6/12/2014 “You Got the Job” Virtual Reality Job Interview Skill Training for People in Recovery Recovery Workforce Summit Psychiatric Rehabilitation Association Baltimore, MD June 25, 2014 Morris Bell, Ph.D., ABPP Professor of Psychiatry Yale University School of Medicine Senior Research Career Scientist Rehabilitation Research & Development Department of Veterans Affairs E-mail: Morris.Bell@Yale.edu Research Support • Department of Veterans Affairs • National Institute of Mental Health • National Institute of Drug Abuse • Department of Defense 1
6/12/2014 Disclosure • Morris Bell, Ph.D. is a paid consultant to SIMmersion, LLC. He was involved in the development of the software described in this presentation. VA/Yale Learning-Based Recovery Center Mission Statement: “Exploring Ways to Restore Cognitive and Work Capacity” Why focus on Work? • An essential part of recovery • A basic human need • Most clients want to work (at least a little). • Unemployment and poverty are stressors. 2
6/12/2014 Symptoms after 6 months of paid work activity 72.6 75 73 * 71 Pay 66 69 No-Pay 67 65 63 61 PANSS Total Score Bell, Lysaker, Milstein, 1996 Re-hospitalizations during 6 months of Work Activity 45 34% 40 35 * Pay 30 19% 25 No-Pay 20 15 10 5 0 Percentage Rehospitalization Bell, Lysaker, Milstein, 1996 Quality of Life after 6 months of paid work activity 47.44 * 41.95 Pay * 22.36 18.57 No-Pay Total Intrapsychic QLS scores at end of IWT Bryson, Lysaker & Bell, 2002 3
6/12/2014 Four Psychological Approaches • Regular work performance feedback and goal setting. • Cognitive Behavior Therapy (CBT) for negative beliefs and better coping with job stress. • Training attention, memory and planning that are important for work performance. • Social Skills Training for job related Interactions (e.g. Work Place Fundamentals). – Job Interviews: the First Hurdle to Successful Employment “You Got the Job!” Virtual Reality Job Interview Skills Training for People with Psychiatric Disabilities Jobinterviewtraining.net 4
6/12/2014 Live Role-play training: Advantages • Role-Play is one of the most effective training methods. • It takes advantage of implicit learning • It provides exposure to the anxieties associated with job interviewing. Live Role-play Training: Limitations • It is limited by the skill of the role-play trainer. • It is limited by the time the vocational specialist can give to it, so few repetitions. • Feedback is not systematic, and there is not usually a transcript for review. • No scoring system or careful examination of good or poor responses. • Many people feel awkward performing role- plays in front of others. THE WALL STREET JOURNAL . Adults With Autism Find New Source for Job Interview Advice A Computer Program Coaches Applicants on Giving Better Answers TODAY Health Adults With Autism Find New Source for Job Interview Advice FOX NEWS AUTISM FBI training software repurposed to help autistic adults get jobs Autism Speaks It’s Time To Listen. Virtual Job Interviews Help Adults with Autism Make a Positive Impression. Business Standar ard Thursday, May 8, 2014 14:36 Technique to help autistic people impress employers. 5
6/12/2014 The Scenario • In collaboration with SIMmersion, (simmersion.com) we created simulated role-play software that allows an individual to practice job interview skills over and over again on their own time and in a safe environment. • In this scenario, a new department store is opening and has advertised for a number of positions. • You fill out an on-line application and you are told that you must negotiate your schedule for Thursday afternoons off because you have a fixed appointment. 6
6/12/2014 Molly at Wondersmart Molly from Human Resources is your interviewer. You can choose to have a “friendly” Molly, a “business - like” Molly or a “serious” Molly You select your responses from a list and using voice recognition software speak directly to Molly. The Coach in the Corner As the conversation progresses, Molly reacts to how well you are doing. If you have established a good rapport, she gets friendlier. If not, she becomes more curt. There is a coach in the corner who lets you know how you’re doing. You can ask her for help as well. When it’s over you get your scores. You can replay the whole conversation and you can start all over. Scoring the Interview 7
