Effects of VHA Policy Directive 1163 on Acceptance and Employment Rates for Veterans with Substance Use Disorders Referred to VHA Vocational Rehabilitation

Abstract

Introduction: Research has shown that Veterans with Substance/Alcohol Use Disorders (SUDs/AUDs) are at a greater risk for employment-related issues (eg, lower labor force participation rates), and interventions such as Vocational Rehabilitation (VR) have been used as a tool to reduce employment obtainment and maintenance. The purpose of the current study was to evaluate acceptance rates and employment rates at closure for Veterans with SUDs/AUDs prior to the implementation of VHA Policy Directive 1163 (mandated that Veterans are not refused services based on prior or current SUD/AUDs). SUD/AUDs were coded to reflect DSM 5-TR criteria of active use and in-remission. Methods: Data from a VHA Vocational Rehabilitation program in the Veterans Integrated Service Network 12 network were obtained for the purpose of the current study. Results: Findings showed that Veterans with AUDs were less likely to be accepted for VR services prior and after implementation of VHA Policy Directive 1163. Conclusions: When examining active and inactive SUDs/AUDs, findings showed that implementation of VHA Policy Directive 1163 was not effective for Veterans with AUDs. One factor that was not explored but could explain disparities in program acceptance rates is duration of program entry. If a Veteran has a consult placed for VHA Vocational Rehabilitation services, and their program entry date (date accepted) is a significant duration, then perhaps Veterans with active AUDs start drinking again given that they are waiting for vocational assistance. Thus, it would be important to assist Veterans with active AUDs into services in a timely manner (perhaps prior them being discharged from SUD treatment).

Disparities in program enrollment and employment outcomes for veterans with psychiatric and co-occurring substance use disorders referred or enrolled for VHA vocational rehabilitation

“…VR is a method of assisting veterans to obtain the skills and tools needed to successfully secure and maintain competitive employment. A primary focus is on removing employment-related barriers for veterans that have difficulty obtaining or maintaining employment (18,19). VHA VR programs are expected to adhere to VHA Policy Directive 1163.02, which was released on August 19, 2019.…”

“…VHA VR programs are expected to adhere to VHA Policy Directive 1163.02, which was released on August 19, 2019. Prior research has shown that implementation of this policy did not impact program enrollment rates for veterans with SUDs, but veterans with AUDs were less likely to be enrolled prior to the implementation of VHA Policy Directive 1163 (18). This policy explicitly states the following: "no discriminatory practices are acceptable for Veterans with SUD or AUDs "regardless of duration of sobriety, routine vocational testing, or required time in a treatment program or clinical services prior to participation in VHA Vocational Rehabilitation" (p. 43 and resources needed for successful transition to competitive employment.…”

“…Despite the evidence showing how psychiatric and SUD/AUD diagnoses can impact a veteran's independent functioning and psychological well-being, the purpose of this study was to focus on the impact of having these diagnoses as they co-occur in terms of how it effects VHA vocational rehabilitation program enrollment and employment at discharge. Studies have shown that employment at discharge decreases when a veteran presents a SUD/AUD diagnosis or a mental health condition (18,19), but there is limited research examining the impact when both co-occur for veterans enrolled in VR within the VA healthcare system.…”

“…The DSM 5-TR classifies SUD into three categories (active usage, early remission, sustained remission) to provide details on the severity of the disorder (31). Researchers examining employment challenges for Veterans have generally combined all drug and alcohol related diagnoses into one category (29,32), without differentiating whether the diagnoses are in remission or an active problem (18,19). In the current study, it was intended to (1) evaluate program enrollment rates and employment rates at discharge by only differentiating between SUD or AUD and no SUD or AUD, and (2) separating SUD and AUD into none, active usage, early remission, and sustained remission.…”

The Road to Reintegration: Evaluating the Effectiveness of VA Healthcare in Vocational Rehabilitation and Employment Retention for Veterans with Mental Health and Substance Use Disorders

“…On the one hand, sustained treatment can be viewed as advantageous, while on the other hand, reduced treatment engagement following employment can be indicative of veterans’ improved well-being and reduced need for such services. 1 , 4 , 7 , 15 Thus, the findings of Abraham et al can be considered positive.…”