Clozapine and clubhouse treatment model and vocational outcomes of adults with schizophrenia

Abstract

This quasi-experimental study of the vocational outcomes of persons with schizophrenia who participated in both of two different psychosocial treatment models and one of two different psychopharmacological treatments. Vocational outcomes of clients requesting vocational rehabilitation services and participating in clubhouse model programs were compared with vocational outcomes of clients requesting vocational rehabilitation services and participating in traditional day treatment programs. Vocational outcomes of clients taking clozapine were compared with those taking other psychotropic medications. Combined effects of the psychosocial treatments and the psychopharmacological treatments was also examined. Included in this study were 150 clients with schizophrenia, all of whom participated in a cooperative vocational program of the Colorado Rehabilitation Services and the Colorado Division of Mental Health from 7/1/94 to 7/1/96. Successful employment outcomes for these clients were defined as sixty days of continuous employment, or "Status 26". Clients with schizophrenia who participated in a clubhouse model had significantly higher employment rates than those participating in a traditional day treatment model. Clients with schizophrenia taking clozapine had significantly higher employment rates than those taking other medications. Clients with schizophrenia participating in a clubhouse and taking clozapine did not have significantly higher employment rates than those only participating in clubhouse or those only taking clozapine. However, for those clients taking clozapine only, participating in a clubhouse only or both, had significantly higher employment rates than clients under neither condition. Four secondary results involving all participants with all diagnoses (n=439) were provided for future research: a) persons with major mental illness who participated in a clubhouse program had 16.9% better employment outcomes than participants in a day treatment program; b) males and females with major mental illness had equal employment outcomes, whether participating in a clubhouse or day treatment; c) no employment outcome differences occurred between the Denver metropolitan area's and other large cities' day treatment programs, but significantly better employment outcomes were observed in the metro Denver clubhouses than in the other large cities' clubhouses; d) employment data for 1994-1995 and 1995-1996 for all diagnoses showed that 11.4% more clients were successfully employed in the first year of the study than the second.