Michael F Fleming’s research while affiliated with Northwestern University and other places

Objective: Virtual Reality Job Interview Training (VR-JIT) is a computerized interview simulator with efficacy at enhancing interview skills and employment outcomes. A randomized controlled trial assessed VR-JIT effectiveness for participants in individual placement and support (IPS), in which approximately 55% of individuals with serious mental illness obtain employment. Methods: Ninety participants with serious mental illness were randomly assigned to IPS1VR-JIT (N554) or IPS as usual (N536), completing pretest-posttest assessments and an employment evaluation at 9 months. Intent-to-treat chi-square analysis, multivariable logistic regression, Cox proportional hazards models, and mixed-effects linear regressions were conducted. Fifty-one percent were IPS nonresponders (i.e., no employment within the first 90 days of IPS). Results: IPS1VR-JIT participants did not have significantly higher employment rates, compared with IPS-as-usual participants (43% versus 28%). IPS nonresponders (N546) in the IPS1VR-JIT group had greater odds of obtaining employment (odds ratio [OR]55.82, p50.014) and shorter time to employment (hazard ratio52.70, p50.044) compared with IPS nonresponders in the IPS-as-usual group. Intent-to-treat mixed-effects linear analyses indicated that IPS1VR-JIT, compared with IPS as usual, significantly improved interview skills (p50.006), interview confidence (p50.013), and interview anxiety (p50.019). Conclusions: VR-JIT's potential benefits (increased employment in a shorter time) appeared to be specific to IPS non-responders, whereas employment outcomes for recent IPS enrollees were not affected. VR-JIT could be a valuable resource for employment specialists to support IPS non-responders, because 47% of participants engaged in mock interview training with their specialist. Future research should focus on evaluating the effectiveness and implementation of VR-JIT among IPS nonresponders.

Objective: Virtual Reality Job Interview Training (VR-JIT) is a computerized interview simulator with efficacy at enhancing interview skills and employment outcomes. A randomized controlled trial assessed VR-JIT effectiveness for participants in individual placement and support (IPS), in which approximately 55% of individuals with serious mental illness obtain employment. Methods: Ninety participants with serious mental illness were randomly assigned to IPS+VR-JIT (N=54) or IPS as usual (N=36), completing pretest-posttest assessments and an employment evaluation at 9 months. Intent-to-treat chi-square analysis, multivariable logistic regression, Cox proportional hazards models, and mixed-effects linear regressions were conducted. Fifty-one percent were IPS nonresponders (i.e., no employment within the first 90 days of IPS). Results: IPS+VR-JIT participants did not have significantly higher employment rates, compared with IPS-as-usual participants (43% versus 28%). IPS nonresponders (N=46) in the IPS+VR-JIT group had greater odds of obtaining employment (odds ratio [OR]=5.82, p=0.014) and shorter time to employment (hazard ratio=2.70, p=0.044) compared with IPS nonresponders in the IPS-as-usual group. Intent-to-treat mixed-effects linear analyses indicated that IPS+VR-JIT, compared with IPS as usual, significantly improved interview skills (p=0.006), interview confidence (p=0.013), and interview anxiety (p=0.019). Conclusions: VR-JIT's potential benefits (increased employment in a shorter time) appeared to be specific to IPS nonresponders, whereas employment outcomes for recent IPS enrollees were not affected. VR-JIT could be a valuable resource for employment specialists to support IPS nonresponders, because 47% of participants engaged in mock interview training with their specialist. Future research should focus on evaluating the effectiveness and implementation of VR-JIT among IPS nonresponders.

