Career Development in Transitional Work Settings: A Qualitative Investigation Among Veterans and Vocational Counselors

Abstract

Veterans living with mental health conditions have ambitious career goals and want support to find employment that meets their interests and preferences. Despite calls from researchers to “invest” and “commit” to career development research and practice for individuals living with psychiatric conditions, we still do not have empirically tested models for facilitating career development among individuals with mental health conditions, especially veterans. This qualitative study investigates the career development needs and recommended intervention strategies of veterans living with mental health conditions. Vocational counselors from the Veterans Health Administration (VHA) and veterans receiving vocational rehabilitation services (N = 13) participated in semi-structured focus groups. Findings illuminate the tasks, barriers, interventions, implementation strategies, and transitional work context that hinder and support career development of veterans with mental health conditions. Findings offer theoretical and applied guidance to researchers and counselors regarding career development of veterans living with mental health conditions.

Veterans living with mental health conditions (MHCs) want meaningful employment (Stevenson, Gorman et al., 2021); however, this population experiences many barriers, and they often have poor employment outcomes (Zivin et al., 2011). Thus, vocational interventions for veterans with MHCs has predominately focused on rapid job placement (e.g., Individual Placement and Support [IPS] model of Supported Employment [SE]; Drake et al., 2012). Although IPS-SE has been proven effective at helping veterans secure competitive employment (Davis et al., 2018), focusing on immediate job acquisition, at the expense of personal aspirations, is not ideal (Luciano & Carpenter-Song, 2015). Prominent psychiatric rehabilitation scholars have noted that “the longer-term recovery goal of finding personally interesting and challenging work in one’s field of interest continues to remain elusive for many consumers. Success in this endeavor will require an investment and commitment to career development” (Mueser & Cook, 2012, p. 419). Given the importance of attending to longer-term career goals, the Veterans Health Administration (VHA, 2016) recently mandated that career development services be infused into their vocational programming that has typically emphasized rapid job placement. However, evidence-based career development interventions for veterans with MHCs is lacking.

Career Development Interventions

Few career development interventions have been empirically tested among veterans with MHCs. An early study on this topic investigated the use of a narrative, or “storytelling,” intervention among 14 veterans in a vocational rehabilitation program, most of whom had a mental health disorder (Krieshok et al., 1999). Veterans were asked to narrate their desired futures with respect to work, relationships, housing, and recovery, and narrate how they envisioned themselves moving toward this desired future. Krieshok and colleagues (1999) report this narrative intervention enabled participants to better understand their future goals and plans.

A more recent study investigated the feasibility of a career development intervention provided to 90 veterans with MHCs (Stevenson, Gorman et al., 2021). The career development intervention aimed to enhance career and self-exploration, identify vocational goals aligned with needs and preferences, and facilitate connection to needed resources in service of their goals. Informed by Social Cognitive Career Theory (SCCT; Lent et al., 1994), the intervention addressed related topics such as self-efficacy, outcome expectations, interests, goals, and personal/contextual influences. Results provide evidence of feasibility (acceptability, need, and demand) of the intervention for veterans with MHCs; however, the authors noted that the theoretical framework (i.e., SCCT) had not been empirically tested among veterans living with MHCs (Stevenson, Gorman et al., 2021). A lack of research-based career development interventions for veterans living with MHCs, is likely due to few empirical studies on career development among this group.

Employment Needs

A majority of research on veterans with MHCs has focused on how mental health symptoms act as a barrier to attaining employment. For example, veterans with severe mental illness (e.g., psychotic spectrum disorders and bipolar disorders) have low rates of competitive employment (Murdoch et al., 2017). Research also shows that Post Traumatic Stress Disorder (PTSD) is associated with unemployment and other poor vocational outcomes (Stevenson, Mueller et al., 2021), and that major depressive disorder is related to employment status such that higher self-reported depressive symptoms increases the likelihood of a veteran being unemployed (Zivin et al., 2016). Similarly, veterans with substance use disorders experience high rates of unemployment (Humensky et al., 2013).

Few studies have examined employment-related barriers of veterans with MHCs beyond symptoms or diagnoses. One qualitative study found that contextual factors such as age, veteran status, criminal background, housing status, and transportation were common barriers to employment among veterans with MHCs (Kukla et al., 2015). Two additional studies found that negative career thoughts were related to poorer job satisfaction and increased career worry (Bullock et al., 2009), and that conflictual relational messages about work were related to lower vocational identity (Stevenson, Thrower et al., 2021). Others have investigated the career development needs of veterans, in general (not specific to veterans with MHCs), and have particularly focused on career transitions. For example, one study found career adaptabilities and occupational engagement predicted university student veterans’ readiness to engage in career transitions (Ghosh & Fouad, 2016), and another found pre-transition planning (from military to civilian) and social support were helpful to veterans’ employment goals (Keeling et al., 2019).

