Scientific Writing Made Easy: A Step-by-Step Guide to Undergraduate Writing in the Biological Sciences
Sheela P. Turbek,
- Department of Ecology and Evolutionary Biology, University of Colorado, Boulder, Boulder, Colorado, USA
Taylor M. Chock,
- Department of Ecology and Evolutionary Biology, University of Colorado, Boulder, Boulder, Colorado, USA
Caroline A. Havrilla,
Angela M. Oliverio,
- Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, Colorado, USA
Stephanie K. Polutchko,
Lauren G. Shoemaker,
Note: Charlene D'Avanzo is the editor of Ecology 101. Anyone wishing to contribute articles or reviews to this section should contact her at the School of Natural Sciences, Hampshire College, 893 West Street, Amherst, MA 01002. E-mail: firstname.lastname@example.org
Scientific writing, while an indispensable step of the scientific process, is often overlooked in undergraduate courses in favor of maximizing class time devoted to scientific concepts. However, the ability to effectively communicate research findings is crucial for success in the biological sciences. Graduate students are encouraged to publish early and often, and professional scientists are generally evaluated by the quantity of articles published and the number of citations those articles receive. It is therefore important that undergraduate students receive a solid foundation in scientific writing early in their academic careers. In order to increase the emphasis on effective writing in the classroom, we assembled a succinct step-by-Step guide to scientific writing that can be directly disseminated to undergraduates enrolled in biological science courses. The guide breaks down the scientific writing process into easily digestible pieces, providing concrete examples that students can refer to when preparing a scientific manuscript or laboratory report. By increasing undergraduate exposure to the scientific writing process, we hope to better prepare undergraduates for graduate school and productive careers in the biological sciences.
An introduction to the guide
While writing is a critical part of the scientific process, it is often taught secondarily to scientific concepts and becomes an afterthought to students. How many students can you recall who worked on a laboratory assignment or class project for weeks, only to throw together the written report the day before it was due?
For many, this pattern occurs because we focus almost exclusively on the scientific process, all but neglecting the scientific writing process. Scientific writing is often a difficult and arduous task for many students. It follows a different format and deviates in structure from how we were initially taught to write, or even how we currently write for English, history, or social science classes. This can make the scientific writing process appear overwhelming, especially when presented with new, complex content. However, effective writing can deepen understanding of the topic at hand by compelling the writer to present a coherent and logical story that is supported by previous research and new results.
Clear scientific writing generally follows a specific format with key sections: an introduction to a particular topic, hypotheses to be tested, a description of methods, key results, and finally, a discussion that ties these results to our broader knowledge of the topic (Day and Gastel 2012). This general format is inherent in most scientific writing and facilitates the transfer of information from author to reader if a few guidelines are followed.
Here, we present a succinct step-by-step guide that lays out strategies for effective scientific writing with the intention that the guide be disseminated to undergraduate students to increase the focus on the writing process in the college classroom. While we recognize that there are no hard and fast rules when it comes to scientific writing, and more experienced writers may choose to disregard our suggestions these guidelines will assist undergraduates in overcoming the initial challenges associated with writing scientific papers. This guide was inspired by Joshua Schimel's Writing Science: How to Write Papers that Get Cited and Proposals that Get Funded—an excellent book about scientific writing for graduate students and professional scientists—but designed to address undergraduate students. While the guide was written by a group of ecologists and evolutionary biologists, the strategies and suggestions presented here are applicable across the biological sciences and other scientific disciplines. Regardless of the specific course being taught, this guide can be used as a reference when writing scientific papers, independent research projects, and laboratory reports. For students looking for more in-depth advice, additional resources are listed at the end of the guide.
To illustrate points regarding each step of the scientific writing process, we draw examples throughout the guide from Kilner et al. (2004), a paper on brown-headed cowbirds—a species of bird that lays its eggs in the nests of other bird species, or hosts—that was published in the journal Science. Kilner et al. investigate why cowbird nestlings tolerate the company of host offspring during development rather than pushing host eggs out of the nest upon hatching to monopolize parental resources. While articles in the journal Science are especially concise and lack the divisions of a normal scientific paper, Kilner et al. (2004) offers plenty of examples of effective communication strategies that are utilized in scientific writing. We hope that the guidelines that follow, as well as the concrete examples provided, will lead to scientific papers that are information rich, concise, and clear, while simultaneously alleviating frustration and streamlining the writing process.
Undergraduate guide to writing in the biological sciences
The before steps
The scientific writing process can be a daunting and often procrastinated “last step” in the scientific process, leading to cursory attempts to get scientific arguments and results down on paper. However, scientific writing is not an afterthought and should begin well before drafting the first outline. Successful writing starts with researching how your work fits into existing literature, crafting a compelling story, and determining how to best tailor your message to an intended audience.
Research how your work fits into existing literature
It is important to decide how your research compares to other studies of its kind by familiarizing yourself with previous research on the topic. If you are preparing a laboratory write-up, refer to your textbook and laboratory manual for background information. For a research article, perform a thorough literature search on a credible search engine (e.g., Web of Science, Google Scholar). Ask the following questions: What do we know about the topic? What open questions and knowledge do we not yet know? Why is this information important? This will provide critical insight into the structure and style that others have used when writing about the field and communicating ideas on this specific topic. It will also set you up to successfully craft a compelling story, as you will begin writing with precise knowledge of how your work builds on previous research and what sets your research apart from the current published literature.
