Clinical Research Directory

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

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.

Promoting Employment in Persons Living With HIV/AIDS

Many persons living with HIV/AIDS (PLWHA) are unemployed, with estimates indicating rates as high as 60%. This study will examine the efficacy of reinforcing job-acquisition activities for improving employment outcomes in PLWHA who desire to return to the workforce in part- or full-time capacity. In total, this study will randomly assign 144 unemployed PLWHA to one of two interventions. All participants will receive usual unemployment services with an emphasis on specific issues related to HIV/AIDS, plus encouragement for completing activities geared toward employment readiness and acquisition. The enhanced intervention will involve that same treatment plus chances to win prizes for engaging in job-related activities each week. Participants will receive study treatments for 16 weeks and complete follow-up evaluations throughout 18 months. The hypothesis is that participants reinforced for completing job-related activities will transition to employment at higher and faster rates and work more often than those who are not reinforced for job-related activities.