A Mixed-Methods Implementation Evaluation of Virtual Reality Job Interview Training in IPS Supported Employment.

OBJECTIVE: Employment rates among individuals with serious mental illness may be improved by engagement in the individual placement and support (IPS) model of supported employment. Results from a recent randomized controlled trial (RCT) indicate that virtual reality job interview training (VR-JIT) improves employment rates among individuals with serious mental illness who have been actively engaged in IPS for at least 90 days. This study reports on an initial implementation evaluation of VR-JIT during the RCT in a community mental health agency. METHODS: A sequential, complementary mixed-methods design included use of qualitative data to improve understanding of quantitative findings. Thirteen IPS staff trained to lead VR-JIT implementation completed VR-JIT acceptability, appropriateness, and feasibility surveys. Participants randomly assigned to IPS with VR-JIT completed acceptability (N=42) and usability (N=28) surveys after implementation. The authors also conducted five focus groups with IPS staff (N=11) and VR-JIT recipients (N=13) and semistructured interviews with IPS staff (N=9) and VR-JIT recipients (N=4), followed by an integrated analysis process. RESULTS: Quantitative results suggest that IPS staff found VR-JIT to be highly acceptable, appropriate for integration with IPS, and feasible for delivery. VR-JIT was highly acceptable to recipients. Qualitative results add important context to the quantitative findings, including benefits of VR-JIT for IPS staff as well as adaptations for delivering technology-based interventions to individuals with serious mental illness. CONCLUSIONS: These qualitative and quantitative findings are consistent with each other and were influenced by VR-JIT's adaptability and perceived benefits. Tailoring VR-JIT instruction and delivery to individuals with serious mental illness may help optimize VR-JIT implementation within IPS.

Critical elements in the experience of virtual reality job interview training for unemployed individuals with serious mental illness: Implications for IPS supported employment.

OBJECTIVE: Individuals with serious mental illness (SMI) who re-enter the labor market after extended unemployment may benefit from exposure to job interview training. This study explored the processes and perceived benefits of preparing for interviews using Virtual Reality Job Interviewing Training (VR-JIT) among employment specialists (ESs) and clients within the individual placement and support (IPS) model of supported employment. METHOD: This study analyzed secondary qualitative data from a randomized controlled trial (RCT) of VR-JIT including qualitative focus groups comprised of IPS employment specialists (n = 11) and IPS clients (n = 13), semistructured interviews with IPS employment specialists (n = 3), and semistructured interviews with IPS clients (n = 3). Additionally, semistructured interviews with IPS employment specialists (n = 8) who naturalistically implemented VR-JIT at four community mental health agencies independent of the RCT. All focus group and interview data were analyzed using grounded theory methodology. RESULTS: Three main processes were viewed by employment specialists (and their clients) as beneficial for individuals with SMI receiving IPS with VR-JIT: (a) exposure to a simulated interview in a safe environment; (b) practicing and receiving job interviewing feedback; and (c) improved confidence and motivation in job seeking. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: VR-JIT improved IPS participants' confidence in job seeking through proposed mechanisms of exposure to a simulated job interview and repetition and practice of job interview skills. These critical elements indicate that VR-JIT has the potential to improve IPS client engagement particularly with those who have had prolonged periods of unemployment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An RCT of Virtual Reality Job Interview Training for Individuals With Serious Mental Illness in IPS Supported Employment.

