***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Consumers with serious mental illness ( N=166 ) enrolling in two community-based mental health programs , a vocational Program of Assertive Community Treatment and a clubhouse certified by the International Center for Clubhouse Development ( ICCD )  , were asked about their interest in work . About one third of the new enrollees expressed no interest in working . Equivalent supported employment services were then offered to all participants in each program . Stated interest in work and receipt of vocational services were statistically significant predictors of whether a person would work and how long it would take to get a job . Two thirds of those interested in work and half of those with no initial interest obtained a competitive job if they received at least one hour of vocational service . Once employed , these two groups held comparable jobs for the same length of time . These findings demonstrate the importance of making vocational services continuously available to all people with serious mental illness , and the viability of integrating these services into routine mental health care In a previous article in the Schizophrenia Bulletin ( Vol . 22 , No. 1 , 1996 ) , we presented findings of a study on the clinical and rehabilitative effects of work activity on 150 subjects diagnosed with schizophrenia or schizoaffective disorder . Subjects were r and omly assigned to either a Pay ( $ 3.40/hr ) or No-Pay group and given 6-month work placements in a Department of Veterans Affairs medical center . At the 5-month followup , Pay subjects had worked more hours and earned more money ( from any employment ) than No-Pay subjects . Pay subjects also had significantly greater improvement in symptoms and lower rehospitalization rates . Clinical improvement was closely linked to amount of participation . We concluded that pay increased participation . The current study examined clinical and rehabilitative outcomes at 1-year followup , 6 months after the conclusion of the work program . Results indicated that the Pay subjects had a significant decrease in work activity once they had completed the work program . However , 75 percent of those who had fully participated in the program continued working during the subsequent 6 months , either as volunteers or for pay . Clinical outcomes for subjects in the Pay condition were attenuated at 1-year followup but still significantly better than for subjects in the No-Pay condition . More than 40 percent of participants continued to be " much improved " on total symptoms , and more than 50 percent were " much improved " on positive symptoms . Discussion focuses on the importance and limitations of work for pay as a clinical intervention and concludes that continuous work services are necessary and beneficial for many people with schizophrenia BACKGROUND IPS has been demonstrated to increase return to open employment significantly in individuals with mental health problems in the US . Previous experience ( e.g. with ACT ) has demonstrated the sensitivity of complex community mental health interventions to local social and healthcare cultures . Europe has conditions of generally greater employment security than the US and varying ( generally higher ) unemployment rates and welfare benefits . Evidence of the effectiveness of IPS in these conditions , and its potential variation across them , would guide local policy and provide possible insights into its mechanism . METHODS We conducted an RCT of IPS versus high- quality train- and -place vocational rehabilitation in six European centers with very different labor market and health and social care conditions . A sample of 312 individuals with psychotic illness was r and omly allocated ( 50 per site ) . Inclusion criteria were a minimum of two years ' illness duration , with at least one year of continuous unemployment and six months contact with their current mental health services . Follow-up was 18 months . The primary outcome was any open employment , and secondary outcomes included time to employment , duration of employment and hospital admission . FINDINGS IPS was more effective than the Vocational Services for all vocational outcomes . 85 IPS patients ( 54.5 % ) worked for at least one day compared to 43 Vocational Service patients ( 27.6 ) . They were significantly less likely to be rehospitalized . Local unemployment rates explained a significant amount of the variation in IPS effectiveness and both national economic growth and welfare systems influenced overall employment rates in both services . CONCLUSIONS IPS doubles the access to work of people with psychotic illnesses , without any evidence of increased relapse . Its effectiveness is not independent of external circumstances , particularly local unemployment rates To address the effects of dysfunctional cognitions on vocational outcome of people with schizophrenia spectrum disorders , we developed the Indianapolis Vocational Intervention Program ( IVIP ) , a cognitive-behavioral program of group and individual interventions . Fifty participants with schizophrenia or schizoaffective disorder were offered 6-month work placements and r and omized  to  receive IVIP ( n = 25 ) or st and ard support services ( n = 25 ) .  