Stages of Change Scale to Measure Work Readiness of Transition-Age Youth With Disabilities: A Promising Approach

Stages of Change Theory

The stages of change (SOC) theory has been a successful means to increasing motivation and behavioral change across professional disciplines (Levesque et al., 1999; Prochaska & DiClemente, 1983). Aligned with self-determination and self-efficacy theory, SOC seeks to increase an individual’s motivation to change their behavior. People advance through the defined stages until achieving the desired outcome. The process is rarely linear, and individuals often revisit earlier stages before successfully achieving the desired behavioral change (Levesque et al., 1999; Passmore, 2007; Prochaska & DiClemente, 1983). The SOC is composed of five unique stages: precontemplation, contemplation, preparation, action, and maintenance, with progression through the stages representing positive change (Hashemzadeh et al., 2019; Passmore, 2007). While a sixth stage—highlighting termination—was added to the model, it has rarely occurred and therefore was not considered in this study. The SOC theory has been validated through numerous empirical studies and can be adapted for use in many different fields including vocational rehabilitation (VR) (Gervey, 2010; Iwanaga et al., 2020).

Iwanaga et al. (2019) examined the relationship between working alliance and SOC for employment by studying autonomous motivation, outcome expectancy, and VR engagement with participants experiencing chronic illness or disability who were receiving services from VR. Working alliance refers to the relationship and established trust between the VR client and counselor. The study revealed that good working alliance significantly improved autonomous motivation, outcome expectancy, and VR engagement. Consistent with prior research, these factors were found to increase success in progressing through the SOC and enhance the likelihood of obtaining and retaining paid employment (Iwanaga et al., 2019). These findings demonstrate that increasing an individual’s motivation and outcome expectancy can facilitate successful progression through subsequent stages and in turn, contribute to improved outcomes and paid integrated employment.

Counseling individuals through the SOC is important for increasing motivation to change and ultimately achieving the desired behavior change and outcomes (Norcross et al., 2010). It is anticipated that an individual’s progress through the stages will predict their future behavior, in this case, increased motivation to seek out employment opportunities (Levesque et al., 1999). Professionals who assist people with behavior change are recommended to focus on movement through the precontemplation, contemplation, and preparation stages into action and maintenance. Supporting progression into the action and maintenance phases ultimately leads to the desired behavioral change and improved outcomes. Similarly, the provision of additional support and services to those trying to make positive life changes such as obtaining competitive integrated employment and decreasing dependence on public benefits, is key.

Motivation Interviewing

Motivational interviewing (MI) has been studied as a method to assist individuals progress through the SOC and may help increase attainment of the desired behavior change (Britt et al., 2018). Combining SOC and MI has been demonstrated to improve success across differing focus areas including employment assistance for individuals returning to work after an injury, individuals with a disability, and people with serious mental illness (Britt et al., 2018; Hampson et al., 2015). A recent randomized control study examined this concept to determine whether MI helps increase motivation for individuals who are unemployed or underemployed (Britt et al., 2018). All participants were assessed using an SOC measure at enrollment and those in the treatment group received two 3-hour MI interventional workshops. Those remaining in the contemplation stage following the workshops received additional individualized MI support. Results revealed that those in the treatment group who received MI in addition to the standard program demonstrated increased motivation for employment, were more engaged in seeking employment, experienced improved employment outcomes, and retained their intended results (Britt et al., 2018).

Current Study

The current study used a modified SOC Scale to measure work readiness and feelings about work of youth receiving SSI benefits before and after receipt of Wisconsin Promoting Readiness of Minors in Supplemental Security Income (PROMISE) services. Wisconsin PROMISE included services aimed to increase work motivation and readiness including MI, work incentive benefits counseling, financial capability building, counseling on career development and work possibilities for youth with disabilities, and support navigating transition resources. The modified SOC scale included questions about job interests, job searches, positive and negative impacts of employment on family life, and following up on job leads. The scale was designed to evaluate both positive and negative factors that influence work motivation for transition-age youth with disabilities (Hartman et al., 2019). In addition to youth participants, the scale was also administered to a member of the youth’s family, and the youth’s PROMISE counselor through the Wisconsin Division of Vocational Rehabilitation (DVR). The study examined responses to the scale and measured progress through the SOC toward increased work readiness and positive feelings about employment.

Method

Measurements

All youth and their parents signed a consent form and filled out an intake form prior to enrollment in the program. The intake form requested contact information along with basic demographic questions about the youth such as race/ethnicity, gender, household information, number of people living in the household, living arrangements, primary language spoken at home, annual household income, household public assistance, school attendance, education, individualized education plan (IEP) status, prior employment, expectations about the future, disability type, and health status. It also posed questions to family members, and responses were required for at least one parent/guardian although responses from up to seven additional family members were accepted. The questions included contact information, relationship to youth, race/ethnicity, gender, highest level of education, employment status, and expectations about the youth participant’s future.

