Benefits Counseling to Preserve Function Among Disability Applicants

Phase 2

Completed

Brief Summary: This study will address the problem that claimants with psychiatric disabilities who apply for and receive disability benefits go on to work less than those whose claims are denied.

Detailed Description: The objective of this research is to conduct a 6-month randomized clinical trial comparing participants assigned to Benefits Counseling and to those assigned to the control condition, VA Orientation. Benefits Counseling is an adaptation of two counseling approaches to foster veterans' involvement in work and work-related activity compared to the control condition, VA Orientation. The first approach helped recipients of Social Security disability benefits for psychiatric illness return to work in part by alleviating beneficiaries' concerns that they would lose their benefits if they worked. The second approach is a Motivational Interviewing approach that showed great promise in engaging veterans with psychiatric disabilities in compensated work therapy.

Recruitment & Eligibility

Inclusion Criteria

Has never received VBA benefits
Able to provide valid consent
Expresses willingness to discuss benefits with a counselor
Difficulty working as evidenced by a "Yes" to either (a), (b), or (c) of the question below about work-related difficulties: During the past 4 weeks, have you had any of the following problems (such as feeling depressed and anxious):
- Cut down on the amount of time you spent on work or other activities?
- Accomplished less than you would like?
- Didn't do work or other activities as carefully as usual?
Expresses willingness to try Benefits Counseling if assigned to it
An evaluation by a psychiatrist or psychologist is scheduled

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Arm 1	Benefits Counseling	This counseling consists of four sessions each approximately 60 minutes each. The four sessions are organized as follows: a) Orientation to Benefits Counseling: Your Benefits and Your Goals b) Work and Claims c) Financial Review: Implications of Your Work Plan and d) Your Plans After the Benefits Notice. The first session focuses on the disability application process as a non-confrontational way to explore attitudes towards work. The second session more directly addresses the claimant's attitudes about work and beliefs about whether work will prevent receipt of disability benefits. The third session addresses the same issue as the second, ambivalence about work and disability, from a financial perspective. The fourth session occurs after the disability determination has been made, and it is possible the veteran may feel differently about a benefit that has been awarded.
Arm 2	VA Orientation	This will consist of four-session orientation with the sessions organized as follows: a) overview of VHA services, b) Primary Care c) Pharmacy and laboratory services and d) specialty services. After the description of each service, participants will be invited to discuss which services they plan to utilize. The counselor will provide telephone numbers and directions to the sites at which these services are provided.

Primary Outcome Measures

Name	Time	Method
Days of Work and Work-related Activity	Month 6	Number of days in the past 28 spent engaged in any kind of work or related activity. Measured using a timeline follow-back calendar.

Secondary Outcome Measures