RESEARCH WEEKLY: Cognitive Remediation Improves Cognitive and Employment Outcomes in Black Individuals
By Sophie Ali
Racial disparities in treatment outcomes for severe mental illness continue to persist in America. One such disparity is poorer employment outcomes for Black populations with severe mental illness. A recent article published in the Schizophrenia Research Journal by researchers in Massachusetts and Rhode Island found that the integration of cognitive remediation with vocational rehabilitation services improves cognitive and employment outcomes for Black individuals with severe mental illness.
Cognitive remediation’s potential for better employment outcomes
Individuals with severe mental illness typically display poor employment outcomes compared to those without severe mental illness and this disparity increases further for Black individuals compared to their white counterparts with severe mental illness. This is a result of the systemic educational discrimination that reduces employment and financial opportunities for Black Americans. Systemic educational discrimination refers to the lower education levels acquired by Black individuals in comparison to whites and lower levels of education are an established predictor of poorer work outcomes for people with severe mental illness.
Poor employment outcomes for those with serious mental illness have been found to improve using a combination of cognitive remediation and vocational rehabilitation services. Cognitive remediation describes the behavioral interventions that help improve cognitive functioning. No previous research has explored if cognitive remediation and vocational rehabilitation improve employment outcomes of Black individuals with severe mental illness specifically.
Study details and results
An exploratory study led by institutions in Massachusetts and Rhode Island was the first to compare the response of Black and white participants to cognitive remediation for employment outcome improvements. In this study, five randomized control trials were combined and study subjects included a total of 137 Black Americans and 147 white Americans. Participants were assigned to either receive vocational rehabilitation services alone or vocational rehabilitation with the addition of a cognitive remediation intervention known as the Thinking Skills for Work (TSW) program. TSW enhances cognitive function through computer cognitive practice exercises with strategy coaching provided by a trained therapist and by teaching cognitive self-management strategies to improve cognition in everyday work situations. Participants in both conditions were followed for two years to track work outcomes.
Ultimately, participants receiving TSW and vocational rehabilitation demonstrated greater improvements in cognitive functioning compared to vocational rehabilitation alone. Furthermore, the addition of TSW made it more likely for an individual to obtain competitive work, meaning that they earned more wages and worked more weeks than the group without TSW. Notably, there were no significant differences between races in cognitive or vocational outcomes, as both groups displayed high engagement and retention in the TSW program. However, a wage gap between Black and white participants was detected, with white participants earning more wages than Black participants.
Implications
The major takeaway from this study is that Black individuals with severe mental illness receiving vocational services can be successfully engaged in and benefit from cognitive remediation. This finding has profound implications on navigating the influence of systemic educational discrimination on poorer work outcomes for marginalized populations. Moreover, there were no differences in the retention and engagement of the cognitive remediation intervention between Black and white participants which contested previous findings of low mental health service utilization and engagement by Black populations. The authors emphasize the need for Black Americans with severe mental illness to be offered cognitive remediation programs to enhance cognition and improve work functioning. Future investigations on vocational rehabilitation should strive to address the persisting education and wage gaps between Black and white Americans.
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