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Published on: February 12, 2020
Vocational rehabilitation in early psychosis: cluster randomised trial
Tom Craig1, Geoff Shepherd1, Miles Rinaldi1
1Tom Craig, MBBS, PhD, FRPsych, Health Services and Population Research Department (HSPRD), Institute of Psychiatry, King's College London; Geoff Shepherd, BSc, MPhil, PhD, Centre for Mental Health, London; Miles Rinaldi, South West London and St George's Mental Health National Health Service (NHS) Trust, London; Jo Smith, BSc, MSc, PhD, Worcestershire Early Intervention Service, Worcestershire Health and Care NHS Trust and University of Worcester; Sarah Carr, BSc, MSc, Institute of Psychiatry, King's College London; Fay Preston, BSc, Swaran Singh, MBBS, PhD, FRCPsych, Warwick Medical School, University of Warwick, UK.
Background:
Individual placement and support (IPS) is effective in helping patients return to work but is poorly implemented because of clinical ambivalence and fears of relapse.
Aims:
To assess whether a motivational intervention (motivational interviewing) directed at clinical staff to address ambivalence about employment improved patients' occupational outcomes.
Method:
Two of four early intervention teams that already provided IPS were randomised to receive motivational interviewing training for clinicians, focused on attitudinal barriers to employment. The trial was registered with the International Standard Randomised Controlled Trial Register (ISRCTN71943786).
Results:
Of 300 eligible participants, 159 consented to the research. Occupational outcomes were obtained for 134 patients (85%) at 12-month follow-up. More patients in the intervention teams than in the IPS-only teams achieved employment by 12 months (29/68 v. 12/66). A random effects logistic regression accounting for clustering by care coordinator, and adjusted for participants' gender, ethnicity, educational and employment history and clinical status scores, confirmed superiority of the intervention (odds ratio = 4.3, 95% CI 1.5-16.6).
Conclusions:
Employment outcomes were enhanced by addressing clinicians' ambivalence about their patients returning to work.
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