Marginalized Group Career Counseling Paper

Outline is attachedYou can used the attached article or any others that you may needPlease follow all requirement belowFor this assignment you will select a marginalized group (veterans) and write a paper of 1,750 to 2,100 words that can be used as a resource when working with an individual from the selected group. Use peer-reviewed resources to support your use of a specific career theory as well as interventions with this population. The paper should include the following:An explanation of who the population is and why it is important for this group to receive career counselingStatistics on the group (e.g., how large, how many have employment problems, how many utilize career counseling)Discussion of career counseling theory to be used with the group (e.g., Minnesota theory of work adjustment). Include evidence supporting the use of this theory in the general population as well as within the group. Please note: If none are available, it is important to indicate that as well.Basic plan for counseling utilizing chosen theory (e.g., interview, use of assessment tools, explanation of theory)Environmental/personal barriers that may prevent the client from finding work (e.g., disability, substance use history, felony, transportation, limited computer access)Local resources available to help the client obtain work (e.g., job center, training programs, support groups)Your conclusion on whether or not this plan is tenable and will work, based on the information listed above. A minimum of four scholarly references.Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center
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Marginalized Group Career Counseling Paper
I.
Veterans population
A. Explanation of the population
B. Statistics on population
C. Importance of Careers Counseling for Population (e.g., how large, how many have
employment problems, how many utilize career counseling)
II.
Career Counseling Theory/Holland’s Theory
A. Evidence supporting use of theory
B. General Population
C. Veterans Population
III.
Basic Plan for Counseling
A. Explanation of Theory
1. The essence of Holland’s theory is that both people and environments can
be described in terms of their resemblance to six model, or theoretical, types
(Brown, 2013).
2. The interrelationships among the types provide the basis for several
predictions about the kinds of careers people will choose, how satisfied they
will be with their work, how well they will perform in their work, and the
ease with which they will be able to make career decisions (Brown , 2013).
3. Six Personality Types/RIASEC personality types
B. Interviews
1. Career Interest Inventory
C. Assessment Tools
1. Holland Codes
2. Vocational Preference Inventory
3. Self-Directed
4. Strong Interest Inventory
5. Armed Services Vocational Aptitude Battery
IV.
Barriers & Resources
A. Adjustment to Civilian Life
B. Mental Health (PTSD/Anxiety/Depression)
C. Physical Injuries
D. US Department of Veterans Affairs-Tool Kit, Veterans Employment Center,
Vocational Rehabilitation and Employment (VR&E),VetNet and Real Warriors
V.
Conclusion-Feasibility
Resources
Brown, S.D., & Lent, R.W. (2013). Career development and counseling: Putting theory and
research to work (2nd ed.). Hoboken, NJ: John Wiley & Sons.
Davis, L. L., Pilkinton, P., Poddar, S., Blansett, C., Toscano, R., & Parker, P. E. (2014).
Impact of social challenges on gaining employment for veterans with posttraumatic
stress disorder: An exploratory moderator analysis. Psychiatric Rehabilitation
Journal, 37(2), 107-109. doi:10.1037/prj0000058
Ohler, D. L., & Levinson, E. M. (2012). Using Holland’s theory in employment counseling:
Focus on service occupations. Journal Of Employment Counseling, 49(4), 148-159.
doi:10.1002/j.2161-1920.2012.00016.x
Real Warriors. https://www.realwarriors.net/
Ruh, D., Spicer, P., & Vaughan, K. (2009). Helping Veterans with Disabilities Transition to
Employment. Journal Of Postsecondary Education And Disability, 22(1), 67-74.
US Department of Veterans Affairs. Veterans Employment Tool Kit.
https://www.va.gov/vetsinworkplace/veteranresources.asp
US Department of Veterans Affairs. Vocational Rehabilitation and Employment (VR&E).
