1
|
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.
Collapse
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)
| |
Collapse
|
2
|
Bond GR, Al-Abdulmunem M, Ressler DR, Gade DM, Drake RE. A Randomized Controlled Trial of an Employment Program for Veterans Transitioning from the Military: Two-Year Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:1072-1083. [PMID: 35819542 PMCID: PMC9616746 DOI: 10.1007/s10488-022-01208-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Military personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. Many veterans seek help finding employment, but few veteran employment programs have been rigorously studied. Transitioning veterans generally have access to Local Community Resources (LCR), which include the Veterans Health Administration vocational rehabilitation services, the state-federal Vocational Rehabilitation program, and the Department of Labor's American Job Centers. By contrast, the innovative National Career Coach Program (NCCP) offers intensive career coaching and financial incentives for working. METHODS This study used a randomized controlled design to compare the NCCP and LCR approaches for 208 transitioning service members (recent or pending transition). Researchers conducted interviews by telephone every four months for two years. Outcomes included earnings, months worked, and standardized self-report measures of health and well-being. Findings At two-year follow-up, significantly more NCCP participants had worked in paid employment than LCR participants (95% vs. 83%). NCCP participants averaged $2568 in monthly earnings compared to $1865 for LCR participants, thus averaging $16,872 more total income per participant over the two-year period. Employment outcomes significantly improved between Year 1 and Year 2. NCCP participants also reported significantly greater improvements in both physical and mental health compared to LCR participants. Average monthly earnings correlated with changes in health outcomes. CONCLUSIONS Veterans receiving multi-faceted employment services early in the transition from the military showed sustained benefit over a two-year period with increased earnings over time and improved mental and physical outcomes. Positive employment outcomes may have contributed to improved health outcomes.
Collapse
Affiliation(s)
- Gary R. Bond
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH 03766 USA
| | - Monirah Al-Abdulmunem
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH 03766 USA
| | - Daniel R. Ressler
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH 03766 USA
| | - Daniel M. Gade
- Virginia Department of Veterans Services, Richmond, VA USA
| | - Robert E. Drake
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH 03766 USA
| |
Collapse
|
3
|
An Assessment of the 10-Item Mental Health Recovery Measure in a Predominantly African American Sample of Adults with Serious Mental Illness. Psychiatr Q 2022; 93:849-860. [PMID: 35771407 DOI: 10.1007/s11126-022-09995-2] [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] [Accepted: 06/11/2022] [Indexed: 10/17/2022]
Abstract
Study objectives were to 1) assess the reliability and validity of the 10-item Mental Health Recovery Measure (MHRM-10) in sample of predominately African American participants with serious mental illness, and 2) evaluate differences in MHRM-10 scores between the present sample and two other samples of persons with serious mental illness with different racial compositions. Participants included 230 adults (85.7% African American) with chart diagnoses of schizophrenia-spectrum, bipolar-spectrum, and major depressive disorders receiving services from community mental health centers in Detroit, Michigan. In addition to the MHRM-10, participants completed measures of psychological symptoms (Brief Symptom Inventory (BSI)- General Severity Index (GSI) and depression subscale), well-being (12-Item World Health Organization Disability Assessment Schedule 2.0; WHODAS 2.0), and stress-related growth (Stress-Related Growth Scale - Short Form; SRGS-SF). Internal consistency and convergent validity of the MHRM-10 were examined. Differences in MHRM-10 scores between the present sample and other samples were characterized by effect sizes. The MHRM-10 demonstrated excellent internal consistency. Evidence for convergent validity of the MHRM-10 included moderate correlations with the BSI-GSI, BSI-depression subscale, SRGS-SF, and WHODAS 2.0. The present sample of predominately African American participants showed higher MHRM-10 scores than two other samples with smaller proportions of African American participants. The MHRM-10 demonstrates excellent internal consistency and good convergent validity among African Americans with serious mental illness. Although findings are promising, studies should further assess the psychometric properties of the MHRM-10 in African American samples. Additional research that examines racial differences in mental health recovery is needed.