Understand your audience (and write to them)
In order to write effectively, you must identify your audience and decide what story you want them to learn. While this may seem obvious, writing about science as a narrative is often not done, largely because you were probably taught to remain dispassionate and impartial while communicating scientific findings. The purpose of science writing is not explaining what you did or what you learned, but rather what you want your audience to understand. Start by asking: Who is my audience? What are their goals in reading my writing? What message do I want them to take away from my writing? There are great resources available to help science writers answer these questions (Nisbet 2009, Baron 2010). If you are interested in publishing a scientific paper, academic journal websites also provide clear journal mission statements and submission guidelines for prospective authors. The most effective science writers are familiar with the background of their topic, have a clear story that they want to convey, and effectively craft their message to communicate that story to their audience.
The Introduction sets the tone of the paper by providing relevant background information and clearly identifying the problem you plan to address. Think of your Introduction as the beginning of a funnel: Start wide to put your research into a broad context that someone outside of the field would understand, and then narrow the scope until you reach the specific question that you are trying to answer (Fig. 1; Schimel 2012). Clearly state the wider implications of your work for the field of study, or, if relevant, any societal impacts it may have, and provide enough background information that the reader can understand your topic. Perform a thorough sweep of the literature; however, do not parrot everything you find. Background information should only include material that is directly relevant to your research and fits into your story; it does not need to contain an entire history of the field of interest. Remember to include in-text citations in the format of (Author, year published) for each paper that you cite and avoid using the author's name as the subject of the sentence:
“Kilner et al. (2004) found that cowbird nestlings use host offspring to procure more food.”
Instead, use an in-text citation:
“Cowbird nestlings use host offspring to procure more food.”
(Kilner et al. 2004)
Upon narrowing the background information presented to arrive at the specific focus of your research, clearly state the problem that your paper addresses. The problem is also known as the knowledge gap, or a specific area of the literature that contains an unknown question or problem (e.g., it is unclear why cowbird nestlings tolerate host offspring when they must compete with host offspring for food) (refer to the section “Research how your work fits into existing literature”). The knowledge gap tends to be a small piece of a much larger field of study. Explicitly state how your work will contribute to filling that knowledge gap. This is a crucial section of your manuscript; your discussion and conclusion should all be aimed at answering the knowledge gap that you are trying to fill. In addition, the knowledge gap will drive your hypotheses and questions that you design your experiment to answer.
Your hypothesis will often logically follow the identification of the knowledge gap (Table 1). Define the hypotheses you wish to address, state the approach of your experiment, and provide a 1–2 sentence overview of your experimental design, leaving the specific details for the methods section. If your methods are complicated, consider briefly explaining the reasoning behind your choice of experimental design. Here, you may also state your system, study organism, or study site, and provide justification for why you chose this particular system for your research. Is your system, study organism, or site a good representation of a more generalized pattern? Providing a brief outline of your project will allow your Introduction to segue smoothly into your 'Materials and Methods' section.
|A hypothesis is a testable explanation of an observed occurrence in nature, or, more specifically, why something you observed is occurring. Hypotheses relate directly to research questions, are written in the present tense, and can be tested through observation or experimentation. Although the terms “hypothesis” and “prediction” are often incorrectly used interchangeably, they refer to different but complementary concepts. A hypothesis attempts to explain the mechanism underlying a pattern, while a prediction states an expectation regarding the results. While challenging to construct, hypotheses provide powerful tools for structuring research, generating specific predictions, and designing experiments.|
|Observation: Brown-headed cowbird nestlings refrain from ejecting host offspring from the nest even though those offspring compete for limited parental resources.|
|Research question: Why do nestling cowbirds tolerate the presence of host offspring in the nest?|
|Hypothesis: The presence of host offspring causes parents to bring more food to the nest.|
|Prediction: Cowbird nestlings will grow at a faster rate in nests that contain host offspring.|
Materials and Methods
The 'Materials and Methods' section is arguably the most straightforward section to write; you can even begin writing it while performing your experiments to avoid forgetting any details of your experimental design. In order to make your paper as clear as possible, organize this section into subsections with headers for each procedure you describe (e.g., field collection vs. laboratory analysis). We recommend reusing these headers in your Results and Discussion to help orient your readers.
The aim of the 'Materials and Methods' section is to demonstrate that you used scientifically valid methods and provide the reader with enough information to recreate your experiment. In chronological order, clearly state the procedural steps you took, remembering to include the model numbers and specific settings of all equipment used (e.g., centrifuged in Beckman Coulter Benchtop Centrifuge Model Allegra X -15R at 12,000 × g for 45 minutes). In addition to your experimental procedure, describe any statistical analyses that you performed. While the parameters you include in your 'Materials and Methods' section will vary based on your experimental design, we list common ones in Table 2 (Journal of Young Investigators 2005) that are usually mentioned. If you followed a procedure developed from another paper, cite the source that it came from and provide a general description of the method. There is no need to reiterate every detail, unless you deviated from the source and changed a step in your procedure. However, it is important to provide enough information that the reader can follow your methods without referring to the original source. As you explain your experiment step by step, you may be tempted to include qualifiers where sources of error occurred (e.g., the tube was supposed to be centrifuged for 5 minutes, but was actually centrifuged for 10). However, generally wait until the Discussion to mention these subjective qualifiers and avoid discussing them in the 'Materials and Methods' section.
