Evaluating the Efficacy of a Vocational Counseling Intervention to Improve Occupational Functioning and Employment Quality Among Veterans With Mental Health and Substance Use Disorders

NCT07097376 | Not Yet Recruiting DMC

• 1 other identifier: RRD4-001-24W
• Study Type: interventional
• Target: 254
• Locations: 1 country
• Sites: 3

Brief Summary

Veterans living with mental health and substance use conditions are at risk of unemployment, which leads to significant health-related consequences. Though the Veterans Health Administration offers numerous vocational rehabilitation programs to address unemployment, they are not uniformly effective for everyone who participates. This project will test a new model for addressing Veteran unemployment. This new model adds career development services (a vocational counseling program called Purposeful Pathways) to a standard model of vocational rehabilitation (a program called Transitional Work \[TW\]). The investigators will test if adding Purposeful Pathways to TW leads to more Veterans working in quality jobs as well as better quality of life, reduced mental health symptoms, and reduced substance use. This project fills a critical need in advancing research and practice aimed at reducing Veteran unemployment; thereby preventing consequences to Veteran's economic, social, and health related functioning and well-being. The investigators will conduct a phase II, multi-site, RCT comparing Purposeful Pathways + TW (n=127) to TW alone (n=127) among Veterans participating in TW at VA Bedford, VA Hines, and VA North Texas. Aim 1: Evaluate the efficacy of Purposeful Pathways for improving occupational functioning (primary outcome). Hypothesis: Purposeful Pathways + TW, compared to TW only, will improve occupational functioning. Aim 2: Evaluate the efficacy of Purposeful Pathways for improving quality of life, and reducing mental health symptoms and substance use (secondary outcomes). Hypothesis: Purposeful Pathways + TW, compared to TW only, will improve quality of life, and reduce mental health symptoms and substance use. Aim 3 (Exploratory): Explore whether occupational functioning (competitive employment attainment) in the Purposeful Pathways + TW group is mediated by vocational identity, work hope, self-regulation, and/or employment motivation, key factors central to the Purposeful Pathways intervention.

Conditions

Unemployment

Keywords

rehabilitation, vocational

Outcome Measures

Primary Outcomes (6)

• Number of Participants with Competitive Employment

  Number of participants who were competitively employed at any point over the previous month. We define competitive employment as a non-sheltered job that earns salary, wages, or commission, excluding military drill and transient cash-based jobs, such as yard work, babysitting, and manual day labor.

  through study completion, an average of 15 months

• Number of days worked

  The number of days worked in competitive employment over the past month

  through study completion, an average of 15 months

• Total hours worked

  The number of hours worked in competitive employment during previous month

  through study completion, an average of 15 months

• Income earned

  Total wages from competitive employment earned over the past month

  through study completion, an average of 15 months

• Career Adapt-Ability Scale

  One's functional abilities/strengths to successfully manage career-related tasks. Possible scores range from 24 - 120, with greater scores indicating greater career adaptability functioning.

  through study completion, an average of 15 months

• Positive Meaning Scale of the Work as Meaning Inventory

  Degree to which someone perceives their work as meaningful. Scores range from 4 - 28, with higher scores representing greater levels of meaningful work.

  through study completion, an average of 15 months

Secondary Outcomes (10)

• Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form

  through study completion, an average of 15 months

• Patient Health Questionnaire-9

  through study completion, an average of 15 months

• Alcohol misuse

  through study completion, an average of 15 months

• Marijuana misuse

  through study completion, an average of 15 months

• Cocaine, crack, or methamphetamine misuse

  through study completion, an average of 15 months

Other Outcomes (6)

• Vocational identity scale

  through study completion, an average of 15 months

• Work Beliefs Scale

  through study completion, an average of 15 months

• Short Self-Regulation Questionnaire

  through study completion, an average of 15 months

Study Arms (2)

Purposeful Pathways

EXPERIMENTAL

Participants in this arm will receive treatment as usual, which is the transitional work intervention, as well as the Purposeful Pathways intervention

Behavioral: Purposeful Pathways; Other: Transitional Work

Treatment as usual

ACTIVE COMPARATOR

Participants in this arm will receive treatment as usual, which is the transitional work intervention.

Other: Transitional Work

Interventions

Transitional Work OTHER

Provides individuals 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. TW is time-limited. TW is staffed by vocational rehabilitation specialists (VRS).

Also known as: CWT

Purposeful Pathways; Treatment as usual

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.

Purposeful Pathways

Eligibility Criteria

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

You may qualify if:

• enrolled in VHA TW at one of the three VA recruitment sites
• be unemployed
• report interest/intention to return to paid work within the upcoming three years
• presence of a psychiatric disorder as indicated by documented ICD-10 diagnosis (mental health disorder and/or substance use disorder) addressed in an encounter at VHA within the 24 months preceding study enrollment
• ages 18 and over
• willing to participate in weekly vocational counseling sessions

You may not qualify if:

• report a plan to remain unemployed during the upcoming 12 months
• report plans to retire within the next 12 months
• be currently retired
• be a full-time student
• enrolled in Supported Employment
• experiencing significantly elevated mental health symptoms as indicated by a score greater than 26 on the Symptom Checklist-6 (SCL-648)
• have a guardian or conservator

Sponsors & Collaborators

• VA Hines Health Care: collaborator
• VA Office of Research and Development: lead
• North Texas Veterans Healthcare System: collaborator

Study Sites (3)

Edward Hines Jr. VA Hospital, Hines, IL

Hines, Illinois, 60141-3030, United States

Location

VA Bedford HealthCare System, Bedford, MA

Bedford, Massachusetts, 01730-1114, United States

Location

VA North Texas Health Care System Dallas VA Medical Center, Dallas, TX

Dallas, Texas, 75216-7167, United States

Location

Study Officials

• Brian J Stevenson, PhD

  VA Bedford HealthCare System, Bedford, MA

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Brian J Stevenson, PhD

CONTACT

(718) 687-3919; Brian.Stevenson4@va.gov

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 will be randomly assigned to either a treatment as usual condition or to receive treatment as usual along with the additional intervention of Purposeful Pathways.

Study Record Dates

• First Submitted: July 16, 2025
• First Posted: July 31, 2025
• Study Start: May 1, 2026
• Primary Completion (Estimated): October 1, 2030
• Study Completion (Estimated): March 31, 2031
• Last Updated: February 9, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (3)