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OBJECTIVE: To determine the distinctions between the client-keyworker relationship and the client-vocational worker relationship by assessing their impact on clinical outcomes and exploring the associations between the two. METHODS: As part of an international randomised controlled trial of supported employment (n = 312), client-keyworker relationship and client-vocational worker relationship were each tested against clinical and social functioning 6 months later. Associations between the two relationships over time were explored. RESULTS: Client-keyworker relationship predicted quality of life, while client-vocational worker relationship, as rated by the client, did not predict any clinical or social functioning outcomes. Vocational worker-rated relationship predicted reduced depression. The client-keyworker and client-vocational worker relationships were correlated, but this did not change over time. CONCLUSION: The impact of the client-vocational worker is likely to be on the shared task of finding employment, rather than on clinical and social functioning. Good client-vocational worker relationships do not detract from client-keyworker relationships.

Original publication




Journal article


Soc Psychiatry Psychiatr Epidemiol

Publication Date





1187 - 1193


Adolescent, Adult, Community Mental Health Services, Employment, Supported, Follow-Up Studies, Humans, International Cooperation, Multicenter Studies as Topic, Patient Satisfaction, Physician-Patient Relations, Professional-Patient Relations, Prognosis, Psychiatric Status Rating Scales, Psychotic Disorders, Randomized Controlled Trials as Topic, Rehabilitation, Vocational, Social Support, Treatment Outcome