Effectiveness of supported employment for veterans with spinal cord injuries: Results from a randomized multisite study
|Authors:||Ottomanelli, L., Goetz, L., McGeough, C., Suris, A., Sippel, J., Sinnott, P., Wagner, T. H., & Cipher, D. J.|
|Publication||Archives of Physical Medicine and Rehabilitation|
Unemployment for individuals who have sustained a spinal cord injury is a serious problem. Ottomanelli et al report that the average rate of paid employment for individuals post SCI is approximately 35%. The rate of individuals returning to work post injury has been cited as even lower at only 12% returning to their preinjury jobs. In 2004, the Veterans Health Administration implemented an initiative to apply evidence-based supported employment to veterans with serious mental illness (SMI). This article is one of the first multisite, randomized controlled trials of supported employment versus standard vocational rehabilitation care for veterans with spinal cord injury (SCI).
The purpose of this research was to examine whether supported employment is more effective than "treatment as usual" in returning veterans to competitive employment after spinal cord injury.
SCI centers in the Veterans Health Administration. Sites were selected based on location in a metropolitan geographic region, adequate economic and industrial development, strong management and leadership support at the medical center, available subject pool, and existing public transportation system.
A total of 201 Veterans with a spinal cord injury between the ages of 18 and 65 who received medical and/or rehabilitation health care services at 1 of the 6 participating VA Medical Centers were included in the study. Only veterans who were not employed, or were employed earning less than the level of substantial gainful activity as by Social Security were included in the study.
The main outcome measure was competitive employment in the community. Data was collected through subject interviews, chart extraction of sociodemographic information, medical and psychiatric information, Social Security benefits. Veterans were assessed using the Veterans RAND 36-item Health Survey, Quick Inventory for Depressive Symptomatology - Self-Report, and Craig Handicap Assessment and Reporting Technique. In addition, the IPS Fidelity Scale was used to measure the adherence to the SE model.
Power analysis pre study indicated that a total of 126 subjects were needed. Statistical analysis on the data included Student t test or Wilcoxon rank-sum tests, the Pearson chi-square test or Fisher exact test where appropriate. Effect sizes calculated for employment outcome data included rate ratios, and Cohen's d for continuous data, and Cramer's v for categorical data where appropriate. Analyses were performed with SAS version 9.2.
Subjects were randomly assigned at the intervention sites to the supported employment(SE) condition or the treatment as usual-interventional site (TAU-IS). In observational sites where there was no SE program veterans were enrolled in a nonrandomized TAU condition.
Veterans in the SE group were 2.5 times more likely than the treatment as usual group-interventional site and 11.4 times more likely than the treatment as usual-observation site group to obtain competitive employment.
Supported employment as a well-prescribed method of integrated vocational care, was superior to usual practices in improving employment outcomes for veterans with SCI.
|Research Design||Randomized Controlled Trials (RCTs)|