***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: BACKGROUND As of 2011 , over 9 million working-age adults were receiving federal disability benefits and this number is expected to rise steadily . Early intervention programs that seek to maintain employment and forestall the receipt of federal disability benefits offer a promising strategy to reduce the growing number of working-age adults on the disability rolls . OBJECTIVES Using r and om assignment , this study examined whether an early intervention program of personal navigators , enhanced medical care , and employment supports can reduce dependence on federal disability benefits for adult workers with mental health conditions . METHODS The study reports multivariate and descriptive findings based on 2279 participants in the Demonstration to Maintain Independence and Employment ( DMIE ) .  Logistic regression analysis was used to estimate program impacts in the treatment group relative to the control group . Data were integrated from state participant surveys and the SSA Ticket Research File . RESULTS The DMIE intervention significantly reduced the percent of participants who received disability benefits after 12 months of enrollment . Across both states , the difference between the treatment group and control group was 1.1 percentage points ( 2.5 % versus 3.6 % , p < 0.01 ) . In Texas , the difference was 1.2 percentage points ( 3.2 % versus 4.4 % , p < 0.01 ) . CONCLUSIONS Early intervention programs with a personal navigator can reduce dependence on federal disability benefits for adult workers with mental health conditions . Future studies on the cost-effectiveness of such programs are needed 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 r and omised to receive motivational interviewing training for clinicians , focused on attitudinal barriers to employment . The trial was registered with the International St and ard R and omised Controlled Trial Register ( IS RCT N71943786 ) . 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 r and om 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 BACKGROUND This study reports on a preliminary evaluation of a cognitive behavioural intervention to improve social recovery among young people in the early stages of psychosis showing persistent signs of poor social functioning and unemployment . The study was a single-blind r and omized controlled trial ( RCT ) with two arms , 35 participants receiving cognitive behaviour therapy ( CBT ) plus treatment as usual ( TAU )  , and 42 participants receiving TAU alone . Participants were assessed at baseline and post-treatment . METHOD Seventy-seven participants were recruited from secondary mental health teams after presenting with a history of unemployment and poor social outcome . The cognitive behavioural intervention was delivered over a 9-month period with a mean of 12 sessions . The primary outcomes were weekly hours spent in constructive economic and structured activity . A range of secondary and tertiary outcomes were also assessed . RESULTS Intention-to-treat analysis on the combined affective and non-affective psychosis sample showed no significant impact of treatment on primary or secondary outcomes . However , analysis of interactions by diagnostic subgroup was significant for secondary symptomatic outcomes on the Positive and Negative Syndrome Scale ( PANSS ) [ F(1 , 69)=3.99 , p=0.05 ] . Subsequent exploratory analyses within diagnostic subgroups revealed clinical ly important and significant improvements in weekly hours in constructive and structured activity and PANSS scores among people with non-affective psychosis . CONCLUSIONS The primary study comparison provided no clear evidence for the benefit of CBT in a combined sample of patients . However , planned analyses with diagnostic subgroups showed important benefits for CBT among people with non-affective psychosis who have social recovery problems . These promising results need to be independently replicated in a larger , multi-centre RCT BACKGROUND Unemployment is a major problem for people with first-episode psychosis and schizophrenia . This has repercussions for the economy , social functioning and illness prognosis . AIMS To examine whether a vocational intervention - individual placement and support ( IPS ) - which has been found to be beneficial in population s with chronic schizophrenia , was a useful intervention for those with first-episode psychosis . METHOD A total of 41 people with first-episode psychosis were r and omised to receive either 6 months of IPS + treatment as usual ( TAU ) ( n=20 ) or TAU alone ( n=21 ) . RESULTS The IPS group had significantly better outcomes on level of employment ( 13 v. 2 , P<0.001 ) , hours worked per week ( median 38 v. 22.5 , P=0.006 ) , jobs acquired ( 23 v. 3 ) and longevity of employment ( median 5 weeks v. 0 , P=0.021 ) . The IPS group also significantly reduced their reliance on welfare benefits . CONCLUSIONS Individual placement and support has good potential to address the problem of vocational outcome in people with first-episode psychosis . This has economic , social and health implication The Graduated Recovery Intervention Program ( GRIP ) is a new individual cognitive-behavioral therapy program design ed to facilitate functional recovery in people who have experienced an initial episode of psychosis . The purpose s of this study were to evaluate the feasibility and tolerability of the GRIP intervention , and to compare the effectiveness of GRIP versus treatment as usual ( TAU ) for improving specific clinical and psychosocial outcomes . Forty-six individuals with first episode psychosis were r and omized to GRIP+TAU or TAU alone . Primary outcomes focused on social and role functioning , and quality of life . Secondary outcomes included psychotic symptoms , depression , substance use , social support , attitudes toward medications , well-being , and hospitalizations . The results indicate that GRIP was well-tolerated , as evidence d by good attendance and low drop-out rates , and well-received ( based on positive feedback from participants ) . Although the majority of mixed model analyses were not statistically significant , examination of within-group changes and effect sizes suggests an advantage for GRIP over TAU in improving functional outcomes . These advantages and the fact that the GRIP intervention demonstrated feasibility and tolerability suggest that this intervention is worthy of further investigation BACKGROUND The provision of early intervention services for people with psychosis is UK government policy , although evidence for benefit of such services is sparse . AIMS To evaluate the effects of a service providing specialised care for early psychosis ( the Lambeth Early Onset Team ) on clinical and social outcomes , and on service user satisfaction . METHOD One hundred and forty-four people with psychosis , presenting to mental health services for the first or second time ( if previously failed to engage in treatment ) , were r and omly allocated to care by the early onset team or to st and ard care . Information was obtained on symptoms , treatment adherence , social and vocational