Within the Biostatistics, Epidemiology, and Research Design (BERD) component of the Northwestern University Clinical and Translational Sciences Institute, we created a mentoring program to complement training provided by the associated Multidisciplinary Career Development Program (KL2). Called Research design Analysis Methods Program (RAMP) Mentors, the program provides each KL2 scholar with individualized, hands-on mentoring in biostatistics, epidemiology, informatics, and related fields, with the goal of building multidisciplinary research teams. From 2015 to 2019, RAMP Mentors paired 8 KL2 scholars with 16 individually selected mentors. Mentors had funded/protected time to meet at least monthly with their scholar to provide advice and instruction on methods for ongoing research, including incorporating novel techniques. RAMP Mentors has been evaluated through focus groups and surveys. KL2 scholars reported high satisfaction with RAMP Mentors and confidence in their ability to establish and maintain methodologic collaborations. Compared with other Northwestern University K awardees, KL2 scholars reported higher confidence in obtaining research funding, including subsequent K or R awards, and selecting appropriate, up-to-date research methods. RAMP Mentors is a promising partnership between a BERD group and KL2 program, promoting methodologic education and building multidisciplinary research teams for junior investigators pursuing clinical and translational research.

Objectives: To assess the effects of mindfulness-based relapse prevention for alcohol dependence (MBRP-A) intervention on drinking and related consequences. Methods: 123 alcohol-dependent adults in early recovery, recruited from outpatient treatment programs, were randomly assigned to MBRP-A (intervention plus usual-care; N = 64) or Control (usual-care-alone; N = 59) group. MBRP-A consisted of eight-weekly sessions and home practice. Outcomes were assessed at baseline, 8 weeks and 26 weeks (18 weeks post-intervention), and compared between groups using repeated measures analysis. Results: Outcome analysis included 112 participants (57 MBRP-A; 55 Control) who provided follow-up data. Participants were 41.0 ± 12.2 years old, 56.2% male, and 91% white. Prior to "quit date," they reported drinking on 59.4 ± 34.8% (averaging 6.1 ± 5.0 drinks/day) and heavy drinking (HD) on 50.4 ± 35.5% of days. Their drinking reduced after the "quit date" (before enrollment) to 0.4 ± 1.7% (HD: 0.1 ± 0.7%) of days. At 26 weeks, the MBRP-A and control groups reported any drinking on 11.5 ± 22.5% and 5.9 ± 11.6% of days and HD on 4.5 ± 9.3% and 3.2 ± 8.7% of days, respectively, without between-group differences (ps ≥ 0.05) in drinking or related consequences during the follow-up period. Three MBRP-A participants reported "relapse," defined as three-consecutive HD days, during the study. Subgroup analysis indicated that greater adherence to session attendance and weekly home practice minutes were associated with improved outcomes. Conclusions: MBRP-A as an adjunct to usual-care did not show to improve outcomes in alcohol-dependent adults in early recovery compared to usual-care-alone; a return to drinking and relapse to HD were rare in both groups. However, greater adherence to MBRP-A intervention may improve long-term drinking-related outcomes.

Background Virtual reality job interview training (VR-JIT) is an internet-based intervention designed to improve the job interview skills of adults with severe mental illness through repetitively practicing job interviews with a virtual interviewer (and receiving feedback on interview performance). VR-JIT trainees improved interview skills and access to employment across five randomized controlled trials. The aim of the current study is to evaluate the community effectiveness of VR-JIT at enhancing employment readiness outcomes among individuals with severe mental illness enrolled in Individual Placement and Support (IPS) services. This presentation will focus on the study’s preliminary results. Methods Individuals with severe mental illness (i.e., psychotic or mood disorders) enrolled in IPS supported employment were randomized (2:1 ratio) to receive IPS with the addition of VR-JIT (IPS+VR-JIT) (n=29) or IPS only (n=17). Employment (or research) staff delivered VR-JIT at a computer lab located within the mental health service agency. The agency placed the computer lab at a site that was either geographically central among their satellite service provider locations (or on campus at the satellite providers). All participants completed a series of clinical and cognitive assessments at baseline. Participants also completed a series of assessments at pre-test and post-test, including: two job-interview role-plays, and self-report surveys assessing interviewing anxiety, interviewing self-confidence, and interviewing motivation. Results Participants were diagnosed with bipolar disorder (43%), schizophrenia or schizoaffective disorder (38%), or major depressive disorder (19%). Participants randomized to IPS+VR-JIT (compared to IPS only) demonstrated higher employment rates at six-month follow-up (50% compared to 12.5%). In addition, we observed that the IPS+VR-JIT group (compared to the IPS only group) had higher interview role-play performance scores (Cohen’s d=0.51 vs. Cohen’s d= 0.01) and motivation to interview (Cohen’s d=0.52 vs. Cohen’s d= 0.28), and reduced interviewing anxiety (Cohen’s d= -0.63 vs. Cohen’s d= -0.31). Meanwhile, the groups did not differ with respect to changes in interviewing self-confidence (Cohen’s d < 0.40 for both groups). Overall, the groups did not differ with respect to sex, education, race, ethnicity, diagnoses, cognitive ability, and symptom severity. Discussion Preliminary findings are promising and suggest that using VR-JIT as a supplement to IPS services may lead to higher rates of competitive employment within six months as well as increased interviewing skills and interviewing motivation along with decreased anxiety about interviewing.

