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Abraham KM, Dent KR, Resnick SG, McCarthy JF, Zivin K. Associations of Mortality Outcomes With Employment Status at Discharge From VA Vocational Rehabilitation Service Programs. Psychiatr Serv 2024:appips20230489. [PMID: 38693833 DOI: 10.1176/appi.ps.20230489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE The authors evaluated associations between employment at discharge from Veterans Health Administration Vocational Rehabilitation Service (VR) programs and suicide and other causes of death. METHODS For veterans receiving VR between October 1, 2005, and September 30, 2014 (N=78,293), proportional hazards analyses were used to test associations of employment with suicide, drug overdose, and external and natural cause mortality rates over 1 and 5 years postdischarge and through December 31, 2019. The analyses were adjusted for clinical and sociodemographic characteristics and propensity for employment. RESULTS Of the veterans, 94.1% had a psychiatric diagnosis, and 35.5% were employed at VR discharge. In proportional hazards analyses, employment was associated with lower mortality rates through 1 year (suicide, hazard ratio [HR]=0.54; overdose, HR=0.70; external causes, HR=0.62; and natural causes, HR=0.51) and 5 years postdischarge (overdose, HR=0.72; external causes, HR=0.81; and natural causes, HR=0.72). Through December 31, 2019, employment was associated with lower risks for overdose (HR=0.80) and death by external (HR=0.81) and natural (HR=0.80) causes. CONCLUSIONS Employment at VR discharge was associated with lower mortality risk among veterans with psychiatric diagnoses.
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Affiliation(s)
- Kristen M Abraham
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Ann Arbor (Abraham, Dent, McCarthy); Department of Psychology, University of Detroit Mercy, Detroit (Abraham); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, VA, West Haven, Connecticut (Resnick); Department of Psychiatry, School of Medicine, Yale University, New Haven (Resnick); Suicide Prevention Program, Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (McCarthy); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Zivin)
| | - Kallisse R Dent
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Ann Arbor (Abraham, Dent, McCarthy); Department of Psychology, University of Detroit Mercy, Detroit (Abraham); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, VA, West Haven, Connecticut (Resnick); Department of Psychiatry, School of Medicine, Yale University, New Haven (Resnick); Suicide Prevention Program, Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (McCarthy); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Zivin)
| | - Sandra G Resnick
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Ann Arbor (Abraham, Dent, McCarthy); Department of Psychology, University of Detroit Mercy, Detroit (Abraham); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, VA, West Haven, Connecticut (Resnick); Department of Psychiatry, School of Medicine, Yale University, New Haven (Resnick); Suicide Prevention Program, Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (McCarthy); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Zivin)
| | - John F McCarthy
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Ann Arbor (Abraham, Dent, McCarthy); Department of Psychology, University of Detroit Mercy, Detroit (Abraham); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, VA, West Haven, Connecticut (Resnick); Department of Psychiatry, School of Medicine, Yale University, New Haven (Resnick); Suicide Prevention Program, Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (McCarthy); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Zivin)
| | - Kara Zivin
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Ann Arbor (Abraham, Dent, McCarthy); Department of Psychology, University of Detroit Mercy, Detroit (Abraham); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, VA, West Haven, Connecticut (Resnick); Department of Psychiatry, School of Medicine, Yale University, New Haven (Resnick); Suicide Prevention Program, Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (McCarthy); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Zivin)
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2
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Stevenson BJ, Kathawalla U, Smith C, Mueller L. Career Development in Transitional Work Settings: A Qualitative Investigation Among Veterans and Vocational Counselors. JOURNAL OF CAREER DEVELOPMENT 2023; 50:947-964. [PMID: 37463233 PMCID: PMC10288654 DOI: 10.1177/08948453221137344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Veterans living with mental health conditions have ambitious career goals and want support to find employment that meets their interests and preferences. Despite calls from researchers to "invest" and "commit" to career development research and practice for individuals living with psychiatric conditions, we still do not have empirically tested models for facilitating career development among individuals with mental health conditions, especially veterans. This qualitative study investigates the career development needs and recommended intervention strategies of veterans living with mental health conditions. Vocational counselors from the Veterans Health Administration (VHA) and veterans receiving vocational rehabilitation services (N = 13) participated in semi-structured focus groups. Findings illuminate the tasks, barriers, interventions, implementation strategies, and transitional work context that hinder and support career development of veterans with mental health conditions. Findings offer theoretical and applied guidance to researchers and counselors regarding career development of veterans living with mental health conditions.