Theoretical Needs

More empirical investigations of the unique career development needs of veterans with MHCs is necessary to inform evidence-based career development practice for this population. Social Cognitive Career Theory (SCCT; Lent et al., 1994) and Psychology of Working theory (PWT; Duffy et al., 2016), may serve as helpful theoretical models. Social Cognitive Career Theory emphasizes self-efficacy, outcome expectations, as well as personal/contextual influences as impacting career interests, choices, and performance (Lent et al., 1994), while PWT emphasizes marginalization, economic constraints, career adaptability, and work volition as impacting obtainment of decent work (Duffy et al., 2016). Given the barriers, veterans with MHCs face in their career development, PWT’s and SCCT’s emphasis on contextual factors is particularly relevant. Moreover, by naming survival needs as a core component of accessing decent work, PWT may help inform interventions that address both longer-term career development, as well as immediate survival needs, which are both likely to help veterans with MHCs. Although other studies have demonstrated support of PWT and SCCT among individuals living with serious mental illnesses (Millner et al., 2015; 2020), neither theory has been tested among veterans, specifically.

Purpose of Study

This study sought to explore the career development needs and possible interventions for veterans with MHCs. We aimed to give voice to those with lived experience and the vocational counselors supporting veterans in their vocational journeys, to better inform research and practice. Although current theoretical models may sufficiently capture the career development experiences of veterans with MHCs, adaptations may be needed, if not new models all together.

Method

Participants and Procedures

Given the dearth of literature on career development of veterans with MHCs, we utilized an inductive qualitative approach. We used focus groups due to their methodological strengths of being more “naturalistic” than individual interviews, offering a socially contextual basis for meaning making, and shifting power away from the researcher toward the participants (Wilkinson, 1999), in addition to building consensus opinion when existing knowledge on a topic is inadequate (Powell & Single, 1996). It has been recommended to conduct at least two focus groups for each defining demographic characteristic of the group (Carey, 1995). Thus, we conducted two focus groups with veterans and two focus groups with VA vocational counselors.

Two psychologist-researchers with clinical expertise in vocational services, developed a semi-structured interview guide for the focus groups. Open ended questions were developed to gather information on the following: (1) barriers, potential solutions, and needs to promote successful career outcomes; (2) obtaining feedback on the useful elements of theory, research, and best clinical practices on career development (group participants were presented brief descriptions of core elements of SCCT and PWT and asked to discuss the relevance of the theoretical tenets); and (3) exploring issues related to augmenting VA vocational services with career development interventions. All groups were audio recorded and transcribed. Groups were facilitated by the two psychologist-researchers who developed the interview protocol, as well as a notetaker. Study procedures were approved by the local VA Institutional Review Board.

Counselor Focus Groups.

In collaboration with VHA Vocational Rehabilitation Central Office, experts in vocational services were identified from VA hospitals across the United States. The primary investigator emailed 12 expert counselors to solicit their participation. Eight counselors responded and were enrolled in the study to participate in one of two, 90-minute, virtual focus groups. Counselors answered a brief demographic questionnaire prior to their participation. One counselor was unable to attend the focus group, due to scheduling conflicts. Of the seven VA counselors who participated in a focus group, four identified as “Female” and three identified as “Male.” Participants reported their age range as “35 years–50 years” (n = 5), or “51 years–60 years” (n = 2). Most identified their race as “White,” (n = 5), followed by “Hispanic” (n = 1) and “Black” (n = 1). The average years spent providing vocational services to veterans was 11.5 years (SD = 6.04). All counselor participants provided direct vocational services to veterans, and all but one of the counselor participants were in a supervisory position.

Veteran Focus Groups.

Veteran participants were recruited from one VA hospital’s transitional work (TW) program in the Northeast United States in Summer 2021. Transitional work provides veterans a time-limited, non-competitive, paid position that has been contracted by the rehabilitation program. Within VA, TW positions are typically housed at the hospital (e.g., housekeeping, grounds crew, and dishwashing), but are sometimes located in the community. Eight veterans were enrolled into the study to participate in one of two in-person, 90-minute focus groups. Veterans completed a demographic questionnaire. Two veterans did not attend their scheduled focus group.

Of the six veterans who participated in one of two focus groups, all identified as “Male.” Veterans’ ages ranged from 32 to 69 years old (M = 55.5; SD = 11.33). Most identified their race as “White,” (n = 3), followed by “African American/Black,” (n = 2), and multiracial (n = 1). In terms of highest education completed, one veteran had a graduate degree, two had technical school/training, and three completed high school. Five veterans had a diagnosis of PTSD that was co-morbid with depression (n = 2), unspecified bipolar disorder (n = 2), and borderline personality disorder (n = 1), and one veteran had a diagnosis of bipolar I disorder, only. All six veterans reported experiencing homelessness at some point, and a majority were receiving disability compensation (n = 4) and had a co-occurring substance use disorder stemming from alcohol, opiates, and/or cocaine (n = 5).

