Abstract: Virtual Reality Job Interview Training As an Emerging Solution to Employment Inequities Among Individuals with Serious Mental Illness (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

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

Friday, January 13, 2023
Hospitality 3 - Room 432, 4th Level (Sheraton Phoenix Downtown)
* noted as presenting author
Matthew J. Smith, PhD, MSW, LCSW, Associate Professor, University of Michigan-Ann Arbor, MI
Justin Smith, PhD, Associate Professor, University of Utah, UT
Shannon Blajeski, PhD, MSW, Lecturer & Research Associate, University of Michigan-Ann Arbor, Ann Arbor, MI
Brittany Ross, Project Manager, University of Michigan-Ann Arbor, Ann Arbor, MI
Neil Jordan, PhD, Associate Professor, Northwestern University
Eugene A. Oulvey, State Coordinator of Psychiatric Rehabilitation Services, State of Illinois, Division of Rehabilitation Services
Morris Bell, PhD, Professor Emeritus, Yale School of Medicine, CT
Susan McGurk, Professor, Boston University
Kim Mueser, Professor, Boston University
Michael Fleming, MD, Professor Emeritus, Northwestern University
Karley Nelson, M.S., Senior Research Specialist, Thresholds, Inc., IL
Adrienne Brown, M.S., Program Director, Thresholds, Inc., IL
John Prestipino, MS, Assistant Program Director, Thresholds, Inc., IL
Nicole Pashka, MS, Assistant Program Director, Research, Thresholds, Inc., IL
Lisa Razzano, Associate Professor, University of Illinois at Chicago, IL
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.