Improving Vocational Outcomes of Veterans With Psychiatric Disorders: Career Counseling & Development

NCT04698967 | Active Not Recruiting

• 1 other identifier: D3401-W
• Study Type: interventional
• Target: 67
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Unemployment

Keywords

rehabilitation, vocational

Outcome Measures

Primary Outcomes (1)

• Client Satisfaction Questionnaire-8 (CSQ-8)

  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.

  through study completion, an average of 1 year

Secondary Outcomes (8)

• Career Adapt-Abilities Scale (CAAS)

  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

• Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form (Q-LES-Q - SF)

  through study completion, an average of 1 year

• Vocational Identity Scale (VIS)

  through study completion, an average of 1 year

Study Arms (2)

CCD-V Group

EXPERIMENTAL

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

Behavioral: Purposeful Pathways; Behavioral: Transitional Work Experience

Treatment as Usual

ACTIVE COMPARATOR

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

Behavioral: Transitional Work Experience

Interventions

Purposeful Pathways BEHAVIORAL

Purposeful Pathways is a manualized intervention to assist veterans in aspiring and pursuing meaningful employment. Purposeful Pathways is an individual counseling protocol delivered weekly for up to 12 sessions (50 minutes per session) focused on career exploration, goal clarity, job-searching, and self-regulation.

CCD-V Group

Transitional Work Experience BEHAVIORAL

Provides Veterans with immediate access to a non-competitive, paid job contracted by the VA. Positions are typically housed within a VA hospital (e.g., housekeeping, grounds, kitchens, and construction), but are sometimes located in the community. TWE is time-limited. TWE is staffed by vocational rehabilitation specialists (VRS).

Also known as: TWE

CCD-V Group; Treatment as Usual

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• \) 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.

You may not qualify if:

• \) 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.

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (1)

VA Bedford HealthCare System, Bedford, MA

Bedford, Massachusetts, 01730-1114, United States

Location

Related Publications (3)

• Stevenson B, Teravainen T, Kathawalla UK, Singer M, Wilkins S, Mueller L, Kelly M, Ellison M, Shirk SD, Bakken S, Blustein D. Feasibility of a Career Development Intervention for Veterans in Vocational Rehabilitation: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc. 2023 Jun 30;12:e47986. doi: 10.2196/47986.

  PMID: 37389915 BACKGROUND

• Stevenson BJ, Kathawalla U, Smith C, Mueller L. Career Development in Transitional Work Settings: A Qualitative Investigation Among Veterans and Vocational Counselors. J Career Dev. 2023 Aug;50(4):947-964. doi: 10.1177/08948453221137344. Epub 2022 Oct 28.

  PMID: 37463233 RESULT

• Stevenson BJ, Reed C, Falcon A, Hunt T, Kathawalla UK, Mueller L, McNary K, Wilkins S, Blustein D. Purposeful Pathways: An Integrative Career Development Intervention for Vocational, Mental Health, and Substance Use Recovery. J Career Dev. 2025 Apr;52(2):214-235. doi: 10.1177/08948453241313192. Epub 2025 Jan 8.

  PMID: 40029607 RESULT

Study Officials

• Brian J Stevenson, PhD

  VA Bedford HealthCare System, Bedford, MA

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Model Details: Participants in Phase 3 will be randomly assigned to either a treatment as usual condition or to receive the additional intervention of Purposeful Pathways.

Study Record Dates

• First Submitted: November 30, 2020
• First Posted: January 7, 2021
• Study Start: April 1, 2021
• Primary Completion: September 30, 2025
• Study Completion: March 31, 2026
• Last Updated: February 17, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)