SOC scale baseline survey

The SOC scale questions were designed to measure the youth’s feelings about work and to gauge their work readiness. The family survey questions were designed to measure the family member’s feelings about work and their own work readiness. The DVR survey questions were designed to measure the counselor’s perception of the youth’s feeling about work and work readiness. There were nine questions pertaining to the SOC using a 6-point Likert-type scale ranging from 1 (Disagree a lot) to 5 (Agree a lot), along with an Option 6 (“I already have a job I like”). See Table 1 for the complete list of youth and family questions, along with the scale. The DVR counselor survey asked the same questions; however, they were worded slightly differently. For example, instead of “I think about what kind of job I would like,” the DVR counselor surveys asked, “The consumer thinks about what kind of job he or she would like?”

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Table 1.

Stages of Change Questions for Youth and Family.

Stages of change: These questions ask about your feeling on jobs or work.	Disagree a lot	Disagree a little	Not sure	Agree a little	Agree a lot	I already have a job that I like.
I think about what kind of job I would like.
If I were to find a job, it would hurt my family life and I cannot let that happen. a
I am looking for a job right now.
I am following up on job leads.
I am working hard to find a job.
I believe looking for work will hurt my benefits and I cannot do that. a
I am trying to meet with someone to hire me.
I do not know why I need to look for a job. a
I am thinking about training to be able to get a job.

a

Reversed coded for data analyses.

All treatment youth were asked by their PROMISE DVR counselor to take a baseline survey, preferably before any services began. Recruitment and enrollment in the project ended April 2016, and participants had until December 31, 2016, to complete the baseline survey. At least one family member was also asked to take the baseline survey. Family members and DVR Counselors were respectively asked to complete the SOC scale, as the answers pertained to the enrolled youth. To increase response rates, PROMISE researchers emailed, called, and texted reminders. Following data cleaning, deletion of duplicates, and removal of surveys with less than one half of the questions completed, a total of 424 youth, 497 family members, and 807 DVR counselor follow-up surveys were included in the baseline survey. Cronbach’s alphas were as follows: youth baseline survey = .834, family baseline survey = .817, and DVR baseline survey = .854, all indicating good reliability.

SOC scale follow-up survey

PROMISE services ended September 30, 2018. All treatment youth were asked by their DVR counselor or assigned family advocate to complete a follow-up survey near the end of the service provision period. At least one family member was also asked to take the follow-up survey, as was the youth’s PROMISE DVR counselor. To encourage a higher response rate, PROMISE researchers emailed, called, and texted reminders to those who had not yet taken the survey. During their last meeting with the youth, counselors and family advocates also encouraged youth and families to take the survey. Reminders for survey completion were actively sent over a 7-month period between June of 2018 and January 31, 2019. The follow-up SOC scale involved the same questions as the baseline survey. Following data cleaning, deletion of duplicates, and removal of surveys with less than one half of the questions completed, a total of 213 youth, 254 family members, and 498 DVR counselor surveys were included in the follow-up data. Cronbach’s alphas for the follow-up surveys were as follows: youth = .860, family = .878, and DVR = .901, which all fell within the good or excellent reliability range.

Results

Related Samples Wilcoxon Signed-Rank Test

The youth, family, and DVR surveys were all statically significant, p < .01, indicating most youth, family members, and DVR counselors reported a positive change in youth and family member readiness to work, moving from contemplation to action, actively working, and/or finding a job. Figure 1 highlights the reported youth increases in readiness to work, and Figure 2 highlights family members’ increased readiness to work. Figure 3 highlights PROMISE DVR counselors’ reported perception of increases in youth readiness to work.

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Figure 1.

Results from related samples Wilcoxon signed-rank test—youth.

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Figure 2.

Results from related samples Wilcoxon signed-rank test—family.

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Figure 3.

Results from related samples Wilcoxon signed-rank test—DVR.

