Abstract
Objective
To identify any pilot and nonpilot site differences regarding current (1) provision
of supported employment (SE) to veterans with traumatic brain injury (TBI); (2) staffing
and communication between the SE and polytrauma/TBI teams; and (3) provider perceptions
on facilitators and barriers to providing, and suggestions for improving, SE.
Design
Mixed methods cross-sectional survey study.
Setting
Veterans Health Administration SE programs.
Participants
Respondents (N=144) included 54 SE supervisors and 90 vocational rehabilitation specialists.
Interventions
Not applicable.
Main Outcome Measures
Web-based surveys of forced-choice and open-ended items included questions on SE team
characteristics, communication with polytrauma/TBI teams, and experiences with providing
SE to veterans with TBI history.
Results
SE was provided to veterans with TBI at 100% of pilot and 59.2% of nonpilot sites
(P=.09). However, vocational rehabilitation specialists at pilot sites reported that
communication with the polytrauma/TBI team about SE referrals was more frequent than
at nonpilot sites (P=.003). In open-ended items, suggestions for improving SE were similar across pilot
and nonpilot sites, and included increasing staffing for vocational rehabilitation
specialists and case management, enhancing communication and education between SE
and polytrauma/TBI teams, and expanding the scope of the SE program so that eligibility
is based on employment support need, rather than diagnosis.
Conclusions
These findings may contribute to an evidence base that informs SE research and clinical
directions on service provision, resource allocation, team integration efforts, and
outreach to veterans with TBI who have employment support needs.
Keywords
List of abbreviations:
CWT (Compensated Work Therapy), IPS (individual placement and support), SE (supported employment), SMI (severe mental illness), TBI (traumatic brain injury), VA (Department of Veterans Affairs), VHA (Veterans Health Administration)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Analysis of VA Health Care Utilization among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans.(Available at:)http://www.publichealth.va.gov/docs/epidemiology/healthcare-utilization-report-fy2015-qtr2.pdf(Accessed May 1, 2017)Date: 2015
- Anticipating the traumatic brain injury-related health care needs of women veterans after the Department of Defense change in combat assignment policy.Womens Health Issues. 2014; 24: e171-e176
- Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury.Disabil Rehabil. 2017; : 1-7
- Provider perspectives on rehabilitation of patients with polytrauma.Arch Phys Med Rehabil. 2008; 89: 171-178
- Qualitative analysis of barriers to implementation of supported employment in the Department of Veterans Affairs.Psychiatr Serv. 2011; 62: 1289-1295
- Rehabilitation needs of combat-injured service members admitted to the VA Polytrauma Rehabilitation Centers: the role of PM&R in the care of wounded warriors.PM R. 2009; 1: 23-28
- Veterans with history of mild traumatic brain injury and posttraumatic stress disorder: challenges from provider perspective.J Rehabil Res Dev. 2009; 46: 703-716
- A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project.Implement Sci. 2015; 10: 21
- Individual placement and support: an evidence-based approach to supported employment.Oxford Univ Press, New York, NY2012
- Dissemination of supported employment in Department of Veterans Affairs.J Rehabil Res Dev. 2007; 44: 867-877
- Supported employment: a decade of rapid growth and impact.in: Weham P. Revell W.G. West M. Supported employment research: expanding competitive employment opportunities for persons with significant disabilities. VCU Rehabilitation Research and Training Center on Supported Employment, Richmond, VA1997
- Supported employment: an alternative model for vocational rehabilitation of persons with severe neurologic, psychiatric, or physical disability.Arch Phys Med Rehabil. 1991; 72: 101-105
- Making the case for IPS supported employment.Adm Policy Ment Health. 2014; 41: 69-73
- Associations between traumatic brain injury, suspected psychiatric conditions, and unemployment in Operation Enduring Freedom/Operation Iraqi Freedom veterans.J Head Trauma Rehabil. 2016; 31: 191-203
- Supported employment for veterans with traumatic brain injury: patient perspectives.Arch Phys Med Rehabil. 2018; 99: S4-S13
- Traumatic brain injury-related emergency department visits, hospitalizations, and deaths – United States, 2007 and 2013.MMWR Surveill Summ. 2017; 66: 1-16
- DoD numbers for traumatic brain injury.(Available at:) (Accessed October 19, 2016)
- Traumatic brain injury, posttraumatic stress disorder, and pain diagnoses in OIF/OEF/OND veterans.J Rehabil Res Dev. 2013; 50: 1169-1176
- The report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem.Centers for Disease Control and Prevention, Atlanta2003
- DoD worldwide numbers for TBI.2017 (Available at:) (Accessed April 17, 2017)
- Effect of supported employment on the vocational outcomes of persons with traumatic brain injury.J Appl Behav Anal. 1989; 22: 395-405
- Return to work for patients with traumatic brain injury. Analysis of costs.Am J Phys Med Rehabil. 1994; 73: 280-282
- Summary report: evidence for the effectiveness of rehabilitation for persons with traumatic brain injury.J Head Trauma Rehabil. 1999; 14: 176-188
- Neuropsychological assessment and employment outcome after traumatic brain injury: a review.Clin Neuropsychol. 2002; 16: 157-178