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Affiliation(s)
- Brian J. Stevenson
- VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | | | | | - Lisa Mueller
- VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, USA
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3
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Stevenson BJ, Chamberlin E, Smith CM, Teravainen T, Kathawalla UK, Mueller L. Mind the Overlap: A Qualitative Exploration of the Vocational Lives of Veterans Living With Mental Health and Substance Use Conditions. JOURNAL OF CAREER ASSESSMENT 2023. [DOI: 10.1177/10690727231164646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Veterans with mental health and substance use conditions have poor employment outcomes and would likely benefit from integrated career, mental health, and substance use related interventions. However, vocational psychology has overlooked this vulnerable population, and vocational interventions are often relegated as less important than other psychotherapeutic interventions that target substance use or symptom reduction. Drawing upon Social Cognitive Career Theory and Psychology of Working Theory, this qualitative study examined how external and internal factors influenced the vocational trajectories of eight veterans with mental health and substance use conditions. Additionally, this study examined participants’ perspective on the usefulness of improving career outcomes in supporting their lives and recoveries. Using Consensual Qualitative Research methodology, this study uncovered how personal, environmental, relational, mental health, and substance use factors impacted the vocational trajectories of veterans living with mental health and substance use conditions. Findings also highlight that veterans want fulfilling employment and more clarity in their vocational lives to support their mental well-being and prevent substance use. Implications for vocational psychology theory and integrative practice are discussed.
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4
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Total Metacognitive Capacity Predicts Competitive Employment Acquisition Across 6 Months in Adults With Serious Mental Illness Receiving Psychiatric Rehabilitation Services. J Nerv Ment Dis 2022; 210:869-873. [PMID: 35687810 DOI: 10.1097/nmd.0000000000001554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Deficits in metacognitive capacity are common among people with serious mental illness (SMI), although there is a gap in knowledge regarding how these impairments predict later functioning, especially employment. This study aimed to prospectively examine the relationship between metacognitive capacity and 6-month competitive employment attainment in adults with SMI who were participating in a study testing a cognitive behavioral therapy intervention added to supported employment services. Sixty-seven participants with complete data at baseline and the 6-month follow-up comprised the sample. Data were analyzed using stepwise logistic regression covarying for work history and study assignment. Results indicate that total metacognitive capacity at baseline significantly predicted employment acquisition at 6 months; the final model correctly classified 83.3% of participants who obtained work. In conclusion, these findings suggest that better overall metacognitive capacity may be key for future work functioning. Thus, interventions that target metacognitive capacity may lead to enhancements in community outcomes.
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5
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Bond GR, Al-Abdulmunem M, Ressler DR, Drake RE, Davis LL, Meyer T, Gade DM, Frueh BC, Dickman RB. Evaluation of an Employment Intervention for Veterans Transitioning From the Military: A Randomized Controlled Trial. J Nerv Ment Dis 2022; 210:321-329. [PMID: 34937846 DOI: 10.1097/nmd.0000000000001472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Military personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. The Independence Project compared an innovative employment program (National Career Coach Program) with standard employment services (Local Community Resources) in a randomized controlled trial. Study participants were transitioning veterans with self-reported service-connected disabilities seeking permanent employment. The primary outcomes were paid employment and disability ratings over 1 year. Secondary outcomes included health and well-being. At 1-year follow-up, National Career Coach Program participants were significantly more likely to work, had significantly greater earnings, and reported significantly greater improvements in physical and mental health compared with participants assigned to Local Community Resources. Both groups increased in disability ratings over 12 months, with no difference between groups. Multifaceted supports delivered by the National Career Coach Program increased employment, earnings, mental health, and physical health over 1 year. These significant differences appeared even though control group participants achieved considerable employment success.