Analytic Method

The focus group transcripts were analyzed using the Hamilton (2013) rapid analytic approach, which is a commonly used analytic method in health services research to rapidly summarize collected data using a template of domains and data condensing. This approach is best suited to short-term projects using interview guides (Hamilton & Finley, 2019), such as used in the current project. The Hamilton analytic technique improves on past rapid procedures through its systematic, rigorous approach, yielding accessible results (Averill, 2002). The Hamilton approach has been successfully applied in previous qualitative research with veterans (e.g., Moreau et al., 2018). The three researchers—the principal investigator (PI; a counseling psychologist), and two other researchers (a counseling psychologist and a social worker/research associate)—all met for to discuss the analytic method and to review relevant training materials.

Based on this study’s interview guide, as well as the interviews themselves, the PI developed an analytic template organized by topic areas covered in the focus groups: (1) Career Development Tasks, (2) Barriers to Career Development, (3) Helpful Interventions, and (4) Implementation Strategies and (5) Other. The three researchers individually applied the derived template to summarize one interview to test the usability and relevance of the template to the transcript. Afterward, all three researchers met to establish consistency in how the template was used to summarize the transcript and to clarify definitions of each topic area. Disagreements were discussed until consensus was reached. Then, the remaining three focus groups were independently summarized by all three researchers. Once completed, the team met to review all four transcripts (one-by-one) to reach consensus on the summaries. We collectively gathered the summary data from each individual transcript onto one master matrix sorted by topic area and subject group (veteran vs. counselor). The PI then condensed the summaries in the master matrix by identifying and organizing recurring themes across the team derived summaries. The PI eliminated redundancies and grouped similarities into themes for clarity and parsimony of data. The other two researchers audited the condensed matrix to the original master matrix to confirm all summary points had been maintained, and that topic areas and themes had been appropriately identified. All three researchers met to discuss the audits of the condensed matrix, and to make necessary revisions and resolve disagreements until consensus was reached.

Results

The four topic areas identified from the interview guide—(a) Career Development Tasks, (b) Barriers to Career Development, (c) Helpful Interventions, and (d) Implementation Strategies—fit the data well. A fifth topic area—(e) Transitional Work Context—emerged from the “Other” topic area. See Table 1 for a summary overview of the topics, themes, and source of these data (i.e., veteran focus groups, counselor focus groups, or both).

Table 1.

Overview and Source of Topics and Themes Emerging from Qualitative Analysis.

Topic	Theme	Brief Description	Veteran	Provider
Career development tasks	Future career fit	Need to find a personally important/exciting career	x	x
	Maintaining employment	Need skills/tools for job maintenance such as interpersonal skills, understanding workplace culture, developing work-life balance, and getting treatment	x	x
	Job-searching	Need skills/tools to navigate the job-search process; resumes, interviewing, etc.	x	x
Barriers to career development	Job application process	Discrimination, stigma, lack of resources, lack of skills interviewing, and unhelpful beliefs about job searching	x	x
	Substance use & mental health	Difficulty balancing SUD/MH recovery, survival needs, and vocational goals	x	x
	Identifying job-goals	Not having, or difficulty, identifying vocational goal due to low self-worth and questioning one’s ability to work	x	x
	Environment	Lack of resources and social support for their vocational pursuits	x	x
Helpful interventions	Initial assessment	Counselors should get to know the veterans’ skills, strengths, background, training, interests, preferred work setting, experiences, and education	x	x
	Facilitating career exploration	Ongoing process of exposing veterans to career options; requires a lot of time	x	x
	Job-search skills training	Training on completing job applications, addressing gaps on resume, interviewing, soft skills (e.g., communication), and how to address substance use concerns on a job-site or with potential employers	x	x
	Outreach	Need for resources and information about vocational support programs	x
	Recovery-based interventions	Need to address both recovery needs, in addition to vocational goals		x
Implementation strategies	Veteran-centered recovery approach	Interventions should be flexible and attentive to veteran’s needs	x	x
	Qualities of career counselors	Basic helping skills leading to effective veteran-counselor relationships	x	x
	Timing	When to implement career development interventions should be unique to veteran’s needs	x
	Administrative components	Counselors want standardized note templates		x
Transitional work context	Helpfulness	Provides opportunity for new experiences and pathway to full-time, competitive employment	x	x
	Placements	Want more community-based jobs based on interests, skills, & experiences	x	x
	Discharge planning	Veteran-centered approach to terminating TW services (e.g., tapering, have plan in place)	x	x
	Admission decisions	Restricting TW participation to those individuals who have explicit short and long-term goals of competitive employment in the community		x
	Administrative challenges & opportunities	Challenges establishing community and VA placements due to “slowness,” “bureaucracy,” and other administrative delays		x

Note. An “x” indicates consensus endorsement of the theme across all veteran focus groups or all provider focus groups.