Individual Placement and Support (IPS) is the evidence-based model of supported employment that increases employment rates in adults with severe mental illness (SMI). Although IPS is largely successful, over 80% of adults with SMI remain unemployed. An enhancement to high fidelity IPS could be an evidence-based job interview training component. To meet this training need, our group recently completed a series of randomized controlled efficacy trials funded by the National Institute of Mental Health to develop and test virtual reality job interview training (VR-JIT) in a lab setting. The results demonstrated that the intervention was efficacious at helping trainees improve their job interview skills and receive job offers within six months of completing VR-JIT compared to non-trainees. The overarching goal of this study is to evaluate the effectiveness of VR-JIT as an enhancement to IPS when delivered in a large community-based mental health service provider via a randomized controlled trial and initial process evaluation. Our aims are to: evaluate whether IPS services-as-usual in combination with VR-JIT, compared to IPS services-as-usual alone, enhances IPS outcomes for adults with SMI; evaluate mechanisms of employment outcomes and psychological distress; and conduct a multilevel, multidisciplinary, and mixed-method process evaluation of VR-JIT adoption and implementation to assess the acceptability, scalability, generalizability, and affordability of VR-JIT.

Objective: Four randomized controlled trials revealed that virtual-reality job interview training (VR-JIT) improved interviewing skills and the odds of obtaining a job offer among trainees with severe mental illness or autism spectrum disorder. This study assessed whether postintervention interviewing skills mediated the relationship between completion of virtual interviews and receiving job offers by six-month follow-up. Methods: VR-JIT trainees (N=79) completed pre- and posttest mock interviews and a brief survey approximately six months later to assess whether they received a job offer. Results: As hypothesized, analyses indicated that the number of completed virtual interviews predicted greater posttest interviewing skills (β=.20, 95% posterior credible interval [PCI]=.08-.33), which in turn predicted trainees' obtaining a job offer (β=.28, 95% PCI=.01-.53). Conclusions: VR-JIT may provide a mechanism of action that helps trainees with various psychiatric diagnoses obtain job offers in the community. Future research can evaluate the community-based effectiveness of this novel intervention.

Background: Individuals with severe mental illness have low employment rates, and the job interview presents a critical barrier for obtaining employment. Four randomized controlled trials (RCTs) revealed that virtual reality job interview training (VR-JIT) improved interviewing skills and the odds of obtaining a job offer among trainees with severe mental illness (i.e., schizophrenia and mood disorders) or autism spectrum disorder. This study assessed whether trainees across all four trials had greater odds than controls at receiving a job offer by 6-month follow-up. We also evaluated if interviewing skills mediated the relationship between virtual interview trial completion and receiving job offers by 6-month follow-up. Methods: VR-JIT trainees (n = 79) completed pre- and posttest role-plays and a brief survey approximately 6 months later to assess if trainees received a job offer. VR-JIT trainees completed up to 17 virtual interviews, while controls received services as usual. We used logistic regression to assess the odds of receiving a job offer. We also conducted mediational path model with Mplus 7.2 using a Bayesian estimator (with Sobel Test) to test if post-test interviewing skills mediated the relationship between virtual interviews completed and receiving job offers by 6-month follow-up. Results: The odds of receiving a job offer were higher for VR-JIT trainees across all four cohorts compared to the controls from across all four cohorts (OR = 2.68, 95% CI = 1.14–6.29; P = .03). As hypothesized, the relationship between number of virtual interviews completed and job offer attainment was fully mediated as indicated by the direct effect between completed interviews and job offer changing from significant (B = .09, P < .05; SD = .046, β = .30, 95% PCI:.01–.54) to nonsignificant (B = .07, P < .05; SD = .05, β = .23, 95% PCI:−.06 to −.49) in the mediation model when accounting for posttest job interview performance. In turn, the number of completed virtual interviews predicted posttest interviewing skills, which in turn predicted obtaining a job offer (Product-of-coefficients = .02, SD = .01, P < .05; 95% PCI:.01–.04). Conclusion: Results suggest that VR-JIT trainees have greater odds of receiving a job offer and may provide a mechanism of action that helps trainees across various psychiatric diagnoses obtain job offers in the community. Future research can evaluate the community-based effectiveness of this novel intervention.

