Career Counseling for Mental Illness

Recruiting at 1 trial location

Overseen By Brian J Stevenson, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Acute suicide/homicide risk, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

76 Participants Needed

Trial Summary

What is the purpose of this trial?

The Veterans Health Administration (VHA) offers robust vocational programming that have helped countless Veterans obtain competitive employment; however, these services are not uniformly effective as recent data suggests that only 35 to 43% of Veterans are competitively employed at time of discharge. For those who become competitively employed, job tenure may be brief, which is often attenuated by underemployment or poor person-job fit. Moreover, only 3.5% of Veterans experiencing vocational problems engage in vocational services offered by the VHA. On average, it takes Veterans more than four years to utilize vocational services. These Veterans are at high risk of acquiring multiple functional losses and developing chronic disabilities as their vocational needs go unmet for years. Research suggests that intrinsic factors like lacking clear vocational goals, perceiving barriers to employment, and negative beliefs about one's ability to work contribute to low engagement, outcomes, and tenure of some consumers of vocational rehabilitation services. Thus, the VA may be able to improve vocational engagement, outcomes, and tenure of Veterans with psychiatric disorders by enhancing vocational services with added interventions targeting unhelpful psychological factors. Career counseling and development services have been shown to be effective in helping civilian populations clarify vocational goals and identity, enhance vocational self-efficacy, and increase proactive vocational behaviors in the face of obstacles. Additionally, career counseling and development services help facilitate greater "match" between a person and their job, and person-job match is a key determinant of long-term career tenure among individual with psychiatric disorders. The researchers of this project propose a three-aim study to develop a career counseling and development intervention for Veterans with psychiatric disorders (Purposeful Pathways). The first aim will focus on the design and development of the Purposeful Pathways intervention with veteran and provider input (n=16). The second aim will pilot test the intervention in an open trial (n=10) to gather Veteran input on the initial intervention. The third and final aim will consist of a feasibility pilot randomized controlled trial (n=50) to examine acceptability and feasibility outcomes and to explore the impact of the Purposeful Pathways intervention in terms of functional improvement and other vocational outcomes. Purposeful Pathways consists of up to 12 individual sessions that will be offered concurrently with existing VHA vocational rehabilitation services, (e.g., transitional work experience \[TWE\]). The final product of this study is to produce a manual of Purposeful Pathways, and corresponding fidelity monitoring checklist, to be tested later in a larger efficacy trial.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on career counseling and development, so it's likely you can continue your current treatments, but you should confirm with the trial coordinators.

What data supports the effectiveness of the treatment Career Counseling & Development for Veterans?

Research shows that veterans with mental health conditions have a strong desire for career development services to help them find meaningful employment. Although specific programs like Purposeful Pathways are still being developed, studies highlight the importance of integrating vocational services into mental health care, which can support veterans in achieving their career goals. ^{1 2 3 4 5}

How is the Career Counseling & Development for Veterans treatment different from other treatments for mental illness?

This treatment is unique because it specifically addresses the career development needs of veterans with mental health conditions, offering tailored support to help them find meaningful employment, which is not typically the focus of standard mental health treatments. ^{1 2 6 7 8}

Research Team

Brian J Stevenson, PhD

Principal Investigator

VA Bedford HealthCare System, Bedford, MA

Eligibility Criteria

This trial is for Veterans with psychiatric disorders like PTSD, mood or anxiety-related disorders, psychotic disorders, substance use disorders who are unemployed or struggling at work due to their condition. They must plan to work for three years post-study and be eligible for Transitional Work Experience (TWE). Those at acute risk of harm to self/others, currently in supported employment services, or unlikely to complete the study due to deployment/incarceration/hospitalization/relocation are excluded.

Inclusion Criteria

Eligibility for, and planning to enroll in TW, or within 16 weeks of having enrolled in TW

I am mentally capable of understanding and signing a consent form.

Self-identification as either unemployed, underemployed, or employed but functioning poorly at work as a result of mental illness or substance use

Exclusion Criteria

Not otherwise eligible for TW services

I am not willing to participate in weekly career development sessions.

Your score on the Symptom Checklist-6 is higher than 26.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Development

Develop a career counseling and development treatment manual for Veterans with psychiatric disorders

Several months

Pilot Testing

Pilot test the manual by treating a small number of Veterans in an open trial

8 weeks

Randomized Controlled Trial

Conduct a randomized controlled pilot study comparing Purposeful Pathways to treatment as usual

3 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 months

Treatment Details

Interventions

• Career Counseling & Development for Veterans
• Transitional Work Experience

Trial Overview The 'Purposeful Pathways' intervention is being tested alongside existing VHA vocational rehabilitation services. It includes up to 12 individual sessions aimed at improving job fit and tenure by addressing psychological barriers. The study will develop this intervention with veteran input and test its feasibility and impact on functional improvement in a small randomized controlled trial.

Participant Groups

Group I: CCD-V Group Experimental Treatment 2 Interventions

Veterans in this arm will receive treatment as usual, which is transitional work experience intervention, as well as the CCD-V intervention

Group II: Treatment as Usual Active Control 1 Intervention

Veterans in this arm will receive treatment as usual, which is transitional work experience intervention.

