Employment After Vocational Rehabilitation Predicts Decreased Health Care Utilization in Veterans With Mental Health Diagnoses

Using a Workplace Rehabilitation and Reintegration Program Tracker Tool to Explore Factors Associated With Return to Duty Among Ill/Injured Military Personnel: A Preliminary Analysis

INTRODUCTION

A great deal of time and resources have been spent on developing and implementing evidence-based return to work programs over the past few decades, compelling researchers to better understand the factors associated with more favorable outcomes. Using data collected as part of a participant tracking system trial for the Canadian Armed Forces (CAF) Return to Duty (RTD) program, analyses were conducted to better understand the trajectories of program participants and identify the factors associated with RTD.

MATERIALS AND METHODS

Participants included 205 Regular Force CAF members from a single military base located in Eastern Canada who entered the RTD program during the trial period between April 2018 and March 2020. The health condition they were facing was mostly recent (i.e., onset within the past 6 months; 43%) and involved their mental health (67%). Data were collected on various demographic, military, health, and program characteristics using the RTD Data Collection Tool, which was updated periodically by program coordinators. Using data gathered by the Tool, a cumulative incidence function was generated to estimate the overall marginal probability of RTD over the duration of the program. Associations between RTD and a range of factors that were captured using the Tool were also examined in a series of competing-risks regressions.

RESULTS

Findings indicated that the rate of RTD among program participants increased at around 3 months and began to level off around 9 months, suggesting that the likelihood of RTD after this window is diminished. Of the many factors that were considered, only years of service and work placement status at 3 months were found to be associated with RTD. Specifically, lower rates of RTD were observed among participants with 15 or more years of service compared to those with less than 5 years of service in the CAF and among those who were not yet assigned a work placement at 3 months relative to those who were.

CONCLUSION

This study represents a first step in addressing the gap in our current knowledge about the characteristics of CAF members participating in the RTD program and the factors associated with RTD. Several recommendations are made for improving the participant tracking system in view of enhancing the level and quality of information that is available to assess participants' trajectories and inform further development of the program.

Disparities in program enrollment and employment outcomes for veterans with psychiatric and co-occurring substance use disorders referred or enrolled for VHA vocational rehabilitation

Introduction

The purpose of the study was to investigate factors that influence vocational rehabilitation program enrollment and employment at discharge of veterans with psychiatric and co-occurring alcohol and other substance use disorders enrolled at a veteran health administration (VHA) medical center.

Methods

A sample of 2,550 veteran patients referred for VHA vocational rehabilitation between 2016 and 2021 were examined for the current study. The current study was classified as quality improvement/assurance, thus resulting in exempt research by the U.S. Department of Veteran Affairs Institutional Review Board.

Results

Veterans with active alcohol use disorders (AUDs) and co-occurring depression, anxiety, post-traumatic stress disorder, or bipolar disorders were less likely to be enrolled for vocational rehabilitation program services compared to those without these co-occurring diagnoses. Veterans with AUD (active & in-remission status combined into one category) and a diagnosis of anxiety were less likely to be employed at discharge compared to veterans with AUDs and no anxiety diagnosis (anxiety diagnosis - 3.5% vs. no anxiety diagnosis - 5.8%).

Discussion

VHA vocational rehabilitation can be an effective intervention to assist veterans in reintegrating back into the community. Yet, there appears to be some disparities in the program enrollment and employment at discharge, depending on the nature of the psychiatric diagnosis. Investigating the factors contributing (mediating or moderating) to these discrepancies are needed. Although it appears access is not the issue in being referred for vocational rehabilitation services, other factors are likely contributing to program entry.

Mental health professionals' expectations and efforts to include employment for people with moderate to severe mental illness in treatment settings

BACKGROUND

Research suggests that employment is an important factor for recovery and improved quality of life for people with mental illnesses. Mental health professionals often serve as gatekeepers for employment interventions, yet little is known about their expectations about employment for people with mental illness in Norway. The purpose of this study is to examine mental health professionals' expectations and efforts to include employment for people with moderate to severe mental illness in treatment settings.

METHODS

Two hundred seven mental health professionals were recruited from municipal mental health services, specialized clinics, social media, and professionals' networks across Norway. Participants completed a survey package comprising demographic questions, current practices and a revised version of the self-reported measure Expectations for the Employability of People with Serious Mental Illness (EESMI), a validated measure consisting of three subscales.

RESULTS

Results suggested overall favorable expectations of employment for people with moderate to severe mental illness. Analyses revealed that patients participating more frequently in collaborative meetings predicted more favorable expectations about employment among mental health professionals compared to less frequent meetings. In addition, findings suggest that psychiatrist hold more negative expectations about employment in comparison to the other educational groups. Lastly, more than half of mental health professionals reported that they have integrated discussions about employment, and routines to address work-oriented activity in consultations with patients, however, there are substantial variations in routines for addressing work or work-oriented activity as a topic in consultations with patients.

CONCLUSIONS

These results suggest that efforts are being made to integrate employment in treatment settings for people with mental illness in Norway; however, more work is needed to remove barriers and facilitate evidence-based approaches.

Utilization and outcomes of a Whole Health model of care by Veterans with psychiatric illness

OBJECTIVES

The Veterans Health Administration (VHA) is implementing a model of healthcare known as Whole Health (WH). The goal of WH is to shift from a disease-oriented system to one that emphasizes health promotion and disease prevention as well as promotes the use of Complementary and Integrative Health. The aim of this project was to investigate utilization and outcomes of WH programming among Veterans with psychiatric disorders.

DESIGN

This was a retrospective study. Subjects were 7138 Veterans who had a mental health diagnosis. Descriptive data, as well as within- and between-subjects analyses were conducted to investigate utilization and outcomes.

SETTING

The study was conducted at a large VHA medical center.

INTERVENTIONS

Whole health interventions considered in this study were mindfulness training, health education, wellbeing, and nutrition classes as well as health coaching. Other whole health interventions, such as acupuncture and message were not evaluated.

MAIN OUTCOME MEASURES

Utilization of mental health treatment services, medication prescriptions, pain scores and suicide-related behaviors were the primary outcome measures.

RESULTS

There were 305 Veterans with at least one WH appointment. The existence of several specific psychiatric disorders was associated with WH utilization. The mean number of appointments completed per individual was 6.9 for all WH programming. Finally, WH participation was associated with decreased risk of suicide as well as reduced use of mental health services. There were no significant changes to other outcome variables.

CONCLUSIONS

WH programming shows promise to reduce suicide risk and the need for mental health services among this population. Additionally, WH services were underutilized and there was a lack of treatment engagement.