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

退伍军人健康管理局(VHA)提供了强大的职业规划，这有助于 无数退伍军人获得了有竞争力的就业；然而，这些服务并不是一致有效的，因为 最近的数据表明，只有35%到43%的退伍军人在退役时有竞争性就业。为 那些成为竞争性就业的人，工作期限可能很短，这通常会被 就业不足或人与工作的适合性差。此外，只有3.5%的退伍军人遇到职业问题 从事VHA提供的职业服务。平均而言，退伍军人需要四年以上的时间才能利用 职业服务。这些退伍军人具有获得多种功能丧失和发展的高风险 长期残疾，因为他们的职业需求多年来得不到满足。 研究表明，内在因素，如缺乏明确的职业目标，感知障碍 就业，以及对自己工作能力的负面看法，都会导致参与度、结果和 职业康复服务部分消费者的保有期。因此，VA可能能够改善 退伍军人精神障碍患者的职业参与度、结局和任期 增加针对无益心理因素的干预的服务。职业咨询和 发展服务被证明在帮助平民明确职业目标方面是有效的。 和认同感，增强职业自我效能感，增加面对 障碍。此外，职业咨询和发展服务有助于促进 人与其工作、人与工作的匹配是个人长期职业生涯的关键决定因素 患有精神障碍。 该项目的研究人员提出了一项三目标研究，以发展职业咨询和 退伍军人精神障碍发展干预(CCDV)。第一个目标将集中在 设计和开发具有退伍军人和提供者输入的CCD-V干预(n=16)。第二个目标是 飞行员在公开试验中测试干预(n=10)，以收集关于初始干预的经验丰富的意见。第三和 最终目标将包括可行性试点随机对照试验(n=50)，以检查可接受性和 可行性结果，并探讨CCD-V干预在功能改善方面的影响 以及其他职业成果。拟议的CCD-V干预将由大约8名个人组成 将与现有的VHA职业康复服务同时提供的课程(例如，过渡期 工作经验[TWE]。这项研究的最终产品是制作一份手动的CCD-V干预，以及 相应的保真度监测核对表，稍后将在更大的疗效试验中进行测试。

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 (CCD-V). The first aim will focus on the design and development of the CCD-V 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 CCD-V intervention in terms of functional improvement and other vocational outcomes. The proposed CCD-V intervention will consist of approximately eight 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 manualized CCD-V intervention, and corresponding fidelity monitoring checklist, to be tested later in a larger efficacy trial.