Authors: Elizabeth W. Twamley, Ph.D.; Dewleen G. Baker, M.D.; Sonya B. Norman, Ph.D.; James O.E. Pittman, M.S.W.; James B. Lohr, M.D.; Sandra G. Resnick, Ph.D.
Abstract
“High rates of mental health conditions and unemployment are significant problems facing Veterans of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF). We examined two national Veterans Health Administration (VHA) databases from fiscal years 2008-2009: a larger database (n = 75,607) of OIF/OEF Veterans with posttraumatic stress disorder, depression, substance use disorder, or traumatic brain injury (TBI) and a smaller subset (n = 1,010) of those Veterans whose employment, was tracked during their participation in VHA vocational services. Only 8.4% of Veterans in the larger database accessed any vocational services and retention was low, with most Veterans attending one or two appointments. Veterans with TBI and with more mental health conditions overall, were more likely to access vocational services. Only 2.2% of Veterans received evidence-based supported employment. However, supported employment was effective, with 51% of those Veterans receiving it obtaining competitive work. Effect sizes quantifying the effect of supported employment provision on competitive work attainment, number of jobs, job tenure, and retention in vocational services were large. Given the high success rate of supported employment for these IN SERVICE TO THOSE WHO HAVE SERVED 315.443.0141 vets@syr.edu vets.syr.edu IVMFSyracuseU Veterans, additional supported employment specialists for this population, would be expected to improve work outcomes for post-9/11 Veterans who want assistance returning to work.”
Implications
For Practice
Given the benefit of supported employment and vocational programs, unemployed veterans with mental health conditions who want to return to the workforce should participate in the Department of Veterans Affairs’ (VA) supported employment and vocational programs. To maximize the benefit of supported employment and vocational programs, veterans should attend multiple sessions. Veterans with mental health conditions who are seeking employment should discuss best supports for them with a supported employment specialist or vocational rehabilitation counselor. Providers serving veterans with mental health conditions might find it beneficial to outline an employment plan with their veterans, which can include steps to gain employment, such as utilizing supported employment services available through the VA. Since participation in the VA’s supported employment programs has been shown to improve the chances of obtaining competitive work for veterans with a mental health condition, family, friends, and coworkers should encourage veterans to participate in supported employment and vocational programs.
For Policy
The VA might consider making publicly accessible the number of OIF/OEF veterans with mental health conditions who were referred to VHA vocational services each year. Since the Compensated Work Therapy/Supported Employment (CWT/SE) program successfully connects veterans to meaningful work, the VA should continue CWT/SE in each of its Veteran Health Administration healthcare systems across the United States. The VA might continue evaluating its non-evidence-based vocational rehabilitation programs, including Transitional Work Experience (TWE) and Incentive Therapy (IT). The VA might evaluate the accessibility of its vocational programs, especially as they relate to veterans with posttraumatic stress disorder (PTSD). Given the number of veterans who would benefit from supported employment programs, the VA might consider expanding its supported employment and vocational programs. To increase the capacity of its vocational services, the VA might hire additional employment specialists. Since most veterans attended only 1 or 2 supported employment sessions, the VA might examine how to engage veterans over time. To increase awareness of supported employment and vocational rehabilitation programs and services available to veterans through the VA, the VA might distribute pamphlets and information about these resources through multiple channels, such as the Department of Defense and the Department of Labor.
For Future Research
One limitation of this study is that available data from the VA does not include the number of OIF/OEF veterans with mental health issues that were referred to VHA vocational services from 2008-2009. Further research could be conducted one the usage of VHA vocational services, particularly since 2010. Since many veterans only attended 1-2 sessions, future researchers should examine reasons why veterans with mental health conditions stopped attending the sessions so early. Researchers should consider barriers to engagement and way to improve retention. Future researchers should continue evaluating the effectiveness of supported employment and vocational services for veterans with and without mental health conditions. To further improve VA vocational programs for post-9/11 veterans, researchers should analyze the unemployment and underemployment rates of OIF/OEF veterans with mental health issues.
