# Work as a determinant of health: A pragmatic trial of enhanced cognitive behavioral therapy to bolster competitive work and wellness in veterans with serious mental illness (WORKWELL)

> **NIH VA I01** · RLR VA MEDICAL CENTER · 2022 · —

## Abstract

Project background: Work is a major social determinant of health. In people with serious mental illness
(SMI), work is associated with better wellbeing, physical and mental health, quality of life, and may
prevent the onset of disability. Among Veterans with SMI, work is a protective factor against suicide.
 Most veterans with SMI are unemployed and suffer substantially worse health and recovery
across key domains. Despite quality VHA vocational services, such as supported employment (SE),
two-thirds or more of veterans who receive these services experience work dysfunction. A probable
explanation lies in unsolved cognitive and behavioral barriers, such as low work-related self-efficacy,
ineffective coping skills, little hope that work is attainable, poor work motivation and sense of self.
 The Cognitive Behavioral Therapy for Work Success (CBTw) intervention was designed to
target these problems and augment VHA SE services to synergistically improve work, as well as health
and recovery, in Veterans with SMI. In an open trial pilot, CBTw was associated with significant
increases in hours worked and wages earned and the majority of CBTw participants became steady
workers. Veterans also experienced improvements in symptoms, recovery, and quality of life.
Project goals: Using Hybrid 1 RCT design, this project will test the effects of CBTw on competitive work
and health and recovery outcomes over a 9-month study period at 3 VA SE programs. Informed by the
RE-AIM framework, an implementation evaluation will examine the success of using SE staff to deliver
CBTw, barriers and facilitators to implementation, and strategies utilized.
Relevance to priorities: This project has high implementation potential and is responsive to the VHA
priority regarding Health Equity, as it will address work functioning, an under studied social determinant
of health. WORKWELL also holds promise to improve health and recovery outcomes among Veterans
with SMI, another HSR&D area of emphasis. Lastly, this study is consistent with the goal of finding
novel strategies toward suicide prevention among vulnerable Veteran groups, including those with SMI.
Objectives: Aim 1: Test the effects of CBTw + SE compared to a control of psychoeducation + SE on
work. Hypotheses: Participants in the CBTw+ SE arm will work significantly more total weeks in
competitive jobs (primary study outcome) and will be more likely to become steady workers.
Aim 2: Test the effects of CBTw + SE on health and recovery. Hypotheses: Participants in the CBTw +
SE arm will have greater improvements on subjective recovery and health-related quality of life, and
decreases in symptoms, suicidal ideation, and inpatient service utilization.
Aim 3: Guided by the RE-AIM implementation science framework, conduct an evaluation of the
implementation of CBTw, including examination of the feasibility of using SE staff to deliver CBTw, and
related barriers and facilitators. The objective is to spur future wide scale CBTw imp...

## Key facts

- **NIH application ID:** 10242637
- **Project number:** 5I01HX002874-02
- **Recipient organization:** RLR VA MEDICAL CENTER
- **Principal Investigator:** Marina Kukla
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10242637

## Citation

> US National Institutes of Health, RePORTER application 10242637, Work as a determinant of health: A pragmatic trial of enhanced cognitive behavioral therapy to bolster competitive work and wellness in veterans with serious mental illness (WORKWELL) (5I01HX002874-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10242637. Licensed CC0.

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