Providing Career Development Services to Veterans: Perceived Need,Acceptability,and Demand

Abstract

Providing career development services, through career counseling and assessment, is part of vocational rehabilitation programming. However, there is no applied evidence that such career development services are feasible or accepted among individuals with psychiatric disorders. We examined feasibility (acceptability, demand, and perceived need) of the Vocational Evaluation Center (VEC), one veterans affairs (VA) hospital’s method of career development services for veterans with psychiatric disorders. Demographics, referral source, and service utilization were analyzed among 90 veterans referred to the VEC. Qualitative analysis identified patterns to veterans’ reasons for seeking VEC services. Veterans referred to the VEC were predominately unemployed and disabled. Veterans tolerated the intervention well, with 16.7% dropping out. Reported needs for VEC services included (a) vocational uncertainty, (b) functional considerations in vocational planning, and (c) finding purpose. Veterans with psychiatric disorders want career development services. The VEC model appears feasible, well-tolerated, and aligned with consumers’ needs.

Keywords

career development veterans vocational rehabilitation career counseling social cognitive career theory

Introduction

Purposeful activity is vital to sustain motivation, increase hope, and empower those living with psychiatric disorders to engage in recovery-oriented activities (Salyers et al., 2004). Attaining employment is often considered one of the primary platforms for recovery among individuals living with psychiatric disorders (Dunn et al., 2008). However, over the course of several years, individuals living with psychiatric disorders may face difficulties maintaining consistent employment, particularly when one is unable to work in jobs he or she prefers. For example, in their qualitative study of 120 individuals living with co-occurring substance abuse and psychiatric disorders, Strickler et al. (2009) found that participants with the most consistent employment histories, over a 16-year time period, were those employed in jobs they enjoyed, or even loved, and that matched their interests, needs, and skills. Conversely, individuals with inconsistent employment histories reported working in jobs they did not enjoy and that did not match their preferences (Strickler et al., 2009). Similarly, Kukla and Bond (2012) found that individuals with serious mental illness who worked in jobs that matched their interests and were considered enjoyable, and that captured their attention, had significantly longer job tenure than individuals working in jobs that did not match individual interests and preferences. Moreover, Beveridge and Fabian (2007) found that consumers of state-funded vocational rehabilitation programs who obtained jobs that matched their vocational preferences had significantly higher wages than individuals who found jobs that did not match their preferences. Taken together, these findings support the message of prominent vocational rehabilitation scholars who have called attention to the need for research and practice addressing the ongoing career development of persons living with psychiatric illness (Drake & Bond, 2008; Mueser & Cook, 2012).

Career counseling and assessment (CC&A) services are likely to support the career development of individuals living with psychiatric disorders. CC&A services have been shown to be effective in helping individuals clarify vocational goals and identity, enhance vocational self-efficacy, and increase proactive vocational behaviors in the face of obstacles (Whiston & Rahardja, 2008). Moreover, CC&A may help facilitate greater “match” between a person and their job, thereby increasing the long-term career development of individuals living with psychiatric disorders.

Over several decades, scholars of vocational psychology have developed research supported theories that address issues related to career development through multiple lenses: person-job fit (Holland, 1997), developmental stages and tasks (Super, 1980), and social-cognitive learning theories (Lent et al., 1994, 2000). Recently, there have been targeted attempts to investigate the usefulness and applicability of career development theory for individuals living with psychiatric disorders. For example, in a qualitative exploration of the work lives of individuals living with serious mental illness, Millner and colleagues (2015) found evidence that the perspectives of work among this group largely clustered under categories typical of the social cognitive career theory (SCCT) model (Lent et al., 1994, 2000).