https://www.benefits.va.gov/vocrehab/index.asp
US State Department of Labor. VETERANS’ EMPLOYMENT AND TRAINING
SERVICE (VETS).https://www.dol.gov/vets/#
VetNet. http://www.vetnethq.com/
Marginalized Group Career Counseling Paper
Page 2 of 2
Journal of Affective Disorders 193 (2016) 194–202
Contents lists available at ScienceDirect
Journal of Affective Disorders
journal homepage: www.elsevier.com/locate/jad
Research paper
Employment status, employment functioning, and barriers
to employment among VA primary care patients
Kara Zivin a,b,c,d,n, Matheos Yosef b, Debra S. Levine a,b,e, Kristen M. Abraham e,f,
Erin M. Miller b, Jennifer Henry a, C. Beau Nelson b,g, Paul N. Pfeiffer a,b,
Rebecca K. Sripada a,b,e, Molly Harrod a, Marcia Valenstein a,b
a
Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
c
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
d
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
e
Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
f
Department of Psychology, University of Detroit Mercy, USA
g
Mental Health Service, VA Ann Arbor Healthcare System, USA
b
art ic l e i nf o
a b s t r a c t
Article history:
Received 15 October 2015
Received in revised form
18 December 2015
Accepted 26 December 2015
Available online 30 December 2015
Background: Prior research found lower employment rates among working-aged patients who use the
VA than among non-Veterans or Veterans who do not use the VA, with the lowest reported employment
rates among VA patients with mental disorders. This study assessed employment status, employment
functioning, and barriers to employment among VA patients treated in primary care settings, and examined how depression and anxiety were associated with these outcomes.
Methods: The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical
Center. Bivariate and multivariable analyses were conducted examining associations between sociodemographic and clinical predictors of six employment domains, including: employment status, job
search self-ef?cacy, work performance, concerns about job loss among employed Veterans, and employment barriers and likelihood of job seeking among not employed Veterans.
Results: 54% of respondents were employed, 36% were not employed, and 10% were economically inactive. In adjusted analyses, participants with depression or anxiety (43%) were less likely to be employed, had lower job search self-ef?cacy, had lower levels of work performance, and reported more
employment barriers. Depression and anxiety were not associated with perceived likelihood of job loss
among employed or likelihood of job seeking among not employed.
Limitations: Single VA primary care clinic; cross-sectional study.
Discussion: Employment rates are low among working-aged VA primary care patients, particularly those
with mental health conditions. Offering primary care interventions to patients that address mental
health issues, job search self-ef?cacy, and work performance may be important in improving health,
work, and economic outcomes.
Published by Elsevier B.V.
Keywords:
Employment
Depression
Anxiety
Work performance
1. Background
Ensuring Veteran employment needs are met is a top priority
for the Department of Veterans Affairs (VA) and the United States
Government. President Obama issued the ?rst strategic plan to
increase hiring of Veterans in the federal civil service (United
States Of?ce of Personnel Management, 2010), the Vow to Hire
n
Correspondence to: University of Michigan North Campus Research Complex,
2800 Plymouth Road, Building 16, 228W, Ann Arbor, MI 48109-2800, USA.
E-mail address: kzivin@umich.edu (K. Zivin).
http://dx.doi.org/10.1016/j.jad.2015.12.054
0165-0327/Published by Elsevier B.V.
Heroes Act (Democratic Policy and Communications Center, 2010),
and the Veterans Job Corps (Department of Veterans Affairs, 2012;
President’s Council of Economic Advisers and the National Economic Council, 2012). These initiatives recognize a critical need to
identify and address obstacles to obtaining and maintaining employment for returning Veterans. Over two million troops have
served in Operations Enduring Freedom and Iraqi Freedom (OEF/
OIF) since 2001. These Veterans are younger and more often
working-aged than other VA service users, but suffer from high
levels of mental disorders (Seal et al., 2009) that may signi?cantly
affect work functioning (Adler et al., 2011; Erbes et al., 2011) and
access to full-time work (Burnett-Zeigler et al., 2011). Younger
K. Zivin et al. / Journal of Affective Disorders 193 (2016) 194–202
195
Table 1
Characteristics of 287 working age VA primary care patients, by employment status (N/% unless otherwise noted).
