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Frontline Report   |    
Supported Education for Adults With Psychiatric Disabilities
Sharon A. Gutman, Ph.D., O.T.R.
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.3.326-a
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Dr. Gutman is an occupational therapist and an associate professor affiliated with Programs in Occupational Therapy, Columbia University, 710 W. 168th St., NI-8, New York, NY 10032 (e-mail: sg2422@columbia.edu).

The Bridge Program is a supported education service for adults with psychiatric disabilities who wish to pursue postsecondary education or employment. Because the onset of psychiatric disability commonly occurs in late adolescence and early adulthood, many people with psychiatric disability have difficulty completing high school and entering postsecondary education or employment. Consequently, many possess gaps in their basic educational knowledge and lack interpersonal skills needed to succeed in the student or worker role.

The Bridge Program consists of 12 classroom-lab modules, each lasting two hours. They include training programs, degrees, and work options; study skills; time management skills; effective reading skills; basic writing skills; basic computer skills; introduction to Internet skills; basic math skills; library resources; public speaking strategies; professional behaviors and social skills; and stress management tools. An hour of one-on-one mentoring follows each two-hour module. Mentors help participants to explore available educational and job training programs, complete application forms for specific schools or training, complete financial aid forms, study for the GED or school or job placement tests, and use customized compensatory strategies to enhance school and work performance. The program is held twice weekly over a six-week period. Participants who complete the program and become actively engaged in school or vocational pursuit are offered an additional six weeks of mentoring to facilitate a successful transition to the student or worker role.

To participate in the program, individuals must possess a tenth-grade reading and writing level and be fluent in English. Individuals having an active substance use disorder are ineligible to participate until they can demonstrate six consecutive months of sobriety.

The program was tested for effectiveness with 38 participants who were randomized to an experimental (21 participants) or control group (17 participants). The experimental group attended the 12-session Bridge Program and received treatment as usual at their mental health facilities. Control group participants received only treatment as usual at their mental health facilities during the six-week study. The Bridge Program was implemented in the occupational therapy program at Columbia University; both faculty and graduate-level occupational therapy students participated as instructors and mentors. Data were collected before and after the program, with follow-up at one month and six months.

Recruitment occurred at three outpatient mental health facilities in the New York metropolitan area. The participants, 22 men and 16 women, ranged in age from 19 to 55. Most participants were Hispanic (15 participants, or 39%), African American (14 participants, or 37%), or Caucasian (eight participants, or 21%). Psychiatric diagnoses included schizophrenia (16 participants, or 42%), schizoaffective disorder (11 participants, or 29%), bipolar disorder (six participants, or 16%), and depression (five participants, or 13%). The highest education level achieved for most participants was a high school diploma or GED (22 participants, or 58%). Eight participants (21%) completed some college. Another eight participants (21%) did not complete high school. No participants were currently employed.

Sixteen (76%) of the 21 experimental group participants completed the Bridge Program. At a six-month follow-up, ten of these 16 participants (63%) had enrolled in some form of educational program or job training, had obtained employment, or were in the process of applying to a specific program in the next year. Only one of 17 control group participants (6%) reported being involved in school or work; he was involved in school coursework.

The results suggest that the program helped participants to increase their skill level in basic academic areas, improve professional behaviors and social skills needed for school and work settings, and gain confidence to test their skills in the larger community. Factors that correlated with success in the program included adherence to a medication routine (r=.70, p≤.001), possession of a stable residence (r=.64, p<.001), and motivation to attend the program regularly (r=.84, p≤.001). Diagnosis, prior educational level, number of hospitalizations in the past five years, age of illness onset, and parental education level had no relationship to success in the program. Data collection at a one year follow-up is planned.

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