|• Site characterization:|
|Study organism used, its origin, any pre-experiment handling or care|
|Description of field site or site where experiment was performed|
|• Experimental design:|
|Step-by-step procedures in paragraph form|
|Equipment used, including model numbers and year|
|Important equipment settings (e.g., temperature of incubation, speed of centrifuge)|
|Amount of reagents used|
|Specific measurements taken (e.g., wing length, weight of organism)|
|• Statistical analyses conducted (e.g., ANOVA, linear regression)|
The 'Materials and Methods' section should be written in the past tense:
“On hatch day, and every day thereafter for 9 days, we weighed chicks, measured their tibia length, and calculated the instantaneous growth constant K to summarize rates of mass gain and skeletal growth.”
(Kilner et al. 2004)
While it is generally advisable to use active voice throughout the paper (refer to the section “Putting It All Together,” below), you may want to use a mixture of active and passive voice in the 'Materials and Methods' section in order to vary sentence structure and avoid repetitive clauses.
The Results section provides a space to present your key findings in a purely objective manner and lay the foundation for the Discussion section, where those data are subjectively interpreted. Before diving into this section, identify which graphs, tables, and data are absolutely necessary for telling your story. Then, craft a descriptive sentence or two that summarizes each result, referring to corresponding table and figure numbers. Rather than presenting the details all at once, write a short summary about each data set. If you carried out a complicated study, we recommend dividing your results into multiple sections with clear headers following the sequence laid out in the 'Materials and Methods' section.
As you relate each finding, be as specific as possible and describe your data biologically rather than through the lens of statistics. While statistical tests give your data credibility by allowing you to attribute observed differences to nonrandom variation, they fail to address the actual meaning of the data. Instead, translate the data into biological terms and refer to statistical results as supplemental information, or even in parenthetical clauses (Schimel 2012). For example, if your dependent variable changed in response to a treatment, report the magnitude and direction of the effect, with the P-value in parentheses.
“By day 8, cowbirds reared with host young were, on average, 14% heavier than cowbirds reared alone (unpaired t16 = −2.23, P = 0.041, Fig. 2A).”
(Kilner et al. 2004)
If your P-value exceeded 0.05 (or your other statistical tests yielded nonsignificant results), report any noticeable trends in the data rather than simply dismissing the treatment as having no significant effect (Fry 1993). By focusing on the data and leaving out any interpretation of the results in this section, you will provide the reader with the tools necessary to objectively evaluate your findings.
Discussion and conclusion
The Discussion section usually requires the most consideration, as this is where you interpret your results. Your Discussion should form a self-contained story tying together your Introduction and Results sections (Schimel 2012). One potential strategy for writing the Discussion is to begin by explicitly stating the main finding(s) of your research (Cals and Kotz 2013). Remind the reader of the knowledge gap identified in the Introduction to re-spark curiosity about the question you set out to answer. Then, explicitly state how your experiment moved the field forward by filling that knowledge gap.
After the opening paragraph of your Discussion, we suggest addressing your question and hypotheses with specific evidence from your results. If there are multiple possible interpretations of a result, clearly lay out each competing explanation. In the cowbird example, a higher feeding rate in the presence of host offspring could indicate either (1) that the parents were more responsive to the begging behavior of their own species or (2) that the collective begging behavior of more offspring in the nest motivated the host parents to provide additional food (Kilner et al. 2004). Presenting and evaluating alternative explanations of your findings will provide clear opportunities for future research. However, be sure to keep your Discussion concrete by referring to your results to support each given interpretation.
Intermingled with these interpretations, reference preexisting literature and report how your results relate to previous findings (Casenove and Kirk 2016). Ask yourself the following questions: How do my results compare to those of similar studies? Are they consistent or inconsistent with what other researchers have found? If they are inconsistent, discuss why this might be the case. For example, are you asking a similar question in a different system, organism, or site? Was there a difference in the methods or experimental design? Any caveats of the study (e.g., small sample size, procedural mistakes, or known biases in the methods) should be transparent and briefly discussed.
The conclusion, generally located in its own short section or the last paragraph of the Discussion, represents your final opportunity to state the significance of your research. Rather than merely restating your main findings, the conclusion should summarize the outcome of your study in a way that incorporates new insights or frames interesting questions that arose as a result of your research. Broaden your perspective again as you reach the bottom of the hourglass (Fig. 1). While it is important to acknowledge the shortcomings or caveats of the research project, generally include these near the beginning of the conclusion or earlier in the Discussion. You want your take-home sentences to focus on what you have accomplished and the broader implications of your study, rather than your study's limitations or shortcomings (Schimel 2012). End on a strong note.
Putting it all together
No matter how many boards you stack on top of each other, you still need nails to prevent the pile from falling apart. The same logic applies to a scientific paper. Little things—such as flow, structure, voice, and word choice—will connect your story, polish your paper, and make it enjoyable to read.