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Affiliation(s)
- Gary R Bond
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | - Monirah Al-Abdulmunem
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | - Daniel R Ressler
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | - Robert E Drake
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | | | - Thomas Meyer
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Daniel M Gade
- Department of Public Administration and Policy, American University, Washington, DC
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6
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Stroupe KT, Jordan N, Richman J, Bond GR, Pogoda TK, Cao L, Kertesz SG, Kyriakides TC, Davis LL. Cost-Effectiveness of Individual Placement and Support Compared to Transitional Work Program for Veterans with Post-traumatic Stress Disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:429-439. [PMID: 34677786 DOI: 10.1007/s10488-021-01173-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
Post-traumatic stress disorder (PTSD) leads to significant disability, unemployment, and substantial healthcare costs. The cost-effectiveness of vocational rehabilitation (VR) interventions is important to consider when determining which services to offer. This study assesses the cost-effectiveness and return on investment of Individual Placement and Support (IPS) compared to transitional work (TW) programs. Employment outcomes from a multisite randomized trial comparing IPS to TW in military veterans with PTSD (n = 541) were linked to Veterans Health Administration (VHA) archival medical record databases to examine the comparative cost-effectiveness and return on investment. Effectiveness was defined as hours worked and income earned in competitive jobs. Costs for VR, mental health, and medical care and income earned from competitive sources were annualized and adjusted to 2019 US dollars. The annualized mean cost per person of outpatient (including vocational services) were $3970 higher for IPS compared to TW ($23,245 vs. $19,276, respectively; P = 0.004). When TW income was included in costs, mean grand total costs per person per year were similar between groups ($29,828 IPS vs. $26,772 TW; P = 0.17). The incremental cost-effectiveness analysis showed that while IPS is more costly, it is also more effective. The return on investment (excluding TW income) was 32.9% for IPS ($9762 mean income/$29,691 mean total costs) and 29.6% for TW ($7326 mean income/$24,781 mean total costs). IPS significantly improves employment outcomes for individuals with PTSD with negligible increase in healthcare costs and yields very good return on investment compared to non-IPS VR services.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA. .,Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua Richman
- Birmingham VA Medical Center, Birmingham, AL, USA.,Department of Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Building 9, Office 218, 150 South Huntington Avenue (152M), Boston, MA, 02130, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA
| | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA.,Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Tassos C Kyriakides
- West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Health Care System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Lori L Davis
- Research and Development Service, Tuscaloosa VA Medical Center-Psychiatry, 3701 Loop Rd, Tuscaloosa, AL, 35404, USA.,Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham, AL, USA
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7
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Stevenson BJ, Thrower SJ, Mueller L, Kelly MM. Vocational identity of veterans with co-occurring mental health and substance use disorders. JOURNAL OF VOCATIONAL REHABILITATION 2021. [DOI: 10.3233/jvr-211153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: No studies have examined vocational identity among individuals with co-occurring mental health and substance use disorders. OBJECTIVE: Influenced by Blustein’s relational theory of working (2011), this study examined the relationships between several social-environmental variables (external/relational conflicts, employment barriers, substance abuse stigma) and vocational identity. METHODS: Eighty-four veterans receiving treatment from the Veterans Health Administration (VHA) for co-occurring mental health and substance use disorders participated in this survey study. RESULTS: Education, employment, clinical, disability, and substance abuse factors were not associated with vocational identity, but external/relational conflicts, employment barriers, and substance abuse stigma were. Multiple regression analysis found that these variables accounted for 34%of the variance in vocational identity and that external/relational conflicts was the only significant predictor. CONCLUSIONS: Findings suggest that more conflictual messages about work from external/relational sources is related to less clarity around one’s vocational interests, goals, and talents.
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Affiliation(s)
- Brian J. Stevenson
- VISN 1 New England Mental Illness Research, Education and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Stephanie J. Thrower
- VISN 1 New England Mental Illness Research, Education and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
| | - Lisa Mueller
- VISN 1 New England Mental Illness Research, Education and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
| | - Megan M. Kelly
- VISN 1 New England Mental Illness Research, Education and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
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8
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Ahonle ZJ, Kreider CM, Hale-Gallardo J, Castaneda G, Findley K, Ottomanelli L, Romero S. Implementation and use of video tele-technologies in delivery of individualized community-based vocational rehabilitation services to rural veterans. JOURNAL OF VOCATIONAL REHABILITATION 2021. [DOI: 10.3233/jvr-211159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Telerehabilitation is an effective health delivery method for patients with a variety of health conditions. There is insufficient knowledge about use of telerehabilitation to support patients with disabilities and chronic illness in obtaining or sustaining competitive employment. Employment rates of Veterans are lower than civilian rates, and the employment gap is higher for Veterans living in rural areas. OBJECTIVE: To investigate factors that enabled and constrained routine use of video tele-technologies in delivering individualized community-based vocational rehabilitation (referred to as Tele-VR) services and to identify impacts and promising practices in implementation. METHODS: Semi-structured interviews with providers from two Veterans Health Administration Medical Sites that use telerehabilitation to supplement their existing face-to-face individualized community-based VR services. Interviews were analyzed using thematic analysis. RESULTS: Five themes in the implementation of Tele-VR were identified (1) Enhancing Workflow for Providers, (2) Improving Quality of Therapeutic Care, (3) Practicalities in Implementing Tele-VR, (4) Embedding Vocational Rehabilitation into Interdisciplinary Care as a Facilitator to Implementation, and (5) Impact of Tele-VR. CONCLUSIONS: The telerehabilitation delivery of employment service to Veterans with disabilities is a viable means for remotely providing or enhancing face-to-face individualized and community-based VR services that support Veterans’ competitive employment and job stability within their communities.