- Supported employment for persons with traumatic brain injury: a preliminary investigation of long-term follow-up costs and program efficiency.Arch Phys Med Rehabil. 2003; 84: 192-196
- Veterans health administration vocational services for Operation Iraqi Freedom/Operation Enduring Freedom veterans with mental health conditions.J Rehabil Res Dev. 2013; 50: 663-670
- Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for veterans with traumatic brain injury: pilot randomized controlled trial.J Rehabil Res Dev. 2014; 51: 59-70
- Enhanced vocational rehabilitation for veterans with mild traumatic brain injury and mental illness: pilot study.J Rehabil Res Dev. 2016; 53: 307-320
- Return to work following traumatic brain injury: trends and challenges.Disabil Rehabil. 2007; 29: 1387-1395
- Return to work for persons with traumatic brain injury.Am J Phys Med Rehabil. 2001; 80: 852-864
- Predictors of employment outcomes in veterans with traumatic brain injury: A VA Traumatic Brain Injury Model Systems Study.J Head Trauma Rehabil. 2017; 32: 271-282
- Workers' risk of unemployment after traumatic brain injury: a normed comparison.J Int Neuropsychol Soc. 2005; 11: 747-752
- Acute predictors of return to employment after traumatic brain injury: a longitudinal follow-up.Arch Phys Med Rehabil. 2002; 83: 635-641
- Investigation of factors related to employment outcome following traumatic brain injury: a critical review and conceptual model.Disabil Rehabil. 2004; 26: 765-783
- Factors contributing to outcome following traumatic brain injury.Neurorehabilitation. 2013; 32: 803-815
- Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.J Rehabil Med. 2004; : 84-105
- Outcome from mild traumatic brain injury.Curr Opin Psychiatry. 2005; 18: 301-317
- Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study.JAMA. 2003; 290: 2556-2563
- Two decades of advances in understanding of mild traumatic brain injury.J Head Trauma Rehabil. 2005; 20: 5-18
- Psychometric Assessment of the Neurobehavioral Symptom Inventory-22: the structure of persistent postconcussive symptoms following deployment-related mild traumatic brain injury among veterans.J Head Trauma Rehabil. 2012; 27: 55-62
- Screening for traumatic brain injury in troops returning from deployment in Afghanistan and Iraq: initial investigation of the usefulness of a short screening tool for traumatic brain injury.J Head Trauma Rehabil. 2007; 22: 377-389
- Prevalence, assessment, and treatment of mild traumatic brain injury and posttraumatic stress disorder: a systematic review of the evidence.J Head Trauma Rehabil. 2011; 26: 103-115
- Exploring the convergence of posttraumatic stress disorder and mild traumatic brain injury.Am J Psychiatry. 2009; 166: 768-776
- Neuropsychiatric diagnosis and management of chronic sequelae of war-related mild to moderate traumatic brain injury.J Rehabil Res Dev. 2009; 46: 757-796
- Assessment and diagnosis of mild traumatic brain injury, posttraumatic stress disorder, and other polytrauma conditions: burden of adversity hypothesis.Rehabil Psychol. 2009; 54: 239-246
- “To care for him who shall have borne the battle and for his widow and his orphan” (Abraham Lincoln): the Department of Veterans Affairs Polytrauma System of Care.Arch Phys Med Rehabil. 2008; 89: 160-162
- The interdisciplinary team and polytrauma rehabilitation: prescription for partnership.Arch Phys Med Rehabil. 2008; 89: 179-181
- Program development and defining characteristics of returning military in a VA Polytrauma Network Site.J Rehabil Res Dev. 2007; 44: 1027
- Mail and internet surveys: the tailored design method. Vol 2. Wiley, New York2000
- Qualitative data analysis: an expanded sourcebook.Sage, Thousand Oaks, CA1994
- Supporting the education goals of post-9/11 veterans with self-reported PTSD symptoms: a needs assessment.Psychiatr Rehabil J. 2012; 35: 209-217
- Supported education for returning veterans with PTSD and other mental disorders.J Rehabil. 2012; 78: 4
- Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF/OEF veterans: polytrauma clinical triad.J Rehabil Res Dev. 2009; 46: 697-702
- Critical strategies for implementing supported employment.J Vocat Rehabil. 2007; 27: 13-20
- Validation of the Revised Individual Placement and Support Fidelity Scale (IPS-25).Psychiatr Serv. 2012; 63: 758-763
- A randomized controlled trial of supported employment among veterans with posttraumatic stress disorder.Psychiatr Serv. 2012; 63: 464-470
- Effectiveness of supported employment for veterans with spinal cord injuries: results from a randomized multisite study.Arch Phys Med Rehabil. 2012; 93: 740-747
Article info
Publication history
Published online: August 04, 2017
Footnotes
Presented to the 2015 Annual Research Meeting of AcademyHealth, June 15, 2015, Minneapolis, MN; National Meeting of VA Health Services Research and Development Service, July 9, 2015, Philadelphia, PA; 2015 VA Office of Research & Development TBI State-of-the-Art Conference, August 24, 2015, Washington, DC; and the 2016 Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Summit, September 13, 2016, Falls Church, VA.
Supported by the VA Health Services Research & Development Center for Healthcare Organization and Implementation Research.
The views expressed in this article are the authors' and do not necessarily represent the views of the Department of Veterans Affairs or the U.S. Government.
Publication of this article was supported by the American Congress of Rehabilitation Medicine.
Disclosures: None.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
