Pilot Project 2
Addressing Vocational Problems Before Job Loss: A Pilot Study of Supported Employment Engage and Keep (SEEK) for Employed Veterans with Psychiatric Disabilities and Vocational Problems
Employment is central to community reintegration. Unfortunately, the employment rate for adults with psychiatric disabilities is very low. To address this problem, governmental agencies, including the VA, have invested heavily in vocational services. In each of its medical centers, the VHA provides supported employment services, an evidence-based model designed to help unemployed adults obtain jobs and become steady workers. However, the VA currently has no vocational services designed for early intervention with individuals who are employed but experiencing difficulties on the job. In fact, virtually all vocational services models for individuals with serious mental illness, as well as the research studies that evaluate them, tend to focus on unemployed adults with years of unemployment, underemployment, and/or multiple job failures.
Many Veterans with mental illness experience work problems related to clinical symptoms and/or have difficulty managing the competing demands of clinical care and work requirements. Evidence from a recent VA study suggests that 80% of such Veterans eventually lose their jobs and then are unemployed for years before seeking vocational rehabilitation services. By that time, the Veteran has experienced the direct impact of lost income, has lost the valued role of worker, and has little confidence in his or her ability to work. SEEK is designed to help Veterans with SMI to retain employment and to continue to be productive members of the community. It provides early intervention at the time that they begin to experience vocational problems secondary to their clinical needs.
The goal of this pilot project is to develop and test the feasibility and acceptability of “Supported Employment—Engage and Keep” (SEEK), an early intervention designed to prevent job loss among Veterans with psychiatric disabilities who are employed, but experiencing vocational problems. The SEEK model is adapted from the Individual Placement and Support model of supported employment (IPS SE). We expect the key advantages of SEEK to be that: (a) it helps Veterans maintain valued jobs, avoiding the monetary, social and psychological costs that accompany job loss and the long process back to valued jobs; and (b) it reduces the likelihood of unemployment, and thus the intensity of the services needed to reach a positive outcome. This service model could be particularly advantageous for OEF/OIF/OND Veterans who are more likely to be early in the progression of vocational problems and it could potentially reduce eventual costs to the VA.
The primary research aims of this pilot study are 1) to develop a SEEK manual for providing supported employment services to employed Veterans with who are at risk of job loss due to vocational problems and 2) to pilot test the SEEK model. Pilot testing will assess the feasibility and acceptablility of this newly designed vocational rehabilitation intervention. We will explore the preliminary effects of SEEK on job retention, income, work self-efficacy, job satisfaction, social relationships, quality of life and community integration. First we will conduct an open trial with 10 veterans who are employed but experiencing work problems related to SMI. We will then conduct a randomized controlled pilot study with 50 veterans to compare SEEK to a drop-in support group for discussing vocational problems. The pilot study will gather feasibility and acceptability data of the SEEK intervention. (e.g., recruitment and retention rates, Veteran, provider, family and employer acceptance, fidelity monitoring, and treatment adherence). We expect to find that veterans who receive SEEK services have longer job tenure, work more weeks overall, have higher income, have greater productivity, self-efficacy and satisfaction related to work, and have better social relationships, quality of life and community integration.
