Developing the WorkingWell Mobile App to Promote Job Tenure for Individuals With Serious Mental Illnesses

Abstract

Objective:

Individuals living with serious mental illnesses are key stakeholders in user experience design and the development of the WorkingWell mobile app to enhance on-the-job follow-along support. In this study, Individual Placement and Support (IPS) consumers identify challenges in sustaining employment, provide data regarding their use of technology, and suggest technology-based solutions for coping on the job to inform app development.

Method:

Focus groups were conducted in 3 agencies providing IPS services to examine consumers’ perspectives on supported employment, work, and their preferences for technology-based supports. Qualitative data were coded thematically in a multistep, collaborate approach to ensure trustworthiness. Survey data were collected to describe participants and their current technology use; these data were analyzed descriptively.

Results:

A total of 25 IPS consumers reported work challenges related to interpersonal relationships and social situations; job characteristics, tasks, and expectations; illness- and treatment-related issues; lifestyle/wellness and conditions apart from work; and motivation. The majority owned mobile phones, felt comfortable using technology, and could see how technology-based tools could help sustain employment. Participants highlighted the potential benefits of technology-based supports for work challenges, and underscored the potential for independence and empowerment as a consequence.

Conclusions and Implications for Practice:

Study findings suggest the value of a WorkingWell mobile app that is innovative, easy to access, self-directed, and individually tailored to enhance IPS follow-along support. The WorkingWell app, if proven effective, will provide an empowering set of tools designed with input from individuals with serious mental illnesses, and integrated into a single, accessible interface.

Employment is often a priority for individuals with serious mental illnesses (e.g., schizophrenia, bipolar disorder, major depression) because it provides structure, daily activity, meaning, a normal adult role, social contact, community integration, self-esteem, increased income, and a better quality of life (Luciano, Bond, & Drake, 2014). Effective strategies to help individuals obtain and sustain meaningful employment are key to the recovery process. Individual Placement and Support (IPS) supported employment is well studied, with a solid evidence base (Drake, Bond, & Becker, 2012; Marshall et al., 2014; Swanson & Becker, 2013). The rate of attainment of competitive employment among IPS participants is routinely significantly better than the employment rate for individuals receiving traditional vocational rehabilitation services (Marshall et al., 2014). Yet a significant portion of individuals receiving IPS do not become steady workers, and relatively brief job tenures have been reported and criticized (Bond & Drake, 2008; Cook et al., 2005; Mueser et al., 2005). In addition, the optimal level of job support for each individual client may fluctuate across time (Drake et al., 2012).

Follow-along support for individuals who attain employment is a cornerstone of the IPS model. Technology-based interventions and tools (e.g., “apps”) set in mobile devices (e.g., smartphones, tablets or laptop computers) may offer solutions for supporting individuals with serious mental illnesses in the workplace in readily accessible, nonstigmatizing, personally tailored ways, with the potential to address work challenges, optimize work functioning, and sustain employment (Lord et al., 2014). Research shows that people with mental illnesses, including those with significant cognitive impairments, can successfully interact with and benefit from technology-based systems that are designed with their needs in mind, and that individuals with serious mental illnesses have access to and use mobile technologies (Ben-Zeev, 2012; Ben-Zeev, Davis, Kaiser, Krzsos, & Drake, 2013). The objective of the WorkingWell project is to engage IPS consumers in laying the groundwork for a smartphone app to provide on-the-job follow-along support and enhance job tenure.

Knowledge Translation, New Product Development, and Intervention Integrity

Enhancing an evidence-based supported employment model like IPS via technology-based tools requires consideration of individuals’ characteristics, needs, experiences, and preferences to develop an acceptable, feasible technology-based solution (Lord et al., 2014). The Need to Knowledge (NtK) Model provides an evidence-based framework for generating technological innovations (Flagg, Lane, & Lockett, 2013; Lane & Flagg, 2010). In this model, the technological innovation process is defined as comprising three phases: discovery, invention, and innovation. Research plays an important role in the discovery phase in identifying a problem, scoping existing solutions and filling gaps in existing knowledge (Lane, 2012). The NtK model and user experience design (Norman, 2013) suggest the value added of integrating consumer voice and choice into the development of technology-based solutions.

Objective

Technology-based tools may provide a solution to the IPS follow-along challenge. However, the acceptability, feasibility and potential benefits of the translation of IPS theories and strategies from an in-person intervention to one accessed via mobile device, particularly one that supports a consumer once he or she is employed, require further exploration. Consumers are key stakeholders in this translation process. In this study, we explore the following research questions:

1. What do individuals with serious mental illnesses receiving IPS services identify as challenges in sustaining employment?

