Acceptability and Feasibility of Work-Oriented, Veteran-Centric, Social-Cognitive Skills Training

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Supported employment is an evidence-based practice that places individuals with serious mental illness into competitive employment. Employment specialists are embedded into mental health teams and work with individuals to identify employment consistent with their interests and personal goals. Supported employment programs consistently have been found to be effective at job placement. However, maintenance of employment continues to be a significant challenge for individuals living with a serious mental illness. Interpersonal difficulties often contribute to job terminations. Individuals with a serious mental illness often have difficulty with interpreting emotional expressions, perspective taking, and social problem-solving. Thus, in addition to assistance with job placement, individuals living with a serious mental illness are also likely to benefit from intervention focused on developing skills to manage the social demands of work. An existing, evidence-based, psychosocial skills intervention, Social Cognition and Interaction Training (SCIT), will be adapted for use in this study. SCIT targets emotion recognition, perspective taking, and social problem-solving skills. The curriculum will be tailored to work settings and to Veterans with serious mental illness. Then, a pilot study will be conducted to assess the acceptability of integrating this psychosocial skills training with supported employment and the feasibility of conducting a randomized controlled trial in the future. To accomplish the first objective, structured stakeholder interviews will be conducted with Veterans who have participated previously in supported employment (n = 20) and employment specialists at the VA (n = 5) to identify educational topics and work examples to incorporate into SCIT. The curriculum will be piloted to elicit feedback on the session content and flow. Then, to assess acceptability and feasibility, an open trial pilot study will be conducted with 20 Veterans with serious mental illness who are enrolled in the supported employment program at the Minneapolis VA Health Care System. Upon study enrollment, participants will attend one 2-hour skills training session weekly for 13 weeks. Group size will be limited to 4-6 participants. To promote generalization of skills training, assignments will be given weekly to prompt participants to use skills outside of group. After completion of skills training, participants will continue to meet with their employment specialist. Materials will be developed for the employment specialists to use in session to prompt participants to continue to use skills at work. Participants will complete baseline, post-intervention, and 3-month follow-up assessments so that social functioning, relationship quality, work performance, self-efficacy, quality of life, and symptom severity can be measured. In addition, participants and employments specialists will complete an individual, semi-structured, qualitative exit interview that will (1) assess attitudes about the intervention components, structure, and materials; (2) elicit suggestions for intervention improvement; and (3) ask participants for their observations about the impact of the program on intervention targets. Acceptability will be assessed quantitatively as: 1) uptake (percentage of Veterans who participate); 2) engagement (number of sessions attended); and 3) participant ratings of interest, value, and satisfaction. Specifically, we predict: a study uptake rate of 50%; 70% session completion; and positive endorsement on measures of interest, value, and satisfaction. Acceptability also will be measured through qualitative analysis of participant and employment specialist exit interviews. Feasibility will be measured by: participant enrollment; retention in skills training and supported employment at 3- and 6-months post-enrollment; treatment fidelity; and completeness of data collection at baseline, post-intervention, and 3-month follow-up assessments. Main indicators of feasibility will be: enrollment of 3 participants per a month; 75% and 60% participant retention at 3- and 6-months, respectively; 90% consistency with study interventions; and 85% of data points completed.