OBJECTIVE: Virtual Reality Job Interview Training (VR-JIT) is a computerized interview simulator with efficacy at enhancing interview skills and employment outcomes. A randomized controlled trial assessed VR-JIT effectiveness for participants in individual placement and support (IPS), in which approximately 55% of individuals with serious mental illness obtain employment. METHODS: Ninety participants with serious mental illness were randomly assigned to IPS+VR-JIT (N=54) or IPS as usual (N=36), completing pretest-posttest assessments and an employment evaluation at 9 months. Intent-to-treat chi-square analysis, multivariable logistic regression, Cox proportional hazards models, and mixed-effects linear regressions were conducted. Fifty-one percent were IPS nonresponders (i.e., no employment within the first 90 days of IPS). RESULTS: IPS+VR-JIT participants did not have significantly higher employment rates, compared with IPS-as-usual participants (43% versus 28%). IPS nonresponders (N=46) in the IPS+VR-JIT group had greater odds of obtaining employment (odds ratio [OR]=5.82, p=0.014) and shorter time to employment (hazard ratio=2.70, p=0.044) compared with IPS nonresponders in the IPS-as-usual group. Intent-to-treat mixed-effects linear analyses indicated that IPS+VR-JIT, compared with IPS as usual, significantly improved interview skills (p=0.006), interview confidence (p=0.013), and interview anxiety (p=0.019). CONCLUSIONS: VR-JIT's potential benefits (increased employment in a shorter time) appeared to be specific to IPS nonresponders, whereas employment outcomes for recent IPS enrollees were not affected. VR-JIT could be a valuable resource for employment specialists to support IPS nonresponders, because 47% of participants engaged in mock interview training with their specialist. Future research should focus on evaluating the effectiveness and implementation of VR-JIT among IPS nonresponders.

How early stigmatizing experiences, peer connections, and peer spaces influenced pathways to employment or education after a first-episode of psychosis.

OBJECTIVE: This study explored the pathways to employment, education, and/or disability among young adults with First-Episode Psychosis (FEP) with the intent to reduce poverty and disability among this population. METHOD: Using a critical case design, 10 young adults (ages 21-28) completed two qualitative interviews exploring the key moments that influenced their pathway toward employment and education or disability after experiencing a first-episode of psychosis. Participants had lived experience of an FEP, had completed a Coordinated Specialty Care (CSC) program, and were members of the Early Assessment and Support Alliance's Young Adult Leadership Council (YALC). Qualitative analysis was completed using a four-step template approach and focus group. RESULTS: Early stigmatizing behavior by hospital staff and the diagnostic label of psychosis challenged participants' self-identity and self-confidence which led to a pause in vocational activities. Meeting peers (i.e., other individuals who had experienced a first-episode of psychosis) through their CSC program normalized their psychosis diagnosis and alleviated feelings of self-stigma; this was integral in returning to and initiating new employment and education goals. YALC involvement provided opportunities for practicing work skills, such as public speaking, and additional peer support that further eradicated self-stigma and improved connection to employment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Implications for CSC models include broad consideration of the ways that early psychiatric labeling can construct self-stigma, and how this phenomenon stunts the self-confidence needed to pursue employment and education goals. Specific recommendations include utilizing peer connections, peer spaces, and peer-delivered anti-stigma interventions to enhance employment and education pathways. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Job Interview and Vocational Outcomes Among Transition-Age Youth Receiving Special Education Pre-Employment Transition Services.

Vocational outcomes among transition-age youth receiving special education services are critically poor and have only incrementally improved since the implementation of the Workforce Innovation Opportunity Act. Few studies highlight whether interviewing may be critical to obtaining vocational outcomes such as competitive employment or internships. This study evaluated vocational interviewing and outcomes among 656 transition-age youth receiving special education pre-employment transition services from 47 schools. Results suggest 20.8% of these youth were currently employed, and 88.8% of these employed youth interviewed prior to obtaining their job, which is higher than anecdotal evidence suggests and speaks to the importance of job interview skills as an intervention target for special education pre-employment transition services. We discuss the implications and directions for further study.

Computerized Clinical Training Simulations with Virtual Clients Abusing Alcohol: Initial Feasibility, Acceptability, and Effectiveness.