2. Are IPS consumers experienced with and interested in using technology?

3. What do they suggest as technology-based solutions for dealing with on-the-job challenges?

Consumers’ reports of their challenges and experiences, and suggestions for meeting their needs, are integrated into recommendations for the proposed WorkingWell smartphone app to promote job tenure.

Method

Qualitative methods are useful in user-centered design and development processes as a way of collecting first-person perspectives on needs and priorities. For this development project, focus groups were conducted with IPS consumers to examine perspectives on the supported employment process, work, and job-seeking experiences, and to explore the potential for technology to support consumers’ vocational needs and preferences. Survey data were collected to describe study participants and to capture their perspectives regarding current and anticipated use of technology.

Recruitment of Participants

Data were derived from convenience samples of consumers receiving services through three participating IPS-supported employment programs located in mental health organizations in metropolitan areas in the Northeastern and Mid-Atlantic United States. The sites included a large community mental health agency, a peer-led mental health agency, and a private nonprofit organization specializing in treatment of co-occurring disorders. Participants were recruited with the assistance of clinical and administrative staff at the sites. Individuals receiving IPS services were eligible to participate.

The study was reviewed and approved by the college Committee for the Protection of Human Subjects. Individuals received an information sheet describing the purpose, procedures, and risks of the study, and gave verbal consent to complete the survey and participate in focus groups. They were compensated $20.00 for their participation.

Procedures

Focus groups were conducted during the summer and fall of 2013. The project director coordinated with IPS agency supervisors to identify potential participants and schedule the focus groups. Two trained researchers facilitated each focus group, conducted in conference rooms at the agencies. The researchers used a topic guide, based on the aims of the project, to structure the focus group inquiry. Focus group probes began with general questions about supported employment and technology, and gradually became more specific about follow-along supports and technology-based solutions. Topics included intervention engagement (e.g., “What has been helpful about supported employment and what would you change?”), goal setting (e.g., “In what ways do you think technology might help you find a job and prepare for working?”), job searching (e.g., “How do you currently use technology, like your mobile phone, tablet or computer, and the Internet for job seeking?”), work experiences (e.g., “What types of challenges come up during a typical day at work?”), follow-along supports (e.g., “Can you think of ways technology might help you cope with challenges during the workday?”), and technology use (e.g., “In what ways is technology helpful to you in your everyday life?”). To supplement open-ended questions, examples of technology-based approaches were displayed to help guide discussion about current use and additional ways that technology-based tools and strategies could be incorporated into the supported employment process. Focus groups lasted about an hour and were audio recorded. Participants also completed a paper-based survey regarding demographic information, current technology use, and attitudes relating to technology as a support for employment and recovery.

Analysis

Focus-group transcript data were managed and analyzed with the aid of Atlas.ti (Friese, 2015). We used a multistep, collaborative approach to strengthen the trustworthiness of the qualitative analysis (Shenton, 2004). An initial code list was developed through a combination of inductive review of transcripts to identify themes and deductive categories derived from the main research questions and domains covered in the focus group topic guide. A research team member coded the transcripts in Atlas.ti and the code list was revised per additional themes that emerged through continued immersion in the data set. Two researchers independently reviewed a selection of the coded data to ensure the coded segments of text were consistent with the code definitions. Inconsistencies were resolved through discussion to achieve consensus.

A subset of codes was selected as relevant for the present analysis. As an additional check on the credibility of the qualitative codes used for this analysis, a team member reviewed the original focus group transcripts alongside the previously coded data to ensure that all relevant text passages were included in the final code reports used for the present analysis. Members of the team independently read the code reports and wrote qualitative memos to interpret the data. Memos were shared and discussed among team members. The integration of these memos and dialogue among team members were foundational to the results presented herein.

Results

Findings relate to participants’ characteristics and the research questions regarding consumers’ challenges and needs, their amenability to technology-based tools, and suggested solutions.

Participants

A total of 25 IPS consumers participated in focus groups. The majority of the participants were male (80%) and White/Caucasian (80%), with fewer indicating Black/African American (12%) or Other (8%) racial groups. A small percent were Hispanic (4%). Participants spanned age group categories, with 24% in the 18- to 24-year-old group; 28% from 25 to 40 years of age; 36% between the ages of 41 and 55; and 12% over the age of 55. The greatest number was employed part-time (44%), while 28% were actively searching for work. Sixteen percent were students and 12% were in volunteer or intern positions (see Table 1.)