Employed N ¼154
Depression
Yes
No
Anxiety
Yes
No
Depression or anxiety
Yes
No
Demographic characteristics
Age (mean, SD)
Gender
Female
Male
Marital status
Single/widowed
In a relationship
Married
Divorced/separated
Hispanic
Yes
No
Race
Caucasian
African American
Other
Education
High school or less
Some college
Bachelor’s degree or more
Rank (current or at discharge)
Enlisted
Of?cer
Annual household income
None/don’t know
$0–$19,999
$20,000–$49,000
Z $50,000
Dif?culty paying monthly bills
None
Some
Extreme
Prefer to be working
Yes
No
Other
Not employed
N ¼ 104
Economically inactive
N¼ 29
p-Value comparing employed
to not employed
p-Value comparing across all
three groups
41
106
27.89
72.11
59
38
60.82
39.18
8
21
27.59
72.41
o 0.0001
o 0.0001
31
115
21.23
78.77
42
55
43.30
56.70
4
25
13.79
86.21
0.0002
0.0002
49
97
33.56
66.44
61
36
62.89
37.11
8
21
27.59
72.41
o 0.0001
o 0.0001
44.89
8.56
46.23
8.20
43.18
9.22
0.2158
0.1904
33
120
21.57
78.43
21
82
20.39
79.61
4
25
13.79
86.21
0.8204
0.6346
25
27
69
30
16.56
17.88
45.70
19.87
26
11
43
23
25.24
10.68
41.75
22.33
6
6
6
11
20.69
20.69
20.69
37.93
0.1856
0.0608
2
143
1.38
98.62
6
92
6.12
93.88
0
28
0.00
100.00
0.0421
0.0626
133
8
11
87.50
5.26
7.24
81
16
5
79.41
15.69
4.90
24
5
0
82.76
17.24
0.00
0.0181
0.0276
26
69
58
16.99
45.10
37.91
26
44
33
25.24
42.72
32.04
4
15
10
13.79
51.72
34.48
0.2544
0.4462
119
33
78.29
21.71
94
9
91.26
8.74
25
4
86.21
13.79
0.0061
0.0208
8
32
48
62
5.33
21.33
32.00
41.33
19
44
25
15
18.45
42.72
24.27
14.56
5
11
8
5
17.24
37.93
27.59
17.24
o .0001
o 0.0001
62
74
17
40.52
48.37
11.11
14
55
32
13.86
54.46
31.68
10
13
6
34.48
44.83
20.69
o 0.0001
o 0.0001
130
11
6
88.44
7.48
4.08
54
36
8
55.10
36.73
8.16
19
4
5
67.86
14.29
17.86
o 0.0001
o 0.0001
74.50
25.50
40
58
40.82
59.18
20
9
68.97
31.03
o 0.0001
o 0.0001
11.78
11.06
35.95
37.25
13.36
14.59
45.58
46.45
11.55
12.55
o 0.0001
o 0.0001
o 0.0001
o 0.0001
1.17
1.69
1.36
1.17
1.10
0.0032
0.0072
38.31
13.64
4.55
7.79
10.39
0.00
20.13
27.27
8.78
57
16
2
12
16
5
37
31
17.20
54.81
15.38
1.92
11.54
15.38
4.81
35.58
29.81
9.50
12
6
0
1
3
0
6
6
9.00
41.38
20.69
0.00
3.45
10.34
0.00
20.69
20.69
9.43
0.0090
0.6943
0.2601
0.3095
0.2325
0.0060
0.0057
0.6575
o 0.0001
0.0005
0.3260
0.3889
0.3022
0.3148
0.0220
0.0042
0.1018
o 0.0001
18.33
34.65
21.10
17.31
18.83
o 0.0001
o 0.0001
55.10
44.90
67
30
69.07
30.93
12
17
41.38
58.62
0.0288
0.0131
21.23
17
17.53
8
27.59
0.4772
0.4814
Clinical and psychosocial characteristics
Self-rated health
Excellent/very good/good
111
Fair/poor
38
Health status (SF-12)
Physical health (mean, SD)
44.06
Mental health (mean, SD)
46.55
Comorbid conditions
Total comorbid conditions
1.22
(mean, SD)
High blood pressure
59
Diabetes
21
Cancer
7
Lung problems
12
Heart problems
16
Stroke
0
Psychiatric disorder
31
Arthritis
42
Functional impairment (mean,
8.49
SD)
Pain (mean, SD)
20.73
PTSD
Yes
81
No
66
Alcohol use disorder
Yes
31
196
K. Zivin et al. / Journal of Affective Disorders 193 (2016) 194–202
Table 1 (continued )
Employed N ¼154
No
Injury
Yes
No
Sleep disturbance (mean, SD)
Stressful life events (mean, SD)
Life enjoyment and satisfaction
(mean, SD)
Interpersonal support (mean,
SD)
Not employed
N ¼104
Economically inactive
N ¼ 29
p-Value comparing employed
to not employed
p-Value comparing across all
three groups
115
78.77
80
82.47
21
72.41
25
129
8.97
1.35
47.78
16.23
83.77
6.36
0.63
10.63
23
81
13.16
1.55
36.32
22.12
77.88
6.00
0.77
11.01
0
29
9.66
1.37
47.93
0.00
100.00
6.34
0.50
12.45
0.2337
0.0181
o 0.0001
0.0628
o 0.0001
o 0.0001
0.1448
o 0.0001
24.43
8.52
19.26
9.19
24.59
8.95
o 0.0001
o 0.0001
Table 2
Work performance and job security among employed respondents by depression/anxiety status*.