First, a paper needs to flow. The reader should easily be able to move from one concept to another, either within a sentence or between paragraphs. To bolster the flow, constantly remind yourself of the overarching story; always connect new questions with resolutions and tie new concepts to previously presented ideas. As a general rule, try to maintain the same subject throughout a section and mix up sentence structure in order to emphasize different concepts. Keep in mind that words or ideas placed toward the end of a sentence often convey the most importance (Schimel 2012).
The use of active voice with occasional sentences in passive voice will additionally strengthen your writing. Scientific writing is rife with passive voice that weakens otherwise powerful sentences by stripping the subjects of action. However, when used properly, the passive voice can improve flow by strategically placing a sentence's subject so that it echoes the emphasis of the preceding sentence. Compare the following sentences:
“The cowbird nestlings tolerated the host nestlings.”
“The host nestlings were tolerated by the cowbird nestlings.”
If host nestlings are the focus of the paragraph as a whole, it may make more sense to present the passive sentence in this case, even though it is weaker than the active version. While passive and active voices can complement each other in particular situations, you should typically use the active voice whenever possible.
Lastly, word choice is critical for effective storytelling (Journal of Young Investigators 2005). Rather than peppering your report or manuscript with overly complicated words, use simple words to lay the framework of your study and discuss your findings. Eliminating any flourish and choosing words that get your point across as clearly as possible will make your work much more enjoyable to read (Strunk and White 1979, Schimel 2012).
Editing and peer review
Although you have finally finished collecting data and writing your report, you are not done yet! Re-reading your paper and incorporating constructive feedback from others can make the difference between getting a paper accepted or rejected from a journal or receiving one letter grade over another on a report. The editing stage is where you put the finishing touches on your work.
Start by taking some time away from your paper. Ideally, you began your paper early enough that you can refrain from looking at it for a day or two. However, if the deadline looms large, take an hour break at the very least. Come back to your paper and verify that it still expresses what you intended to say. Where are the gaps in your story structure? What has not been explained clearly? Where is the writing awkward, making it difficult to understand your point? Consider reading the paper out loud first, and then print and edit a hard copy to inspect the paper from different angles.
Editing is best done in stages. On the first run-through of your paper, make sure you addressed all of the main ideas of the study. One way to achieve this is by writing down the key points you want to hit prior to re-reading your paper. If your paper deviates from these points, you may need to delete some paragraphs. In contrast, if you forgot to include something, add it in. To check the flow of your paragraphs, verify that a common thread ties each paragraph to the preceding one, and similarly, that each sentence within a paragraph builds on the previous sentence. Finally, re-read the paper with a finer lens, editing sentence structure and word choice as you go to put the finishing touches on your work. Grammar and spelling are just as important as your scientific story; a poorly written paper will have limited impact regardless of the quality of the ideas expressed (Harley et al. 2004).
After editing your own paper, ask someone else to read it. A classmate is ideal because he/she understands the assignment and could exchange papers with you. The editing steps described above also apply when editing someone else's paper. If a classmate is not available, try asking a family member or a friend. Having a fresh set of eyes examine your work may help you identify sections of your paper that need clarification. This procedure will also give you a glimpse into the peer review process, which is integral to professional science writing (Guilford 2001). Don't be discouraged by negative comments—incorporating the feedback of reviewers will only strengthen your paper. Good criticism is constructive.
While the basics of writing are generally taught early in life, many people constantly work to refine their writing ability throughout their careers. Even professional scientists feel that they can always write more effectively. Focusing on the strategies for success laid out in this guide will not only improve your writing skills, but also make the scientific writing process easier and more efficient. However, keep in mind that there is no single correct way to write a scientific paper, and as you gain experience with scientific writing, you will begin to find your own voice. Good luck and happy writing!
For those interested in learning more about the skill of scientific writing, we recommend the following resources. We note that much of the inspiration and concrete ideas for this step-by-step guide originated from Schimel's Writing Science: How to Write Papers that Get Cited and Proposals that Get Funded.
- Journal of Young Investigators. 2005. Writing scientific manuscripts: a guide for undergraduates. Journal of Young Investigators, California.
- Lanciani, C. A. 1998. Reader-friendly writing in science. Bulletin of the Ecological Society of America 79: 171–172.
- Morris, J., T. Jehn, C. Vaughan, E. Pantages, T. Torello, M. Bucheli, D. Lohman, and R. Jue. 2007. A student's guide to writing in the life sciences. The President and Fellows of Harvard University, Massachusetts.
- Schimel, J. 2012. Writing science: how to write papers that get cited and proposals that get funded. Oxford University Press, Oxford.
We thank Nichole Barger and the University of Colorado, Boulder 2016 graduate writing seminar for helpful discussions that greatly enhanced the quality of this essay.
Potential Conflicts of Interest
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© 2016 The Authors. The Bulletin of the Ecological Society of America, published by Wiley Periodicals, Inc., on behalf of the Ecological Society of America.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Issue online:
- Version of record online:
- Baron, N.2010. Escape from the ivory tower: a guide to making your science matter. Island Press, Washington, D.C.
- Cals, J. W., and D. Kotz. 2013. Effective writing and publishing scientific papers, part VI: discussion. Journal of Clinical Epidemiology66:1064.