Career Development Tasks

The area of Career Development Tasks includes the concrete tasks that counselors and veterans believe need to occur in order to promote career development. Three themes emerged from the focus groups in this area. Themes included (1) future career fit, (2) maintaining employment, and (3) job-searching.

Future Career Fit.

The findings emphasized the importance of the veteran finding a personally important and exciting career. Veterans described the significance of finding something they can be proud of, that fits their current life needs, and is more valuable than substances. For example, a veteran said, “we need to find something that’s more important than the drug or the drink or whatever it is that will occupy the space in your mind, and for a lot of us it’s – you know, it’s your career.” Counselors also emphasized the need for veterans to identify what excites them about work or a future career to move beyond TW. However, counselors also noted that veterans should have realistic job expectations, with both short- and long-term goals.

Maintaining Employment.

Veterans shared many specific skill areas that they need to develop to maintain employment including: being self-directive, proactive, and aware of their needs. Veterans also highlighted the value of interpersonal skills, noting their need for openness to feedback and help from others to maintain employment. Veterans described how active substance interferes with employment maintenance. For example, a veteran said, “if I’m using I’m not tryin’ to get a job, and if I have a job I’m gonna lose it because I’m using.” Both veterans and counselors identified the importance of engaging in positive activities outside of work as a form of self-care to maintain employment. Counselors also focused more on proactive skills connected to the workplace such as developing an understanding of workplace culture; especially, communication, hierarchies, power, allies, reasonable accommodations, and ways to self-advocate for their needs.

Job-Searching.

Job-searching was a clear career development task for veterans and counselors. Veterans described the need for a phone, a resume, a place to live, and a calendar/schedule to successfully manage a job-search. They also highlighted a need for developing tangible interview skills. Veterans also emphasized the need to support their self-esteem during a job-search by reminding themselves of their self-worth, above and beyond their potential jobs and maintaining hope for meaningful work. For example, a veteran said, “I have to keep my self-esteem high. Know that I’m worth more than what I’m applying for…its [bad job] gonna affect your self-worth.” Counselors similarly emphasized the need for veteran to develop concrete job-search skills like interviewing, networking, and leveraging social supports.

Barriers to Career Development

The area of Barriers to Career Development describes roadblocks that impact veterans’ ability to pursue meaningful employment and develop their career identity. Four themes emerged from the focus groups in this area. Themes included (1) job application process, (2) substance use and mental health, (3) identifying job goals, and (4) environment.

Job Application Process.

For veterans, challenges with the job application process included not having an address to list on applications due to homelessness, stigma related to lacking a driver’s license, and challenges related to having a criminal record. Veterans also emphasized bias barriers within the job application process related to age stigma and gaps in their job history. Counselors also discussed the challenges veterans face with interviewing and networking due to veterans’ disinterest in the process and lack of social support. Counselors also mentioned that some veterans believe employers hold all the power, preventing veterans from self-advocating. Conversely, counselors mentioned overconfidence and inflated salary expectations as a barrier.

Substance Use and Mental Health.

Both veterans and counselors described substance use and poor mental health as barriers to career development. Veterans emphasized the struggle and challenges of finding meaningful employment versus being in “survival mode” and taking any available job due to mental health and substance concerns. Veterans also discussed worrying about job loss due to potential relapse and concerns about balancing work and recovery. A veteran said, “while you work TW still get your therapy because people are so concentrated on the work that you forget about yourself.” Veterans described tension attending to career goals that they know will help their recovery while also experiencing mental health symptoms. A veteran described this as a “catch-22” stating, “you’ll feel better if you do this. Yeah, well I’ll do this when I feel better.” Counselors similarly described the problematic challenges of overfocusing on jobs and dismissing one’s recovery. For example, a counselor linked a veterans resumed substance use as an example of focusing too much on work, and neglecting recovery—“they work so hard to get that, and they get to that point and they relapse…They’re working on getting a job, but they’re not working on their recovery.” Counselors also noted barriers related to employer bias, untreated mental health conditions, veterans not believing they have a mental health condition, inconsistent use of psychiatric medications, dependence on substances for fun, and seasonal/cyclical mental health symptoms.

Identifying Job-Goals.

Both counselors and veterans discussed problems with identifying job-goals as a barrier to career development. Veterans described challenges perceiving a future for themselves and how TW reinforces being “broken” due to the “lower echelon jobs” and receiving negative messages from others regarding TW participation. Veterans also discussed lack of desire for work due to long-term unemployment or receiving financial disability benefits. Counselors discussed concerns, such as veterans with minimal hope or confidence, and also emphasized challenges identifying job-goals due to veterans viewing TW as an end goal or only being interested in federal jobs, which they described as a poor fit for many veterans. Counselors also described how limited work experience and veterans’ concerns about the impact of employment on financial benefits makes career exploration and identifying job goals challenging.