The SCCT model is recognized as a comprehensive model for understanding the development of vocational interests/goals, action-oriented behavior, and occupational attainment. There is an extensive literature base supporting the main propositions of this model, which states that vocational goals and behaviors are primarily the result of self-efficacy beliefs (belief in one’s ability to complete a task) and outcome expectations (beliefs about what will happen if one engages in a particular task). The SCCT model further explicates that self-efficacy beliefs and outcome expectations develop from learning experiences which are shaped by personal and contextual factors, accomplishments, vicarious learning, and persuasion. Compared with other theories of career choice and development, SCCT is often lauded for its focus on contextual and environmental factors that contribute to job obtainment. As such, SCCT has shown applicability to marginalized groups, such as racial/ethnic minorities and individuals from low income backgrounds (Flores et al., 2017; Fouad & Santana, 2017). Although some have suggested applying a SCCT framework to career intervention for individuals living with serious mental health disorders (Fabian, 2000; A. Smith & Milson, 2011), there have been no empirical studies investigating this suggested practice. Based on SCCT, clinicians at a veterans affairs (VA) hospital in the Northeast United States conceptualized and implemented a career development center for veterans living with psychiatric disorders: the Vocational Evaluation Center (VEC).

Description of Intervention

The goals of the VEC are to enhance career development by (a) facilitating career- and self-exploration to enhance understanding of one’s employment and educational preferences, (b) identifying employment and educational goals that are well-aligned with one’s needs and preferences, and (c) facilitating connection to needed resources that will support one’s employment or educational goals. VEC services were operationalized using a SCCT framework while keeping in mind the goals and guidelines of the Office of Veterans Health Administration (VHA) Vocational Rehabilitation Services and veteran-centered, recovery-oriented care (see Table 1 for overview).

Table 1.

Overview of VEC Services Accounting for the Office of VHA VRS Recommended Guidelines for Career Development Practice and the Principle Components of SCCT.

Office of VHA VRS guidelines	SCCT variables
Office of VHA VRS guidelines	Self-efficacy	Outcome expectations	Interests	Goals	Personal/contextual influencers
Exploratory and supportive	Identifying and reinforcing past work-based skills, accomplishments, abilities, and talents	Discussing perceived positive and negative outcomes for pursuing career and/or educational goals	Identifying interests, hobbies, enjoyed activities, and past work environments with high perceived fit	Clarifying, identifying, and supporting commitment of career and/or educational goals	Exploring personal (e.g., strengths, values, disability) and environmental factors (e.g., financial constraints, social support) as impacting career development
Assessment	Self-Efficacy Questionnaire (SEQ; Lennox & Subich, 1994); VIA Character Strengths Survery-120 (VIA-120; Peterson & Seligman, 2004)	Perceived Employment Barriers Scale (PEBS; Hong et al., 2014)	John Holland’s SDS: Self-Directed Search (Holland & Messer, 2013); O*NET Work Importance Locator (WIP; U.S. Department of Labor, 2000)	Vocational Identity Scale (VIS; Holland et al., 1980)	Career Decision-Making Difficulties Questionnaire (CDDQ; Gati et al., 1996); Employment Flexibility Scale (EFS; Stevenson & Brown, 2019)
Vocational planning	Increasing self-efficacy for achieving long-term vocational/educational goals	Providing psychoeducation on career development; clarifying misinformation	Integrating interests into decision-making and planning	Developing actionable short term goals in service of long-term career goals	Accommodating vocational plans/goals in light of strengths, values, skills, limitations, and other external constraints
Knowledge of educational/training resources	Discussing and providing referrals to relevant VA-based, local- and state-level education/training resources, as relevant to Veteran’s short- and long-term career goals
Knowledge of available funding options	Discussing and providing referrals to relevant VA-based, local- and state-level funding options, as relevant to Veteran’s short- and long-term career goals
Development of methods to provide educational support	Coordinating care (e.g., warm-hand offs, consultation, referral, service provision) with supported employment, Veterans Integration into Academic Leadership (VITAL) programs, and other mental health service providers

Note. VEC = Vocational Evaluation Center; VHA = Veterans Health Administration; VRS = Vocational Rehabilitation Services; VA = veterans affairs; SCCT = social cognitive career theory.

