After demonstrating efficacy at improving interview skills, self-confidence, and access to employment across 5 randomized controlled trials, the research team sought and was awarded funding from the National Institute of Mental Health (R01 MH110524) to evaluate whether participants randomized to use VR-JIT within an IPS model would demonstrate better employment outcomes within 6 months compared to participants randomized to receive IPS-as-usual. The study was led by Dr. Matthew Smith, Associate Professor at the University of Michigan’s School of Social Work in partnership with Northwestern University and Thresholds, Inc.
The study was a 2-arm randomized control trial in which clients 18 years or older with a history of serious mental illness and enrolled in IPS services were randomized to receive IPS-as-usual or in combination with VR-JIT. 54 participants were randomized to the IPS-as-usual + VR-JIT group and 36 participants were randomized to the IPS-as-usual only group. Participants completed study measures, among them mock job interviews and self-report measures on interview anxiety and self-confidence prior to and after the intervention period. Participants also completed a 6-month follow-up visit and received monthly follow-up phone calls asking about job interview completions and employment status.
1) Higher rates of competitive employment for participants using VR-JIT. We observed that 28% of IPS-as-usual participants had attained competitive employment by 9 months, while 41% of IPS+VR-JIT participants had found competitive employment by 9 months.
2) Different rates of competitive employment for participants depending on if they were IPS recent enrollees or IPS non-responders. We observed that 40% of IPS-as-usual participants (IPS recent enrollees) had found competitive employment by 9 months, 35% of IPS+VR-JIT (IPS recent enrollees) had found competitive employment by 9 months, 19% of IPS-as-usual participants (IPS non-responders) had found competitive employment by 9 months, and 52% of IPS+VR-JIT (IPS non-responders) had found competitive employment by 9 months.
3) Improved job interview skills for participants using VR-JIT. Participants engaged in IPS who practiced with VR-JIT showed more improvement in job interview skills than those in IPS-as-usual.
4) Decreased job interview anxiety for participants using VR-JIT. Participants engaged in IPS who practiced with VR-JIT showed larger decreases in job interviewing anxiety than those in IPS-as-usual.
5) Increased interviewing self-confidence for participants using VR-JIT. Participants engaged in IPS who practiced with VR-JIT showed increases in job interviewing self confidence compared to those in IPS-as-usual.
Findings suggest that using VR-JIT as a supplement to IPS services may lead to higher rates of competitive employment, increased interviewing skills, decreased anxiety and increased self-confidence for clients around interviewing.
1) IPS employees may be able to use their time more efficiently when clients are using VR-JIT. In order to analyze VR-JIT’s effect on IPS employee effort, Threshold Employment Specialists (ESs) were asked to complete bi-weekly “cost capture surveys.” These surveys asked ESs to estimate the number of hours they spent on various categories of tasks. An average of 34 weeks of data were collected from 13 ESs. The ESs were split into two groups: those who had study participants on their caseload assigned to the VR-JIT intervention and those without any participants on their caseload assigned to the VR-JIT intervention.
Trends were noticed across 4 categories:
Job Interview Training: ES staff with clients on their caseload assigned to VR-JIT spent an average of 0.6 hours less per week per staff member on interview preparation and mock interviewing than ES staff who did not have clients on their caseload using VR-JIT.
Job Application Skills: ES staff with clients on their caseload using VR-JIT spent an average of 1.45 hours less per week working with clients on job application skills than ES staff who did not have clients on their caseloads using VR-JIT.
Administrative Tasks/Documentation: ES staff with clients on their caseload using VR-JIT spent an average of 2.8 hours more per week on administration tasks and documentation, suggesting that clients using VR-JIT may free up more time in an ES staff member’s day to work on other administrative duties.
Job Developing/Supports: ES staff with and without clients on their caseload using VR-JIT spent similar hours per week in the community developing jobs and helping clients with other skills to support their employment.
2) Pre-implementation Costs. Data was collected on the time and cost of preparing to implement the intervention, which included creating a computer lab and training employment staff (6 Employment Specialists and 4 Team Leaders) to run it. The process took a total of 261 staff hours from the Thresholds team (15 total research and employment staff) and 305 staff hours from the Northwestern/University of Michigan research team (1 Principal Investigator, 2 staff) which amounted to a total labor cost of $22,882. The non-labor costs to create a computer lab with 5 work stations amounted to $2599.
Preliminary findings suggest that integrating VR-JIT into IPS services may lead to a more efficient use of staff time, including less time performing job interview training and application skills and more time completing administrative tasks. The overall cost to plan for and implement the intervention is reasonable.
June 12, 2020