Assessing the Effect of Distance Learning Vocational Rehabilitation on Employment Outcomes of Veterans With Psychiatric Illness and Histories of Legal Convictions

64,000 Veterans are released annually from jails and prisons. These Veterans have a weekly unemployment rate of up to 40-55%. However, many are unable to access traditional vocational rehabilitation, not to mention specialized vocational rehabilitation for those with felony histories. Distance learning may be effective in improving access to rehabilitation as well as improving employment outcomes. The Compass system was developed to incorporate both synchronous and asynchronous distance learning to provide effective services. This study will evaluate 150 Veterans with histories of legal convictions and mental illness and/or a substance use disorder. Veterans will be randomly assigned to either a basic vocational resources condition or the the Compass condition. In the basic condition, Veterans will be provided with basic information about where they can access vocational services and a paper version of a vocational reintegration manual, specifically the About Face Vocational Manual. Veterans assigned to the Compass condition will be given access to the online instruction through Videos, live chat features, and tele-health practice interviews with feedback. Veterans will be followed for 6 months. The primary outcomes are employment and interview skills.

Study Overview

• Status: Completed
• Conditions: Substance Use Disorder; Mental Illness; Unemployment; Legal History
• Intervention / Treatment: Other: Basic vocational services; Behavioral: Distant vocational learning

Detailed Description

At this time, there are over 131,000 Veterans in US prisons and over 50,000 in US jails. When discharged, these Veterans will be forced to cope with high rates of psychosocial and health issues including homelessness, divorce, mental illness, and infectious diseases.

One of the most significant consequences of incarceration is a high rate of unemployment. Evaluations of employment find those with felony histories worked, on average, between 10% and 23% fewer hours than those without felony histories. These negative employment outcomes are caused by a combination of eroded skills, poor social connections, legal restrictions, and stigma.

Though the VA offers a number of vocational rehabilitation and reintegration services, these services are typically not targeted towards Veterans with criminal histories. Also the programs have limitations restricting the range of Veterans that can be served. For example, Veterans living a great distance from a major medical center, rural Veterans, homeless Veterans, and Veterans without transportation may have difficulty accessing services.

To reach the most Veterans, tele-health and distance learning methods must be developed to bring services to the Veterans rather than bring the Veterans to the services. Already well integrated into many educational classrooms, distance learning can be a very effective method of imparting training, skills, and information while mitigating many of the logistical limitations encountered by Veterans with histories of incarceration.

To be successful distance learning should incorporate a number of different best practices. Distance learning should be engaging, avoiding long periods of reading. It should focus on small 'chunks' of information to improve learning and retention. Due to differences in learning, a multiple modality approach is most likely to be successful. Questions, short quizzes, and problem based activities with immediate feedback should be used to keep participants both engaged and to assess progress.

An important aspect to effectively implementing distance learning is to provide blended learning or a hybrid between asynchronous learning, where the participant and teacher are not interacting in real-time, and synchronous learning, where the participant and teacher are interacting directly with each other either in person or across some type of medium. Used effectively, hybrid distance learning can bring a number of positives aspects to the learning environment, including the ability to review information and lessons, practice and role playing, more time to reflect on answers, and less pressure to respond in a group.

Based on effective distance learning principles, the Compass system was developed. Compass builds on a previous pilot online system, the About Face Online System (AFOS), which placed a vocational manual into an online fillable format; however, though Veterans engaged the AFOS, a number of limitations were identified that limited Veterans' enthusiasm, including use of extended reading passages, no direct interaction with a person, and not enough focus on interviews.

Compass uses distance learning best practices including the use of both synchronous and asynchronous learning. The asynchronous components of Compass use video and online content. Veterans are also quizzed at each step of the process on what responses should be given through a multiple choice method. Synchronous components of Compass include tele-health practice interviews, phone coaching sessions, and live-chat features that are used to assist Veterans tailor their information and improving their interview skills.

This study is a four-year project to compare the effectiveness of the Compass system to basic resources. 150 Veterans with legal convictions and mental illness and/or substance use disorders will be followed for six months. Half will receive access to the Compass system and half will receive only basic resources (i.e. a hard copy vocational manual). Outcomes evaluated are employment and interview skills.

The goals of the study are:

1. Compare rates of employment of Compass to those receiving basic resources.
2. Compare improvements in interviewing skills between those receiving an online program to those receiving basic resources.

Hypotheses/expected results

1) Veterans using Compass will have superior rates of employment and improved interviewing skills compared to those receiving basic services.

• Study Type: Interventional
• Enrollment (Actual): 136
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Texas
    • Dallas, Texas, United States, 75216-7167
      • VA North Texas Health Care System Dallas VA Medical Center, Dallas, TX

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• mental illness or substance use disorder
• history of a felony conviction or non-traffic related misdemeanor

Exclusion Criteria:

• cognitive impairment which prohibits active participation in study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Self-help resources; a self-help vocational manual	Other: Basic vocational services; self-help manual; Other Names: Basic services
Experimental: Compass; a distant learning vocational program	Behavioral: Distant vocational learning; use of hybrid distance learning to facilitate successful employment outcomes; Other Names: Compass

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Competitive Employment Within Six Months of Random Assignment.	Competitive Employment within 6 months of randomization. Competitive employment is defined as a paid position open to anyone, at least at minimum wage, and not a sheltered work position such as the VA's Compensated Work Therapy program. Additionally, day labor type activities were not counted as success.	6 months
Interviewing Skills	Changes in Veterans scores on an interviewing rating form (the Veteran Interview Scale) were compared one month after entry into the study. Scores range from 0 to 30. Higher values are better.	one month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Job Search Self-Efficacy	Change in job-search efficacy scores were compared between systems at enrollment (point 1) and after 30 days using the systems (point 2). The Job Search Efficacy Scale was used (Cronbach's alpha= .93). Range 10 - 50; higher scores indicate more job search efficacy.	30 days

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: James P. LePage, PhD, VA North Texas Health Care System Dallas VA Medical Center, Dallas, TX

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2019
• Primary Completion (Actual): October 3, 2022
• Study Completion (Actual): May 30, 2023

Study Registration Dates

• First Submitted: October 31, 2017
• First Submitted That Met QC Criteria: October 31, 2017
• First Posted (Actual): November 6, 2017

Study Record Updates

• Last Update Posted (Actual): June 28, 2024
• Last Update Submitted That Met QC Criteria: March 19, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: distance learning; incarceration; employment
• Additional Relevant MeSH Terms: Chemically-Induced Disorders; Substance-Related Disorders; Mental Disorders
• Other Study ID Numbers: D2451-R; RX002451 (Other Grant/Funding Number: VA RR&D)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No