Depression or anxiety N ¼49
Mean
Work performance
Summary score
How often was your performance higher than most workers on your job?
How often was your performance lower than most workers on your job?
How often did you do no work at times when you were supposed to be
working?
How often did you ?nd yourself not working as carefully as you should?
How often was the quality of your work lower than it should have been?
How often did you not concentrate enough on your work?
How often did health problems limit the kind or amount of work you
could do?
How likely are you to lose your job in the next 12 months (N, %)
Likely
Not likely
Job search self-ef?cacy
*
**
SD
No depression or anxiety N¼ 97
Mean
Effect size or p-value**
SD
3.95
3.45
2.22
1.88
1.41
1.19
1.23
0.99
2.67
3.84
1.52
1.49
0.86
0.89
0.75
0.65
–1.192
0.395
–0.748
–0.495
2.15
2.12
2.37
3.12
0.87
0.97
0.99
1.09
1.74
1.43
1.79
1.66
0.82
0.63
0.83
0.93
–0.483
–0.914
–0.647
–1.488
16
33
3.56
32.65
67.35
0.85
18
79
3.91
18.56
81.44
0.97
0.057
0.380
There were 8 employed respondents with missing depression/anxiety assessments.
Effect sizes are used for continuous variables, categorized as absolute values of 0.2 ¼small; 0.5 ¼ medium; 0.8 ¼ large; 1.3 ¼very large.
Veterans also constitute a large proportion of patients seeking
treatment in VA primary care (PC) settings.
Depression and anxiety are prevalent mental health disorders
that negatively impact functioning, with depression projected to
be the second leading cause of disability by 2020 (Murray and
Lopez, 1996). Over 6% and 11% of working-aged Americans suffer
from major depression and anxiety disorders respectively (Kessler
and Frank, 1997; Peer and Tenhula, 2011; Smit et al., 2006). Depressed and anxious workers cost their employers billions annually in lost productive time due to reduced job performance
(Stewart et al., 2003), indecisiveness, and poor motivation and
concentration (Peer and Tenhula, 2011; Wald, 2011). Depression
and anxiety rival chronic medical illnesses such as arthritis, back
pain, and heart disease for workplace burden (Druss et al., 2000).
Reductions in depression and anxiety improve employment
functioning (Berndt et al., 1998; Peer and Tenhula, 2011; Rost et al.,
2004; Wald, 2011; Wang et al., 2007), and, conversely, returning to
the workforce can decrease depression and anxiety and facilitate
recovery (Brenninkmeijer et al., 2008; Murphy and Athanasou,
1999).
Our prior research found lower employment rates among
working-aged VA patients than non-Veterans and Veterans who
do not use VA, with the lowest employment rates being found
among VA patients with mental disorders (Zivin et al., 2011). Existing programs to address employment needs for VA patients
with mental disorders have focused on serious mental illnesses
(SMI) including schizophrenia and bipolar disorder (Department
of Veterans Affairs, 2007, 2011), and patients seen in specialty
mental health clinics rather than not employed PC patients with
depression and anxiety (Schoenbaum et al., 2002; Smith et al.,
2002). These latter patients far outnumber SMI patients and may
bene?t from evidence-based mental health treatment focused on
employment and work capacity. In our prior evaluation of employment service use across the VA, we found that 2.33% of patients with anxiety and 3.96% of patients with depression received
employment services in a given year (Abraham et al., 2014). The
predicted probability of receiving services was signi?cantly lower
for Veterans with anxiety and depression than it was for Veterans
with schizophrenia and bipolar disorder. Among patients who
received employment services, those with anxiety or depression
were less likely than patients with schizophrenia to receive supported employment (an evidence-based practice) and were more
likely to receive vocational assistance, a combination of individual
and group services for which there is no established evidence.