Environment.

Veterans described lack of support, from family and counselors, as a barrier to career development. Veterans felt that counselors did not show enough interest in their career interests and said, “it was probably like 1 of 83 questions.” Veterans also described counselors’ lack of follow-through on therapy requests and lack of support when transitioning from residential programs. Veterans highlighted challenges with accessing VA services and benefits due to lack of knowledge/information. Veterans with a history of incarceration reported difficulty with their transition back into the community. Counselors described similar challenges and also discussed veterans’ lack of basic needs (e.g., housing, food) due to expensive cost of living and lack of social support in the community.

Helpful Interventions

The area of Helpful Interventions describes interventions or approaches that counselors and veterans have identified as helpful for veterans’ career development process. Five themes emerged in this area. Themes included (1) initial assessment, (2) facilitating career exploration, (3) job-search skills training, (4) outreach, and (5) recovery-based interventions.

Initial Assessment.

Both counselors and veterans emphasized the importance of the initial assessment in career development. Veterans discussed the need for counselors to take time to get to know the veterans’ skills, strengths, training, interests, preferred work setting, and education. Veterans noted that talking about breaking out of the cycle of survival mode early on would be helpful. Veterans also highlighted that addressing poor fit between counselor and veteran is needed, if apparent. Similarly, counselors discussed important components of the initial assessment which additionally included exploring childhood career aspirations, outcome expectations, genuine interests, and reasons for past job loss. Counselors emphasized the importance of exploring the experience of having disabilities, transferable skills analysis, and work setting preferences (structure, time, duties, and colleagues). For example, a counselor said, “talking to them about how do they understand how their disability affects their daily life and what their symptoms really are, and what does that really mean in real words, like in words that they get.” Counselors also expressed the importance of assessing the veterans’ environmental context including the impact of employment on housing benefits.

Facilitating Career Exploration.

Veterans suggested inviting speakers from different professions to talk to them about their careers and their recovery. Veterans also added that transferring life skills to a job setting would help facilitate career exploration. Veterans emphasized how career exploration is an ongoing process, requiring sustained attention, “you gotta keep throwing things as us until something piques our interest.” Counselors discussed suggestions for engaging veterans in career exploration including self-disclosure of the counselor’s own career journey and reviewing performance on TW placements. Counselors also discussed exploring short- and long-term goals, identifying dream jobs, exploring rationale behind interests, and using formal assessment tools. They conveyed the importance of backward planning (i.e., start with long-term goal and identify progressive steps), as well as encouraging veterans to talk with people in their lives about their career goals. They also acknowledged the help of community resources or employers to explore education and work. Counselors suggested challenging veterans’ beliefs if they say a job is too hard. Finally, the counselors underscored the importance of budget and salary calculations, and benefits planning.

Job-Search Skills Training.

Veterans discussed the need for job application training, addressing gaps on resumes, interviewing, soft skills (e.g., communication), and addressing substance use concerns on a job-site or with potential employers. Counselors largely reiterated what veterans suggested in addition to increasing basic computer skills. Counselors also discussed the importance of improving networking and informational interviewing. Some described using a group format (or “job club”) consisting of weekly, topical presentations from a facilitator, to teach job-search skills and to monitor veterans’ job-search behavior. Counselors suggested using job-searching guidebooks and providing training on online job search engines.

Outreach.

Only veterans highlighted the importance of outreach and VA providing resources. Veterans suggested handouts and posters about training/employment benefits, and materials that reminded veterans to balance their recovery and their job are helpful. Veterans also emphasized the need for resources for veterans to think about life after incarceration.

Recovery-Based Interventions.

Only counselors emphasized strategies under the theme of recovery-based interventions. Counselors thought it was important to develop “vocational coping plans” (i.e., a plan for the veterans to cope and manage life stressors before quitting or losing one’s job) as an important intervention to support veterans’ career development. These coping plans include identifying supports and warning signs, planning for life outside of work, the importance of problem solving, and communicating needs with staff when obstacles arise or during a crisis. Counselors also emphasized the need to increase veterans’ awareness of their environment’s impact on recovery and to encourage building healthy environments and social supports. Relatedly, VA counselors believed it important to instill a sense of control in veterans’ ability to manage their recovery and substance use, to get needed accommodations at a job, navigate difficult relationships, and to manage their finances. With respect to careers, counselors promoted viewing jobs as transitions, versus permanent choices, and conveying a sense of hope.

Implementation Strategies

The area of Implementation Strategies includes suggestions from counselors and veterans on how to implement career focused interventions in a rehabilitation setting. Four themes emerged from focus groups in this area. Themes included (1) veteran-centered recovery approach, (2) qualities of career counselors, (3) timing, and (4) administrative components.

Veteran-Centered Recovery Approach.