- Casenove, D., and S. Kirk. 2016. A spoonful of science can make science writing more hedged. Electronic Journal of Science Education20:138–149.
- Day, R., and B. Gastel. 2012. How to write and publish a scientific paper. Cambridge University Press, Cambridge.
- Fry, J. C.1993. Biological data analysis: a practical approach. IRL Press Ltd, Oxford.
- Guilford, W. H.2001. Teaching peer review and the process of scientific writing. Advances in Physiology Education25:167–175.
- Harley, C. D., M. A. Hixon, and L. A. Levin. 2004. Scientific Writing And Publishing-A Guide For Students. Bulletin of the Ecological Society of America85:74–78.
- Journal of Young Investigators. 2005. Writing scientific manuscripts: a guide for undergraduates. Journal of Young Investigators.
- Kilner, R., J. Madden, and M. Hauber. 2004. Brood parasitic cowbird nestlings use host young to procure resources. Science305:877–879.
- Nisbet, M. C.2009. Framing science: a new paradigm in public engagement. Pages 40–67inL. Kahlor and P. Stout, editors. Understanding science: new agendas in science communication. Taylor and Francis, New York, New York.
- Schimel, J.2012. Writing science: how to write papers that get cited and proposals that get funded. Oxford University Press, Oxford.
- Strunk, W., and E. B. White. 1979. The elements of style. Third edition. Macmillan Publishing Co, New York, New York.
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This paper should be used only as an example of a research paper write-up. Horizontal rules signify the top and bottom edges of pages. For sample references which are not included with this paper, you should consult the Publication Manual of the American Psychological Association, 4th Edition.
This paper is provided only to give you an idea of what a research paper might look like. You are not allowed to copy any of the text of this paper in writing your own report.
Because word processor copies of papers don't translate well into web pages, you should note that an actual paper should be formatted according to the formatting rules for your context. Note especially that there are three formatting rules you will see in this sample paper which you should NOT follow. First, except for the title page, the running header should appear in the upper right corner of every page with the page number below it. Second, paragraphs and text should be double spaced and the start of each paragraph should be indented. Third, horizontal lines are used to indicate a mandatory page break and should not be used in your paper.
The Effects of a Supported Employment Program on Psychosocial Indicators
for Persons with Severe Mental Illness
William M.K. Trochim
Running Head: SUPPORTED EMPLOYMENT
This paper describes the psychosocial effects of a program of supported employment (SE) for persons with severe mental illness. The SE program involves extended individualized supported employment for clients through a Mobile Job Support Worker (MJSW) who maintains contact with the client after job placement and supports the client in a variety of ways. A 50% simple random sample was taken of all persons who entered the Thresholds Agency between 3/1/93 and 2/28/95 and who met study criteria. The resulting 484 cases were randomly assigned to either the SE condition (treatment group) or the usual protocol (control group) which consisted of life skills training and employment in an in-house sheltered workshop setting. All participants were measured at intake and at 3 months after beginning employment, on two measures of psychological functioning (the BPRS and GAS) and two measures of self esteem (RSE and ESE). Significant treatment effects were found on all four measures, but they were in the opposite direction from what was hypothesized. Instead of functioning better and having more self esteem, persons in SE had lower functioning levels and lower self esteem. The most likely explanation is that people who work in low-paying service jobs in real world settings generally do not like them and experience significant job stress, whether they have severe mental illness or not. The implications for theory in psychosocial rehabilitation are considered.
The Effects of a Supported Employment Program on Psychosocial Indicators for Persons with Severe Mental Illness
Over the past quarter century a shift has occurred from traditional institution-based models of care for persons with severe mental illness (SMI) to more individualized community-based treatments. Along with this, there has been a significant shift in thought about the potential for persons with SMI to be "rehabilitated" toward lifestyles that more closely approximate those of persons without such illness. A central issue is the ability of a person to hold a regular full-time job for a sustained period of time. There have been several attempts to develop novel and radical models for program interventions designed to assist persons with SMI to sustain full-time employment while living in the community. The most promising of these have emerged from the tradition of psychiatric rehabilitation with its emphases on individual consumer goal setting, skills training, job preparation and employment support (Cook, Jonikas and Solomon, 1992). These are relatively new and field evaluations are rare or have only recently been initiated (Cook and Razzano, 1992; Cook, 1992). Most of the early attempts to evaluate such programs have naturally focused almost exclusively on employment outcomes. However, theory suggests that sustained employment and living in the community may have important therapeutic benefits in addition to the obvious economic ones. To date, there have been no formal studies of the effects of psychiatric rehabilitation programs on key illness-related outcomes. To address this issue, this study seeks to examine the effects of a new program of supported employment on psychosocial outcomes for persons with SMI.
Over the past several decades, the theory of vocational rehabilitation has experienced two major stages of evolution. Original models of vocational rehabilitation were based on the idea of sheltered workshop employment. Clients were paid a piece rate and worked only with other individuals who were disabled. Sheltered workshops tended to be "end points" for persons with severe and profound mental retardation since few ever moved from sheltered to competitive employment (Woest, Klein & Atkins, 1986). Controlled studies of sheltered workshop performance of persons with mental illness suggested only minimal success (Griffiths, 1974) and other research indicated that persons with mental illness earned lower wages, presented more behavior problems, and showed poorer workshop attendance than workers with other disabilities (Whitehead, 1977; Ciardiello, 1981).
