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Supported Employment for Veterans With Traumatic Brain Injury: Provider Perspectives

  • Terri K. Pogoda
    Correspondence
    Corresponding author Terri K. Pogoda, PhD, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Building 9, Office 218, 150 S Huntington Ave (152M), Boston, MA 02130.
    Affiliations
    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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  • Kathleen F. Carlson
    Affiliations
    Center to Improve Veteran Involvement in Care and National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR

    Oregon Health and Science University-Portland State University School of Public Health, Portland, OR
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  • Katelyn E. Gormley
    Affiliations
    Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
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  • Sandra G. Resnick
    Affiliations
    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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Published:August 04, 2017DOI:https://doi.org/10.1016/j.apmr.2017.06.029

      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)
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