Approximately 85-90% of those with serious mental illness are unemployed (9, 10). This level of unemployment exists despite the finding that, among people who have a psychiatric disability and are unemployed, 55-61% desire employment, with the total reaching 75% when concern about losing benefits was taken into account (1, 2). The rewards of employment for adults with SMI are greater than simply an increase in financial resources. Studies have found that people with serious mental illness who worked competitively scored higher on measures of self-esteem, satisfaction with finances, leisure, and overall life satisfaction compared to those worked little or not at all (11). Supported employment (SE) has been more effective than any other vocational rehabilitation approach for this population (3, 4) and the VA has mandated that SE be integrated into all current VHA Compensated Work Therapy (CWT) programs (VHA Directive 2007-005). Two areas of concern include (a) national utilization of SE services is low (13), and (b) the percentage of SE participants who obtain at least one job during the studies averages 56% even though everyone who enters the program expressed an interest in working (13). Motivational interviewing (MI) is an evidence-based practice that has been effective in enhancing a range of clinical services (6), but has just recently been applied to employment and vocational services by Drebing et al. (7) and Glynn et al. (8). In the Drebing et al. study, a single session of motivational interviewing was associated with a 43% increase in entry and doubling the length of participation in VR, raising the likelihood that motivational enhancement interventions may be effective for addressing a range of VR outcomes. The proposed project is a randomized trial of Adapted Motivational Interviewing for Supported Employment (AMI-SE) provided to veterans and their significant others (family members or key friends) in order to address the internal and external barriers to the veteran enrolling in supported employment and returning to work. The intervention consists of 6 sessions that (a) identify and resolve a veteran's and the significant other's ambivalence about working, (b) provide information about the SE program to both parties, and (c) assist the dyad to develop a change plan to address the veteran's and significant other's emotional and practical concerns regarding SE enrollment and employment. One hundred and fifty veterans from the Bedford VA Hospital will be randomly assigned to AMI-SE or a control condition. The groups will be compared on SE entry rate, CE entry rate, number of weeks working in CE, and SE participation. In addition, the study will examine whether variables related to the Health Belief Model are predictive of vocational rehabilitation entry and outcome.
At completion, results will provide VHA policymakers, investigators, and vocational rehabilitation specialist with findings and recommendations regarding (a) the usefulness of an extended motivational interviewing protocol for veterans and their significant others, and (b) topic areas for development of additional strategies to improve access and outcomes in supported employment. If effective, the motivational intervention could be conducted by case managers of clinicians of veterans with serious mental illness to increase rates of employment. The proposed study seeks to ensure full utilization of SE, including the provision of services specifically designed for those who are unsure about work and employment, moving VA SE services into the cutting edge of access, utilization, and success.
