Late Breaking Research Poster 2280874| Volume 104, ISSUE 3, e9-e10, March 2023

Achieving Competitive, Customized Employment through Specialized Services for Veterans with Spinal Cord Injuries (SCI)

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      Research Objectives

      To determine whether a Customized Employment (CE) model adapted for SCI rehabilitation (ACCESS-Vets) is more effective than standard care (IPS) for helping Veterans with Spinal Cord Injury obtain and maintain employment. Previously, Individual Placement and Support Supported Employment is the only vocational intervention that has been rigorously studied and shown to be effective with Veterans with spinal cord injury.


      4-year, 2-site randomized clinical trial, concurrent mixed methods.


      VA Medical Centers, Tampa and Richmond.


      100 Veterans with SCI ages 18-65, who desire employment and live near the VAMC will be randomly assigned using a priori generated matrix and complete surveys at baseline, 6, 9, and 12 months. A sub-sample of 30 Veterans and 20 providers will complete qualitative interviews.


      CE using the following elements: Discovery, job planning, development, negotiation, accommodations and retention supports. Control group: IPS using evidence-based supported employment. Assignment is unblinded. The primary adaptation will be integrating CE into medical rehabilitation.

      Main Outcome Measures

      Competitive integrated employment as defined by the Work Innovation and Opportunity Act7. Secondary outcomes: employment indicators, quality of life (QOL) and participation.


      168 medical records reviewed for basic inclusion/exclusion criteria, 26 Veterans screened, 11 met inclusion criteria and were enrolled. Of the 11 participants enrolled 7 completed baseline surveys and were randomized to treatment arms (intervention n=3; control n=4).


      The proportion of Veterans who attain employment will be greater for the ACCESS-Vets than IPS group and they will have higher job satisfaction, wages and retention. Employed Veterans will demonstrate significant improvements in self-sufficiency, QOL, and participation. Interview data will show how strategies used in the adapted intervention and standard care address barriers to employment and impact outcomes.

      Author(s) Disclosures

      The authors declare that they have no conflict of interest.Funding and disclaimer: VA Office of Research and Development, VA Rehabilitation Research and Development (RR&D) #D3349R. Contents of this poster do not represent the views of the Department of Veterans Affairs or the United States Government. Clinical trial # NCT04832802

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