Table 1.

Background and Demographic Characteristics

Variable	Percent	n
Sex
Male	80	20
Female	20	5
Race
White/Caucasian	80	20
Black or African American	12	3
Other race (write in)	8	2
Hispanic
No	96	24
Yes	4	1
Age (years)
18–24	24	6
25–40	28	7
41–55	36	9
55 +	12	3
Employment status
Part time	44	11
Unemployed–actively searching for a job	28	7
Student	16	4
Volunteer/Intern	12	3

Question 1: What Are the Needs of IPS Consumers—Challenges and Resources?

Challenges at work, at home, and those that derive from external factors can undermine job tenure and threaten employment, as reported by study participants. Sustaining motivation can be problematic.

Interpersonal relationships and social situations.

Participants referred to challenges in interpersonal relationships and social situations more frequently than challenges in any other category identified in the focus group data. Some challenges in this domain corresponded to an individual’s impairments or lack of experience. In these cases, participants were ill equipped to manage commonplace interpersonal relationships and social situations. As one participant explained, “I become kind of defensive sometimes when I’m in new situations around new people, and I said something, kind of, sarcastic to the manager. And then it started a conflict that I didn’t mean to start.”

Other challenges in this domain were reflective of a work milieu in which the rules of interaction were not overtly defined or where roles, responsibilities, and relationships lacked clarity. For example,

I was working with six other people at the time and we were all cramped into one aisle … I was getting frustrated because I couldn’t put the stuff on the shelves fast enough because everyone else was moving so lethargically.

Participants reported challenges in working with seemingly unreliable or overly sociable colleagues, and in interacting with or feeling comfortable among coworkers more generally. One participant described “worrying that other people know what I’m thinking … just makes me not want to be there.” Less common, but still frequent, were reports of challenging situations pertaining to supervisor-supervisee interactions. “I had a confrontation with one of my bosses,” explained one participant. Another participant explained, “I thought I was going to get fired right there on the spot.”

Not all social challenges had an objectively negative valence, but were troubling anyway. For some participants, social scenarios that could be construed as positive were challenging: “Everyone wants to socialize. I don’t go to work with the idea of making friends.” Further adding to the complexity of this domain, certain social challenges were entwined with illness- and treatment-related issues. As one participant expressed, “Large groups tend to aggravate my mental health issues. Sometimes I can be a little moody, and I just have those days where I just want to go to work and just work.”

Job characteristics, tasks, and expectations.

Relevant challenges in this domain were numerous, arising from participants’ inexperience in the work environment, unclear or difficult-to-meet expectations, or poor management, or emerged at the intersection of these origins. Describing a challenge that may have abated with time and experience, one participant remarked, “Well, my usual problem is trying to find out when they want me on in terms of scheduling.” Other challenges reflected enduring struggles to understand expectations or remember job tasks. One participant recalled, “I’m looking at it like, ‘What am I supposed to do?’ And it’s normally the simplest things that you miss.” Many participants had difficulty in meeting expectations even when objectives were clear:

People start coming to the register and taking their orders, and taking a minute or two to get their order done just … kept on going, and going, and going. And by the end of the day I just wanted to shut down.

Challenges in this domain reflective of low-wage service sector jobs (e.g., physical discomforts, fast-paced work, pressure to complete tasks more quickly, feeling that the work is not respected or valued, and unpredictable scheduling) were of particular prevalence. Several participants described challenging physical job characteristics: “I had a job and I was working at a supermarket in the cold … It was challenging to be in the cold all the time.” One participant alluded to working in an emotionally challenging environment, asserting that, “We don’t get any respect for what we do. We’re underpaid.”

Adding to the breadth of this domain, challenges pertaining to job characteristics, tasks, and expectations often traversed the interpersonal and illness- and treatment-related domains. For example, one participant described a challenging situation involving both job tasks and interpersonal relationships, stating,

There’s one boss who is nasty … It doesn’t matter what you’re cleaning … [or] doing, but sometimes they will say, “Okay get this done in 20 minutes.” And it’s something that will take an hour normally … I couldn’t say anything about it.

Another participant recalled a situation that transected the illness- and treatment-related domain and which led to job termination: “I’m a very like tactile person and there was literally nothing in the room … I basically curled under the table and went into an emotional breakdown.”

