Testing the Efficacy of Opening Doors: A Career Guidance Intervention for Individuals With Psychiatric Disabilities

This project is designed as a three-stage mixed methods study to test the efficacy of a
career guidance intervention called Opening Doors to improve the employability and employment
trajectory of individuals with psychiatric disabilities.

Stage 1 involved a pilot-test of the Opening Doors (OD) career guidance intervention to
conduct a feasibility test. In Stage 2 the investigators are conducting a randomized control
trial (RCT) to test the efficacy of the intervention. Stage 3, which is a qualitative and
process sub-study to understand the value of the OD intervention from the perspective of
participants, is being conducted simultaneously with Stage 2 The Opening Doors Intervention:
The Opening Doors intervention is a new career guidance intervention for individuals with
psychiatric disabilities that uses traditional career guidance resources, progressive
employment principles and mainstream Internet-based resources, delivered in the context of
providing tailored supports for participants' with mental illness. Opening Doors is designed
as an approximately 12- week group and individual career guidance intervention. The
curriculum is delivered by trained career counselors in small groups over about 20 sessions
of 90 minutes each with the addition of up to 8 weekly 1 hour individual sessions. Opening
Doors also has optional on-going drop-in hours available for participants of the program
(current and past) to improve their job application potential on an on-going basis. Opening
Doors includes considerable peer involvement i.e. the consultation and inclusion of
individuals with lived experience of psychiatric disabilities in the development and delivery
of the intervention.

Method: The Opening Doors intervention has been pilot-tested using a simple pretest-posttest
design in order to assess feasibility of the intervention and research procedures. The
investigators are currently using a randomized clinical trial design (RCT) to test the
effectiveness of the Opening Doors intervention. Up to 108 participants are expected to
participate in the intervention. Baseline assessments are completed and random assignment to
experimental or control conditions are performed, stratifying for gender and minority status
using a computer generated randomization plan. Assessments are conducted at baseline, 3, 6, 9
and 12 months post-baseline for both experimental and control groups. Control participants
are placed on a waitlist and offered participation at a later date i.e. 12 months after the
baseline assessment. The investigators use qualitative methods for a sub-study and process
evaluation. Twelve participants (2 per wave) who have completed at least 12 sessions of the
OD will be invited to participate in one-hour qualitative interviews to obtain their
perspectives on the intervention. Each participant participates in a one hour single-session
audio-taped interview by research staff. Data from the qualitative interviews is collected
using an interview guide and participants are probed for perceived benefits of the
intervention and hypothesized helpful mechanisms of OD. The investigators also query the
staff about their perceptions of the barriers and facilitators to delivering OD. Additional
process information described above in "process data" is collected on all study participants.

Data Analysis: Depending on the level of measurement, analysis of variance, t-tests, or
chi-square tests will be conducted to determine baseline equivalency between Experimental and
Control groups. All hypotheses will be tested using mixed modeling analyses, adjusting for
baseline values and examining effects for time, group, and the group-by-time interactions.
Differences between the experimental and control groups are expected to provide information
on the effectiveness of the intervention on the hypothesized variables. Qualitative
interviews will be transcribed for analysis using a grounded theory approach. Transcribed
interviews will be analyzed by two researchers.

Inclusion Criteria:

1. are 18 years or older;

2. have a psychiatric disability as evidenced by a) the presence of a psychiatric
diagnosis, b) the interference of psychiatric symptoms with important areas of life
functioning such as, work or school, and c) current or past use of psychiatric
services such as, medications, hospitalizations, psychotherapy, etc.;

3. express an interest in exploring their career options;

4. are unemployed or engaged in part-time employment;

5. express an interest in working in the future;

6. have basic knowledge of using computers; and,

7. are willing and able to attend a 1-2 hour orientation session at the Recovery Center.

Exclusion Criteria:

1. are unable to give full and knowing consent;

2. are unable to participate in data collection;

3. are actively receiving vocational counseling; and, 4) have full-time paid employment;

5) have a legal guardian.