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Affiliation(s)
- Zaccheus J. Ahonle
- Veterans Rural Health Resource Center –Gainesville, Department of Veterans Affairs, Gainesville, FL, USA
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Consuelo M. Kreider
- Veterans Rural Health Resource Center –Gainesville, Department of Veterans Affairs, Gainesville, FL, USA
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Jennifer Hale-Gallardo
- North Florida/South Georgia Veterans Health System, Department of Veterans Affairs, Gainesville, FL, USA
| | - Gail Castaneda
- Veterans Rural Health Resource Center –Gainesville, Department of Veterans Affairs, Gainesville, FL, USA
| | - Kimberly Findley
- Veterans Rural Health Resource Center –Gainesville, Department of Veterans Affairs, Gainesville, FL, USA
| | - Lisa Ottomanelli
- VA - James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - Sergio Romero
- Veterans Rural Health Resource Center –Gainesville, Department of Veterans Affairs, Gainesville, FL, USA
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
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9
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Abraham KM, Chang MUM, Van T, Resnick SG, Zivin K. Employment After Vocational Rehabilitation Predicts Decreased Health Care Utilization in Veterans With Mental Health Diagnoses. Mil Med 2021; 186:850-857. [PMID: 33825897 DOI: 10.1093/milmed/usab113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/20/2021] [Accepted: 03/16/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Although the benefits of employment for veterans with mental health conditions are well-known, the effect of veterans' employment on a health system has not been evaluated. The purpose of this study was to evaluate the effect of veterans' employment (versus unemployment) on subsequent health care utilization in the Veterans Health Administration (VHA). MATERIALS AND METHODS This study used a sample of 29,022 veterans with mental health and substance use disorders who were discharged from VHA's employment services programs between fiscal years 2006 and 2010. Veterans' employment status (employed/unemployed) upon discharge from VHA employment programs was ascertained from program discharge forms and linked with VHA administrative health care utilization data for the subsequent 1- and 5-year periods. RESULTS Multivariable ordinary least-squares and logistic regression models adjusted for site clustering and covariates indicated that employment (versus unemployment) predicted less health care utilization 1 year and 5 years post-discharge from employment services, including fewer outpatient mental health visits, homelessness services visits, employment services visits, primary care visits, and lower odds of mental health hospitalizations, mental health or vocational rehabilitation residential stays, and medical hospitalizations. Employment did not predict emergency department visits. CONCLUSIONS VHA's investment in employment services for veterans with mental health and substance use disorders could reduce health care utilization system wide.
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Affiliation(s)
- Kristen M Abraham
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor, MI 48105, USA.,Department of Psychology, University of Detroit Mercy, Detroit, MI 48221, USA
| | - Ming-Un Myron Chang
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Tony Van
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Sandra G Resnick
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, West Haven, CT 06516, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Kara Zivin
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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10
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Kukla M, Strasburger AM, Salyers MP, Rollins AL, Lysaker PH. Psychosocial outcomes of a pilot study of work-tailored cognitive behavioral therapy intervention for adults with serious mental illness. J Clin Psychol 2020; 77:488-495. [PMID: 32860466 DOI: 10.1002/jclp.23048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many people with serious mental illness (SMI) continue to struggle with work functioning despite the receipt of supported employment (SE) services. In response, adjunctive interventions to SE have begun to be developed. One such approach, the cognitive behavioral therapy for work success (CBTw) intervention, targets cognitive and behavioral barriers to competitive work success in adults with SMI. Using a pre-post design, this pilot study examined the psychosocial outcomes of the CBTw program in 52 adults with SMI receiving SE. METHOD Recovery attitudes, work-related self-efficacy, self-esteem, and symptom domains (depression, anxiety, psychosis) were measured at baseline and after the 12-week intervention. Paired samples t-tests examined changes in outcomes over time. RESULTS At posttreatment, participants had significant improvements in recovery attitudes, self-esteem, depressive, and negative symptoms. Other psychosocial outcomes did not significantly change. CONCLUSIONS This pilot work demonstrates CBTw is a promising intervention to improve recovery and wellness in SMI.