Collapse
|
4
|
Davis LL, Mumba MN, Toscano R, Pilkinton P, Blansett CM, McCall K, MacVicar D, Bartolucci A. A Randomized Controlled Trial Evaluating the Effectiveness of Supported Employment Integrated in Primary Care. Psychiatr Serv 2022; 73:620-627. [PMID: 34521208 DOI: 10.1176/appi.ps.202000926] [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: 11/30/2022]
Abstract
OBJECTIVES Mental health issues can cause serious problems in occupational functioning, including higher rates of unemployment. Individual placement and support (IPS) is an evidence-based supported employment intervention that is typically integrated within a mental health setting; however, many primary care patients view referral to a mental health clinic as stigmatizing. Thus, this study examined whether delivery of IPS in a primary care setting provides an effective treatment option and avoids unnecessary delays in obtaining competitive employment. METHODS U.S. military veterans (N=119) who had a diagnosis in a broad range of nonpsychotic psychiatric disorders and who were receiving care from Veterans Health Administration (VHA) patient-aligned care teams were prospectively randomly assigned to IPS (N=58) or standard VHA non-IPS vocational rehabilitation (VR) (N=61). The primary outcome was achievement of steady worker status, defined as holding a competitive job for ≥6 months of the 12-month follow-up. RESULTS As hypothesized, a significantly greater proportion of IPS participants achieved steady worker status (45%), compared with VR participants (25%) (p=0.02; odds ratio=2.49, 95% confidence interval=1.14-5.43). On average, the IPS participants worked significantly more weeks (p=0.003) and earned significantly more income (p=0.033) from competitive jobs, compared with VR participants. CONCLUSIONS The results provide supporting evidence for offering IPS within primary care with the aim of restoring meaningful and sustained competitive employment for veterans living with a mental disorder. Such modifications could improve veterans' vocational outcomes, moving a significantly greater number of disabled veterans back to full and productive lives in the community.
Collapse
Affiliation(s)
- Lori L Davis
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Mercy N Mumba
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Richard Toscano
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Patricia Pilkinton
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Catherine M Blansett
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Kimberly McCall
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - David MacVicar
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| | - Al Bartolucci
- Research Service, Department of Veterans Affairs (VA) Medical Center, Tuscaloosa, Alabama (Davis, Mumba, Toscano, Pilkinton, Blansett, McCall, MacVicar); Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham (Davis); Capstone College of Nursing, University of Alabama, Tuscaloosa (Mumba); Department of Psychiatry and Behavioral Medicine, University of Alabama College of Community Health Sciences, Tuscaloosa (Pilkinton); Department of Biostatistics, University of Alabama at Birmingham, Birmingham (Bartolucci)
| |
Collapse
|
5
|
Davis LL, Blansett CM, Mumba MN, MacVicar D, Toscano R, Pilkinton P, Gay W, Bartolucci A. The methods and baseline characteristics of a VA randomized controlled study evaluating supported employment provided in primary care patient aligned care teams. BMC Med Res Methodol 2020; 20:33. [PMID: 32066380 PMCID: PMC7027030 DOI: 10.1186/s12874-020-0919-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article describes the design and baseline sample of a single-site trial comparing Individual Placement and Support (IPS) supported employment delivered within a Veterans Health Administration (VHA) primary care Patient Aligned Care Team (PACT) to treatment-as-usual vocational rehabilitation (TAU-VR) that includes transitional work. METHODS Unemployed U.S. military veterans receiving care in a VHA PACT who were seeking competitive work, otherwise eligible for vocational rehabilitation, and diagnosed with a mental health condition other than a psychotic or bipolar I disorder were prospectively randomized to receive either IPS or TAU-VR. Employment outcomes and measures of quality of life, self-esteem, and community reintegration are being collected for 12 months. RESULTS The participant sample (n = 119) is comprised of 17.6% female, 73.1% African-Americans, and 1.7% Hispanic. Average age is 38.2 (SD ± 8.41) years; 80.7% served in the military since 2001; 78% are receiving or applying for U.S. Department of Veterans Affairs (VA) service-connected disability; 26.9% have not held a competitive job in the past 3 years; and the average length of pre-randomization unemployment is 1.4 (SD ± 2.3) years. CONCLUSIONS Unique design features include evaluating the efficacy of evidenced-based IPS within the primary care setting, having broad diagnostic eligibility, and defining the primary outcome criterion as "steady employment", i.e. holding a competitive job for ≥26 weeks of the 12-month follow-up period. The findings illustrate the characteristics of a primary care veteran sample in need of employment services. TRIAL REGISTRATION www.clinicaltrials.gov Identifier: NCT02400736.