In the 1980s, a new model of services called Supported Employment (SE) was proposed as less expensive and more normalizing for persons undergoing rehabilitation (Wehman, 1985). The SE model emphasizes first locating a job in an integrated setting for minimum wage or above, and then placing the person on the job and providing the training and support services needed to remain employed (Wehman, 1985). Services such as individualized job development, one-on-one job coaching, advocacy with co-workers and employers, and "fading" support were found to be effective in maintaining employment for individuals with severe and profound mental retardation (Revell, Wehman & Arnold, 1984). The idea that this model could be generalized to persons with all types of severe disabilities, including severe mental illness, became commonly accepted (Chadsey-Rusch & Rusch, 1986).
One of the more notable SE programs was developed at Thresholds, the site for the present study, which created a new staff position called the mobile job support worker (MJSW) and removed the common six month time limit for many placements. MJSWs provide ongoing, mobile support and intervention at or near the work site, even for jobs with high degrees of independence (Cook & Hoffschmidt, 1993). Time limits for many placements were removed so that clients could stay on as permanent employees if they and their employers wished. The suspension of time limits on job placements, along with MJSW support, became the basis of SE services delivered at Thresholds.
There are two key psychosocial outcome constructs of interest in this study. The first is the overall psychological functioning of the person with SMI. This would include the specification of severity of cognitive and affective symptomotology as well as the overall level of psychological functioning. The second is the level of self-reported self esteem of the person. This was measured both generally and with specific reference to employment.
The key hypothesis of this study is:
HO: A program of supported employment will result in either no change or negative effects on psychological functioning and self esteem.
which will be tested against the alternative:
HA: A program of supported employment will lead to positive effects on psychological functioning and self esteem.
The population of interest for this study is all adults with SMI residing in the U.S. in the early 1990s. The population that is accessible to this study consists of all persons who were clients of the Thresholds Agency in Chicago, Illinois between the dates of March 1, 1993 and February 28, 1995 who met the following criteria: 1) a history of severe mental illness (e.g., either schizophrenia, severe depression or manic-depression); 2) a willingness to achieve paid employment; 3) their primary diagnosis must not include chronic alcoholism or hard drug use; and 4) they must be 18 years of age or older. The sampling frame was obtained from records of the agency. Because of the large number of clients who pass through the agency each year (e.g., approximately 500 who meet the criteria) a simple random sample of 50% was chosen for inclusion in the study. This resulted in a sample size of 484 persons over the two-year course of the study.
On average, study participants were 30 years old and high school graduates (average education level = 13 years). The majority of participants (70%) were male. Most had never married (85%), few (2%) were currently married, and the remainder had been formerly married (13%). Just over half (51%) are African American, with the remainder Caucasian (43%) or other minority groups (6%). In terms of illness history, the members in the sample averaged 4 prior psychiatric hospitalizations and spent a lifetime average of 9 months as patients in psychiatric hospitals. The primary diagnoses were schizophrenia (42%) and severe chronic depression (37%). Participants had spent an average of almost two and one-half years (29 months) at the longest job they ever held.
While the study sample cannot be considered representative of the original population of interest, generalizability was not a primary goal -- the major purpose of this study was to determine whether a specific SE program could work in an accessible context. Any effects of SE evident in this study can be generalized to urban psychiatric agencies that are similar to Thresholds, have a similar clientele, and implement a similar program.
All but one of the measures used in this study are well-known instruments in the research literature on psychosocial functioning. All of the instruments were administered as part of a structured interview that an evaluation social worker had with study participants at regular intervals.
Two measures of psychological functioning were used. The Brief Psychiatric Rating Scale (BPRS)(Overall and Gorham, 1962) is an 18-item scale that measures perceived severity of symptoms ranging from "somatic concern" and "anxiety" to "depressive mood" and "disorientation." Ratings are given on a 0-to-6 Likert-type response scale where 0="not present" and 6="extremely severe" and the scale score is simply the sum of the 18 items. The Global Assessment Scale (GAS)(Endicott et al, 1976) is a single 1-to-100 rating on a scale where each ten-point increment has a detailed description of functioning (higher scores indicate better functioning). For instance, one would give a rating between 91-100 if the person showed "no symptoms, superior functioning..." and a value between 1-10 if the person "needs constant supervision..."
Two measures of self esteem were used. The first is the Rosenberg Self Esteem (RSE) Scale (Rosenberg, 1965), a 10-item scale rated on a 6-point response format where 1="strongly disagree" and 6="strongly agree" and there is no neutral point. The total score is simply the sum across the ten items, with five of the items being reversals. The second measure was developed explicitly for this study and was designed to measure the Employment Self Esteem (ESE) of a person with SMI. This is a 10-item scale that uses a 4-point response format where 1="strongly disagree" and 4="strongly agree" and there is no neutral point. The final ten items were selected from a pool of 97 original candidate items, based upon high item-total score correlations and a judgment of face validity by a panel of three psychologists. This instrument was deliberately kept simple -- a shorter response scale and no reversal items -- because of the difficulties associated with measuring a population with SMI. The entire instrument is provided in Appendix A.
