the current proposal, we plan to examine the relationship of effort valuation with engagement in supported employment services and employment outcomes in complementary prospective and retrospective studies. Participants will be individuals with psychotic disorders drawn from two local supported employment programs. For the prospective study, we plan to include 50 newly-enrolled supported employment participants (n=25 per site) to examine the relationship between effort valuation and degree of engagement over the first four months of supported employment service delivery. For the retrospective study, we plan to include 60 former recipients of supported employment within the past two years to fill the following categories (n=20 per group, 10 per site): a) non-workers, b) worked < 6 months, c) worked > 6 months. For both studies, participants will receive a baseline battery to assess effort valuation and selected client and environmental factors (e.g., stigma, job complexity) putatively related to supported employment outcomes. Program fidelity will be measured as well. For the prospective study, our focus is on examining the relationship between effort valuation and degree of participant engagement during the critical period for obtaining competitive employment, the job search process (a proximal outcome). For the retrospective study, our primary focus is on examining differences in effort valuation between groups of supported employment participants with divergent work histories (a distal outcome). For both studies, we will examine the amount of unique variance explained by effort valuation beyond client, program, and environmental factors.
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NIH ExPorter