Illness- and treatment-related issues.

Some participants described challenges associated with becoming symptomatic at work. For others, side effects of medication made it difficult to work effectively. For one participant, these issues collided when she intentionally stopped medication so as to not be “doped up” at work, but then was “running manic all the time.” Eventually, she chose to leave this profession when she felt “discriminated against” for her mental illness. Other participants mentioned stigma, and felt its pernicious effects manifested in limited opportunities to advance at work or contributed to being “picked on and teased.” For some participants, being the target of stigma seemed to galvanize strength and the desire to upend discriminatory assumptions: “We are disabled, but we aren’t incapable.”

Lifestyle/wellness and conditions apart from work.

Participants described factors external to the work environment that could impact job performance. For example, multiple participants discussed needing help with transportation or childcare, issues that impact one’s ability to both get and keep a job. In discussing how transportation posed a challenge, one participant recalled, “I was making minimum wage and the taxi was costing me more to go home than what I was making, so—so, it didn’t work out for me.”

Participants also noted lifestyle and wellness issues that blurred the line between work and life. One participant explained how working with a romantic partner led to the termination of his last job:

So it was, kind of, like half fired and half quitting kind of thing. It was just like my ex-girlfriend was working there and we were breaking up at the time and it was just easier to just be like—wash my hands of the situation kind of thing.

Similarly, for some participants, becoming employed created a negative lifestyle condition that, in turn, made work more challenging. For one focus group participant, receiving a paycheck triggered substance use and subsequently job termination: “My drug addiction. Having to leave work to go get drugs and quitting—quitting work. I relapsed on a Friday night because I got a paycheck.”

Motivation.

One participant underscored the importance of work: “You can improve yourself, buy something new and better—nice pair of clothes food—things to make yourself better and improve yourself.” However, sustaining motivation to work was challenging for participants. Challenges in this domain affected participants both during and outside of work. A lack of motivation at work was demoralizing and affected stamina. One participant reflected, “Some days I just go, ‘What am I here for?’ Dang, the place is hard on you.” Another individual highlighted the consequences of having low motivation outside of work: “If you don’t like your job it makes it difficult to go.” In describing challenges in sustaining motivation, participants often stated the importance of having a job they like, and the challenge of working in a job that is not interesting: “I just wish that I could find something that … I would feel better about.”

Question 2: Are IPS Consumers Experienced With and Interested in Using Technology?

Over half of the participating consumers (52%) owned basic mobile phones. Over one third (36%) owned smartphones with Internet access. Nearly half (44%) reported owning laptop computers; over one quarter (28%) owned desktop computers; and one quarter (25%) owned tablet computers (e.g., iPads). When asked about technology use in the past 30 days, nearly three quarters (72%) reported searching the Internet using Google. Sixty percent indicated they visited Facebook and YouTube sites. Over half (52%) use Gmail or another e-mail service. Sixteen percent went to the Careerbuilder.com site, 12% accessed Monster.com, 8% used Indeed.com, and 4% went to Snagajob.com—all employment-related web resources. The vast majority (80%) communicated with their employment specialist by telephone in the past 30 days. About one third (32%) communicated by e-mail. Sixteen percent text messaged. Sixty percent of the consumers reported that cell phones made it “a lot easier” or “somewhat easier” to plan and schedule their daily routines.

Most participants were comfortable using technology such as mobile phones or websites (88%), would feel comfortable using technology to help with the employment process (84%), and can see how technology-based tools could help with employment or further education (92%). Three quarters of participants indicated they would use a smartphone or other technology-based tool to help them obtain employment or education support (76%). Slightly fewer than half reported concerns about privacy issues and technology use (48%).

Question 3: What Do IPS Consumers Suggest as Technology-Based Supports?

Participants talked about ways in which mobile technology tools might help with managing stress on the job, particularly if suggestions for coping strategies were readily available and easily accessible. As one participant suggested, “It could help you with a little bit of the stress on the job. You’d feel like you have somebody there with you.” Another made a more specific suggestion, highlighting the benefits of having a readily accessible, tailored tool available in the moment of stress: “You would be able to look at your management skills and be able to look through and see which management skill might help you at that current point in time.” Another participant explained, “It dawned on me, there’s probably no end to what you could do for yourself with the right type of suggestions and things.”

