Support Lifts Employment Odds for Vets with PTSD
Mahoney, Diana, Clinical Psychiatry News
Unemployed veterans with post-traumatic stress disorder experience better employment outcomes when they receive individual job placement and support services, compared with standard vocational rehabilitation services, new research shows.
Recipients of evidence-based individual placement and support (IPS) were significantly more likely to gain competitive employment than were recipients of the standard Vocational Rehabilitation Program (VRP) services, Dr. Lori L. Davis of the Tuscaloosa (Alabama) Veterans Affairs Medical Center and her colleagues reported. Additional employment outcomes, including time worked and total earnings, also favored IPS, they wrote (Psychiatric Serv. 2012 [doi:10.1176 /appi.ps.201100340]).
The study is the first to examine employment outcomes for veterans with PTSD who received IPS, compared with those with PTSD enrolled in the VRP, which is offered by the U.S. Department of Veterans Affairs.
For the prospective study, 85 unemployed veterans with PTSD aged 19-60 years at the Tuscaloosa VA Medical Center from 2006-2011 were randomized to either IPS-supported employment (42) or VRP treatment as usual (43). The employment rates and occupational outcomes of the veterans were followed for 12 months. All of the subjects were medically cleared to participate in a work activity were interested in competitive employment, and were planning to remain within a 100-mile radius of the medical center for the duration of the study.
Excluded from the study were veterans with a severe disorder resulting from severe traumatic brain injury; those diagnosed with schizophrenia, schizoaffective disorder, bipolar I disorder, or dementia; those with an immediate need for alcohol or drug detoxification; or those with pending active legal charges with expected incarceration.
The main tenets of the evidence-based IPS supported employment model are client choice, rapid job finding where appropriate, competitive education programs, integrated education and work settings, and follow-along supports. The individualized client-centered services are provided by a multidisciplinary team that integrates and coordinates treatment and rehabilitation, according to the authors. Standard VRP care includes routine prevocational testing and evaluation; vocational rehabilitation therapy comprising a work regimen and the use of special employer incentives; on-the-job training; apprenticeships; and unpaid work experience.
At baseline, all of the study participants underwent a psychiatric and general medical evaluation, including a medical history, psychiatric history, and family psychiatric history. A clinical research coordinator also evaluated each participant for PTSD and other Axis I disorders using the Mini-International Neuropsychiatric Interview at baseline and 1-, 2-, 3-, 4-, 6-, 8-, 10-, and 12-month follow-up visits. …