Improving Vocational Outcomes of Veterans With Psychiatric Disorders: Career Counseling & Development
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 67
- 试验地点
- 1
- 主要终点
- Client Satisfaction Questionnaire-8 (CSQ-8)
研究概览
简要总结
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.
详细描述
AIM 1: Develop a career counseling and development treatment manual for Veterans with psychiatric disorders (i.e., Purposeful Pathways) along with a fidelity monitoring checklist based on veteran and provider needs assessment (n=16).
Procedures. Manual development will be an iterative process that spans over Aim 1 and Aim 2 (Open Trial) and will include: 1) reviewing clinical procedures and interventions of the Vocational Evaluation Center (VEC) for career counseling and development in vocational rehabilitation, related treatment manuals (Opening Doors), and relevant career development theory; 2) conducting veteran and provider focus groups to gather perspectives on necessary treatment components; 3) developing a preliminary version of the manual through a two-day retreat attended by key CDA-2 mentors and consultants, and 4) revising the manual based on mentor, provider, and veteran feedback. A fidelity monitoring checklist will also be developed to monitor treatment adherence of clinicians implementing the Purposeful Pathways protocol. The fidelity monitoring checklist will be used in Aim 2 and Aim 3 of this study to monitor treatment adherence of the study clinicians.
Needs Assessment Focus Groups. Two focus groups will be conducted with veterans (n=8), and two focus groups will be conducted with mental health providers (n=8) with knowledge in vocational rehabilitation practice (psychologists, social workers, and vocational rehabilitation specialists). The providers will be recruited from outside the Bedford VA to capture perspectives from clinicians who are not familiar with the Bedford VA Vocational Evaluation Center. Half of veteran participants will be recruited from currently enrolled TWE veterans. The other half of veteran participants will be individuals who previously participated in TWE and were unsuccessful in obtaining employment. Focus groups will be 90 minutes, and will be audio recorded for future transcription and analysis with NVIVO. Transcription will be completed by a VA approved contractor.
A qualitative interview guide drawing upon Psychology of Working theory, protocol developed through the Vocational Evaluation Center (VEC) as well as the Opening Doors manual when conducting provider and veteran focus groups. Overall, the goal is to gain an unfiltered perspective on career development and factors related to successful vocational recovery, while also querying on aspects of existing practices An open-ended interview guide consisting of open-ended questions will focus on 1) barriers, potential solutions, and perceived needs to promote successful career outcomes among veterans with psychiatric disorders; 2) obtain feedback on the useful elements of Psychology of Working theory, as well as the VEC and Opening Doors protocols as it relates to their clinical experience/expertise; 3) explore issues related to augmenting VA vocational services with career counseling and development interventions.
The purpose of the veteran focus groups are to gather personal accounts from people with lived experience on career development/vocational recovery, and to connect that to the best available research and clinical practice to inform treatment development. The qualitative interview guide will consist of open-ended questions to gather the following information: 1) barriers, potential solutions, and perceived needs to promote successful career outcomes among veterans with psychiatric disorders; 2) obtain feedback on the useful elements of Psychology of Working theory, as well as the VEC and Opening Doors protocols as it relates to their lived experiences; 3) gather information regarding preferred methods of implementation of adjunctive career counseling and development services.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •1) eligibility for, and planning to enroll in TW, or within 16 weeks of having enrolled in TW, 2) the presence of a current psychiatric disorder of PTSD, Mood Disorders (e.g., Bipolar Disorders, Major Depression), Anxiety-Related Disorders (e.g., Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Obsessive Compulsive Disorder), Psychotic Disorders (e.g., Schizophrenia, Schizoaffective Disorder), Substance Use Disorders (e.g., Alcohol, Opioid, Cannabis, Cocaine, Sedative, Hypnotic, or Anxiolytic, Other Stimulants), which is indicated by an ICD-10 diagnosis encounter in the participants VA medical record within the last six months, inputted by a licensed mental health provider (psychiatrist, psychologist, licensed clinical social worker, psychiatric nurse practitioner), 3) self-identification as either unemployed, underemployed (self-report of falling into one of five categories: overeducated, job-education mismatch, skill underutilization, being involuntarily engaged in part-time, temporary, or intermittent employment [i.e., hours underemployed], or earning wages in a job that are 20% less compared to a previous job, or for recent college graduates, earning wages that are 20% less compared to graduating peers of similar education/training [i.e., pay underemployment]. [13]), or self-report that they are employed but functioning poorly at work as a result of mental illness or substance use, 4) self-identification as not being on leave from a job for which there are arrangements to return to their job following the completion of TW, 5) having plans to work for three years beyond the end of this study, and 6) competency to provide written informed consent.
排除标准
- •1) acute suicide/homicide risk requiring treatment focused on safety to self or others based on self-report of current and active thoughts of harm to self or others with intent and plan that requires crisis stabilization in an acute psychiatric unit, 2) being not otherwise eligible for TW services, 3) current enrollment in CWT's supported employment services, 4) Symptom Checklist-6 [14] score greater than 26, 5) Veterans RAND-12 (VR-12) physical component score [15] less than 12, and VR-12 mental composite score [15] less than 8, 6) improbability that participant will complete the study for the following reasons: expected deployment, expected incarceration, expected long-term hospitalization, or expected relocation from the vicinity of the participating VA during the study period, and 7) unwillingness to engage in a weekly career development intervention.
研究组 & 干预措施
CCD-V Group
Veterans in this arm will receive treatment as usual, which is transitional work experience intervention, as well as the CCD-V intervention
干预措施: Purposeful Pathways (Behavioral)
CCD-V Group
Veterans in this arm will receive treatment as usual, which is transitional work experience intervention, as well as the CCD-V intervention
干预措施: Transitional Work Experience (Behavioral)
Treatment as Usual
Veterans in this arm will receive treatment as usual, which is transitional work experience intervention.
干预措施: Transitional Work Experience (Behavioral)
结局指标
主要结局
Client Satisfaction Questionnaire-8 (CSQ-8)
时间窗: through study completion, an average of 1 year
The Client Satisfaction Questionnaire-8 (CSQ-8) will be used to measure satisfaction, perceived quality, and effectiveness of the treatment. This self-report questionnaire consists of eight items, scored 1 to 4, with higher scores indicating higher satisfaction with treatment.
次要结局
- Career Adapt-Abilities Scale (CAAS)(through study completion, an average of 1 year)
- Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form (Q-LES-Q - SF)(through study completion, an average of 1 year)
- Work Needs Satisfaction Scales (WNSS)(through study completion, an average of 1 year)
- Sheehan Disability Scale (SDS)(through study completion, an average of 1 year)
- Vocational Identity Scale (VIS)(through study completion, an average of 1 year)
- Decent Work Scale (DWS)(through study completion, an average of 1 year)
- Job-Search Intensity Scale (JSIS)(through study completion, an average of 1 year)
- Work Confidence and Importance(through study completion, an average of 1 year)