Veterans described a need for a career development intervention to be implemented in a flexible way, as some veterans may need more time to move forward than others. Veterans also felt that treatment format decisions (i.e., group vs. individual) should match a veteran’s unique needs and choices. Veterans also encouraged utilizing peer support. The VA counselors similarly stressed the importance of a veteran-paced, “non-cookie-cutter,” flexible approach to delivering career development interventions. They also highlighted a need for a holistic approach that integrates work and other areas of life functioning, necessitating collaboration with other providers. Finally, counselors suggested orienting treatment toward long-term career rather than “just finding any job.”

Qualities of Career Counselors.

Veterans emphasized the importance of the counselor–veteran relationship by noting that they would be less likely to follow through with a counselor they did not like. Veterans described many qualities of an effective career development counselor including: open minded, compassionate, and non-judgmental. These ideal counselors would ask questions to understand the veteran and provide check-ins or follows up with the veteran in a caring manner. Counselors also emphasized the importance of building strong relationships with veterans, as well as communicating hope and demonstrating basic counseling skills. The VA counselors believed a master’s degree was needed, in addition to experience with job-placement, ability to drive a government vehicle, and some experience with marketing.

Timing.

Veterans described the importance of timing an intervention appropriately for each veteran due to varied experiences in recovery. Some may be ready for vocational work shortly after getting sober, while others took a year to “think clearly enough.” Finally, veterans thought individuals who are incarcerated could benefit from conversations about one’s career before transitioning into the civilian world.

Administrative Components.

VA counselors noted a preference for standardized note templates. Counselors also identified the discrepancy that exists when hospital leadership view some directives (such as the VHA Vocational Services directive to integrate career development into programming) as suggestions rather than imperatives.

Transitional Work Context

Veterans and counselors described how the Transitional Work Context played a role in veterans’ career development. Veterans and counselors both discussed themes of (1) helpfulness, (2) placements, and (3) discharge planning. Counselors also shared feedback that fit into themes of (4) admission decisions, and (5) administrative challenges and opportunities.

Helpfulness.

Veterans described how TW provides an opportunity and pathway to full-time, competitive employment (particularly for veterans with criminal records), in addition to allowing veterans to try out multiple different job roles. One veteran stated “TW sent me out to a kitchen and before that, I hadn’t cooked for years, not even like ramen, and before that I was an executive chef, so it definitely re-sparked my interest and love for cooking.” Finally, Veterans described that having a job helped to maintain sobriety. The VA counselors noted that TW can be helpful by allowing veterans to address employment barriers and gain experience with managing obstacles in a worksite. As possible limitations, the counselors noted the possibility that TW could limit transition into a similar type of competitive job within the agency if the veteran does not perform reliably on their TW placement. Additionally, TW may poorly prepare veterans for community employment if the TW job is considerably “easier.”

Placements.

Veterans expressed a desire for more community-based job options that were based on veterans’ interests, skills, and experiences beyond “unskilled labor.” One veteran stated “most jobs [in TW] are unskilled labor. You know, totally aren’t likable because they’re—you know, they don’t really tap into any of your skillsets and your strengths. They don’t really give you a chance to grow as a person.” Veterans also wanted TW placement decisions to be made with an intention to help veterans learn new skills, try new roles, or spark interest to support career development goals. Counselors discussed shifting the focus from TW placements at the VA hospital to placements in the community.

Discharge Planning.

Veterans described the need for a veteran-centered approach to terminating TW. Veterans thought that TW counselors should taper down services rather than implement arbitrary endings, understanding that recovery is a process. Relatedly, veterans noted that they should leave TW with a plan for life and career. The counselors echoed the perspective of veterans, noting that length of participation in TW should be based on clinical need.

Admission Decisions.

VA counselors discussed the ideal recipients of TW services. Some described restricting TW participation to those individuals who have explicit short and long-term goals of competitive employment in the community. Relatedly, some counselors indicated that veterans with goals of working in the VA may not be appropriate for TW, but rather for some other job-search assistance type of programs.

Administrative Challenges.

The VA counselors spoke about difficulty in developing more community-based TW placements. Additionally, counselors discussed the challenge of hospital leadership pushing for TW contracts rather than what may be best for veterans (e.g., viewing TW as a business rather than a rehabilitation program). Finally, counselors noted that career development directives are best received when there are implementation strategies.

Discussion

Theoretical Insights

The findings from this study offer important information about the career development tasks and barriers of veterans living with MHCs. Several environmental barriers including discrimination, bias, lack of support, difficulty in treatment environments, lack of stability with basic survival needs, and cost of living were reported as negatively impacting employment outcomes of veterans with MHCs. These external barriers seem conceptually related to the PWT model which links marginalization and economic constraints directly to an individual’s obtainment of decent work (Duffy et al., 2016). Additionally, results suggest that internal barriers, especially mental health and substance use symptoms, negatively impact employment outcomes. Although PWT does not specifically emphasize the link between internal barriers, like mental health symptoms, to employment outcomes, van Hooft and colleagues’ (2021) meta-analysis on job-search success similarly found that mental health does directly impact employment success. For veterans with MHCs, a complete theoretical model may need to include external and internal barriers as directly related to employment outcomes.