6/12/2014 Participant Ratings in Feasibility Trial • Very high ratings on ease of use • Very high ratings on overall value of training • 9 out of 10 found the simulation entertaining, which may be important for maintaining interest • 8 out of 10 said that they would be curious to try the simulation again • All 10 agreed that this simulation was a comparable alternative to a live role play Qualitative Responses • “I learned a lot from this simulation about myself and job interviewing.” • “It kept me interested and focused.” • “It portrayed accurately what might be said in a job interview.” • “I felt the interactions were life - like.” • “It stimulated my brain. I thought it was very educational.” SBIR-II: Product Development and Efficacy Trial • Product development included – More than 5000 video clips of Molly integrated into software to create smooth, logical and emotionally authentic simulations. – Script vetted by experts in SMI, autism, ex- offender, spinal cord injury and school to work programs. – E-learning information regarding job seeking skills more broadly was written at 6 th grade reading level. – Screen layout has minimum cognitive demands. – Scoring system refinement. 8
6/12/2014 Efficacy Trial: Can training improve job interview skills? Northwestern University N = 96 (32 Autism, 32 SMI from community agencies, 32 Veterans from Hines VA. Randomized to VR or wait list control in a 2 to 1 ratio. 5 days of training for up to 10 hours. 2 pre-test role-play interviews and 2 post-test interviews videotaped and rated independently. Employment at 6-month follow-up (subset). Job Interview Skill Self-Assessment 1. How comfortable are you about going on a job interview? How skilled are you at: 2. Sounding interested in working 3. Being honest and following store policy 4. Telling the interviewer about your strong points for the job 5. Asking questions to learn more about the job. 6. Negotiating the best arrangements for yourself (e.g. schedule) 7. Maintaining rapport throughout the interview 8. Overall, how ready are you for job interviews? Participants • 64% male, • Average age of 42.5 (sd = 13.9) • average of 15 (sd = 2.5) years of education. • 46% African American, 44% Caucasian, 7% Hispanic and 3% Asian. • 36 months (sd = 44.2) since their last job. 9
6/12/2014 Adherence Participants (N = 96) showed excellent adherence to the intervention with most participants (94%) completing 3 or more hours of trainin g . 7.1 hours (sd = 3.6, median = 7.0) of total training. Learning Curve 100 95 R² = 0.8557 Series1 90 Transition 85 Points 80 Easy Medium Hard 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 The learning curve shows that most participants made rapid gains in skill acquisition, with 87% obtaining a score of 100 at the hardest level at least once by the end of training Relationships to Baseline Characteristics Length of Time Since Last Employed and First Trial Score r = -.77 . That is, the longer the time since last employment, the worse the person’s job interview skills at the beginning of training. Length of Time since Last Employed and Final Training Score is somewhat weaker (r = -.51). VR training may partially mitigate that relationship. To say it another way, training may decrease the impact of length of unemployment on job interview skills. 10
6/12/2014 Neurocognitive and Job Interview Skills Neurocognition was strongly related to First Trial Score (r = .64) but becomes weaker for Final Training Score (r = .43). These findings suggest that neurocognitive impairment affects initial job interviewing skills but may be partially mitigated by training. Social Cognitive Functioning Social cognition, was not significantly related to First Trial Score (r = -.04) although it was strongly related to Final Training Score (r = .70). This may indicate that social cognition may play some role in attaining job interview skills through VR training. Role-Play Assessments (N = 96) • Highly significant treatment condition effect for VR (F (1,86)= 8.3, p < .005). • Three individual items demonstrated significant (p < .05) pre-post improvements: – sounding easy to work with – sounding interested – sounding professional. • Differences by diagnostic group were not significant, suggesting that this intervention may be beneficial to a wide range of disorders. 11
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