Collapse
Affiliation(s)
- Lori L Davis
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA. .,Department of Psychiatry, University of Alabama School of Medicine, Birmingham, AL, USA.
| | - Catherine M Blansett
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA
| | - Mercy N Mumba
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA.,Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - David MacVicar
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA
| | - Richard Toscano
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA
| | - Patricia Pilkinton
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA.,Department of Psychiatry, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Whitney Gay
- Tuscaloosa VA Medical Center, 3701 Loop Road East (151), Tuscaloosa, AL, 35404, USA
| | - Al Bartolucci
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
6
|
Lerner D, Adler DA, Rogers WH, Ingram E, Oslin DW. Effect of Adding a Work-Focused Intervention to Integrated Care for Depression in the Veterans Health Administration: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e200075. [PMID: 32108889 PMCID: PMC7049076 DOI: 10.1001/jamanetworkopen.2020.0075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Thousands of working-age veterans with depression experience impaired occupational functioning. OBJECTIVES To test whether the Veterans Health Administration (VHA) integrated care (IC) program combined with telephonic work-focused counseling, known as Be Well at Work (BWAW), is superior to IC alone for improving occupational functioning and depression, to determine whether these effects persist 4 months later, and to determine whether the return on investment is positive. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted from October 21, 2014, to December 6, 2019, patients undergoing IC at VHA facilities were screened for eligibility and randomized to IC alone or IC plus BWAW. Blinded interviewers administered questionnaires before the intervention, immediately after completion of the intervention at month 4, and at month 8. Eligibility criteria were individuals 18 years or older who were working at least 15 hours per week in a job they had occupied for at least 6 months, were experiencing work limitations, and had current major depressive disorder or persistent depressive disorder. Exclusion criteria were individuals who could not read or speak English, had planned maternity leave, or had a history of bipolar disorder or psychosis. Data analyses were conducted from January 1, 2018, to December 6, 2019. INTERVENTIONS Integrated care is multidisciplinary depression care involving screening, clinical informatics, measurement-based care, brief behavioral interventions, and referral as needed to specialty mental health care. Be Well at Work counseling involves 8 biweekly telephone sessions and 1 telephone booster visit after 4 months. Doctoral-level psychologists helped patients to identify barriers to functioning and to adopt new work-focused cognitive-behavioral and work-modification strategies. MAIN OUTCOMES AND MEASURES The primary outcome was the adjusted mean group difference in changes from before to after intervention (hereafter, adjusted effect) in the percentage of at-work productivity loss, measured with the Work Limitations Questionnaire (range, 0%-25%). The secondary outcome was adjusted effect in the Patient Health Questionnaire 9-item symptom severity score (range, 0-27, with 0 indicating no symptoms and 27, severe symptoms). RESULTS Of 670 veterans referred for participation, 287 veterans (42.8%) consented and completed eligibility screening, and 253 veterans (37.8%) were randomized. Among these 253 patients (mean [SD] age, 45.7 [11.6] years; 218 [86.2%] men; 135 [53.4%] white), 114 (45.1%) were randomized to IC and 139 (54.9%) were randomized to IC plus BWAW. At the 4-month follow-up, patients who received IC plus BWAW had greater reductions in at-work productivity loss (adjusted effect, -1.7; 95% CI, -3.1 to -0.4; P = .01) and depression symptom severity (adjusted effect, -2.1; 95% CI, -3.5 to -0.7; P = .003). The improvements from IC plus BWAW persisted 4 months after intervention (at-work productivity loss mean difference, -0.5; 95% CI, -1.9 to 0.9; P = .46; depression symptom severity mean difference, 0.6; 95% CI -0.9 to 2.1; P = .44). The cost per patient participating in BWAW was $690.98, and the return on investment was 160%. CONCLUSIONS AND RELEVANCE These findings suggest that adding this work-focused intervention to IC improves veterans' occupational and psychiatric outcomes, reducing obstacles to having a productive civilian life. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02111811.
Collapse
Affiliation(s)
- Debra Lerner
- Program on Health, Work and Productivity, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts University School of Medicine and Tufts Graduate School of Biomedical Sciences, Boston, Massachusetts
- Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts
| | - David A. Adler
- Program on Health, Work and Productivity, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts University School of Medicine and Tufts Graduate School of Biomedical Sciences, Boston, Massachusetts
- Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts
| | - William H. Rogers
- Program on Health, Work and Productivity, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts University School of Medicine and Tufts Graduate School of Biomedical Sciences, Boston, Massachusetts
| | - Erin Ingram
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - David W. Oslin
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
7
|
Shepherd-Banigan M, Sperber N, McKenna K, Pogoda TK, Van Houtven CH. Leveraging institutional support for family caregivers to meet the health and vocational needs of persons with disabilities. Nurs Outlook 2019; 68:184-193. [PMID: 31570147 DOI: 10.1016/j.outlook.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/09/2019] [Accepted: 08/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Family caregivers might enhance veteran engagement in health and nonhealth services (i.e., vocational/educational assistance). PURPOSE To describe how veterans with disabilities perceive their recovery needs, identify types of social support from caregivers that help veterans engage in Veterans Affairs (VA) health and nonhealth services, and explore participant views of VA institutional support for caregivers to help veterans engage in these services. METHODS Joint in-depth qualitative interviews with U.S. veterans and family caregivers (n = 26). FINDINGS Caregivers performed social support functions that helped veterans engage in health and vocational/educational services and institutional support from VA enhanced caregivers' capacity. DISCUSSION Caregivers are well positioned to align health and nonhealth services with patient needs to enhance recovery. Staffing a point person for caregivers within the health system is key to help families develop a coordinated plan of treatment and services to improve patient success across health and nonhealth domains. Nurses are well suited to perform this role.
