466 July/August 2004, Volume 58, Number 4 An Evaluation of a Hybrid Occupational Therapy and Supported Employment Program in Japan for Persons With Schizophrenia Masao Oka, Kensei Otsuka, Nuburo Yokoyama, Jim Mintz, Kenyo Hoshino, Shin-Ichi Niwa, Robert Paul Liberman V ocational rehabilitation has been shown to enhance vocational, social, and quality of life outcomes in persons with schizophrenia (Bond, 1992; Lehman, 1995; Rebeiro, Day, Semeniuk, O’Brien, & Wilson, 2001). A meta-analytic review showed an association of vocational interventions with reduced hospital admission (Bond). Other improvements associated with vocational rehabilitation include an increased likelihood of medication adherence (Kuldau & Dirks, 1977) and an improvement in social participation and family role performance (Wolkon, Karmen, & Tanaka, 1971). Vocational rehabilitation has also been related to improvements in work-related outcomes such as rates of paid employment, dura- tion of employment, higher wages, and more job starts (Bond). However, no stud- ies have reported long-term effects on therapeutic outcomes after vocational reha- bilitation (Bond; Lehman, 1995). Follow-up studies have been a useful tool for evaluating the natural course of schizophrenia and long-term outcomes of psychiatric treatment (Fenton & McGlashan, 1991; Harding, Brooks, Takama, Strauss, & Breier, 1987; McGlashan, 1984; Ogawa et al., 1987). Despite their methodological limitations, Masao Oka, MD, is Staff Psychiatrist, Yabuki Prefectural Hospital, Fukushima, Japan. Kensei Otsuka, MD, is Staff Psychiatrist, Yabuki Prefectural Hospital, Fukushima, Japan. Nuboru Yokoyama, MD, is Staff Psychiatrist, Yabuki Prefectural Hospital, Fukushima, Japan. Jim Mintz, PhD, is Professor, UCLA Department of Psychiatry & Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, California. Kenyo Hoshino, MD, is Staff Psychiatrist, Yabuki Prefectural Hospital, Fukushima, Japan. Shin-Ichi Niwa, MD, is Professor of Psychiatry, Fukushima Medical University, Fukushima, Japan. Robert Paul Liberman, MD, is Professor, UCLA Department of Psychiatry & Biobehavioral Sciences, UCLA School of Medicine Psychiatric Rehabilitation Program, UCLA Neuropsychiatric Institute, 760 Westwood Plaza, Los Angeles, California 90095; rpl@ucla.edu OBJECTIVE. A vocational rehabilitation program (occupational therapy and supported employment) for pro- moting the return to the community of long-stay persons with schizophrenia was established at a psychiatric hospital in Japan. The purpose of the study was to evaluate the program in terms of hospitalization rates, com- munity tenure, and social functioning with each individual serving as his or her control. METHODS. Fifty-two participants, averaging 8.9 years of hospitalization, participated in the vocational reha- bilitation program consisting of 2 to 6 hours of in-hospital occupational therapy for 6 days per week and a post- discharge supported employment component. Seventeen years after the program was established, a retro- spective study was conducted to evaluate the impact of the program on hospitalizations, community tenure, and social functioning after participants’ discharge from hospital, using an interrupted time–series analysis. The postdischarge period was compared with the period from onset of illness to the index discharge on the three outcome variables. RESULTS. After discharge from the hospital, the length of time spent by participants out of the hospital increased, social functioning improved, and risk of hospitalization diminished by 50%. Female participants and those with supportive families spent more time out of the hospital than participants who were male or came from nonsupportive families. CONCLUSION. A combined program of occupational therapy and supported employment was successful in a Japanese psychiatric hospital when implemented with the continuing involvement of a clinical team. Interventions that improve the emotional and housing supports provided to persons with schizophrenia by their families are likely to enhance the outcome of vocational services. Oka, M., Otsuka, K., Yokoyama, N., Mintz, J., Hoshino, K., Niwa, S. I., & Liberman, P. (2004). An evaluation of a hybrid occu- pational therapy and supported employment program in Japan for persons with schizophrenia. American Journal of Occupational Therapy, 58, 466–475. Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930155/ on 06/18/2017 Terms of Use: http://AOTA.org/terms