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Affiliation(s)
- Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Amy M Strasburger
- Richard L. Roudebush VA Medical Center, Psychiatry Service, Indianapolis, Indiana, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.,ACT Center of Indiana, Indianapolis, Indiana, USA
| | - Angela L Rollins
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.,ACT Center of Indiana, Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Psychiatry Service, Indianapolis, Indiana, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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11
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Vocational Rehabilitation in the Veterans Health Administration Polytrauma System of Care: Current Practices, Unique Challenges, and Future Directions. J Head Trauma Rehabil 2020; 34:158-166. [PMID: 31058758 DOI: 10.1097/htr.0000000000000493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE/PURPOSE Veterans and service members (V/SMs) with traumatic brain injury (TBI) and comorbid conditions are treated in the Veterans Health Administration (VHA) Polytrauma System of Care (PSC). These V/SMs comprise a unique population with distinct needs for restoring community reintegration, including participation in meaningful employment. Low employment rates after TBI vary and are influenced by many factors. Employment is a central aspect of the VHA priority of facilitating adjustment, and addressing vocational needs alongside healthcare is critical to community reintegration. The purpose of this article is to outline current practices of addressing vocational rehabilitation in the PSC, discuss the unique challenges in serving Veterans with polytrauma, and outline future directions to improve vocational services and outcomes. METHODS Briefly review literature on V/SM with TBI and employment, describe the PSC and VHA vocational programs for V/SM with polytrauma, and synthesize proceedings on vocational rehabilitation from the 2017 VHA "Community Reintegration in the Polytrauma System of Care" meeting. CONCLUSIONS To advance and expand vocational services the following guidelines were recommended: (1) designing flexible services based on individualized needs, (2) increasing access to vocational services through communication and collaboration, (3) promoting cross-disciplinary education and engagement in vocational care, and (4) systematically tracking employment outcomes.
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12
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Clark JMR, Seewald PM, Wu K, Jak AJ, Twamley EW. Aspects of Executive Dysfunction and Racial/Ethnic Minority Status Are Associated With Unemployment Duration in Veterans With a History of Mild-to-Moderate Traumatic Brain Injury. Arch Phys Med Rehabil 2020; 101:1383-1388. [PMID: 32416150 DOI: 10.1016/j.apmr.2020.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/17/2020] [Accepted: 04/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine demographic, psychiatric symptom, and neuropsychological performance factors associated with duration of unemployment in Iraq/Afghanistan Veterans with a history of mild-to-moderate traumatic brain injury (TBI). DESIGN Cross-sectional, secondary data analysis of baseline measures in a supported employment study. SETTING VA medical center. PARTICIPANTS Participants (N=50) were veterans with a history of mild-to-moderate TBI who were unemployed, stating a goal of returning to work, and had documented impairment in at least 1 neuropsychological domain. Participants were referred from VA vocational and assessment-based clinics. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Duration of unemployment, neuropsychological, and psychiatric symptom assessments. RESULTS Bivariate correlations revealed that longer duration of unemployment was associated with greater posttraumatic stress disorder (P<.10) and depressive (P<.05) symptom severity, worse executive functioning (P<.05), and racial/ethnic minority status (P<.05). A multiple linear regression analysis including these independent variables explained 26.5% of the variance in duration of unemployment. Worse executive functioning, specifically reasoning and set-shifting, and minority status were each associated with longer duration of unemployment in the context of multiple independent variables. CONCLUSIONS Our results underscore the importance of objective assessment of cognitive functioning in job-seeking Veterans with TBI histories. It may be useful to target aspects of executive functioning in vocational rehabilitation interventions and to provide additional assistance to Veterans from racial/ethnic minority groups.
