Supported Employment in Patient Aligned Care Teams
Efficacy of Supported Employment Within the OIF/OEF Patient Aligned Care Team
1 other identifier
interventional
119
1 country
1
Brief Summary
In response to the Rehabilitation Research and Development (RR\&D) Deployment Health Research, this study addresses the delivery of an evidenced-based vocational rehabilitation, specifically Individual Placement and Support (IPS), for Veterans who are facing unemployment and mental illness as they try to recovery and re-establish civilian life. This study provides the requisite evidence needed to guide the Veterans Health Administration (VHA) as to whether to expand the target population for IPS to Veterans with any mental disorder, delivered directly within the primary care setting (i.e. Patient Aligned Care Team; PACT). Such modifications in VHA practice could substantially improve Veteran vocational rehabilitation access and outcomes, moving a significantly greater number of disabled Veterans back to full and productive lives in the community.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P50-P75 for not_applicable
Started Aug 2015
Longer than P75 for not_applicable
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
March 10, 2015
CompletedFirst Posted
Study publicly available on registry
March 27, 2015
CompletedStudy Start
First participant enrolled
August 3, 2015
CompletedPrimary Completion
Last participant's last visit for primary outcome
September 30, 2019
CompletedStudy Completion
Last participant's last visit for all outcomes
September 30, 2020
CompletedResults Posted
Study results publicly available
March 30, 2021
CompletedMarch 9, 2022
February 1, 2022
4.2 years
March 10, 2015
October 14, 2020
February 15, 2022
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Steady Worker
Participants were categorized as a steady worker if they held a competitive job for 50% or more of the 12-month follow-up (i.e. 26 or more weeks out of 52 weeks).
12 months
Secondary Outcomes (7)
Weeks Worked in a Competitive Job
12 months
Time to First Competitive Job
12 months
Income Earned From Competitive Jobs
12 months
Symptom Checklist-90-Revised Change From Baseline to Month 12.
Change from baseline to month 12 (value at 12 months minus value at baseline) is shown below. Additionally, all relevant time points used in the calculation timeframe from baseline to 12 months (baseline, months 4, 6, 8, and 12) included in analysis.
Income Earned From All Sources
12 months
- +2 more secondary outcomes
Other Outcomes (1)
Community Reintegration of Service Members
12 months
Study Arms (2)
Individual Placement and Support (IPS)
EXPERIMENTALIndividual Placement and Support (IPS) is supported employment and involves the following domains: 1) competitive employment: IPS assists participants to enter into competitive jobs; 2) eligibility based on client choice, i.e. "zero exclusion"; 3) integration of IPS and treatment team, i.e. the PACT; 4) patient-centered job match for competitive employment; 5) personalized benefits counseling: IPS specialists help Veterans obtain information about their VA, Social Security, Medicaid, and other government entitlements; 6) rapid job search: IPS specialists use a rapid job search, rather than providing lengthy pre-employment assessment, training, counseling; 7) job development: IPS specialists build an employer network based on Veterans' interests; 8) time-unlimited and individualized support: follow-along IPS supports are individualized and continue for as long as needed during the 12-month study.
Treatment as Usual Vocational Rehabilitation/Transitional Work (TAU-VR)
ACTIVE COMPARATORTreatment as Usual Vocational Rehabilitation includes pre-vocational counseling, Community Based Supported Employment, or most commonly Transitional Work assignments (TW) which involves 1) time-limited set-aside work experiences: short-term transitional work experiences in a brokered or set-aside work setting; 2) no strict entrance criteria other than general medical clearance; 3) limited integration of TW and clinical Services; 4) not patient-centered: TW jobs are pre-arranged, set-aside jobs are less likely to have a meaningful relationship to the Veterans' preferences; 5) personalized benefits counseling; 6) limited job search: TW specialists provide variable and limited guidance for competitive job search; 7) no job development: TW specialists do not engage in community based job development; 8) time limited: The TW specialist does not provide long-term follow-up after the first job is obtained.
