Article Details

Research Database: Article Details

Citation:  Davis L. L., Leon A. C., Toscano R., Drebing C. E., Ward L. C., Parker P. E., Kashner T. M., & Drake R. E. (2012). A randomized controlled trial of supported employment among veterans with post-traumatic stress disorder. Psychiatric Services in Advance, 63 (5), 464-470.
Title:  A randomized controlled trial of supported employment among veterans with post-traumatic stress disorder
Authors:  Davis L. L., Leon A. C., Toscano R., Drebing C. E., Ward L. C., Parker P. E., Kashner T. M., & Drake R. E.
Year:  2012
Journal/Publication:  Psychiatric Services in Advance
Publisher:  American Psychiatric Association
DOI:  https://doi.org/10.1176/appi.ps.201100340
Full text:  https://www.ncbi.nlm.nih.gov/pubmed/22307881   
Peer-reviewed?  Yes
NIDILRR-funded?  No
Research design:  Randomized controlled trial

Structured abstract:

Background:  Post traumatic stress disorder (PTSD) is a potentially disabling mental illness that can cause occupational dysfunction. 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.
Purpose:  This study is the first to examine the outcome of evidence-based supported employment for veterans with PTSD. Study addressed this gap in the field of rehabilitation research.
Setting:  The setting for the study was the Tuscaloosa Veterans Administration Medical Center.
Study sample:  Veterans were eligible for the study if they had a diagnosis of PTSD, wee aged 19-60, were eligible for the VAMC Vocational Rehabilitation Program, were currently unemployed, were interested in competitive employment, and were planning to remain in a 100 mile radius of the Tuscaloosa VAMC for the 12-month duration.
Intervention:  Unemployed veterans with PTSD were randomly assigned to either individual placement and support (IPS) supported employment (N = 42) or a Veterans Health Administration Vocational Rehabilitation Program (VRP) treatment as usual (N = 43). Employment rates and occupational outcomes were followed for 12 months. IPS intervention involved several important features. For example, 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 employment, had a caseload of no more than 25 clients, and provided continuous time unlimited follow along supports for vocational services.
Control or comparison condition:  The VRP followed the standard care in place at the VMC, which included one or more of these components: routine prevocational testing and evaluation for all patients on referral to VRP, vocational rehabilitation therapy and provided a work regimen with monetary incentives, and a transitional work program that included a temporary work experience.
Data collection and analysis:  Using intent to treat analyses and two tailed tests with significance set at p less than or equal to .05, researchers compared rates of competitive employment, as well as number of weeks , day and hours worked; gross wages earned from all sources; and gross wages earned from competitive jobs.
Findings:  During the 12-month study, 76% of the IPS participants gained competitive employment, compared with 28% of the VRP participants (number needed to treat = 2.07; ?(2) = 19.84, df = 1, p<.001). Veterans assigned to IPS also worked substantially more weeks than those assigned to VRP (42% versus 16% of the eligible weeks, respectively; Mann-Whitney z test p<.001) and earned higher 12-month income (mean ± SD income of $9,264 ± $13,294 for IPS versus $2,601 ± $6,009 for VRP; Mann-Whitney z test p<.001) during the 12-month period.
Conclusions:  Veterans with PTSD who received IPS were 2.7 times more likely to gain competitive employment than those who received VRP. Because work is central to recovery, these results should assist stakeholders in planning improved services for veterans with PTSD.

Disabilities served:  Bi-polar
Depression
Post-traumatic stress disorder (PTSD)
Populations served:  Gender: Female and Male
Race: American Indian or Alaska Native
Race: Black / African American
Race: White / Caucasian
Veterans
Interventions:  Individual Placement and Support (IPS) model of supported employment
Outcomes:  Employment acquisition