Veterans Health Administration vocational services for Operation Iraqi Freedom/Operation Enduring Freedom Veterans with mental health conditions

Abstract

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 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.

Factors impacting work success in Veterans with mental health disorders: A Veteran-focused mixed methods pilot study

“…These statistics are consistent with recent data showing that the vast majority of OEF/OIF Veterans with conditions including PTSD (that study sample also included OEF/OIF Veterans with traumatic brain injury, depression, and/or a substance use disorder) are not receiving VA vocational services [45]. Further, our finding that Veterans with SMI perceived vocational services as a facilitator to work success converges with a large body of literature demonstrating the positive impact of evidence-based vocational services (i.e., IPS model of supported employment) on employment outcomes for Veterans with mental illness [7,15].…”

“…Little is known about barriers and facilitators for those with PTSD and how these may differ from other diagnostic groups. In a related vein, shedding light on the vocational barriers and facilitators faced by Veterans with PTSD is in line with recent calls for an adaptation of evidence-based supported employment services for this population [15,38,45]. In order to best tailor supported employment services, a comprehensive understanding of the unique factors that impact work outcomes is necessary.…”

Receipt of employment services among Veterans Health Administration users with psychiatric diagnoses

“…The majority of research supporting the effectiveness of SE was conducted in samples of people with psychotic or mood disorders [13] and VHA guidelines suggest that a minimum of 75 percent of Veterans enrolled in SE should be individuals with psychosis [25]; thus, it is not surprising that VHA users with schizophrenia or bipolar disorder were more likely to access SE. Moreover, it is possible that VHA users with less severe mental health conditions require less intensive employment services.…”

“…VHA users were considered to have a specific psychiatric diagnosis if they were assigned a diagnosis in the same category during one inpatient visit or two outpatient visits during FY2010. Prior research supports this method of using VHA administrative data to ascertain psychiatric diagnosis [25], particularly when the presence of two of the same diagnoses in administrative data [26] are used to determine diagnosis. Within the random sample, 52,542 of the VHA users (19%) had at least one of the aforementioned psychiatric diagnoses.…”

“…The mutually exclusive hierarchy was designed to (1) reflect a continuum of the type of employment service most focused on competitive employment and with the largest evidence base (i.e., SE) [27] through type of employment service that is most sheltered and does not focus on competitive employment (i.e., IT) and (2) capture VHA users who received only Voc Assist and no other employment services. Prior research has used a similar hierarchy to classify type of employment services received [25]. In analyses comparing the type of employment services used, the employment service variable was dummy-coded with TW serving as the reference group, because this is the type of employment service most commonly received [14].…”