All four of the measures evidenced strong reliability and validity. Internal consistency reliability estimates using Cronbach's alpha ranged from .76 for ESE to .88 for SE. Test-retest reliabilities were nearly as high, ranging from .72 for ESE to .83 for the BPRS. Convergent validity was evidenced by the correlations within construct. For the two psychological functioning scales the correlation was .68 while for the self esteem measures it was somewhat lower at .57. Discriminant validity was examined by looking at the cross-construct correlations which ranged from .18 (BPRS-ESE) to .41 (GAS-SE).
A pretest-posttest two-group randomized experimental design was used in this study. In notational form, the design can be depicted as:
R O X O
R O O
R = the groups were randomly assigned
O = the four measures (i.e., BPRS, GAS, RSE, and ESE)
X = supported employment
The comparison group received the standard Thresholds protocol which emphasized in-house training in life skills and employment in an in-house sheltered workshop. All participants were measured at intake (pretest) and at three months after intake (posttest).
This type of randomized experimental design is generally strong in internal validity. It rules out threats of history, maturation, testing, instrumentation, mortality and selection interactions. Its primary weaknesses are in the potential for treatment-related mortality (i.e., a type of selection-mortality) and for problems that result from the reactions of participants and administrators to knowledge of the varying experimental conditions. In this study, the drop-out rate was 4% (N=9) for the control group and 5% (N=13) in the treatment group. Because these rates are low and are approximately equal in each group, it is not plausible that there is differential mortality. There is a possibility that there were some deleterious effects due to participant knowledge of the other group's existence (e.g., compensatory rivalry, resentful demoralization). Staff were debriefed at several points throughout the study and were explicitly asked about such issues. There were no reports of any apparent negative feelings from the participants in this regard. Nor is it plausible that staff might have equalized conditions between the two groups. Staff were given extensive training and were monitored throughout the course of the study. Overall, this study can be considered strong with respect to internal validity.
Between 3/1/93 and 2/28/95 each person admitted to Thresholds who met the study inclusion criteria was immediately assigned a random number that gave them a 50/50 chance of being selected into the study sample. For those selected, the purpose of the study was explained, including the nature of the two treatments, and the need for and use of random assignment. Participants were assured confidentiality and were given an opportunity to decline to participate in the study. Only 7 people (out of 491) refused to participate. At intake, each selected sample member was assigned a random number giving them a 50/50 chance of being assigned to either the Supported Employment condition or the standard in-agency sheltered workshop. In addition, all study participants were given the four measures at intake.
All participants spent the initial two weeks in the program in training and orientation. This consisted of life skill training (e.g., handling money, getting around, cooking and nutrition) and job preparation (employee roles, coping strategies). At the end of that period, each participant was assigned to a job site -- at the agency sheltered workshop for those in the control condition, and to an outside employer if in the Supported Employment group. Control participants were expected to work full-time at the sheltered workshop for a three-month period, at which point they were posttested and given an opportunity to obtain outside employment (either Supported Employment or not). The Supported Employment participants were each assigned a case worker -- called a Mobile Job Support Worker (MJSW) -- who met with the person at the job site two times per week for an hour each time. The MJSW could provide any support or assistance deemed necessary to help the person cope with job stress, including counseling or working beside the person for short periods of time. In addition, the MJSW was always accessible by cellular telephone, and could be called by the participant or the employer at any time. At the end of three months, each participant was post-tested and given the option of staying with their current job (with or without Supported Employment) or moving to the sheltered workshop.
There were 484 participants in the final sample for this study, 242 in each treatment. There were 9 drop-outs from the control group and 13 from the treatment group, leaving a total of 233 and 229 in each group respectively from whom both pretest and posttest were obtained. Due to unexpected difficulties in coping with job stress, 19 Supported Employment participants had to be transferred into the sheltered workshop prior to the posttest. In all 19 cases, no one was transferred prior to week 6 of employment, and 15 were transferred after week 8. In all analyses, these cases were included with the Supported Employment group (intent-to-treat analysis) yielding treatment effect estimates that are likely to be conservative.
The major results for the four outcome measures are shown in Figure 1.
Insert Figure 1 about here
It is immediately apparent that in all four cases the null hypothesis has to be accepted -- contrary to expectations, Supported Employment cases did significantly worse on all four outcomes than did control participants.
The mean gains, standard deviations, sample sizes and t-values (t-test for differences in average gain) are shown for the four outcome measures in Table 1.
Insert Table 1 about here
The results in the table confirm the impressions in the figures. Note that all t-values are negative except for the BPRS where high scores indicate greater severity of illness. For all four outcomes, the t-values were statistically significant (p<.05).
The results of this study were clearly contrary to initial expectations. The alternative hypothesis suggested that SE participants would show improved psychological functioning and self esteem after three months of employment. Exactly the reverse happened -- SE participants showed significantly worse psychological functioning and self esteem.