Collapse
Affiliation(s)
- Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC.
| | - Nina Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Kevin McKenna
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Duke-Margolis Center for Health Policy, Duke University, Durham, NC
| |
Collapse
|
8
|
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] [MESH Headings] [Grants] [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).
Collapse
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
| |
Collapse
|
9
|
Duan-Porter W, Martinson BC, Greer N, Taylor BC, Ullman K, McKenzie L, Rosebush C, MacDonald R, Falde S, Wilt TJ. Evidence Review-Social Determinants of Health for Veterans. J Gen Intern Med 2018; 33:1785-1795. [PMID: 30030735 PMCID: PMC6153229 DOI: 10.1007/s11606-018-4566-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/07/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Veterans Health Administration (VHA) is committed to providing high-quality care and addressing health disparities for vulnerable Veterans. To meet these goals, VA policymakers need guidance on how to address social determinants in operations planning and day-to-day clinical care for Veterans. METHOD MEDLINE (OVID), CINAHL, PsycINFO, and Sociological Abstracts were searched from inception to January 2017. Additional articles were suggested by peer reviewers and/or found through search of work associated with US and VA cohorts. Eligible articles compared Veterans vs non-Veterans, and/or Veterans engaged with those not engaged in VA healthcare. Our evidence maps summarized study characteristics, social determinant(s) addressed, and whether health behaviors, health services utilization, and/or health outcomes were examined. Qualitative syntheses and quality assessment were performed for articles on rurality, trauma exposure, and sexual orientation. RESULTS We screened 7242 citations and found 131 eligible articles-99 compared Veterans vs non-Veterans, and 40 included engaged vs non-engaged Veterans. Most articles were cross-sectional and addressed socioeconomic factors (e.g., education and income). Fewer articles addressed rurality (N = 20), trauma exposure (N = 17), or sexual orientation (N = 2); none examined gender identity. We found no differences in rural residence between Veterans and non-Veterans, nor between engaged and non-engaged Veterans (moderate strength evidence). There was insufficient evidence for role of rurality in health behaviors, health services utilization, or health outcomes. Trauma exposures, including from events preceding military service, were more prevalent for Veterans vs non-Veterans and for engaged vs non-engaged Veterans (low-strength evidence); exposures were associated with smoking (low-strength evidence). DISCUSSION Little published literature exists on some emerging social determinants. We found no differences in rural residence between our groups of interest, but trauma exposure was higher in Veterans (vs non-Veterans) and engaged (vs non-engaged). We recommend consistent measures for social determinants, clear conceptual frameworks, and analytic strategies that account for the complex relationships between social determinants and health.
Collapse
Affiliation(s)
- Wei Duan-Porter
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA.
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA.
| | - Brian C Martinson
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
- HealthPartners Institute, Bloomington, MN, USA
- School of Public Health, University of Minnesota, Twin Cities Campus, Minneapolis, MN, USA
| | - Nancy Greer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA
- School of Public Health, University of Minnesota, Twin Cities Campus, Minneapolis, MN, USA
| | - Kristen Ullman
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Lauren McKenzie
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Christina Rosebush
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Samuel Falde
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA
| |
Collapse
|
10
|
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.