Participants noted that a technology-based solution like an app could potentially address challenges in managing job tasks and expectations. As one participant explained, having a technology-based tool “where you could link up and see what’s going on for the day without having to call anybody” would be “pretty cool.” Another participant pointed out, “I think a useful tool for me would be to be able to deal with things concurrently and consecutively, so you knew what irons you’ve got in the fire … what I have left to do to follow up.” Another suggestion was to have instructions for completing work tasks or using work tools readily available via a smartphone app. A participant described a scenario: “Well, sometimes I’m not good with machines … so I could just text right there and I’ll get instructions.” Reminders were also suggested as potentially helpful, for managing to get to work (e.g., “alarms for work”) as well as on the job (e.g., “Some people do that. They set reminders for when they need to [do something]”).

Participants highlighted the possible benefits of ready access to support from professionals, family members, and peers. They described ways in which their support networks helped with practical issues (e.g., transportation), emotional issues (e.g., motivation), and managing issues on the job (e.g., getting along with coworkers): “You’d have a network to help you with the issues you’re trying to deal with so you’re not alone.” Facilitated access to peer support was mentioned as particularly helpful. A technology tool, such as a smartphone, could be a place to store important contact information as well as a way to connect, via phone call, e-mail, or text messaging, with an employment specialist, family member or peer, as well as to share successes, for example, through Facebook posts.

Technology-based tools were described as potentially empowering:

It adds another layer of independence for you. Instead of depending on your employment specialist to help you with certain resources, you have this resource right there in your hand or on the computer screen in front of you. You can act as your own case manager in managing yourself through your employment status.

Final recommendations emphasized the importance of designing tools with consumer/end users in mind: “Just keep it simple. You don’t want to be … trying to figure out what option to use when your butt is on the line. You need the button that takes you where you need to go.” Additionally, the need for training for some end users was underscored: “I think some type of technology training for people who haven’t been exposed to that would be really important.”

Discussion

The characteristics of IPS consumers participating in this study differed somewhat from participants in IPS trials, in that a significant percent were employed at the time of the study (i.e., compared with participants’ characteristics in outcome studies in which, by design, participants are not competitively employed at baseline; Campbell, Bond, & Drake, 2011). This was a strength in the current study, as the objective of recruiting participants at different stages of the employment process was met. A greater number of participants were male than in previous research; the percent of Caucasian participants was higher. The majority of participants fell in the 25- to 55-year-old age group, which is consistent with the average ages of participants in other IPS studies (Campbell et al., 2011).

Participants provide important perspectives on challenges in sustaining employment and experiences with and interest in technology, and readily made recommendations regarding technology-based resources and supports. Consumers are clearly an essential source of information regarding the potential targets and content of a technology-based follow-along tool. The challenge in translating and enhancing IPS into an app lies, perhaps, in integrating knowledge regarding consumer need with essential IPS principles or strategies specifically relevant to the follow-along phase of employment, and then linking these to technology-based intervention elements or components, and relevant outcomes. These principles or strategies inform thinking about the interactive aspects of a potential app, so that the app mimics or mirrors the IPS approach as much as possible, given the inherent differences between a technology tool and an in-person intervention. For example, the IPS emphasis on client preferences and individualized services suggest the benefits of providing opportunities for making choices and tailoring supports in an app. The IPS focus on developing concrete strategies for success using a strengths-based approach suggests that users would benefit from an interface that guides them in setting specific goals, provides encouraging feedback on their progress, and offers new directions if success is not achieved as planned.

Interpersonal relationships and social situations are reported to be quite challenging. In some instances, simple solutions may be found by accessing guidance or tips on social skills in general (e.g., how to initiate a friendly conversation with a coworker or how to end a possibly distracting conversation initiated by another in the workplace). Other social challenges may require more complex problem-solving approaches, where roles or responsibilities are not well defined or a power hierarchy contributes to interpersonal dynamics (e.g., conflict with a supervisor). These nuances suggest the value of access to quick tips for managing relationships or situations in the moment, as well as to somewhat more lengthy recommendations for problem solving for more careful consideration at another time, perhaps outside the work place.

Participants report challenges with task and time management, changing expectations (e.g., as the consumer is assigned new tasks over time), and challenges in coping with feeling overwhelmed and stressed as a consequence. Recommendations include an app feature that would help with organizing the steps in a specific task, as well as provide structure for sequencing tasks appropriately to have a productive, successful day. Users may benefit from a place to make notes regarding steps and sequences, and the capacity to set reminders to prompt specific actions or promote successful transitions between tasks. The user could tailor notes to reflect changes in work assignments over time, as initial tasks are mastered and new tasks are assigned. It is important to note that some challenges may be indicative of poor job fit. These challenges fall beyond the purview of WorkingWell, the features and functions of which are intended to promote job tenure under the condition of good job fit.