During the first one to two sessions of VEC services, a clinician utilized the Vocational Assessment Profile (VAP; Office of VHA Vocational Rehabilitation Services, n.d.), which consists of semi-structured questions to stimulate discussions pertaining to: basic background information, strengths and gifts, personality, obstacles or other interfering factors, life experiences, current routines and community contacts, and dreams or aspirations. During this interview protocol, the clinician takes time to clearly assess the individual’s presenting career-related problem. This thorough clinical interview is critical to determining whether assessments are clinically indicated. Veterans not needing vocational assessment typically engaged in three to four career counseling sessions. Informed by SCCT, these sessions focused on clarifying short- and long-term employment goals, increasing self-efficacy for achieving one’s goals, increasing proactive vocational behavior, working though unhelpful career beliefs or expectations that keep them stuck, and addressing employment barriers by connecting veterans to appropriate resources. When additional assessment is indicated, measures are utilized in accordance to veteran’s perceived need and clinical relevance. For clarity, Figure 1 provides a visual overview of typical progress of VEC meetings.

Figure 1.

Model depiction of typical progression through VEC services.

Purpose of Current Study

Scholars have described, in theoretical terms, how SCCT interventions can be helpful to individuals living with psychiatric disorders (Fabian, 2000; A. Smith & Milson, 2011), yet there is a need for empirical evidence demonstrating that such clinical services are needed and welcomed among individuals with psychiatric conditions and disabilities. This article seeks to fill this gap in the literature through two primary goals. First, we aim to examine indicators of feasibility (as outlined by Bowen et al., 2010) by describing and investigating populations served and acceptability of VEC services (i.e., how well received the intervention is among providers and consumers) as well as demand for VEC services (i.e., the extent that veterans with psychiatric disorders utilize services). Second, we aim to explore VEC consumers’ perceived need for career development services and the extent to which these needs map onto a SCCT framework.

Method

When a veteran was referred to the VEC, program evaluation data were collected and de-identified by clinicians affiliated with the program, which included one counseling psychologist as well as several pre- and post-doctoral psychology trainees. Data were gathered from the veteran’s self-report during clinical services in addition to his or her medical record and included: demographic information, employment status (full-time employed, part-time employed, unemployed, full-time student, part-time student, or both employed and student), education status (less than a high school diploma, high school diploma, technical school/training, some college, associate’s degree, bachelor’s degree, or graduate degree), and service connection percentage (the VA disability compensation rating system). Substance abuse diagnoses and mental health diagnoses were recorded if a veteran had an “active problem” listed in their medical record. Active problems consist of a variety of International Statistical Classification of Diseases and Related Health Problems (10th revision; ICD-10) diagnoses and can only be entered into a veteran’s medical record by a licensed provider. Other clinical data maintained by VEC clinicians included: source of referral, early termination, completed case, and amount of time spent providing services to a particular individual.

In addition, veterans who engaged in VEC described their reasons for seeking these services during their initial intake appointment with a VEC clinician. Reasons for seeking career development services were elicited through open-ended questions and documented by the VEC clinician. These reasons for seeking career development services, which were typically one to three sentences in length, were entered by the VEC clinician into an anonymous program evaluation database along with other demographic characteristics. The VEC psychologist, and two additional VA psychologists not affiliated with the program, analyzed the quantitative and qualitative programmatic data gathered during VEC treatment. Our local Institutional Review Board (IRB) approved the analysis of this de-identified program evaluation data.

Participants

The sample for this study consisted of veterans referred to the VEC between December 2016 and June 2018. A total of 90 veterans were referred to the VEC. Most participants referred to the VEC identified as male (85.6%) followed by female (13.3%), and one veteran identified as transgender. The average age of referred veterans was 39.8 years (SD = 11.6). The majority of referred veterans identified as White (78.9%) followed by African American (10.0%), Latino/a (7.8%), Asian American (2.2%), and Biracial (1.1%). Most veterans referred for VEC services were currently unemployed (72.2%), while 13.3% had some type of employment (i.e., full or part-time work) and 13.3% were currently in school. Data on one veteran’s employment/education status were unavailable. In terms of educational background, many referred veterans had completed some college (34.4%), a portion had completed their bachelor’s degree (21.1%), some had completed an associate’s degree (2.2%), and one participant had completed graduate studies. In addition, 30.0% had earned a high school diploma and 7.8% had completed technical training. Education history from three veterans were unavailable. The majority of those referred had a service connection rating of 10% or more (73.3%), with almost half (47.8%) having a 70% or higher service connection rating, and a quarter (24.4%) having a 100% service connection rating.

