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Overview. Overview of the problemOverview of Cognitive Information Processing Brief Review of foundational researchInitial results of current young adult career readiness study findingsApplications to service delivery. The Broad Problem . As the number of individuals surviving cancer continues to increase, career development and employment are becoming central factors that impact the individual's community integration and well-being. .
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1. Career Readiness in Young Adult Brain Tumor Survivors David R. Strauser, Ph.D.
Department of Kinesiology and Community Health
October 19, 2009
1:00-2:30 p.m.
2. Overview Overview of the problem
Overview of Cognitive Information Processing
Brief Review of foundational research
Initial results of current young adult career readiness study findings
Applications to service delivery
3. The Broad Problem As the number of individuals surviving cancer continues to increase, career development and employment are becoming central factors that impact the individual’s community integration and well-being.
4. Cancer and Employment: Adults Employment rates of cancer survivors range from 41 to 84%
Mean rate of 62% (Taskilia &Lindbohm, 2007)
16.8% of working age cancer survivors (vs. 5% for matched controls) are “unable to work because of physical, mental, or emotional problems”
7.4% (vs. 3.2% of matched controls) “were limited in the kind or amount of work they could perform” (Hewitt, Rowland, & Yancik, 2003)
Long term cancer survivors
One in five survivors reported “cancer related disabilities”
with 50% continuing to work.
13% of all survivors had withdrawn from work for cancer related reasons within four years (Short et al, 2005)
5. Cancer and Employment: Adult Unequal employment practices are forms of discrimination for cancer survivors (Feuerstein, et al., 2007)
More likely to file claims related to job loss and differential treatment
Cancer combined with another impairment increases relationship problems at work
Duration of sick leave associated with difficulties in returning to work in cancer survivors (Amir et al. 2007)
Males use less sick leave then females
Males have longer sick leave
Sick leave used most by those economically deprived
6. Cancer and Employment: Young Adults Young adults who are childhood cancer survivors experience significant difficulty in obtaining employment
Adult survivors of childhood cancer are twice as likely to be unemployed compared to their healthy controls
5 times more likely to be unemployed in CNS cancer survivors. (deBoer et al, 2006)
Young adults who are childhood cancer survivors experience concerns about obtaining employment
19% with a history of childhood bone marrow transplant reported work as a major concern vs. 2% of their age matched controls (Bradley,2002)
Co-Morbid health conditions (depression, anxiety, fatigue, cardiovascular disease, visual impairments, and impaired attention span) have been linked to difficulty in obtaining employment in childhood cancer survivors (deBoer et al, 2006)
7. Career Development and Cancer Survivorship Career counseling has an important role with young cancer survivors
Cognitive Information Processing (CIP) provides a theoretical model regarding the provision of career services
Two core constructs
Information Processing Domains
Decision-Making Cycle
8. Theoretical Assumptions (CIP) Career decision making involves both emotions (affect) and thoughts (cognition)
Knowledge-content of career choice
Process-what we need to do
Knowledge and Emotions are dynamic states
Impacted by health and disability (i.e. cancer)
Career problem solving and decision making are skills that can be learned
Can improve with practice
Career counseling and resources
9. Dysfunctional Career Thoughts Dysfunctional career thoughts lead to…
Avoidance of career and other life decisions
Decreased life satisfaction
Depression and anxiety
Decreased job satisfaction
Increased job stress
Interpersonal relationship problems
Expressed through…
Behavior-poor performance
Verbal-negative statements and expressions
Emotions-depression and anxiety
11. Self-Knowledge Values, interests, skills, and employment preferences are influenced by
Personal characteristics
Life experience
Values, interests, skills, and employment preferences may be influenced by
Religious or spiritual beliefs
Cancer Related Issues
Symptom burden-fatigue, depression, anxiety, decreased concentration
Receptive and Expressive skills
12. Self-Knowledge Stored in episodic memory
Perceptions rather than facts
Influenced by interpretation of past events
Influenced by present emotions
13. Environmental Knowledge Knowledge of Environmental Demands
Direct experience or observing others
Expands over time
Components of Environmental Knowledge
Tasks
Tools & Technology
Knowledge (i.e. language, interpersonal)
Skills & Abilities
Work Activities (i.e. communicating, moving objects)
Work Context ( i.e. contact with others)
Work Styles (i.e. stress tolerance, dependability)
Work Values (i.e. relationship, support, achievement)
Interests
Expressive and Receptive demands
14. Occupational Knowledge Stored in semantic memory
Verifiable facts rather than perceptions
Not influenced by interpretation of past events
Not influenced by present emotions
15. Decision-Making Cycle
16. Meta-Cognitions (Executive Processing Domain) Thoughts That Influence Decision Making
