NCT07097376 · VA Office of Research and Development
Evaluating the Efficacy of a Vocational Counseling Intervention to Improve Occupational Functioning and Employment Quality Among Veterans With Mental Health and Substance Use Disorders
What this study is about
Veterans living with mental health and substance use conditions are at risk of unemployment, which leads to significant health-related consequences. Though the Veterans Health Administration offers numerous vocational rehabilitation programs to address unemployment, they are not uniformly effective for everyone who participates.
View original scientific description
Veterans living with mental health and substance use conditions are at risk of unemployment, which leads to significant health-related consequences. Though the Veterans Health Administration offers numerous vocational rehabilitation programs to address unemployment, they are not uniformly effective for everyone who participates. This project will test a new model for addressing Veteran unemployment. This new model adds career development services (a vocational counseling program called Purposeful Pathways) to a standard model of vocational rehabilitation (a program called Transitional Work \[TW\]). The investigators will test if adding Purposeful Pathways to TW leads to more Veterans working in quality jobs as well as better quality of life, reduced mental health symptoms, and reduced substance use. This project fills a critical need in advancing research and practice aimed at reducing Veteran unemployment; thereby preventing consequences to Veteran's economic, social, and health related functioning and well-being. The investigators will conduct a phase II, multi-site, RCT comparing Purposeful Pathways + TW (n=127) to TW alone (n=127) among Veterans participating in TW at VA Bedford, VA Hines, and VA North Texas. Aim 1: Evaluate the efficacy of Purposeful Pathways for improving occupational functioning (primary outcome). Hypothesis: Purposeful Pathways + TW, compared to TW only, will improve occupational functioning. Aim 2: Evaluate the efficacy of Purposeful Pathways for improving quality of life, and reducing mental health symptoms and substance use (secondary outcomes). Hypothesis: Purposeful Pathways + TW, compared to TW only, will improve quality of life, and reduce mental health symptoms and substance use. Aim 3 (Exploratory): Explore whether occupational functioning (competitive employment attainment) in the Purposeful Pathways + TW group is mediated by vocational identity, work hope, self-regulation, and/or employment motivation, key factors central to the Purposeful Pathways intervention.
Interventions
BEHAVIORAL
Purposeful Pathways
Purposeful Pathways is a manualized intervention to assist Veterans in aspiring and pursuing meaningful employment. Purposeful Pathways is an individual counseling protocol delivered weekly for up to 12 sessions (50 minutes per session) focused on career exploration, goal clarity, job-searching, and self-regulation.
OTHER
Transitional Work
Provides individuals with immediate access to a non-competitive, paid job contracted by the VA. Positions are typically housed within a VA hospital (e.g., housekeeping, grounds, kitchens, and construction), but are sometimes located in the community. TW is time-limited. TW is staffed by vocational rehabilitation specialists (VRS).
Primary outcome measures
Number of Participants with Competitive Employment
Time frame: through study completion, an average of 15 months
Number of participants who were competitively employed at any point over the previous month. We define competitive employment as a non-sheltered job that earns salary, wages, or commission, excluding military drill and transient cash-based jobs, such as yard work, babysitting, and manual day labor.
Number of days worked
Time frame: through study completion, an average of 15 months
The number of days worked in competitive employment over the past month
Total hours worked
Time frame: through study completion, an average of 15 months
The number of hours worked in competitive employment during previous month
Income earned
Time frame: through study completion, an average of 15 months
Total wages from competitive employment earned over the past month
Career Adapt-Ability Scale
Time frame: through study completion, an average of 15 months
One's functional abilities/strengths to successfully manage career-related tasks. Possible scores range from 24 - 120, with greater scores indicating greater career adaptability functioning.
Positive Meaning Scale of the Work as Meaning Inventory
Time frame: through study completion, an average of 15 months
Degree to which someone perceives their work as meaningful. Scores range from 4 - 28, with higher scores representing greater levels of meaningful work.
Who can participate
This study lists these criteria on ClinicalTrials.gov. A study coordinator reviews eligibility during screening — this page does not determine whether you qualify.
Inclusion criteria
- enrolled in VHA TW at one of the three VA recruitment sites
- be unemployed
- report interest/intention to return to paid work within the upcoming three years
- presence of a psychiatric disorder as indicated by documented ICD-10 diagnosis (mental health disorder and/or substance use disorder) addressed in an encounter at VHA within the 24 months preceding study enrollment
- willing to participate in weekly vocational counseling sessions
Exclusion criteria
- report a plan to remain unemployed during the upcoming 12 months
- report plans to retire within the next 12 months
- be currently retired
- be a full-time student
- enrolled in Supported Employment
- experiencing significantly elevated mental health symptoms as indicated by a score greater than 26 on the Symptom Checklist-6 (SCL-648)
- have a guardian or conservator
Where
- Hines, Illinois
- Bedford, Massachusetts
- Dallas, Texas
Collaborators
North Texas Veterans Healthcare System, VA Hines Health Care
Related conditions & keywords
Frequently asked questions
What is a clinical trial?
A clinical trial is a research study that tests new medical treatments, drugs, devices, or procedures to determine their safety and effectiveness. Trials are carefully designed and monitored to protect participants while advancing medical knowledge.
Is it safe to participate?
Clinical trials follow strict safety guidelines and ethical standards. Trials must be reviewed and approved, and participants are closely monitored by medical professionals throughout the study. You can withdraw at any time if you choose.
Will I be compensated?
Many clinical trials offer compensation for your time, travel expenses, and inconvenience. The specific compensation varies by study and will be discussed during the screening process. All study-related medical care is typically provided at no cost to participants.
Will I receive a placebo instead of treatment?
When effective treatment exists, participants typically receive either the standard treatment plus the study intervention, or the standard treatment plus placebo. You would not be denied effective care. Placebos are primarily used when no proven treatment is available, or in addition to standard care. Your trial consent form will clearly explain what treatments you may receive.
Can I leave a trial if I change my mind?
Absolutely. Participation in clinical trials is completely voluntary. You have the right to withdraw from the study at any time, for any reason, without penalty or loss of benefits to which you are otherwise entitled.
How long does a clinical trial last?
Trial duration varies widely depending on the study design and purpose. Some trials last just a few weeks, while others may continue for months or years. The study coordinator will provide specific timeline information during your screening call.
Data: ClinicalTrials.gov · synced Sep 9, 2026 · Source of record for eligibility and locations