SELECTED NEUROPSYCHOLOGICAL AND REHABILITATION ASSESSMENT MEASURES WITH CHRONICALLY MENTALLY ILL ADULTS.

Abstract

This project represents a descriptive study of 35 chronically mentally ill (CMI) adults enrolled in a community-based vocational rehabilitation program during the 1981 calendar year. As part of their first month in the program, subjects were administered a screening battery consisting of the Trail Making Test, Reitan-Indiana Aphasia Screening Test, Reitan-Klove Sensory Perceptual Examination, Valpar Independent Problem Solving Work Sample (IPSWS) and Wide Range Interest Opinion Test (WRIOT). Correlations were derived among these and with other variables, including the Work Adjustment Rating Form, schizophrenic versus nonschizophrenic psychiatric diagnosis, time in program and period of competitive employment resulting from program involvement. The issue of medication and its potential for impacting on subjects' performance in the program was also addressed. The neuropsychological measures in the battery were significantly correlated among themselves and discriminated between schizophrenic and nonschizophrenic CMI subjects in the sample with 100% accuracy. However, results on neuropsychological tests did not predict whether or not a subject would realize competitive employment during the year of the study. Both schizophrenic and nonschizophrenic subjects produced average performances in the impaired range of functioning according to published criteria for the neuropsychological instruments, although schizophrenic subjects consistently performed closer to the normal population. Vocational instruments included in the battery appeared to measure a more heterogeneous set of functions than the neuropsychological tests, and did not appear to represent a vocational factor. Two scores from these vocational instruments, Valpar IPSWS and WRIOT Negative Bias, were combined with Trail Making Test (Part A) scores in a discriminant function that classified subjects with 81% accuracy on attainment of competitive employment status. Over half (56%) of the people who participated for three months or more experienced some competitive employment, and 39% of those who completed three months or more were able to maintain full-time or part-time competitive employment for longer than 60 days. These results supported the effectiveness of Fountain House Model programs in achieving vocational rehabilitation goals with the difficult CMI population. Support was also provided for community-based research to study both social programs and their clientele.