Career Counseling & Development for Veterans is already approved in United States for the following indications:

Approved in United States as Vocational Rehabilitation and Employment (VR&E) for:

• Psychiatric Disorders
• Vocational Rehabilitation

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

The Purposeful Pathways intervention is designed specifically for veterans with psychiatric disorders to enhance their career development and is currently being evaluated for feasibility and acceptability in a pilot study involving 50 participants.

This study will assess various outcomes, including vocational functioning and mental health, over a 12-week period, with data collection expected to be completed by February 2026, providing valuable insights into the effectiveness of tailored career counseling for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of a Career Development Intervention for Veterans in Vocational Rehabilitation: Protocol for a Pilot Randomized Controlled Trial. Stevenson, B., Teravainen, T., Kathawalla, UK., et al.[2023]

Veterans with mental health conditions have strong career aspirations and seek support tailored to their interests, highlighting a gap in effective career development models for this population.

The study, involving 13 veterans and vocational counselors, identified key barriers and recommended strategies for enhancing career development, providing valuable insights for researchers and practitioners in the field.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Career Development in Transitional Work Settings: A Qualitative Investigation Among Veterans and Vocational Counselors. Stevenson, BJ., Kathawalla, U., Smith, C., et al.[2023]

Project WINS integrates vocational services into case management teams, employing both Vocational Specialists and Peer Support Specialists to enhance employment opportunities for individuals with psychiatric conditions.

The program aims to improve client outcomes in both mental health and vocational areas, although it faces challenges and barriers in its implementation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Project WINS: integrating vocational services on mental health case management teams. Mowbray, CT., Rusilowski-Clover, G., Arnold, J., et al.[2019]

The Motivational Aftercare Planning (MAP) intervention significantly changed the focus of mental health recovery plans from clinical stability and symptom management to promoting general wellness and social connections, based on a qualitative analysis of 110 recovery plans.

The shift in language from third to first person in the recovery plans indicates a greater emphasis on consumer involvement and personal agency in the recovery process, suggesting that MAP may enhance collaboration between consumers and clinicians.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The language we use - the effect of writing mental health care plans in the first person. Wyder, M., Kisely, S., Meurk, C., et al.[2019]

The Successful Living skills training group, designed for chronic mental patients at a Veterans Administration hospital, effectively helps participants set and achieve personal goals through behavioral rehearsal and homework assignments.

Out of 22 initial participants, 88% completed their homework assignments, leading to positive outcomes for 49% of the total assignments, demonstrating a strong desire for social change among chronic patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Successful living: a social skills and problem-solving group for the chronic mentally ill. Hierholzer, RW., Liberman, RP.[2019]

A survey of 233 vocational providers in the Veterans Health Administration revealed that job development practices are perceived as difficult, with an average of only 11 employer contacts made every two weeks, mostly through face-to-face interactions.

Effective job development strategies identified include an employer-focused approach, targeted marketing, genuine interpersonal engagement, and tailored communication techniques, which can enhance the success of job placements for veterans with mental illness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Helping veterans achieve work: A Veterans Health Administration nationwide survey examining effective job development practices in the community. Kukla, M., McGuire, AB., Strasburger, AM., et al.[2018]

A study involving 76 adults with serious mental illness revealed that their perspectives on work align with key concepts of social cognitive career theory (SCCT), suggesting that this theory can inform vocational services for this population.

The research identified important factors influencing work-related self-efficacy, such as personal accomplishments and social support, indicating that addressing these factors could enhance vocational outcomes for individuals with mental illness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring the work lives of adults with serious mental illness from a vocational psychology perspective. Millner, UC., Rogers, ES., Bloch, P., et al.[2018]

A new vocational potential assessment tool and counselling module for individuals with severe mental disorders was developed and validated through input from 38 stakeholders, including patients, caregivers, and mental health professionals.

The tool is user-friendly, requiring about 45 minutes to 1 hour for assessment, and includes a scoring key to assist professionals in evaluating vocational potential effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of vocational potential assessment tool and counseling module for persons with severe mental disorders. Harish, N., Jagannathan, A., Kumar, CN., et al.[2020]

References

1. Canada pubmed.ncbi.nlm.nih.gov

Feasibility of a Career Development Intervention for Veterans in Vocational Rehabilitation: Protocol for a Pilot Randomized Controlled Trial. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Career Development in Transitional Work Settings: A Qualitative Investigation Among Veterans and Vocational Counselors. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Project WINS: integrating vocational services on mental health case management teams. [2019]

4. England pubmed.ncbi.nlm.nih.gov

The language we use - the effect of writing mental health care plans in the first person. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Successful living: a social skills and problem-solving group for the chronic mentally ill. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Helping veterans achieve work: A Veterans Health Administration nationwide survey examining effective job development practices in the community. [2018]

7. United States pubmed.ncbi.nlm.nih.gov

Exploring the work lives of adults with serious mental illness from a vocational psychology perspective. [2018]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Development of vocational potential assessment tool and counseling module for persons with severe mental disorders. [2020]