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Individual Placement and Support in Spinal Cord Injury: A Longitudinal Observational Study of Employment Outcomes

Published:January 20, 2017DOI:https://doi.org/10.1016/j.apmr.2016.12.010

      Abstract

      Objective

      To determine the effects of a 24-month program of Individual Placement and Support (IPS) supported employment (SE) on employment outcomes for veterans with spinal cord injury (SCI).

      Design

      Longitudinal, observational multisite study of a single-arm, nonrandomized cohort.

      Setting

      SCI centers in the Veterans Health Administration (n=7).

      Participants

      Veterans with SCI (N=213) enrolled during an episode of either inpatient hospital care (24.4%) or outpatient care (75.6%). More than half the sample (59.2%) had a history of traumatic brain injury (TBI).

      Intervention

      IPS SE for 24 months.

      Main Outcome Measure

      Competitive employment.

      Results

      Over the 24-month period, 92 of 213 IPS participants obtained competitive jobs for an overall employment rate of 43.2%. For the subsample of participants without TBI enrolled as outpatients (n=69), 36 obtained competitive jobs for an overall employment rate of 52.2%. Overall, employed participants averaged 38.2±29.7 weeks of employment, with an average time to first employment of 348.3±220.0 days. Nearly 25% of first jobs occurred within 4 to 6 months of beginning the program. Similar employment characteristics were observed in the subsample without TBI history enrolled as outpatients.

      Conclusions

      Almost half of the veterans with SCI participating in the 24-month IPS program as part of their ongoing SCI care achieved competitive employment, consistent with their expressed preferences at the start of the study. Among a subsample of veterans without TBI history enrolled as outpatients, employment rates were >50%. Time to first employment was highly variable, but quite long in many instances. These findings support offering continued IPS services as part of ongoing SCI care to achieve positive employment outcomes.

      Keywords

      List of abbreviations:

      CE (competitive employment), IPS (Individual Placement and Support), PrOMOTE (Predictive Outcome Model Over Time for Employment), RCT (randomized controlled trial), SCI (spinal cord injury), SCI-VIP (Spinal Cord Injury Vocational Integration Program), SE (supported employment), TBI (traumatic brain injury), VHA (Veterans Health Administration), VR (vocational rehabilitation)
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