Of those referred, almost half (45.6%) had a diagnosis of an alcohol use disorder. Other common substance use disorders included opioids (21.1%), marijuana (12.2%), cocaine (11.1%), and multiple drug use (2.2%). More than half of those referred (58.9%) had a diagnosis of posttraumatic stress disorder (PTSD), with other common diagnoses being mood disorders (43.3%), anxiety disorders (20.0%), and attention deficit hyperactivity disorder (ADHD; 13.3%). Less common but still present were personality disorders (5.6%), traumatic brain injury (TBI; 5.6%), and schizophrenia-spectrum disorders (2.2%).

Data Analysis

After examining the clinical and demographic characteristics of our sample, we then examined sources of referral and service utilization rates. Analyses were then conducted to determine whether there were patterns of differences in demographics between individuals who did, or did not engage in VEC services after being referred. Independent sample T-tests were used to investigate mean score differences in age and VA disability rating (i.e., service connection), while chi-square analyses were used to examine differences in race, gender, employment status, education status, substance use diagnosis, and mental health diagnosis. Given the small number of participants in this study, the race, gender, employment status, education status, substance use diagnosis, and mental health diagnosis variables were grouped into dichotomous variables to increase cell sample sizes. Fisher’s exact test was used when the assumptions of the chi-square tests were violated.

The three psychologists conducting this program evaluation, who all had previous experience in qualitative analysis, utilized a thematic analysis approach to code the qualitative data (Braun & Clarke, 2014). Each evaluator independently utilized thematic analysis procedures to identify patterns across the data and then met to establish consensus among themes until there was 100% agreement. The thematic analytical process offered a theoretically flexible approach to allow for a realistic and descriptive method to code the phenomenological data and included six phases: (a) coders familiarized themselves with the data; (b) generated initial codes; (c) they searched for themes; (d) reviewed themes; (e) defined and named themes; and (f) produced a report (Braun & Clarke, 2014). This thematic analysis approach was selected given the applied nature of this qualitative analysis, in addition to the limits of the qualitative dataset consisting of a few sentences per participant focused on one specific question (reason for seeking career development services). Thus, there was not a need for a strong theoretical commitment as with other more intensive qualitative analyses (Braun & Clarke, 2014).

Results

More than half of those referred (64.4%) received some type of vocational support through the VEC, with some completing a full assessment (32.3%), some receiving only career counseling services without assessment (8.9%), some currently in treatment at time of study (6.5%), and some dropping out prematurely before completion (16.7%). The remaining 35.6% who did not receive vocational support either declined the referral, did not respond to outreach, or were deemed an inappropriate referral. There were no significant differences across any demographic variable when comparing veterans who engaged in services and those who did not engage in services. See Table 2 for detailed results.

Table 2.

Differences in Demographics Between Veterans That Engaged in VEC Services and Veterans That Did Not Engage in VEC Services.

Demographic Characteristic	Engaged (N = 58)	Did not engage (N = 32)	T-value	χ²	p value
Age	M = 40.00 SD = 11.44	M = 39.50 SD = 11.99	0.195		.954
VA Disability Rating	M = 45.52SD = 41.60	M = 58.75SD = 39.66	−1.468		.234
Race
White	46	26		0.166	.638
All other	12	6
Gender
Male	51	26		0.745	.532
All other	7	6
Employment
Unemployed	41	24		0.465	.495
Status
All others	17	7
Education status
Some college and below	45	20		1.569	.299
Associate degree and above	12	10
Substance use diagnosis
Yes	37	19		0.465	.495
No	21	13
Mental health diagnosis
Yes	49	28		0.465	.495
No	9	4

Note. VEC = Vocational Evaluation Center; VA = veterans affairs.