Self-Talk
Positive vs. Negative
Self-Awareness
Thoughts, Emotions and Behaviors
Reactions of self to significant others
Monitoring and Control
Where they are in the process
Purposeful engagement
17. Two Dimensions of Career Readiness Capability
Cognitive and affective ability to engage in effective career problem solving and decision making
Career Thoughts Inventory (CTI) Subscales
Decision Making Confusion (DMC)
Commitment Anxiety (CA)
Complexity
Contextual factors, originating in the family, society, economy, or employing organizations that make it (more or less) difficult to solve career problems or make decisions
CTI Subscale
External Conflict (EC)
18. Two Dimensional Model of Readiness
19. Foundational Research Career Readiness and Disability
20. Key Findings (Disability Specific) People with disabilities have increased levels of dysfunctional career thoughts compared to controls (Strauser et al, 2002, Strauser et al., 2004)
The Career Thoughts Inventory (CTI) can be used with individuals with disabilities to identify their levels of career readiness (Lustig et al., 2003)
Cognitive and affective states negatively impact career readiness (Yanchak et al., 2005; Strauser et al., 2006a; Strauser et al., 2006b)
PWB is positively related to career readiness (Lustig et al, 2002; Lustig et al. 2008; Strauser et al, 2008)
21. Key Findings (Broader Career Literature) Career services are effective in reducing negative career thoughts (Dipeolu et al. 2002)
Completion of higher education is related to less dysfunctional career thoughts (Reardon, et al., 2000)
Positive effect of Vocational and Career services for individuals with disabilities (Bolton & Akridge, 1995; Enright, 1995; Merz & Syzmanski, 2002)
22. Current Research in Career Readiness and Young Adult CNS Survivors
23. Purpose of Current Exploratory Study The overall purpose of this exploratory study is two fold.
Examine the relationship between career readiness, vocational identify and relevant career and psycho-social outcomes in young adult brain tumor survivors
Enhancing career readiness can increase career and vocational functioning and career and psycho-social outcomes
Determine if we can classify brain tumor survivors according to their level of career readiness
Classifying survivors according to their level of career readiness can guide the implementation of clinical and vocational interventions focused on improving career and employment outcomes.
24. Aim 1 Aim 1
Examine the relationship between career readiness, vocational identity, and relevant work and psycho-social outcomes
Ho: There will be a significant and positive relationship between career readiness, vocational identify, and relevant work and psycho-social outcomes
25. Conceptual Model Guiding Aim 1
26. Aim 2 Aim 2
Determine if it is feasible to classify brain tumor survivors according to their reported level of career readiness.
Ho: Brain tumor survivors can be classified according their reported level of career readiness. Specifically, we hypothesize that we will be able to classify individuals into three groups (High, Moderate, and Low) which then can be used to guide the type, level, and implementation of career intervention
27. Intervention Matrix for Aim 2
28. Procedures Surveys distributed to young adult brain tumor survivors
Age 18-30
IRB approval
Research packet contained
Demographic Form
Career Thoughts Inventory (CTI)
Contextual Work Behaviors (CWB)
Community Integration Scale (CIS)
Satisfaction with Life Scale (SWLS)
29. Participating Sites Children’s Brain Tumor Foundation
St. Jude Children’s Hospital
Camp-Make-A-Dream
Hope Advocate Hospital-Chicago
L.A. Children’s Hospital-City of Hope
30. Study Demographics
31. Results Aim 1
32. Aim 1 Results
33. Multivariate Results Research Aim 1
34. Multivariate Results Aim 1
35. Summary Aim 1 Findings Career Thoughts significantly and positively related to vocational identity
Complexity and capability not a unique predictor at this time
Vocational identity significantly and positively related to:
Contextual Work Behaviors (CWB)
Community Integration (CIS)
Individual Well-being (SWLS)
36. Grouping Results Aim 2 Cluster analysis (Ward’s method) was used to classify participants into three groups.
Results from Chi-square or F-statistics analysis indicated that all demographic characteristics, except were not significant (p > 0.05).
37. Grouping Results Aim 2
38. Grouping Results Aim 2
39. Results Aim 2
40. Differences on CTI across 3 Groups
41. Conceptual Model
46. Results Aim 2 Able to group cancer survivors according to their level of career readiness
No differences in demographic variables
Ethnicity-may emerge as significant (Low Group)
Education-may emerge as significant (Low Group)
No difference across groups for
CWB-may emerge as significant
CIS-may emerge as significant
SWLS
47. Implications for Practice Readiness assessment valuable as a means to identify level of career and vocational intervention
High Readiness- Self-help Services
Moderate Readiness- Brief Assisted Services
Low Readiness- Intensive Services
48. Implications Improving Readiness may increase CWB
Job Maintenance behaviors
Handling stress
Making adjustments
Dealing with co-workers
Dealing with supervisors
Improving Readiness may increase Community Integration
Level of community support
Level of independence
Level of occupational participation
49. Questions? Comments ?
50. Research Team