Interventions
Individual Placement and Support (IPS) is the evidenced based model of supported employment.
Vocational Rehabilitation Treatment as Usual includes pre-vocational counseling, Community Based Supported Employment, or most commonly Transitional Work assignments (TW).
Eligibility Criteria
You may qualify if:
- Age 19\* (\<19 years of age is the state of Alabama defined minor)
- Receiving primary care treatment in the Tuscaloosa VA Medical Center (TVAMC) PACT, called the Transition Center (i.e. served during the OEF/OIF/OND/other Southwest Asia conflicts) or other Primary Care PACT providing care for OEF/OIF/OND/other Southwest Asia Veteran
- Otherwise eligible for TVAMC vocational rehabilitation services, in the event that the Veteran is randomized to TW
- Currently unemployed, defined as not working in a competitive job for a wage or under-employed, defined as (defined as: working less than 20 hours per week in a job that is low wage and is not in keeping with the Veteran's ability, aptitude, or skills)
- Expression of interest in competitive employment
- Willing and able to give informed consent.
- Note: Veterans with history of mild traumatic brain injury (TBI) may be included in the study.
You may not qualify if:
- Current diagnosis of (i) schizophrenia, (ii) schizoaffective, (iii) bipolar I disorder, or major depression with psychotic features, since these Veterans may receive IPS in mental health
- Diagnosis of dementia (evidenced in the medical record)
- Clinically significant unstable or severe medical condition, or terminal illness, that would contraindicate study participation or expose them to an undue risk of a significant adverse event
- Unlikely that participant can complete the study, e.g. expected deployment, incarceration, long-term hospitalization, or relocation from the vicinity of the TVAMC during the study period
- Active suicidal or homicidal ideation making it unsafe for Veteran to be included in study
- Current participation in another interventional trial.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
Tuscaloosa VA Medical Center, Tuscaloosa, AL
Tuscaloosa, Alabama, 35404, United States
Related Publications (2)
Davis LL, Blansett CM, Mumba MN, MacVicar D, Toscano R, Pilkinton P, Gay W, Bartolucci A. The methods and baseline characteristics of a VA randomized controlled study evaluating supported employment provided in primary care patient aligned care teams. BMC Med Res Methodol. 2020 Feb 17;20(1):33. doi: 10.1186/s12874-020-0919-1.
PMID: 32066380BACKGROUNDDavis LL, Mumba MN, Toscano R, Pilkinton P, Blansett CM, McCall K, MacVicar D, Bartolucci A. A Randomized Controlled Trial Evaluating the Effectiveness of Supported Employment Integrated in Primary Care. Psychiatr Serv. 2022 Jun;73(6):620-627. doi: 10.1176/appi.ps.202000926. Epub 2021 Sep 15.
PMID: 34521208DERIVED
Related Links
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Limitations and Caveats
Limitations: single-site, veterans only, under representation of women, and the site only achieved "fair" level of implementation of IPS based on the IPS Fidelity Scale. Transitional work assignments may have weakened employment outcomes in control group; but only half of the control group held a TW assignment. Strengths: randomized approach, credible control group, 12-month follow-up, broad eligibility criteria, and novel setting (i.e. primary care setting).
Results Point of Contact
- Title
- Lori L. Davis, M.D.
- Organization
- Tuscaloosa VA Medical Center
Study Officials
- PRINCIPAL INVESTIGATOR
Lori L Davis, MD
Tuscaloosa VA Medical Center, Tuscaloosa, AL
Publication Agreements
- PI is Sponsor Employee
- Yes
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- FED
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
March 10, 2015
First Posted
March 27, 2015
Study Start
August 3, 2015
Primary Completion
September 30, 2019
Study Completion
September 30, 2020
Last Updated
March 9, 2022
Results First Posted
March 30, 2021
Record last verified: 2022-02
Data Sharing
- IPD Sharing
- Will not share
No individual participant data will be shared.