Veterans were referred from a range of programs with an average rate of six referrals per month (over the course of 15 months; December 2016 to February 2018). The highest percentage of referrals (32.2%) came from the Domiciliary, a residential program for veterans experiencing homelessness. Compensated Work Therapy (CWT) programs (transitional work experience, supported employment, community-based employment services) accounted for 28.9% of referrals; followed by Supported Education Programs (i.e., Veterans Integration To Academic Leadership [VITAL] and Strategies for Transition, Academia, Readjustment and Success for Military Students [STARS]) (18.9%), the mental health clinic (12.2%), and primary care behavioral health (4.4%). The remaining programs (e.g., CWT/transitional residence house, neuropsychology, and a community-based outpatient treatment program) each referred one veteran. Table 3 provides a demographic comparison of veterans referred to the VEC to veterans enrolled in the Domiciliary and CWT (the two highest referral sources).

Table 3.

Demographic Comparison of all Veterans Referred to VEC to Veterans Enrolled in Domiciliary and CWT Programs During Fiscal Year 2017.

Demographic Characteristic	VEC (n = 90)	Domiciliary (n = 191)	CWT (n = 203)
Gender
Male	85.6%	97.4%	95.5%
Female	13.3%	2.6%	4.5%
Age (mean)	39.80	47.70	47.40
Race/ethnicity
White	78.9%	79.6%	84.2%
Black	10.0%	12.0%	8.9%
Hispanic/Latino	7.8%	2.6%	3.0%

Note. VEC = Vocational Evaluation Center; CWT = compensated work therapy.

Results from the qualitative, thematic analysis found that veterans sought VEC services for three main reasons: (a) vocational uncertainty, (b) functional considerations in vocational planning, and (c) finding purpose. Veterans who expressed vocational uncertainty sought VEC services to develop clarity around self, world of work, and their place within it. Veterans who sought VEC services for functional considerations in vocational planning did so to identify pathways that would accommodate both their internal constraints and preferences (e.g., pain, recovery goals, and disability). Those that sought VEC services to find purpose did so to identify and develop a pathway toward meaningful vocational activity. See Table 4 for a visual overview of all themes, definitions, and frequencies of participant responses.

Table 4.

Thematic Codes, Definitions, and Frequencies of Veterans’ Reported Reasons for Seeking VEC Services.

Theme	Subtheme	Definition	Frequency
Vocational uncertainty		Veteran sought VEC services to develop clarity around self, the world of work and their place within it	59
	Career development, early	Veterans had little or no understanding or knowledge of themselves, the world of work, and their place within it	39
	Career development, advanced	Veterans expressed some crystallized vocational pathways based on knowledge of self and work	20
Functional considerations in vocational planning		Veterans sought VEC services to identify vocational pathways that would accommodate their internal constraints and preferences	17
Finding purpose		Veterans sought VEC services to identify a pathway toward meaningful vocational activity	17

Note. N = 59. VEC = Vocational Evaluation Center.

Vocational Uncertainty

The vocational uncertainty construct was separated into two thematic branches that distinguished responses by level of clarity in their career development process. Veterans in an early career development process had little or no understanding or knowledge of themselves, the world of work, and their place within it. For example, one participant stated, “I am not sure what I want to do . . . I don’t have a dream job . . . I usually take jobs for the wrong reasons . . . I want to be more thoughtful in developing a career plan.”

The second thematic branch consisted of responses indicative of someone in an intermediate career development process who expressed a more crystallized understanding of possible vocational pathways based on knowledge of self and work. Another individual stated, “I am mostly considering pursuing education and employment in the fields of [architecture] or business. My biggest weakness is making a decision.”