Therefore, we sought to assess how the presence of depression
and anxiety disorders relates to several employment-related
functional domains among VA PC patients, including: patient
employment status, productivity among those who were employed, and barriers to employment among those who were not
employed. Most depression and anxiety treatment occurs in PC,
and this could be a good way to identify patients for VA employment programs if the link is strong. Second, since Veterans often
are underserved and have multiple challenges, it is important to
examine factors that may affect employment functioning, which
this study does in a unique way by investigating many covariates
and barriers. Based on our prior work (Abraham et al., 2014; Zivin
et al., 2011, 2012), we hypothesized that VA patients with depression and anxiety would be less likely to be employed, be less
K. Zivin et al. / Journal of Affective Disorders 193 (2016) 194–202
197
Table 3
Likelihood of job seeking, employment barriers, and job search self-ef?cacy among not employed by depression/anxiety status*.
Depression or anxiety N ¼61
N
Employment barriers
Total employment barriers (mean, SD)
Individual barriers endorsed
Mental health symptoms (depression, anxiety, PTSD, etc.)
Substance abuse or dependence
Physical illness or other health problems
Treatment for mental health, substance use, or medical illness that makes
it dif?cult to work
Time obligations for treatment
A clinical professional discouraged my employment
Family discouragement or expectations
Friend discouragement or expectations
Disincentives from disability bene?ts (VHA, SSDI, SSI, etc.)
Lack of ?nancial need
Inadequate housing or homelessness
Inadequate transportation
Lack of childcare
Criminal background or previous incarceration
Problems getting along with co-workers
Concerns about failure at work based on past dif?culties
Anticipated stress of working
Other
Job seeking (%)
Yes
No
Job search self-ef?cacy (mean, SD)
*
**
%
No depression or anxiety N ¼36 Effect size or p-value**
N
%
7.42
3.79
4.67
3.51
0.744
53
5
49
37
91.38
10.20
87.50
69.81
18
4
20
8
56.25
12.90
60.61
26.67
0.0007
0.7097
0.0033
0.0002
43
21
16
16
15
23
15
22
12
7
26
30
44
11
78.18
45.65
32.65
33.33
33.33
44.23
30.61
40.74
29.27
17.50
53.06
60.00
83.02
78.57
9
5
7
6
8
11
8
7
3
6
4
7
16
7
30.00
16.67
23.33
19.35
27.59
37.93
27.59
24.14
11.11
21.43
13.33
22.58
51.61
63.64
o 0.0001
0.0092
0.3762
0.1759
0.6020
0.5818
0.7770
0.1304
0.0773
0.6851
0.0004
0.0010
0.0021
0.4090
21
38
2.82
35.59
64.41
1.16
19
16
3.34
54.29
45.71
1.05
0.0764
0.4590
There were 7 not employed respondents with missing depression/anxiety assessments.
Effect sizes are used for continuous variables, categorized as absolute values of 0.2 ¼ small; 0.5 ¼ medium; 0.8 ¼ large; 1.3 ¼ very large.
productive, and report greater barriers to employment than VA PC
patients without these disorders.
2. Methods
2.1. Data source and participants
We conducted the Health and Employment Resources: Opportunities for Success (HEROS) survey between June and September
2014. Patients aged 18–55 with a visit in a VA PC clinic in the prior
six months in a large Midwestern VA Medical Center who had
medical chart notes indicating planned follow-up care within that
same clinic were randomly selected for possible survey participation. Participants answered questions assessing employment
status, physical and mental health conditions, work performance,
and employment barriers. They were provided an online survey
link; anyone who did not complete the survey online was also sent
a mailed copy. The survey took approximately 30 minutes to
complete and each participant received a $25 gift certi?cate. The
?nal sample included 287 patients; the response rate was 31%
(N ¼ 934), which is consistent with previous reports of online
survey response rates (Nulty, 2008; Shih and Fan, 2008). Of these,
68 (24%) were completed by mail.
2.2. Measures
The primary outcome variable was employment status, assessed
using the following categories: full-time ( 430 h/week), part-time
(o 30 h/week), unemployed, on disability, retired, student, on illness or sick leave, homemaker, or other. Working full or part-time
was considered “employed”. Being unemployed, on disability, or
on sickness or illness leave was considered “not employed”. Being
retired, a student, a homemaker, or “other” was considered “economically inactive.” Employed and not employed participants
completed …
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