Virtual Reality Job Interview Training As an Emerging Solution to Employment Inequities Among Individuals with Serious Mental Illness

Background and Purpose: Individual Placement and Support (IPS) is the field’s strongest practice to battle employment inequities among individuals with serious mental illness (SMI). However, only 55% of individuals with SMI engaged in IPS obtain employment, which leaves many individuals still unemployed. Thus, innovations to IPS are needed to improve employment outcomes. In particular, job interviewing is a critical barrier to employment, and IPS does not include evidence-based practice to remediate interview skills. To address employment inequities among individuals with SMI, we completed a series of lab-based randomized controlled trials (RCTs) to test the efficacy of Virtual Reality Job Interview Training (VR-JIT). Results suggested that VR-JIT was efficacious at helping individuals with SMI improve their interview skills and obtaining more job offers. Subsequently, we conducted an RCT to evaluate whether VR-JIT (delivered within IPS) was effective at improving real-world employment inequities for individuals with SMI.

Methods: In this RCT, we evaluated VR-JIT within IPS by comparing individuals with SMI engaged with IPS and VR-JIT (IPS+VR-JIT; n=54) to a control group who engaged in IPS-as-usual (n=36). The study design and methods were guided by an advisory board of community stakeholders. Employment specialist and trained implementers delivered VR-JIT to study participants where they received their typical IPS services. All participants concurrently received high fidelity IPS. Employment outcomes included interview skills, interview self-efficacy, interview anxiety, and competitive employment by nine-month follow-up, and time-to-employment. Descriptive statistics characterized the sample, while mixed effects analyses evaluated changes in outcomes between pre-test and post-test; logistic regression evaluated employment rates by 9-month follow-up; and cox regression evaluated time-to-employment.

Results: Intent-to-treat analyses revealed the IPS+VR-JIT group, compared to the IPS-as-usual group, had greater odds of obtaining competitive employment (OR=3.4, p=0.02) within 9 months of randomization. The IPS+VR-JIT group, compared to IPS-as-usual group, significantly improved their job interview skills (p=0.01), job interview self-efficacy (p=0.01), and job interview anxiety (p=0.02) between pre-test and post-test. Post-hoc analyses revealed VR-JIT differential effectiveness for participants who failed to find employment within their first 3 months of IPS engagement and then enrolled in the study (i.e., non-responsive to IPS; n=46). This group can be characterized as the most vulnerable of IPS clients as they historically have the lowest employment rates. Within this subsample, the IPS+VR-JIT group had greater employment (52% vs. 19%, p=.02) and obtained jobs more quickly (HR=2.70, p=.04) by follow-up compared to IPS-as-usual.

Conclusions and Implications: Job interviewing is a critical barrier to employment and the field lacks an evidence-based practice to remediate job interview skills. This RCT revealed that adding VR-JIT to IPS improved interview skills, reduced interview anxiety, and enhanced competitive employment for participants above and beyond the outcomes observed in high fidelity IPS-as-usual; especially among participants who struggled to get jobs within their first 3 months of IPS. Thus, VR-JIT may be valuable for IPS providers to try and reduce employment inequities for individuals with SMI. Future research can test the mechanisms of VR-JIT effectiveness and evaluate the processes required to successfully implement VR-JIT within IPS and other settings.