Functional Considerations in Vocational Planning

Veterans reported a variety of internal constraints that led them to seek VEC services. Responses indicated many veterans were concerned with their own sobriety and viewed work as a means to recovery from substance use. For example, one veteran indicated that “[my]goal is to maintain my sobriety.” Moreover, responses indicated that veterans also viewed work as part of their mental health recovery process. For instance, one veteran noted that he sought career development service to develop a plan that “supports my primary goal of achieving mental and emotional stability.” Furthermore, veterans identified perceived physical limitations as barriers to employment, and explained how these perceived barriers led them to the VEC such as “I’d like to get back to work, but I don’t know what I can do based on my physical disability . . . I can’t stand for periods of time longer than 20 minutes.” Veterans also sought services to navigate chronic pain concerns. One individual stated “I need help figuring out my interests . . . I’ve been thinking about landscape construction . . . but I have a lot of chronic pain so I’m not sure if that’s a good plan.” Veterans also indicated that aging in a physically demanding job as a factor for seeking career change. For example, one person shared that, I am [in my late 50’s] years old, and all I’ve known is construction . . . my body aches so bad at the end of the day, this line of work isn’t sustainable anymore, but I love what I do and don’t know what else to do.

Finding Purpose

Responses indicated veterans may view work as a meaningful part of life, which is demonstrated by one veteran who stated “I want to wake up in the morning and enjoy work . . . money isn’t everything for me . . . I would even work for free if it meant doing something I wanted to do.” Moreover, responses showed that veterans may associate purpose with other benefits. For example, “I still have no idea what I want to do . . . I have no sense of purpose . . . I need to be doing something to feel better.” Veterans also expressed feeling unfulfilled with their current vocational activity and indicated seeking VEC services to change their career to one they perceived as more meaningful. An exemplar quote includes “I’ve been in construction my whole life and I feel like I need something more purposeful, meaningful, something that benefits people.” Other reasons for seeking VEC services were collected but were not at a sufficient frequency to explore further; these included finding employment that meets financial needs, support one’s family, expressed dissatisfaction with current employment or field of study, and navigating vocational opportunities due to legal history.

Discussion

TheVEC was designed to meet the career development needs of veterans with psychiatric disorders and disabilities. The VEC was informed by SCCT (Lent et al., 1994, 2000), as well as the recommended elements of career development services outlined by the Office of VHA Vocational Rehabilitation Services (2016). Findings from this study provide preliminary evidence of acceptability, demand, and need for career development services among veterans with psychiatric disorders. Moreover, findings suggest that the needs of VEC consumers align well with the theoretical propositions of SCCT.

Evidence for acceptability of the VEC is primarily related to the diverse demographics of consumers using VEC services and corresponding rates of service completion. It was notable that veterans referred to the VEC held a range of demographic characteristics—a vast majority were VA service connected for physical and/or mental disabilities, and many were diagnosed with co-occurring mental health and substance use disorders. There were a wide range of ages represented, and a vast majority were unemployed and most did not have a college degree. Given the diverse composition of the veterans referred to the VEC, it was notable that the intervention was tolerable to users of the service, with a dropout rate of only 16.7%. Dropout rates among veterans with similar demographic compositions who are engaged in VA vocational services have been previously reported at 34% (Drebing et al., 2002; Drew et al., 2001) to 43% (Drebing et al., 2005). These reports are similar to the most recent national CWT data collected by the Northeast Program Evaluation Center (NEPEC) which reported 31.6% of VA vocational service consumers did not complete services; due to either leaving involuntarily (failing to comply) or choosing to stop prematurely (Resnick et al., 2018). Compared with national VA CWT attrition rates, dropout rates in this study provide initial evidence that consumers find VEC services to be acceptable. Relatedly, our study found no significant differences in age, gender, race, disability status, employment status, education levels, mental health diagnosis, or substance use diagnosis between veterans who were referred and engaged in VEC services versus those who were referred but did not engage in services. These findings seem to suggest that career development services offered at the VEC were acceptable across demographic characteristics as no discernable pattern was found among those who followed through on a referral and those who did not.

In addition, the VEC served more female veterans, as well as a younger veteran populations, relative to the two highest referral sources—the Domiciliary and CWT program (Resnick et al., 2017; N. Smith et al., 2017). This finding seems particularly important given that younger veterans and female veterans underutilize VA health care services compared with older, male veterans (Gulliver et al., 2010; Washington et al., 2011). Moreover, it was noteworthy that a variety of outpatient and inpatient sources referred veterans with a complex set of problems to the VEC. This provides initial evidence of acceptability of services among clinical providers.