There are two major possible explanations for this outcome pattern. First, it seems reasonable that there might be a delayed positive or "boomerang" effect of employment outside of a sheltered setting. SE cases may have to go through an initial difficult period of adjustment (longer than three months) before positive effects become apparent. This "you have to get worse before you get better" theory is commonly held in other treatment-contexts like drug addiction and alcoholism. But a second explanation seems more plausible -- that people working full-time jobs in real-world settings are almost certainly going to be under greater stress and experience more negative outcomes than those who work in the relatively safe confines of an in-agency sheltered workshop. Put more succinctly, the lesson here might very well be that work is hard. Sheltered workshops are generally very nurturing work environments where virtually all employees share similar illness histories and where expectations about productivity are relatively low. In contrast, getting a job at a local hamburger shop or as a shipping clerk puts the person in contact with co-workers who may not be sympathetic to their histories or forgiving with respect to low productivity. This second explanation seems even more plausible in the wake of informal debriefing sessions held as focus groups with the staff and selected research participants. It was clear in the discussion that SE persons experienced significantly higher job stress levels and more negative consequences. However, most of them also felt that the experience was a good one overall and that even their "normal" co-workers "hated their jobs" most of the time.
One lesson we might take from this study is that much of our contemporary theory in psychiatric rehabilitation is naive at best and, in some cases, may be seriously misleading. Theory led us to believe that outside work was a "good" thing that would naturally lead to "good" outcomes like increased psychological functioning and self esteem. But for most people (SMI or not) work is at best tolerable, especially for the types of low-paying service jobs available to study participants. While people with SMI may not function as well or have high self esteem, we should balance this with the desire they may have to "be like other people" including struggling with the vagaries of life and work that others struggle with.
Future research in this are needs to address the theoretical assumptions about employment outcomes for persons with SMI. It is especially important that attempts to replicate this study also try to measure how SE participants feel about the decision to work, even if traditional outcome indicators suffer. It may very well be that negative outcomes on traditional indicators can be associated with a "positive" impact for the participants and for the society as a whole.
Chadsey-Rusch, J. and Rusch, F.R. (1986). The ecology of the workplace. In J. Chadsey-Rusch, C. Haney-Maxwell, L. A. Phelps and F. R. Rusch (Eds.), School-to-Work Transition Issues and Models. (pp. 59-94), Champaign IL: Transition Institute at Illinois.
Ciardiello, J.A. (1981). Job placement success of schizophrenic clients in sheltered workshop programs. Vocational Evaluation and Work Adjustment Bulletin, 14, 125-128, 140.
Cook, J.A. (1992). Job ending among youth and adults with severe mental illness. Journal of Mental Health Administration, 19(2), 158-169.
Cook, J.A. & Hoffschmidt, S. (1993). Psychosocial rehabilitation programming: A comprehensive model for the 1990's. In R.W. Flexer and P. Solomon (Eds.), Social and Community Support for People with Severe Mental Disabilities: Service Integration in Rehabilitation and Mental Health. Andover, MA: Andover Publishing.
Cook, J.A., Jonikas, J., & Solomon, M. (1992). Models of vocational rehabilitation for youth and adults with severe mental illness. American Rehabilitation, 18, 3, 6-32.
Cook, J.A. & Razzano, L. (1992). Natural vocational supports for persons with severe mental illness: Thresholds Supported Competitive Employment Program, in L. Stein (ed.), New Directions for Mental Health Services, San Francisco: Jossey-Bass, 56, 23-41.
Endicott, J.R., Spitzer, J.L. Fleiss, J.L. and Cohen, J. (1976). The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766-771.
Griffiths, R.D. (1974). Rehabilitation of chronic psychotic patients. Psychological Medicine, 4, 316-325.
Overall, J. E. and Gorham, D. R. (1962). The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799-812.
Rosenberg, M. (1965). Society and Adolescent Self Image. Princeton, NJ, Princeton University Press.
Wehman, P. (1985). Supported competitive employment for persons with severe disabilities. In P. McCarthy, J. Everson, S. Monn & M. Barcus (Eds.), School-to-Work Transition for Youth with Severe Disabilities, (pp. 167-182), Richmond VA: Virginia Commonwealth University.
Whitehead, C.W. (1977). Sheltered Workshop Study: A Nationwide Report on Sheltered Workshops and their Employment of Handicapped Individuals. (Workshop Survey, Volume 1), U.S. Department of Labor Service Publication. Washington, DC: U.S. Government Printing Office.
Woest, J., Klein, M. and Atkins, B.J. (1986). An overview of supported employment strategies. Journal of Rehabilitation Administration, 10(4), 130-135.
Table 1. Means, standard deviations and Ns for the pretest, posttest and gain scores for the four outcome variables and t-test for difference between average gains.
Figure 1. Pretest and posttest means for treatment (SE) and control groups for the four outcome measures.
The Employment Self Esteem Scale
Please rate how strongly you agree or disagree with each of the following statements.
|1. I feel good about my work on the job.|
|2. On the whole, I get along well with others at work.|
|3. I am proud of my ability to cope with difficulties at work.|
|4. When I feel uncomfortable at work, I know how to handle it.|
|5. I can tell that other people at work are glad to have me there.|
|6. I know I'll be able to cope with work for as long as I want.|
|7. I am proud of my relationship with my supervisor at work.|
|8. I am confident that I can handle my job without constant assistance.|
|9. I feel like I make a useful contribution at work.|
|10. I can tell that my co-workers respect me.|
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