Notably, the identified career development tasks were not aimed at dismantling the reported barriers, but rather, focused on generally helpful behaviors and skills related to career development. Results specifically emphasize the following tasks: (1) identifying a career passion, (2) improving job-searching skills, and (3) developing skills for maintaining employment. These career development tasks converge with the meta-analysis of job-search success that found job-search self-regulation (which includes goal exploration, goal clarity, and self-regulation skills) and job-search behavior predicts employment success outcomes (van Hooft, et al., 2021). Moreover, the tasks identified in this study appear well aligned with the “Choose-Get-Keep” model (Rogers et al., 2006) of psychiatric and vocational rehabilitation. Our focus group participants identified a need to Choose a meaningful vocational goal, to develop job-searching skills to help them Get their vocational goal, and finally, improving on skills to Keep jobs once they have them. However, “choosing” a vocational goal may oversimplify our participants’ defined task of finding a future career fit. Participants in our focus groups described the identification of meaningful career goals as something needing to be more important than alcohol or drugs, and that would propel them beyond their positions within TW, which offers access to a paid job opportunity that may not be readily available in the competitive job market. As such, the process of identifying a career goal that holds tremendous personal significance is likely complex and involved. It may be necessary to “explore” as a precursor to, or simultaneously with, the process of “choosing” as outlined in vocational rehabilitation models. Future research is needed to explicate the overlay between models of vocational rehabilitation and career development. The Choose-Get-Keep model (Rogers et al., 2006), PWT (Duffy et al., 2016), and van Hooft’s (2021) model of job-search success offer theoretical bases for future studies.

Intervention Insights

To support the identification of meaningful career goals, focus group participants emphasized the need for an in-depth evaluation to understand the full person’s uniqueness, in addition to facilitating career exploration through an ongoing and repeatedly reinforced process. Counselors also noted a need to understand a veteran’s unique mental and physical disabilities to help inform job goals that are well aligned with their functional capacity as well as their recovery and survival needs. These findings align with previous research that found veterans seek career development support, in part, to identify career paths that account for their personal accommodation needs (Stevenson, Gorman, et al., 2021). A PWT informed counseling model that assesses the degree to which an individual’s survival needs are being met has been previously described (Blustein et al., 2019), and may be helpful to veterans with MHCs. Relatedly, counselors in our focus groups emphasized the specific need to provide veterans with information regarding how employment may impact their receipt of financial disability benefits. Research finds that receipt of financial disability benefits impacts career progress among veterans (Tsai & Rosenheck, 2013), and thus, benefits counseling is a necessary component of vocational rehabilitation practice (Drake et al., 2012). Having information about the interaction of disability benefits and employment may be an important consideration for career development interventions among veterans with MHCs.

In order to help veterans obtain their employment goals, focus group members described how interventions should focus on enhancing job-searching skills. Previous research has adapted job-search skills to veterans living with criminal records, specifically, and is likely a relevant resource for supporting career development interventions for veterans with MHCs, more generally (LePage et al., 2011). The counselor participants in this study indicated a general need for interventions to integrate mental health recovery and career development into an inclusive treatment approach. This message is consistent with vocational scholars who’ve long argued for the integration of personal and career counseling, versus as siloed practices (Betz & Corning, 1993). This message also aligns with best practices of vocational rehabilitation, which requires the integration of mental health with vocational service (Drake et al., 2012).

Though both veterans and counselors identified the need for veterans to develop skills for maintaining employment, only the counselors described interventions that enhance job maintenance skills. Counselors thought it useful to develop “coping plans” with veterans to manage difficult work situations before quitting or being fired. They emphasized interventions to increase awareness to environmental triggers for their mental health and substance use symptoms, bolstering general skills for managing their life and recovery, and instilling realistic views of career development as a process, rather than discreet choice. Coping plans are routinely used in other cognitive-behavioral interventions for self-regulation, so it is reasonable to suspect such interventions could also support job maintenance for veterans with MHCs.

Though not the intended focus of this study, the context of the TW intervention emerged as a central topic among veterans and counselors. For some, TW was described as providing a helpful work opportunity for veterans living with MHCs that would be difficult to find in the community. These opportunities opened the door to career possibilities and interests previously foreclosed. For others, however, the typical manual labor nature of TW jobs, degraded self-worth and contributed to internalized stigma that they are only worth a job lacking career potential. These findings are similar to research on the career development of young adults living with MHCs which found that job placement with no advancement potential were frustrating and lowered one’s sense of confidence (Luciano & Carpenter-Song, 2015). Thus, it may be important to address negative psychological outcomes from participation in TW. Additionally, it may be that TW differentially benefits or degrades someone’s career development in predictable ways. For example, individuals without defined career goals may experience positive outcomes from exploring TW placements, while others who have clear career goals may experience negative outcomes from engaging in TW placements that aren’t aligned with their goals. More research is needed to determine for whom, and under which conditions, TW is most helpful.