Discussion

The results from this study reveal that youth, family, and counselor responses on the SOC scale significantly improved from the time of the baseline survey to the time of the follow-up survey. The SOC scale questions were designed to measure the youths’ feelings about work both before and after the program to examine if their attitudes had changed. The youths’ feelings about work and their work readiness significantly increased throughout the PROMISE program. The results from the counselor survey are consistent with the youth survey which reinforces the finding that youth’s feelings about work and work readiness improved significantly. These results are consistent with increased employment rates of PROMISE youth (Hartman et al., 2019). At enrollment, 2% were working, but these employment rates increased to 67% by the end of services. As readiness for work increased, so did employment rates. This was further tested using employment rates after PROMISE services ended, employment rates significantly increased for youth who had a large increase of scores on the SOC measures from baseline to follow-up compared to youth with a small increase or decrease in scores. Youth who had the largest increase in score were more likely to be working after services ended. Similarly, youth family members, typically a parent or guardian, also reported a significant increase in work readiness and improved perspective about their own work.

The PROMISE program implemented a series of interventions to help progress participants through the SOC to increase work readiness, increase work motivation, and achieve integrated paid employment. Through techniques such as MI and goal-building, to pre-employment services and trial-work experiences, the PROMISE interventions sought to build self-determination and self-efficacy to influence functional outcomes and employment goals. Self-determination interventions have been introduced as effective tools for encouraging people with disabilities to be active participants in all aspects of their treatment and rehabilitation program (Corrigan et al., 2012). A study conducted by Shogren and colleagues (2015) provided evidence that a student’s level of self-determination at the end of high school significantly predicts higher employment, career goals, and community access outcomes.

To guide participants through the SOC, PROMISE implemented interventions to help youth progress through the precontemplation, contemplation, and preparations stages into the action and maintenance stages. PROMISE DVR counselors were trained in MI techniques to implement during their client interactions. MI has been demonstrated to positively influence student’s self-efficacy, self-determination, employment outcome expectations, and employment outcomes (Britt et al., 2018). MI is especially useful in the early SOC, as it is integral for individuals to develop the skills, awareness, and motivation necessary to work toward eliminating ambivalence toward change.

Research has also shown that increasing an individual’s expectations can lead to better employment outcomes (Wagner et al., 2005). To help increase the expectations of both parents and youth participants and to support empowerment, PROMISE offered trainings specific to employment, work incentives benefits counseling, and financial capability. Work incentive benefits counseling helped youth and families navigate benefits while working using work incentives such as Student-Earned Income Exclusion and reduced fears regarding work impact on benefits (Schlegelmilch et al., 2019). “Make Your Money Talk,” a four-session personal finance program covering economic and financial education, was offered to help increase ownership and control over benefits and financial assets, which increased youth and family self-advocacy and self-determination, both of which are predictors of employment and postschool education (Test et al., 2009). Self-advocacy modules were also offered to teach participants the skills and knowledge needed to actively participate in their own treatment.

PROMISE VR counselors and family advocates used MI techniques and empowerment strategies to help move youth and families from ambivalence about work to readiness for employment. One of the empowerment strategies involved strength-based approaches focusing on the youth or family’s identified knowledge, skills, and interests and subsequently identifying job matches that aligned. Another strategy involved listening to youth and family goals, allowing the youth and family to lead their own plans and paths, and helping guide them through the process rather than telling them in what to do and how best to complete tasks. Counselors and family advocates also helped youth and families set smaller attainable goals and then continued to build on these successes. All strategies used were intended to foster development of the youth and family’s independence so that following the completion of PROMISE services, participants had the tools to gain and retain employment on their own.

Given the strong correlation between readiness to work and employment outcomes, VR counselors can improve guidance and counseling by better understanding readiness to work at the beginning of the VR process. Guidance and counseling will vary, depending which stage of change the individual presents at. If consumers are in precontemplation, VR counselors may first need to address fears or concerns. If consumers are contemplating employment, the VR counselor will benefit from discovering the individual’s motivation to work, using MI techniques, and capitalizing on these internal motivations to move the individual toward action. If the consumer comes to VR ready to work, counselors may be able to skip pre-employment services and start with job search and placement immediately. An SOC measure for youth transitioning into adulthood can help VR staff better identify which stage the individual is presenting at to align services, supports, and strategies that help improve work motivation, readiness, and employment outcomes. Including specific interventions such as MI, self-advocacy training, work-incentive benefits counseling, financial capability building, and job shadowing can assist youth in accomplishing smaller successes and increasing work motivation, ultimately leading to better employment outcomes.

Conclusion

This article helps to illustrate the importance of increasing motivation and self-determination for transition-age youth as a means to guide them through the SOC toward meaningful employment opportunities and financial self-sufficiency. The impact of using the SOC framework to help increase work motivation and work readiness can help to inform policy and practices for VR agencies and other programs aimed at supporting transition-age youth receiving SSI benefits in obtaining employment. It is recommended that future research in this area focus on how work motivation influences long-term employment outcomes and financial independence for transition-age youth and their families.