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Affiliation(s)
- Jillian M R Clark
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, La Jolla, California
| | - P Michelle Seewald
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California; VA San Diego Healthcare System, Research Service, San Diego, California
| | - Kevin Wu
- Psychology Department, University of California San Diego, La Jolla, California
| | - Amy J Jak
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, Psychology Service, San Diego, California
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, Research Service, San Diego, California.
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Davis LL, Resnick SG, Maieritsch KP, Weber KC, Erbes CR, Strom TQ, McCall KP, Kyriakides TC. Employment outcomes from VA vocational services involving transitional work for veterans with a diagnosis of posttraumatic stress disorder. Psychiatr Rehabil J 2019; 42:257-267. [PMID: 30945920 PMCID: PMC6910199 DOI: 10.1037/prj0000357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Transitional work (TW) for veterans with psychiatric disabilities is the predominant model of vocational rehabilitation in the Veterans Health Administration (VA). Although, on average, TW employment outcomes have been demonstrated to be inferior to supported employment, little is known about the potential subgroup of veterans for which TW may be most effective. This study of veterans with posttraumatic stress disorder (PTSD) examines differences in competitive employment outcomes and identifies characteristics of veterans who chose to engage in TW compared with those who did not. METHOD A post hoc comparative subgroup analysis of veterans with PTSD randomly assigned to TW as part of a randomized controlled trial was conducted. Veterans were divided into 2 subgroups: those who engaged in TW (n = 141) and nonengagers (n = 129). Differences in baseline characteristics were examined and 18-month employment outcomes were compared. RESULTS There were no differences in 18-month employment outcomes between TW engagers and nonengagers. Compared with TW engagers, those that did not engage in TW were 2.5 times more likely to get a competitive job within the first 6 months and were less likely to obtain lower skilled jobs. Younger age, adequate housing, personal means of transportation, and recent work history factor into the odds of gaining and maintaining competitive work. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Consistent with past research, engagement in TW did not result in improved long-term competitive employment outcomes for veterans with PTSD. Those who did not engage in TW were more likely to gain a competitive job within the first 6 months. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Lori L Davis
- Research and Development Service, Tuscaloosa VA Medical Center
| | | | | | | | | | - Thad Q Strom
- Department of Psychiatry, University of Minnesota Medical School
| | | | - Tassos C Kyriakides
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System
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Wyse JJ, Pogoda TK, Mastarone GL, Gilbert T, Carlson KF. Employment and vocational rehabilitation experiences among veterans with polytrauma/traumatic brain injury history. Psychol Serv 2018; 17:65-74. [PMID: 30265073 DOI: 10.1037/ser0000283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evidence suggests that Iraq and Afghanistan war veterans with polytrauma/traumatic brain injury (TBI) history and neurobehavioral symptoms may face difficulties returning to work, yet also encounter barriers to accessing, navigating, and engaging in Department of Veterans Affairs (VA) vocational rehabilitation programs. This study utilized qualitative interviews and focus groups with veterans with documented polytrauma/TBI history to explore veterans' perceived barriers to employment and vocational rehabilitation program participation, as well as to solicit thoughts regarding interest in an evidence-based vocational rehabilitation program, the Individual Placement and Support model of Supported Employment (IPS-SE). Veterans identified physical, emotional, cognitive, and interpersonal barriers to finding and maintaining work that they described as linked with their polytrauma/TBI symptoms and sequelae. Communication and logistical issues were described as the primary barriers to vocational rehabilitation program access, while barriers to program utilization included eligibility characteristics, fear of losing financial benefits, and a military-cultural belief of self-sufficiency that made help-seeking difficult. Finally, veterans endorsed key aspects of IPS-SE, such as staff serving as translators, advocates, and navigators of the job search and maintenance process. Policy recommendations are addressed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Jessica J Wyse
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
| | | | - Tess Gilbert
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System
| | - Kathleen F Carlson
- Center to Improve Veteran Involvement in Care, and National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System
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A Pilot Test of Group Based Cognitive Behavioral Therapy to Augment Vocational Services for Persons With Serious Mental Illness: Feasibility and Competitive Work Outcomes. J Nerv Ment Dis 2018; 206:310-315. [PMID: 29485477 DOI: 10.1097/nmd.0000000000000796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Persons with serious mental illness (SMI) struggle with work functioning even with the assistance of vocational services. The current study sought to address this problem by examining a cognitive-behavioral therapy to augment vocational services. Fifty-two adults with SMI receiving vocational services participated in a pre-post feasibility trial of the Cognitive Behavior Therapy for Work Success (CBTw) intervention. CBTw is a 12-week manualized intervention that addresses cognitive and behavioral factors that impact work functioning. Competitive work outcomes were assessed in the 12 weeks preceding baseline and after the intervention. The results demonstrate strong session attendance and a low attrition rate. There were also significant improvements in work outcomes. Specifically, among participants unemployed at baseline, 50.0% attained work during follow-up. These findings provide preliminary evidence that CBTw may be a feasible intervention to augment vocational services; further controlled research should examine its benefit to work outcomes in people with SMI.