The symptoms of mental illness may be exacerbated by stress on the job. Medication side effects may contribute to difficulties getting to work on time and staying on task. Study participants recommend ready access to tips or suggestions for coping in the moment at work. Access to reminders of previously successful coping strategies or reminders of new approaches could be quite empowering if they are the “right type of suggestions.” WorkingWell users would potentially benefit from the ability to rate the effectiveness of specific coping strategies or their usefulness in particular situations, to begin to understand patterns in stress management and tailor the suggestions provided by the app. Issues of stigma are perhaps more complicated to address in a technology-based tool or app. An audio or video overview of issues of stigma, disclosure, and work place accommodations could be provided, perhaps with suggestions for initiating conversations with supervisors or coworkers.

Lifestyle and wellness issues, and conditions apart from work, often overlap with work-related challenges. Tips for coping with stress, for example, could include the importance of getting a good night’s sleep or eating a healthy breakfast. Strategies for solving on-the-job problems may involve taking care of oneself outside of work, to promote stamina and resilience at work. Participants highlight the potential benefits of a holistic approach to work and life.

Challenges in sustaining motivation to work affect participants at work and at home, and reflect how well things are going both on and off the job. Motivation is not solely about the anticipated benefits of work, but is also mediated by job fit and, perhaps, by job tenure. Sustaining motivation after the initial honeymoon phase of starting a new job may be a challenge. Users may benefit from motivational quotes or affirmations from professionals or peers, and the capacity to make notes about things that inspire them to work (e.g., taking care of a child or buying a new car).

Participants suggest ways in which support network members are helpful with practical and emotional issues as well as managing situations on the job. Users may benefit from encouragement to request help and share successes. They may need reminders regarding times when work can be interrupted to make a quick phone call or send a text message, and whether it may be more appropriate to wait until a lunch break or after work to connect with others. Consistent with the IPS commitment to recovery and empowerment, users should be supported in distinguishing between challenges they can solve themselves, perhaps with consultation from a support network member and over time, and emergencies that may require immediate attention.

Conclusions and Implications for Practice

The need for follow-along employment supports and readiness on the part of consumers to embrace technology to this end warrant a specific set of next steps for integrated research and development efforts. A multidisciplinary team of researchers and designers will draft an initial specification document detailing the discrete features and functions of the WorkingWell app, reflective of the research efforts to date. The document will be used to inform the design of an initial wireframe prototype of the WorkingWell app to be tested by consumers and other key stakeholders. Feedback from iterative cycles of review will be integrated into the specifications to inform the build of a fully functioning prototype for pilot testing in the field.

While much of the identified consumer desire for technology-based tools and supports could be fulfilled by existing, stand-alone apps, the WorkingWell app potentially adds value through the integration of work-related tools and supports in one well-designed interface that helps to shape and create patterns of behavior to enhance job tenure. Further, the app is being designed with input about consumers as well as from consumers. Previous researchers have recommended critical design elements for individuals with serious mental illnesses, including singular focus, simple architecture, prominent contents, explicit navigation, and inclusive hyperlinks (Rotondi, Eack, Hanusa, Spring, & Haas, 2015). Embracing these elements will reduce barriers to effective use of WorkingWell for our targeted end users.

WorkingWell is a work in progress, but will likely include critical components to encourage and support users in accessing coping tips and skills, making lists and setting reminders, monitoring work performance and wellness, and tracking progress on goals. These core functions will be uniquely tailored to the context of the workplace. For example, while the structure and content of the coping skills component in WorkingWell may be similar to other apps, it will be designed with accessibility in mind, and language will be used to shape appropriate utilization of coping skills in the workplace. While the list-making feature of the WorkingWell app may function similarly to an existing tool, again, the new design will enhance accessibility and encourage users to create lists that are specifically useful for overcoming challenges and sustaining employment.

Study findings suggest the potential value of a WorkingWell app that is innovative, easy to access, self-directed, and individually tailored to enhance IPS follow-along support. Consumers recognize the convenience and potential of technology-based tools, and embrace technology solutions for coping. They express enthusiasm and are ready for the next step: using technology-based tools for employment support not only as a backup in cases when a support person is unavailable but also as a first line of defense for when challenges arise. The WorkingWell app, if proven effective, will provide individualized, empowering, independent support on the job.