Original research| Volume 99, ISSUE 2, SUPPLEMENT , S4-S13.e1, February 2018

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Supported Employment for Veterans With Traumatic Brain Injury: Patient Perspectives

  • Kathleen F. Carlson
    Corresponding author Kathleen F. Carlson, PhD, HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), 3710 SW US Veterans Hospital Rd, Portland, OR 97239.
    Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, OR

    National Center for Rehabilitative Auditory Research, Veterans Affairs, Portland Health Care System, Portland, OR

    OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR
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  • 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
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  • Tess A. Gilbert
    Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, OR
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  • Sandra G. Resnick
    New England Mental Illness, Research and Clinical Center, VA Connecticut Healthcare System, West Haven, CT

    Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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  • Elizabeth W. Twamley
    Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA

    Departments of Medicine and Psychiatry, University of Minnesota, Minneapolis, MN
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  • Maya E. O'Neil
    Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, OR

    Department of Psychiatry and Department of Medical Informatics & Clinical Epidemiology, Oregon Health and Science University, Portland, OR
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  • Nina A. Sayer
    Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN

    Department of Medicine and Psychiatry, University of Minnesota, Minneapolis, MN
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Published:August 03, 2017DOI:



      To quantify the need for, and interest in, supported employment (SE) among recent military veterans with traumatic brain injury (TBI); and to examine characteristics associated with veterans' interest in SE.


      Stratified random sample of Iraq and Afghanistan War veterans confirmed to have TBI through the Veterans Health Administration (VHA) screening and evaluation system.


      Community-based via mailed survey.


      We recruited 1800 veterans with clinician-confirmed TBI (mild TBI: n=1080; moderate/severe TBI: n=720) through multiple mailings. Among 1451 surveys that were not returned undeliverable, N=616 (42%) responded.


      Not applicable.

      Main Outcome Measures

      Veterans rated their interest in SE after reading a script describing the program. Additional measures assessed mental health and pain-related comorbidities, employment, financial/housing difficulties, demographics, and military service characteristics. Estimates were weighted to represent the population of veterans with VHA clinician-confirmed TBI.


      Unemployment was reported by 45% (95% confidence interval [CI], 43–47) of veterans with TBI. Although 42% (95% CI, 40–44) reported they would be interested in using SE if it were offered to them, only 12% had heard of SE (95% CI, 11–14) and <1% had used it. TBI severity and comorbidities were not associated with veterans' interest in SE. However, those who were unemployed, looking for work, experiencing financial strain, or at risk for homelessness were more likely to be interested in SE.


      Our research highlights an important gap between veterans' vocational needs and interests and their use of SE. Systematically identifying and referring those with employment and financial/housing difficulties may help close this gap.


      List of abbreviations:

      CI (confidence interval), OEF/OIF/OND (Operations Enduring Freedom, Iraqi Freedom, and New Dawn), OR (odds ratio), PTSD (posttraumatic stress disorder), SE (supported employment), TBI (traumatic brain injury), VA (Department of Veterans Affairs), VHA (Veterans Health Administration)
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