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Davis LL, Kyriakides TC, Suris AM, Ottomanelli LA, Mueller L, Parker PE, Resnick SG, Toscano R, Scrymgeour AA, Drake RE. Effect of Evidence-Based Supported Employment vs Transitional Work on Achieving Steady Work Among Veterans With Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2018; 75:316-324. [PMID: 29490371 PMCID: PMC5875356 DOI: 10.1001/jamapsychiatry.2017.4472] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) often interferes with a person's ability to obtain or sustain employment, which leads to premature exit from the labor force and reduced income. OBJECTIVE To determine whether individual placement and support (IPS)-supported employment is more effective than stepwise vocational rehabilitation involving transitional work assignments at helping veterans with PTSD attain steady, competitive employment. DESIGN, SETTING, AND PARTICIPANTS The Veterans Individual Placement and Support Toward Advancing Recovery (VIP-STAR) study was a prospective, multisite, randomized clinical trial that included 541 unemployed veterans with PTSD at 12 Veterans Affairs medical centers. Data were collected from December 23, 2013, to May 3, 2017. Intent-to-treat analysis was performed. INTERVENTIONS Individual placement and support is a supported employment intervention that rapidly engages people with disabilities in community job development to obtain work based on their individual job preferences. Transitional work is a stepwise vocational rehabilitation intervention that assigns people temporarily to noncompetitive jobs as preparation for competitive employment in the community. MAIN OUTCOMES AND MEASURES A priori hypotheses were that, compared with those in transitional work, more participants in the IPS group would become steady workers (primary) and earn more income from competitive jobs (secondary) over 18 months. Steady worker was defined as holding a competitive job for at least 50% of the 18-month follow-up period. RESULTS A total of 541 participants (n = 271 IPS; n = 270 transitional work) were randomized. Mean (SD) age was 42.2 (11) years; 99 (18.3%) were women, 274 (50.6%) were white, 225 (41.6%) were African American, and 90 (16.6%) were of Hispanic, Spanish, or Latino ethnicity. More participants in the IPS group achieved steady employment than in the transitional work group (105 [38.7%] vs 63 [23.3%]; odds ratio, 2.14; 95% CI, 1.46-3.14). A higher proportion of IPS participants attained any competitive job (186 [68.6%] vs 154 [57.0%]; P = .005) and had higher cumulative earnings from competitive jobs (median [interquartile range] $7290 [$23 174] in IPS vs $1886 [$17 167] in transitional work; P = .004). CONCLUSIONS AND RELEVANCE This multisite trial demonstrated significantly greater effectiveness of IPS-supported employment over stepwise transitional work vocational rehabilitation for veterans living with chronic PTSD. The results provide supporting evidence for increasing access to IPS for veterans living with PTSD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01817712.
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Affiliation(s)
- Lori L. Davis
- Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama,Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa
| | - Tassos C. Kyriakides
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Alina M. Suris
- Department of Psychiatry, VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas
| | - Lisa A. Ottomanelli
- Health Services Research and Development, Center of Innovation for Disability and Rehabilitation Research, University of South Florida, Tampa,Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa
| | - Lisa Mueller
- Department of Psychology, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts,Veterans Integrated Service Network (VISN) 1 Mental Illness Research Education and Clinical Center, Bedford, Massachusetts
| | - Pamela E. Parker
- Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa
| | - Sandra G. Resnick
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut,VISN 1 Mental Illness Research Education and Clinical Center, West Haven, Connecticut
| | - Richard Toscano
- Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama
| | - Alexandra A. Scrymgeour
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico Healthcare System, Albuquerque
| | - Robert E. Drake
- Individual Placement and Support Employment Center, Rockville Institute, Westat, Rockville, Maryland
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