Employment Program Positive for Veterans with PTSD
Mental Health Weekly February 6, 2012
Bottom Line…Citing evidence from a new study examining evidence-based supported employment for veterans with PTSD, study authors suggest CMH providers consider an employment specialist as part of its treatment team to promote recovery for consumers with PTSD.
Veterans suffering from posttraumatic stress disorder (PTSD) who participated in an evidence based supported employment program were nearly three times more likely to gain competitive employment than participants in a more traditional vocational rehabilitation program, according to a new study release last week.
The study, “A Randomized Controlled Trial of Supported Employment Among Veterans With Posttraumatic Stress Disorder,” is the first study to examine the Individual Placement Support (IPS) program in a population with PTSD. The study was released Feb. 2 in Psychiatric Services in Advance as part of the journals’ new online ahead-of-print initiative. The print version will be published in Psychiatric Services in May.
Although vocational rehabilitation is often prescribed for patients with PTSD, standard vocational services are far from adequate in helping them obtain and maintain competitive employment, according to the study. Unemployment rates for civilians with PTSD and veterans with PTSD are much higher than the rates for the civilian and veteran general population, according to the study.
Study details
From 2006 to 2010, veterans with PTSD at the Tuscaloosa Veterans Administration Medical Center were enrolled in a 12-month, prospective randomized comparison of Individual Placement Support (IPS) and the Veterans Health Administration Vocational Rehabilitation Program (VRP). The study involved 85 participants who were randomly assigned to either IPS (42) or VRP (43).
The (IPS) supported employment is an evidence-based vocational rehabilitation model that has been shown to improve occupational and rehabilitation outcomes for people with severe and persistent mental illness, but few participants with a primary diagnosis of PTSD have been
included in previous studies, according to the study authors.
IPS places people in real-life competitive jobs – not in sheltered or “set-aside” or low-skilled jobs, noted the study. IPS personnel work closely with the VA PTSD treatment team. IPS is a person-centered approach that comprehensively addresses individual vocational needs to support recovery and improved quality of life. Competitive employment rather than sheltered employment has previously been shown to enhance recovery outcomes such as self-esteem, the study indicated.
IPS, VRP interventions
The IPS intervention involved several important features, the study noted. Eligibility was based on the participant’s choice and interest in competitive work. The IPS specialist was integrated into the clinical mental health or PTSD treatment team, carried out all phases of the vocational services, provided predominantly community-based services, provided assertive engagement and outreach in community-based employment.
The IPS specialist also had a caseload of no more than 25 clients, and provided continuous, time-unlimited, follow-along supports for vocational services. Veterans in the IPS program tended to work in administrative, retail or security positions or as skilled laborers and electricians, said Davis.
These were part-time or full-time positions, she said. The secondary outcome from the IPS intervention was a higher income and a longer work week, Davis added.
The VRP model featured a VRP specialist in the intervention who provided some community-based services, provided time-limited job search assistance to help the client obtain competitive employment, and had no maximum caseload. VRP involved short-term work experiences, such as work in the VA Medical Center environmental management services, food services, delivery services, or community jobs in food or other service delivery environments) that were not necessarily individualized to the patient’s long-term needs.
Results
Previously about 13 or 14 randomized controlled studies had been conducted for patients with schizophrenia and bipolar disorder, revealing positive outcomes, said Lori Davis, M.D., associate chief of staff for research at the Tuscaloosa VA Medicaid Center in Alabama and lead author. The findings in the current study are consistent with those of previous studies of IPS in other populations, she said.
“The goal of the study was to see which model of vocational rehabilitation worked best to get unemployed veterans with PTSD back to work, with the hypothesis that IPS employment would be much better than what the VA has been using historically,” Davis told MHW. “We hypothesized that participants assigned to IPS would have a higher competitive employment rate than their counterparts assigned to VRP.”
During the 12-month study, 76 percent of the IPS participants gained competitive employment, compared with 28 percent of the VRP participants. Veterans assigned to IPS also worked substantially more weeks than those assigned to VRP (42 percent versus 16 percent of the eligible weeks, respectively) and earned more during the 12-month period. That is, veterans with PTSD who participated in IPS were 2.7 times more likely to gain competitive employment, said study authors.
Community providers could include the IPS model in their programs and include an employment specialist as part of its treatment team of social workers, nurses, doctors and counselors, she said. “An employment specialist, key to the recovery [process], can be part of a multidisciplinary team,” said Davis.
The model, already proven to work in populations with schizophrenia and bipolar disorder, can work for general populations with PTSD, she said. Many providers also work with veterans who do not have immediate access to a VA center, Davis said.
“It’s all about recovery and community engagement,” she said. “This is the direction of the future.”
The authors anticipate that these results will assist stakeholders in planning improved services for veterans with PTSD, said Davis. “Social Security administrators and other agency administrators should be very interested in [the IPS model] and in trying to help patients with PTSD fully recover,” she said.
Researchers are planning another study involving these interventions with the VA, this time in multisite settings, she said. The upcoming study will be conducted in various VA settings that are more geographically diverse in urban and rural locations, Davis said. •