Hours worked were measured weekly , and work performance was assessed biweekly with the use of the Work Behavior Inventory . Hope and self-esteem were assessed at baseline and at 5 months with the Beck Hopelessness Scale and the Rosenberg Self-Esteem Schedule . Analysis of variance ( ANOVA ) revealed that the IVIP group worked significantly more weeks and had better average work performance than the st and ard support group . Repeated measures ANOVA of baseline and follow-up scores indicated that the IVIP group sustained baseline levels of hope and self-esteem through follow-up , while the st and ard support group experienced declines . Results provide initial evidence of the effectiveness of the IVIP Background There is evidence from North American trials that supported employment using the individual placement and support ( IPS ) model is effective in helping individuals with severe mental illness gain competitive employment . There have been few trials in other parts of the world . Aims To investigate the effectiveness and cost-effectiveness of IPS in the UK . Method Individuals with severe mental illness in South London were r and omised to IPS or local traditional vocational services ( treatment as usual ) ( IS RCT N96677673 ) . Results Two hundred and nineteen participants were r and omised , and 90 % assessed 1 year later . There were no significant differences between the treatment as usual and intervention groups in obtaining competitive employment ( 13 % in the intervention group and 7 % in controls ; risk ratio 1.35 , 95 % CI 0.95–1.93 , P = 0.15 ) , nor in secondary outcomes . Conclusions There was no evidence that IPS was of significant benefit in achieving competitive employment for individuals in South London at 1-year follow-up , which may reflect suboptimal implementation . Implementation of IPS can be challenging in the UK context where IPS is not structurally integrated with mental health services , and economic disincentives may lead to lower levels of motivation in individuals with severe mental illness and psychiatric professionals A cognitive-behavioral therapy ( CBT ) program for posttraumatic stress disorder ( PTSD ) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers .  CBT was compared with treatment as usual ( TAU ) in a r and omized controlled trial with 108 clients with PTSD and either major mood disorder ( 85 % ) or schizophrenia or schizoaffective disorder ( 15 % ) , of whom 25 % also had borderline personality disorder . Eighty-one percent of clients assigned to CBT participated in the program . Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessment s in PTSD symptoms , other symptoms , perceived health , negative trauma-related beliefs , knowledge about PTSD , and case manager working alliance . The effects of CBT on PTSD were strongest in clients with severe PTSD . Homework completion in CBT predicted greater reductions in symptoms . Changes in trauma-related beliefs in CBT mediated improvements in PTSD . The findings suggest that clients with severe mental illness and PTSD can benefit from CBT , despite severe symptoms , suicidal thinking , psychosis , and vulnerability to hospitalizations BACKGROUND Studies conducted in the USA have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment . AIMS To determine the effectiveness of the individual placement and support ( supported employment ) model in a Canadian setting . METHOD A total of 150 adults with severe mental illness , who were not currently employed and who desired competitive employment , were r and omly assigned to receive either supported employment ( n = 75 ) or traditional vocational services ( n = 75 ) . RESULTS Over the 12 months of followup , 47 % of clients in the supported employment group obtained at least some competitive employment , v. 18 % of the control group ( P < 0.001 ) . They averaged 126 h of competitive work , v. 72 in the control group ( P < 0.001 ) . CONCLUSIONS Supported employment proved more effective than traditional vocational services in a setting significantly different from setting s in the USA , and may therefore be generalised to setting s in other countries BACKGROUND An international six-centre r and omised controlled trial comparing individual placement and support ( IPS ) with usual vocational rehabilitation  for people with serious mental illness found IPS to be more effective for all vocational outcomes . AIMS To determine which patients with severe mental illness do well in vocational services and which process and service factors are associated with better outcomes . METHOD Patient characteristics and early process variables were tested as predictors of employment outcomes . Service characteristics were explored as predictors of the effectiveness of IPS . RESULTS Patients with previous work history , fewer met social needs and better relationships with their vocational workers