There are multiple points of evidence that appear to demonstrate demand for VEC services. First, within a relatively short period of time, and with very little outreach effort, veterans were referred to the VEC by a range of referral sources, with referrals continuing at a steady rate. Approximately 31.1% of our sample was referred during the first 5 months, 40% were referred during the next 5 months, and 28.9% were referred during the final 5 months. Given the limited time frame for data collection (15 months), reasons for the final decline in referral rate over the last 5 months is unclear. For example, declining referral rates may have been an indicator of overcapacity or poor performance, or the final rates of referral may reflect a more realistic referral rate following a sharp increase of referrals after the initial opening of the newly developed VEC. Additional preliminary evidence for the demand of career development services was confirmed by the voices of veteran participants themselves, as they discussed their reasons for seeking VEC services.

Qualitative analysis from this study revealed that veterans who received VEC services varied with respect to clarity surrounding their vocational direction (i.e., vocational uncertainty). Most were described as early in their career development process as they discussed having very little understanding of themselves, or the world of work, and their place within it. A smaller group of veterans were further along in their career development process as these individuals expressed more crystallized understanding of possible vocational pathways based on their knowledge of self and work. These veterans were looking for services to help ensure the accuracy of this knowledge.

From an SCCT lens, clarity of vocational interests and goals are important because they lead to goal-directed behavior and eventual job attainment (Lent et al., 1994, 2000). According to SCCT, vocational uncertainty is the product of low self-efficacy beliefs and outcome expectations, which may represent a particular problem for individuals with psychiatric disorders because research indicates that individuals with disabilities have lower career-related self-efficacy and outcome expectation beliefs than individuals without disabilities (Ochs & Roessler, 2001). Thus, developing evidence-based interventions to increase self-efficacy and positive outcome expectations to reduce vocational uncertainty seems to be an important consideration. The VEC integrated interventions to address self-efficacy and outcome expectations through the course of treatment (Table 1), which appears well-aligned with the expressed needs of consumers.

In addition, veterans participating in the VEC indicated that they sought career development services to find a vocational pathway that would contribute to a greater sense of purpose. It is notable that veteran participants, who were often unemployed and facing numerous internal and external constraints, sought career development services to support their need for greater purpose, as opposed to finding a job to meet basic survival needs. We know that not all jobs are created equally, in fact, some employment contributes to worsening functioning and well-being (Friedland & Price, 2003; Millner et al., 2015; Strickler et al., 2009), so finding that veterans sought career development services to enhance vocational meaning and purpose makes intuitive sense. The need for career development services to assist veterans in finding greater purpose in their work-lives is aligned with larger societal demands. Work perceived to be below one’s skill, education, experience level, or that is underpaid or part-time or temporary when permanent or full-time work is preferred (i.e., underemployment) is on the rise (U.S. Department of Labor, 2008), and a recent consumer survey report suggests that veterans experience underemployment at rates 15.6% higher than the civilian population (Barrera & Carter, n.d.).

It is noteworthy that VEC consumers’ wish to find greater purpose appears to be conceptually linked to the goals and interest domains of SCCT. Thus, providing further support for the recommendation that career development services consider methods of addressing self-efficacy and outcome expectation beliefs. This recommendation is in line with previous research that has found self-efficacy and other work-related beliefs to be related to current employment status among adults with psychiatric disabilities (Waghorn et al., 2007).

In addition, many veterans were motivated to seek VEC services to explore ways of accommodating their vocational preferences with internal constraints (e.g., age, chronic pain, mental illness, substance abuse and sobriety maintenance, and physical disability). These findings are similar to other qualitative studies that found individuals with psychiatric disorders often discuss the difficulty in finding and maintaining employment that fits with their experience of mental illness (Millner et al., 2015; Strickler et al., 2009). For some individuals with psychiatric disorders, there is a clearly stated need to explicitly discuss the impact mental illness and other disabilities have on one’s vocational decision-making.