Background: Alcohol dependent liver transplantation (LT) patients who resume alcohol are at risk for a number of alcohol related problems including liver injury and liver failure. Post LT patients are strongly advised to remain abstinent. However, we don't know how well this population complies due to a lack of valid methods (self-report and/or biomarkers) to identify alcohol use. Studies suggest as many as 50% resume alcohol use within 5 years. Phosphatidylethanol (PEth) is a new cell-membrane phospholipid biomarker to identify alcohol use in the past 28 days. This prospective study followed 213 LT recipients at two US liver transplant centers. Methods: Sample included 213 LT subjects. 70.9% (n=151/213) had a history of alcohol dependence prior to transplantation and 29.1% (n=62/213) served as non-alcohol dependent controls. Subjects participated in face-to-face interviews to assess alcohol use using a 30-day calendar. The protocol called for collecting blood samples at baseline, 6- and 12-month follow-up. Results: 70% (149/213) who reported no alcohol use had consistently negative PEth levels (<8ng/ml). A total of 26.4% (57/213), 44 alcohol-dependent patients and 13 controls, had a positive PEth test of >8 ng/ml either at baseline and/or during the follow-up period. 23.8% (n=36/151) alcohol-dependent subjects and 16.1% (n=10/62) controls reported no alcohol use but had at least one positive PEth test. Of the 11.2% (24/213) post LT subjects who reported recent alcohol use over half (11/24) had a positive PEth. The 13 self-reported alcohol users with a negative PEth level reported insufficient drinking to trigger PEth formation. Conclusions: Adoption of PEth as part of routine post-transplant care of LT recipients will enable early identification of patients at risk of alcohol use and facilitate abstinence in patients with a history of alcohol dependence and alcohol related liver damage. This article is protected by copyright. All rights reserved.

Background: Individuals with substance use disorders (SUDs) have low employment rates and job interviewing is a critical barrier to employment for them. Virtual reality training is efficacious at improving interview skills and vocational outcomes for several clinical populations. Objective: This study evaluated the acceptability and efficacy of virtual reality job interview training (VR-JIT) at improving interview skills and vocational outcomes among individuals with SUDs via a small randomized controlled trial (n=14 VR-JIT trainees, n=11 treatment-as-usual (TAU) controls). Methods: Trainees completed up to 10 hours of virtual interviews, while controls received services as usual. Primary outcome measures included two pre-test and two post-test video-recorded role-play interviews and vocational outcomes at six-month follow-up. Results: Trainees reported that the intervention was easy-to-use and helped prepared them for future interviews. While co-varying for pre-test role-play performance, trainees had higher post-test role-play scores than controls at the trend level (p<0.10). At 6-month follow-up, trainees were more likely than controls to attain a competitive position (78.6% vs. 44.4%, p<0.05, respectively). Trainees had greater odds of attaining a competitive position by 6 month follow-up compared to controls (OR: 5.67, p<0.05). VR-JIT participation was associated with fewer weeks searching for a position (r= -0.36, p<0.05). Conclusions: There is preliminary evidence that VR-JIT is acceptable to trainees. Moreover, VR-JIT led to better vocational outcomes with trainees having greater odds of attaining a competitive position by 6-month follow-up. Future studies could evaluate the effectiveness of VR-JIT within community-based services.