were more likely to obtain employment and work for longer . Remission and swifter service uptake were associated with working more . Having an IPS service closer to the original IPS model was the only service characteristic associated with greater effectiveness . CONCLUSIONS The IPS service was found to be more effective for all vocational outcomes . In addition , maintaining high IPS fidelity and targeting relational skills would be a valuable focus for all vocational interventions , leading to improved employment outcomes . Motivation to find work may be decreased by satisfaction with current life circumstances Cognitive deficits are a major determinant of social and occupational dysfunction in schizophrenia , and new treatments are needed that address these impairments . The current study determined whether neurocognitive enhancement therapy ( NET ) in combination with work therapy ( WT ) would show improvement in performance on neuropsychological tests that endured 6 months after completion of training . A total of 145 participants with schizophrenia or schizoaffective disorder were r and omly assigned to NET + WT or WT alone . NET included computer-based training on attention , memory , and executive function tasks . WT included paid work activity in job placements at the medical center . Neuropsychological assessment was performed at baseline , at the end of the 6-month active intervention , and 12 months after training began . Repeated measures multivariate analyses of variance revealed greater neuropsychological improvements on working memory ( p < 0.05 ) and executive function ( p < 0.05 ) for the NET + WT group over the 12 months . Both groups showed sustained improvements on verbal and nonverbal memory BACKGROUND Cognitive deficits are a major determinant of social and occupational dysfunction in schizophrenia . In this study , we determined whether neurocognitive enhancement therapy ( NET ) in combination with work therapy ( WT ) would improve performance on neuropsychological tests related to but different from the training tasks . METHODS Sixty-five patients with schizophrenia or schizoaffective disorder were r and omly assigned to NET plus WT or WT alone . Neurocognitive enhancement therapy included computer-based training on attention , memory , and executive function tasks ; an information processing group ; and feedback on cognitive performance in the workplace . Work therapy included paid work activity in job placements at the medical center ( eg , mail room , grounds , library ) with accompanying supports .  Neuropsychological testing was performed at intake and 5 months later . RESULTS Prior to enrollment , both groups did poorly on neuropsychological testing . Patients receiving NET + WT showed greater improvements on pretest-posttest variables of executive function , working memory , and affect recognition . As many as 60 % in the NET + WT group improved on some measures and were 4 to 5 times more likely to show large effect-size improvements . The number of patients with normal working memory performance increased significantly with NET + WT , from 45 % to 77 % , compared with a decrease from 56 % to 45 % for those receiving WT . CONCLUSIONS Computer training for cognitive dysfunction in patients with schizophrenia can have benefits that generalize to independent outcome measures . Efficacy may result from a synergy between NET , which encourages mental activity , and WT , which allows a natural context for mental activity to be exercised , generalized , and reinforced Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite r and omized study of supported employment . At seven sites , 1,273 people were r and omly assigned to an experimental supported employment program or a control condition  and followed for 2 years . Multivariate regression analysis examined work outcomes including earnings , hours worked , and competitive employment , as well as whether psychiatric disability was disclosed to coworkers and supervisors . Individuals with any comorbidity had lower earnings and were less likely to work competitively . Those with physical comorbidities had lower earnings , worked fewer hours , and were less likely to work competitively . Disclosure was more likely among those with both cognitive and physical comorbidities , as well as those with learning disabilities . Competitive employment was less likely among those with intellectual disability , visual impairment , and human immunodeficiency virus/acquired immuno-deficiency syndrome . The experimental condition was positively related to all outcomes except disclosure . The results suggest that , with some exceptions , comorbidities affect employment outcomes , requiring tailored services and supports to promote vocational success OBJECTIVE Self-esteem is widely used as an outcome variable in studies of 
    Output:
    
Secondary objectives are to establish how far : fidelity to the IPS model affects the effectiveness of supported employment , the effectiveness of supported employment can be augmented by the addition of other interventions