These findings appear aligned with the SCCT model which puts priority on attending to proximal contextual factors that inhibit vocational choice (Lent et al., 1994, 2000). Indeed, even if individuals have developed clear and purposeful vocational goals for themselves, proximal contextual factors (e.g., accommodating disabilities) have an influence on the career development process and ultimate career outcomes (Sheu et al., 2010). Thus, interventions that address contextual influences on career development, such as those included in VEC services (Table 1), seem to be important for individuals living with psychiatric disorders.

Finally, given that VEC services appear to be acceptable and have demand to meet particular vocational needs, an intriguing notion is that career development services could act as a preventive outreach intervention that connects veterans to other vocational rehabilitation programming they may not have otherwise used. Anecdotally, some veteran participants noted that they wouldn’t consider other vocational programming until they had a clearer sense of their vocational options, preferences, and goals. For these veterans, career development services served as an opening to further conversations regarding their reluctance to engage in vocational rehabilitation programming, which led to referrals and warm handoffs to other programs such as transitional work and supported employment. Thus, career development services may engage a large number of individuals with psychiatric disorders who tend to not participate in other vocational rehabilitation programming due to lacking vocational goals (e.g., Mueser et al., 2011).

Limitations and Future Directions

The limitations of this study offer direction for future research endeavors. First, this study was limited by the data collected by VEC providers for clinical and program evaluation purposes. Given the limited nature of this data some questions are left untested, such as why 35.6% of individuals referred for career development services did not engage in treatment. High rates of nonparticipation may, in part, explain why our study found a low dropout rate. Future research investigating feasibility of career development services for individuals with psychiatric disorders would benefit from collecting data to explain the lack of engagement in services. In addition, while previous research has found that matching one’s employment to their preferences, interests, and skills is related to increased vocational functioning (Beveridge & Fabian, 2007; Kukla & Bond, 2012; Strickler et al., 2009), this study provides no outcome information about how career development services have impacted consumers’ ability to find, secure, or progress toward employment aligned with his or her preferences and talents. Future research should track consumers’ progression through career development services and beyond to evaluate and monitor the impact these services have on important vocational behaviors, outcomes, and functioning.

In addition, while our findings suggest that the perceived need for career development services of VEC consumers aligned well with the SCCT model, our study is limited by the relatively small amount of qualitative data collected. Future studies are needed to further support the effectiveness of SCCT-informed career development interventions among individuals living with psychiatric disorders, especially those with multiple and complex psychiatric circumstances that are often underrepresented in psychiatric vocational rehabilitation literature. It appears particularly fruitful for additional research to explicitly investigate the connection between self-efficacy and outcome expectation beliefs on vocational goals, behaviors, and outcomes among individuals living with psychiatric disorders.

Moreover, there is a dearth of evidence related to the psychosocial factors that aid, or hinder, the career development of veterans with psychiatric disorders. Thus, the implementation of VEC services was largely guided by general career development literature. It is likely that the ability to provide effective career development services to veterans with psychiatric disorders would be enhanced by targeted research inquiry. Exploratory and explanatory research could establish relationships between career development processes and behaviors (e.g., career exploration, career decision-making, or vocational identity) to theoretically relevant psychosocial variables (e.g., career beliefs, career barriers, social stigma, or hope).

Finally, recent empirical evidence among a sample of 38,199 veterans participating in VHA Vocational Rehabilitation Services programs found that ancillary vocational services (e.g., prevocational assessment and job clubs) were associated with increased odds of consumers securing competitive employment when paired with a main vocational rehabilitation program such as supported employment and transitional work (Abraham et al., 2017). Given this finding, Abraham and colleagues (2017) recommend evaluating the impact of ancillary programs (such as the career counseling and assessment services discussed in this article) on competitive employment outcomes of veterans when paired with a main vocational rehabilitation program like supported employment or transitional work. We agree that this would be an important line of research that could potentially lead to enhanced competitive employment outcomes for individuals living with psychiatric disorders.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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