functioning , satisfaction and quality of life . Relapse and rehospitalisation data have been reported separately . RESULTS Outcomes for the participants treated by the early onset team were significantly better at 18 months for aspects of social and vocational functioning , satisfaction , quality of life and medication adherence . Symptom improvement did not significantly differ between the groups . CONCLUSIONS The provision of specialised care for early psychosis can achieve better outcomes . The study therefore provides support for current policy Objective : To examine the effects of psychosocial cognitive rehabilitation on employment outcomes in a r and omized controlled trial for individuals with early course schizophrenia . Method : Early course schizophrenia out patients ( N = 58 ) were r and omly assigned to cognitive enhancement therapy ( CET ) or an enriched supportive therapy ( EST ) control and treated for 2 years . Comprehensive data on cognition and employment were collected annually . Results : Individuals treated with CET were significantly more likely to be competitively employed , had greater earnings from employment , and were more satisfied with their employment status by the end of treatment compared to EST recipients . Mediator analyses revealed that improvements in both social and nonsocial cognition mediated CET effects on employment . Conclusion : CET can help facilitate employment in early schizophrenia by addressing the cognitive impairments that limit functioning in the disorder . Inclusion of cognitive rehabilitation in social work practice can support more optimal functional recovery from schizophrenia Background Employment rates among people with severe mental illness are low and work has beneficial effects on mental health . There is now good evidence of the effectiveness of a specialist vocational intervention ( supported employment ) in people with schizophrenia . However , the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested . Methods The aim of our study was to evaluate the effectiveness of a specialist vocational intervention  in aiding vocational recovery following the onset of first episode psychosis . In a naturalistic prospect i ve cohort study , 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service ;  44 resident in an area where a vocational intervention was available and 70 in an area where it was not . Results The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up ( after adjusting for confounders ) . Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not ( OR = 3.53 , 95 % CI = 1.25–10.00 ) . Conclusion This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention  following first episode psychosis . This is an important outcome from the perspective of service users and clinicians alike ( as well as having wider societal value ) . Other important predictors of vocational recovery can not be modified by the time a first episode psychosis emerges While review s of controlled studies of the Individual Placement and Support ( IPS ) model of supported employment for clients with severe mental illness have documented its effectiveness in the US , its generalizability to other countries has not been systematic ally evaluated . This is the first review to compare US to non-US studies . We identified 15 r and omized controlled trials of IPS programs , 9 in the US and 6 outside the US . We examined competitive employment outcomes , including employment rate , days to first job , weeks worked during follow-up , and hours worked . We also considered noncompetitive employment , program retention , and nonvocational outcomes .  IPS programs had significantly better outcomes across a range of competitive employment indicators and higher retention in services than control groups . The overall competitive employment rate for IPS clients in US studies was significantly higher than in non-US studies ( 62 % vs. 47 % ) . The consistently positive competitive employment outcomes strongly favoring IPS over a range of comparison programs in a group of international studies suggest that IPS is an evidence -based practice that may transport well into new setting s as long as programs achieve high fidelity to the IPS model , but further research is needed on international adaptations Forty patients who had been treated for three years in an ad-hoc , assertive treatment team for patients who had suffered a first psychotic episode were compared to forty patients who had been followed up after a first psychotic episode in a community mental health team . All patients had suffered a first or early psychotic episode . The main differences between the two teams was that the ad-hoc team was assertive in its approach , offered more structured psycho-education , relapse prevention and psycho-social interventions , and had a policy of using atypical anti-psychotics at the lowest effective dose . There were many differences in outcome measures at the end of three years between the two groups . The EI patients are more likely to be taking medication at the end of three years . They are more compliant with medication . They are more likely to be prescribed atypical medication . The EI patients are more likely to have returned to work or education . The EI patients are more likely to remain living with their families . They are less likely to suffer depression to the extent of requiring anti-depressants . They appear to commit less suicide attempts . The patients in the EI service also appear to be less likely to suffer relapse and re-hospitalisation , and are less likely to have involuntary admission to hospital . They have systematic relapse prevention plans based on early warning signs . They and their families receive more psycho-education . These indications suggest that the EI patients are at the end of three years better able to manage their illness/vulnerability on their own than the CMHT patients . More patients in the EI group stopped using illicit drugs than in the CMHT group . All the above changes were statistically significant except for the number of patients who stopped using illicit drugs . In this case it is believed that the sample size was too small to demonstrate significance . These results suggest that an ad-hoc early intervention team is more effective than st and ard community mental health team in treating psychotic illness CONTEXT Intensive early treatment for first-episode psychosis has been shown to be effective . It is unknown if the positive effects are sustained for 5 years . OBJECTIVE To determine the long-term effects of an intensive early-intervention program ( OPUS ) for first-episode psychotic patients . DESIGN Single-blinded , r and omized , controlled clinical trial of 2 years of an intensive early-intervention program vs st and ard treatment . Follow-up periods were 2 and 
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CONCLUSIONS In early intervention programmes , supported employment moderately increases employment rates but not rates of enrolment in education .
These improvements are in addition to the modest effects early programmes alone have on vocational/educational outcomes compared with usual services