Journal article review: Supported education for adults with psychiatric disabilities
Supported education for adults with
psychiatric disabilities: Effectiveness of an occupational therapy
program, reviewed by Genevieve Smythe of The
College of Occupational Therapists.
The authors of this study set out to assess the effectiveness of
a supported education program for adults with psychiatric
disabilities in the USA. They randomly assigned 21 service users to
an experimental group that received a program of supported
education and 17 service users to a control group who received
treatment as usual. Using a variety of assessment tools they found
statistically significant differences between the experimental and
control groups and report that at six month follow up, 63% of those
who had completed the supported education programme were in
education or employment while only 6% of the control group were in
education. They advocate repeating the study with larger samples to
be better able to generalise the findings.
The authors offer a fair critique of their
study including the fact that only three of the measures used were
standardised. I would add the following comments on the
quality of this research. Generally there is sufficient
information provided to replicate this study apart from information
about how they conducted their literature review or recruited their
participants. My main concern however with the article’s assertion
about the success of the program versus treatment as usual is there
is no comparison of hours of face to face contact received. For
example, a participant on the training program received six hours
of contact a week, a large amount of input by UK standards. If the
group receiving treatment as usual only received one hour of
contact a week, the results may be due to increased contact rather
than the specific intervention.
Additionally, as the training programme was
delivered by occupational therapy students, the authors have used
the opportunity to rate their attitudes to mental illness before
and after the programme delivery, coming to the unsurprising
conclusion that their attitudes improved by the end of the course.
As this has nothing to do with the aim of the research it is not
clear why it has been included in the report.
Lastly, the authors have only one article in
their reference list which considers the Individual placement and
support model where lengthy training periods to increase skill
levels are replaced with rapid job search, placement and increased
emphasis on post employment support (“place then train” rather than
“train then place”). It is interesting that the authors make no
comment on this alternative, American model particularly as they
assert that improving access to education, by for example,
completing their course, will improve service user’s employment
prospects. The debate about the respective evidence bases for
different methods to increase mainstream participation cannot be
avoided for much longer but may have been beyond the remit of
If you would like to read this research
article the reference is:
Gutman SA, Kerner R, Zombek I, Dulek J, Ramsey
AC (2009) Supported education for adults with psychiatric
disabilities: Effectiveness of an occupational therapy program.
American Journal of Occupational Therapy, 63, 245-254.