The Impact of Vocational Rehabilitation on Mentally III Veterans

Not Applicable

Completed

Interventions: Behavioral: Vocational Rehabilitation Program (VRP)
Behavioral: Individual Placement and Support (IPS)

Brief Summary: To study the impact of Individual Placement and Support (IPS) supported employment (SE) compared to treatment-as-usual vocational rehabilitation program (VRP) for veterans with posttraumatic stress disorder (PTSD).

Detailed Description: Objectives: to study the impact of Individual Placement and Support (IPS) supported employment (SE) compared to treatment-as-usual vocational rehabilitation program (VRP) for veterans with posttraumatic stress disorder (PTSD).

Research Design: This prospective randomized study evaluates the impact of IPS-SE compared to VRP on occupational, sobriety, psychiatric, and quality of life outcomes and health care costs for veterans with chronic PTSD who enter the Tuscaloosa VA Medical Center's (TVAMC) vocational rehabilitation program.

Methodology: Occupational functioning is determined primarily by whether the veteran can obtain and maintain competitive employment, and, secondarily, by time worked and wages earned for those employed. Veterans who meet inclusion criteria will be randomized to either IPS-SE or VRP. Outcomes will be assessed over a fixed 12-month observation period (beginning at randomization and computed for the entire 12-month observation period) as percent subjects employed at least one week (employed rate), and monthly employment rates (maintained employed rate). In addition, PTSD symptoms and other health-related quality of life measures will be evaluated. This strategy uses all available data during the 1-year period.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Lifetime history of severe traumatic brain injury that has resulted in severe cognitive impairment
History of schizophrenia, schizoaffective, disorder, or bipolar I disorder
Pending litigation
In need of immediate detoxification.

Arm && Interventions

Group	Intervention	Description
Vocational Rehabilitation Program (VRP)	Vocational Rehabilitation Program (VRP)	Vocational Rehabilitation Program (VRP). VRP is the treatment as usual, which mostly consisted of transitional work program (TWP) in which client is placed in a set-aside noncompetitive job for time-limited period and then pursues competitive employment at time of discharge from VRP. Limited integration with treatment team and limited follow-along supports that are time-limited
Individual Placement and Support (IPS)	Individual Placement and Support (IPS)	Inidividual Placement and Support (IPS). IPS Supported Employment involves an IPS specialists working with client to identify job preferences, rapidly begin community-based job search, engage in competitive employment, sustain employment via open-ended IPS follow-along supports, and integrate IPS within the PTSD treatment team.

Primary Outcome Measures

Name	Time	Method
Obtain Competitive Employment	1 calendar year	The primary outcome: competitive employment (Yes or No). Competitive employment was defined as a job for regular wages in a setting that was not set aside, or sheltered, that is, the job could be held by people without a mental illness or disability and was not a set-aside job in the VRP. Day labor (babysitting, manual labor by the day, drill, temporary work for family or friends) was not considered competitive employment.

Secondary Outcome Measures

Name	Time	Method
Employment Outcomes (Weeks Competitively Employed)	one year	Number of weeks employed for any time in a competitive job (not set-aside job)
PTSD, Depression, Disability Outcomes	one-year	Clinician Administered PTSD Scale for DSM-IV (CAPS) score range 0-136 with higher=more severe; Quick Inventory of Depression Scale - Clinician-rated (QIDS-CR) score range 0-27 with higher=more severe; Clinical Global Impression-Severity (CGI-S) score range 1-7 with higher=more severe; Davidson Trauma Scale (DTS) score range 0-136 with higher=more severe; and World Health Organization Disability Assessment Scale (WHODAS-II) 36-items rated on 5-point scale, from 1 (no difficulty) to 5 (extreme difficulty/cannot do) in 6 domains of life; domain scores are transformed from the total raw score (sum of items) of each domain according to the following formula: Transformed score=\[(actual raw score - lowest possible raw score) / (possible raw score range)\] x 100.
Employment Outcomes (Gross Income Competitive)	one year	total gross income (US dollars) from all competitive wages, salary, commissions
Employment Outcomes (Days Competitively Employed	one year	Number of days employed in a competitive job (not set-aside job)
Employment Outcomes (Total Gross Income From All Sources	one year	total gross income from all sources of work including noncompetitive and competitive jobs
Employment Outcomes (Hours Competitively Employed)	one year	hours employed in a competitive (not set-aside) job