Implementation Insights

Both veterans and counselors described many basic helping skills as qualities of a helpful counselor. They also reported the need for career development interventions to be flexible and person-centered, rather than being “cookie cutter.” For example, veterans thought the timing of implementing career development interventions should be based on the specific veteran and their readiness for such interventions. At the same time, counselors wanted standardized note templates. Although standardized protocols can be helpful for counselors’ practice, we also know that forcing inflexible treatment protocols onto clients can be problematic as well (Swift et al., 2018). Our findings seem to highlight this tension and indicate that treatment protocols strive to be both informative and structured, while also being flexible to the presenting client’s needs.

Limitations

There are some limitations to this study that warrant consideration. First, a convenience sample of veterans was used, which limits generalizability. The sample, however, is largely representative of veterans who utilize TW services through the VA (see Abraham et al., 2017). Although most of the results of this study are non-specific to veteran identity and the VA context, the results are contextually bound to the VA setting and thus may be less generalizable to non-VA services. Given that the veteran sample was drawn from one VA program, there may be a location bias in their response. However, the VA counselors were represented nationally and include participants identifying as female, which adds to generalizability of findings. Moreover, our sample size was determined a priori based on other similar qualitative research studies, rather than based on data saturation. With a larger sample, it is possible that more themes would have emerged that were not captured in this study. However, a majority of themes (71.4%) were reported across veteran and counselor groups, suggesting the data holds up well. The possibility of missing some topics does not diminish the perspectives of the veterans and counselors in this study. Given the dearth of literature on career development of veterans with MHCs, this initial investigation opens up future possibilities for research and practice. More deductive research is needed to test the application of relevant theory to this population. Finally, veterans in this study had interest in vocational pursuits, given their participation in TW. Whether these findings apply to veterans with MHC’s who are not actively pursuing vocational goals is unclear.

Conclusions

This study contributes to our knowledge of how to support the career pursuits of veterans living with MHCs as they simultaneously navigate their personal recovery journeys. Though this population experiences multiple barriers to their career development, our findings do not suggest that veterans with MHCs want to focus on those barriers. Rather, our findings emphasize a recovery-oriented approach to treatment that shifts focus away from their barriers toward the pursuit of valued career-related tasks, including identifying career goals, enhancing job-search skills, and increasing skills for maintaining employment. To implement such interventions, this study suggests using an integrative approach to career development that takes into account the larger recovery needs of the client. More research is needed to support the career development of this particularly marginalized population.

Biographies

Brian Stevenson is a Clinical Research Psychologist for the VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC) at VA Bedford Healthcare System. He received his PhD in Counseling, Clinical, and School Psychology from the University of California, Santa Barbara. His research focuses on developing vocational interventions that support meaningful employment goals and self-efficacy for veterans with addictions and co-occurring conditions, upstream interventions to prevent job loss, employer bias interventions, provision of recovery-oriented psychological services, and harm reduction. He enjoys hiking, drawing/graphic design, snowboarding, discovering new music, and watching documentaries.

Ummul-Kiram Kathawalla is a counseling psychologist and postdoctoral research associate in the Department of Counseling Psychology & Human Development at Boston University Wheelock College of Education & Human Development. Her mixed-method research examines the associations between societal context, discrimination, identity, and wellbeing to develop culturally informed interventions and technology that address mental health and career development for marginalized populations. She uses an evidenced-based client-centered approach to support her clients and supervisees to foster personal growth and live life according to one’s values. She uses her research and clinical expertise to work with nonprofits to create opportunities for marginalized populations. In her free time, she enjoys engaging in meaningful conversations with friends and family, doing yoga, reading, traveling, trying new foods, and listening to live music.

Camille Smith is a Counseling Psychology PhD candidate at Boston College. She works in Dr. David Blustein’s research lab on topics such as decent work, unemployment/underemployment, and dignity at work. From 2021 to 2022, she was a practicum trainee at VA Bedford Healthcare System where she worked in Dr. Brian Stevenson’s Work and Recovery Lab alongside her clinical training. She also has a MSEd in Mental Health Counseling from Fordham University and a BA in English/Creative Writing and Psychology from Rhodes College. Outside of graduate school, she enjoys running, creative writing, and listening to lots of musical theater cast albums.

Lisa Mueller is a psychologist and an investigator with the VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC) at VA Bedford Healthcare System. As Clinical Director of the Compensated Work Therapy (CWT) program, she assists staff who provide transitional work, supported employment, and supported education. Her research interests include vocational rehabilitation and peer services. Outside of work, she enjoys walking and biking.