Collapse
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
| | | |
Collapse
|
11
|
Zivin K, Yosef M, Levine DS, Abraham KM, Miller EM, Henry J, Nelson CB, Pfeiffer PN, Sripada RK, Harrod M, Valenstein M. Employment status, employment functioning, and barriers to employment among VA primary care patients. J Affect Disord 2016; 193:194-202. [PMID: 26773911 DOI: 10.1016/j.jad.2015.12.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/18/2015] [Accepted: 12/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior research found lower employment rates among working-aged patients who use the VA than among non-Veterans or Veterans who do not use the VA, with the lowest reported employment rates among VA patients with mental disorders. This study assessed employment status, employment functioning, and barriers to employment among VA patients treated in primary care settings, and examined how depression and anxiety were associated with these outcomes. METHODS The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical Center. Bivariate and multivariable analyses were conducted examining associations between socio-demographic and clinical predictors of six employment domains, including: employment status, job search self-efficacy, work performance, concerns about job loss among employed Veterans, and employment barriers and likelihood of job seeking among not employed Veterans. RESULTS 54% of respondents were employed, 36% were not employed, and 10% were economically inactive. In adjusted analyses, participants with depression or anxiety (43%) were less likely to be employed, had lower job search self-efficacy, had lower levels of work performance, and reported more employment barriers. Depression and anxiety were not associated with perceived likelihood of job loss among employed or likelihood of job seeking among not employed. LIMITATIONS Single VA primary care clinic; cross-sectional study. DISCUSSION Employment rates are low among working-aged VA primary care patients, particularly those with mental health conditions. Offering primary care interventions to patients that address mental health issues, job search self-efficacy, and work performance may be important in improving health, work, and economic outcomes.
Collapse
Affiliation(s)
- Kara Zivin
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
| | - Matheos Yosef
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Debra S Levine
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
| | - Kristen M Abraham
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA; Department of Psychology, University of Detroit Mercy, USA
| | - Erin M Miller
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Henry
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - C Beau Nelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Mental Health Service, VA Ann Arbor Healthcare System, USA
| | - Paul N Pfeiffer
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rebecca K Sripada
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
| | - Molly Harrod
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Marcia Valenstein
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
12
|
Abstract
BACKGROUND The unemployment rate is currently higher among women Veterans than among male Veterans and civilian women. Employment is a key social determinant of health, with unemployment being strongly associated with adverse health. OBJECTIVE To identify military-related and health-related characteristics associated with unemployment in women Veterans. RESEARCH DESIGN AND SUBJECTS Secondary analysis of workforce participants (n=1605) in the National Survey of Women Veterans telephone survey. MEASURES Demographics, mental health conditions, health care utilization, and military experiences and effects. Unemployment was defined as being in the labor force but unemployed and looking for work. ANALYSIS The χ analyses to identify characteristics of unemployed women Veterans; logistic regression to identify independent factors associated with unemployment. RESULTS Ten percent of women Veterans were unemployed. Independent correlates of unemployment were screening positive for depression [odds ratio (OR)=4.7; 95% confidence interval [CI], 1.8-12.4], military service during wartime (OR=2.9; 95%, CI 1.1-7.3), and service in the regular military (vs. in the National Guards/Reserves only) (OR=6.8; 95% CI, 2.2-20.5). Two postactive duty perceptions related to not being respected and understood as a Veteran were each independently associated with unemployment. CONCLUSIONS Whether depression underlies unemployment, is exacerbated by unemployment, or both, it is critical to identify and treat depression among women Veterans, and also to investigate women Veterans' experiences and identities in civilian life. Community-based employers may need education regarding women Veterans' unique histories and strengths. Women who served in the regular military and during wartime may benefit from job assistance before and after they leave the military. Gender-specific adaptation of employment services may be warranted.
Collapse
|
13
|
Cook JA, Burke-Miller JK. Reasons for job separations in a cohort of workers with psychiatric disabilities. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2015; 52:371-384. [PMID: 26348698 DOI: 10.1682/jrrd.2014.10.0260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 02/25/2015] [Indexed: 06/05/2023]
Abstract
We explored the relative effects of adverse working conditions, job satisfaction, wages, worker characteristics, and local labor markets in explaining voluntary job separations (quits) among employed workers with psychiatric disabilities. Data come from the Employment Intervention Demonstration Program in which 2,086 jobs were ended by 892 workers during a 24 mo observation period. Stepped multivariable logistic regression analysis examined the effect of variables on the likelihood of quitting. Over half (59%) of all job separations were voluntary while 41% were involuntary, including firings (17%), temporary job endings (14%), and layoffs (10%). In multivariable analysis, workers were more likely to quit positions at which they were employed for 20 h/wk or less, those with which they were dissatisfied, low-wage jobs, non-temporary positions, and jobs in the structural (construction) occupations. Voluntary separation was less likely for older workers, members of racial and ethnic minority groups, and those residing in regions with lower unemployment rates. Patterns of job separations for workers with psychiatric disabilities mirrored some findings regarding job leaving in the general labor force but contradicted others. Job separation antecedents reflect the concentration of jobs for workers with psychiatric disabilities in the secondary labor market, characterized by low-salaried, temporary, and part-time employment.
Collapse
|