Although masters-level social work students typically build clinical skills via role-playing with their peers or instructors, several innovative training simulations are emerging in the literature that may enhance existing skill-building methodologies. We evaluated the initial feasibility, acceptability, usability, and effectiveness of three computerized simulations (two cognitive behavioral therapy, one motivational interviewing) during an interpersonal practice course among 22 students in a Master of Social Work program accredited by the Council on Social Work Education. Trainees repetitively practiced their clinical skills with virtual clients while receiving feedback via real-time nonverbal cues, transcript review, and performance assessment across pre-specified theoretical learning objectives. Across the three simulations, at least 86.4% of students completed the required protocol and completed M = 468.95 (SD = 178.27) minutes of simulated sessions. Students improved their scores (range 0 to 100) across all the simulations from M = 63.41 (SD = 11.13) to M = 93.64 (SD = 3.24). Students found the simulations to be acceptable with strong usability. Paired sample t-tests revealed students reported greater self-efficacy in general clinical skills, exploration skills, insight skills, and action skills between pre-test and post-test after completing the simulations (all p < 0.001). Students reported that the clinical skills learned from the simulations translated into successful interactions with real-world clients during their field placements. We discuss the results of this initial feasibility study within the context of simulation-based learning and the potential for broader implementation within MSW programs.

Acceptability and Feasibility of Peer Specialist-Delivered Virtual Reality Job Interview Training for Individuals with Serious Mental Illness: A Qualitative Study.

This study explored peer specialists' perspectives on delivering vocational interventions, especially Virtual Reality Job Interview Training (VR-JIT). Five focus groups of peer specialists (N = 34) explored their beliefs about vocational services, including VR-JIT. We trained eight peer specialists to be VR-JIT "instructors" and interviewed them about using VR-JIT in their mental health practice. Generally, participants discussed tailoring their vocational services to include sharing their story of recovery. Specifically, participants perceived VR-JIT as acceptable and feasibly implemented within their practice. Overall, participants viewed VR-JIT as a higher level of service and they would be uniquely qualified to support consumers using the tool.

Enhancing vocational training in corrections: A type 1 hybrid randomized controlled trial protocol for evaluating virtual reality job interview training among returning citizens preparing for community re-entry.

The Michigan Department of Corrections operates the Vocational Villages, which are skilled trades training programs set within prisons that include an immersive educational community using virtual reality, robotics, and other technologies to develop employable trades. An enhancement to the Vocational Villages could be an evidence-based job interview training component. Recently, we conducted a series of randomized controlled trials funded by the National Institute of Mental Health to evaluate the efficacy of virtual reality job interview training (VR-JIT). The results suggested that the use of VR-JIT was associated with improved job interview skills and a greater likelihood of receiving job offers within 6 months. The primary goal of this study is to report on the protocol we developed to evaluate the effectiveness of VR-JIT at improving interview skills, increasing job offers, and reducing recidivism when delivered within two Vocational Villages via a randomized controlled trial and process evaluation. Our aims are to: (1) evaluate whether services-as-usual in combination with VR-JIT, compared to services-as-usual alone, enhances employment outcomes and reduces recidivism among returning citizens enrolled in the Vocational Villages; (2) evaluate mechanisms of employment outcomes and explore mechanisms of recidivism; and (3) conduct a multilevel, mixed-method process evaluation of VR-JIT implementation to assess the adoptability, acceptability, scalability, feasibility, and implementation costs of VR-JIT.

Understanding Individual and Family Experiences Associated with DUP: Lessons from the Early Assessment and Support Alliance (EASA) Program in Oregon, USA.

Research shows that a longer duration of untreated psychosis (DUP) is associated with worse psychiatric outcomes, with average length of DUP of 73 weeks in the U.S. The aim was to examine the DUP period for first episode psychosis in Oregon, with a focus on the processes between the first positive symptoms and first treatment. To investigate DUP, researchers used methods consistent with grounded theory to collect data from 9 participants and their families about the process between onset of psychotic symptoms and entrance into treatment. Results suggest that recognition of symptoms was the primary driver of help-seeking in this study, and this was influenced by type of symptom as well as the presence or absence of supportive others, which in most cases was regular family contact. Implications indicate a need for in-depth research on individual and family recognition of symptoms, as well as underscoring the need for community education.