Customized Employment for Veterans With Spinal Cord Injury

Achieving Competitive Customized Employment Through Specialized Services - Veterans: ACCESS-VETS

Sponsor

Lead Sponsor: VA Office of Research and Development

Fonte VA Office of Research and Development
Breve riassunto

The reason for conducting this study is to learn about the best ways to help Veterans with spinal cord injury (SCI) gain meaningful employment. Spinal cord injury is a medically complex disability that poses unique barriers to employment for Veterans. Returning to work after SCI improves health and quality of life, which in turn can lower risk for suicide in this high-risk population. Hence, the Department of Veterans Affairs (VA) supports interventions that help Veterans with SCI return to work and may prevent suicide. Customized employment (CE) is an innovative strategy for tailoring vocational services to meet the needs of people with complex disabilities. To address barriers to employment faced by Veterans with SCI, this study will evaluate whether a customized employment intervention used in non-VA settings can be adapted for use by the VA as a part of SCI medical rehabilitation. The research goal is to evaluate how a CE intervention for Veterans with SCI (ACCESS-Vets) can help them discover their strengths to find and maintain competitive integrated employment in their communities. This study will compare ACCESS-Vets with the usual evidence-based supported employment program, known as Individual Placement and Support (IPS). Veterans with SCI who chose to participate in this study will be randomly selected (i.e. by chance) to work with a vocational rehabilitation specialist as part of the ACCESS-Vets intervention or the usual IPS employment program for about 8 months. Study participants will complete study questionnaires before, during, and after their participation in the employment interventions. Some Veterans and their medical rehabilitation providers will be interviewed about their experiences with the employment interventions. The study expects to find that Veterans who participate in ACCESS-Vets will have better employment and quality of life outcomes then those who participate in IPS. The study will provide information about the strategies used in the ACCESS-Vets and IPS interventions for addressing barriers to employment. Ultimately, this study may provide a model for making VA vocational services for Veterans with SCI more effective and sustainable.

Descrizione dettagliata

This randomized clinical trial (RCT) will test the effectiveness of a customized employment (CE) intervention, Achieving Competitive Customized Employment through Specialized Services (ACCESS-Vets), to complement clinical services for Veterans with spinal cord injury (SCI) and improve their employment outcomes. Background: Restoring employment is an important rehabilitation goal for Veterans with SCI because employment impacts both quality of life (QOL) and longevity. Due to the medical complexity of SCI, however, these Veterans face unique employment barriers that are not adequately addressed by current Department of Veterans Affairs (VA) vocational services. Vocational services for Veterans with SCI need to address these employment barriers, which relate to physical health, finances, time for job search, and caregiver issues. Customized employment, an innovative strategy for tailoring vocational services to meet individual needs of people with complex disabilities, could be adapted for use in SCI rehabilitation. This research will evaluate a CE intervention to help Veterans with SCI discover their strengths, customize employment plans, and find competitive integrated employment in their communities. The proposed intervention, ACCESS, is a user-driven, standardized CE program delivered by a trained employment specialist and is effective for a non-clinical, community-based population of adults with disabilities. This research is needed to test ACCESS as a complement to clinical services for a clinically defined population and to assess the potential of CE for subsequent implementation in the VA. Research Plan: The effectiveness of ACCESS-Vets will be tested with an RCT of 100 Veterans with SCI. The study will have a rolling enrollment period with an intervention period of 26 months. ACCESS-Vets is typically completed in 8 months and includes the following elements: discovery, CE planning, job development, CE negotiation, and accommodations and job retention supports. Individual Placement and Support (IPS), otherwise known as evidence-based supported employment, will serve as an active control group consistent with treatment as usual. ACCESS-Vets and IPS will be compared on changes in employment attainment. The investigators predict Veterans who participate in ACCESS-Vets will have a higher employment rate than Veterans who receiving IPS. Among Veterans who attain employment, the investigators predict those who received ACCESS-Vets will report higher job satisfaction, wages, and retention. The investigators predict, Veterans who attain employment will demonstrate statistically significant improvements in self-sufficiency, QOL, and participation in life roles compared with those who do not attain employment. Finally, qualitative interviews with Veterans and their providers will identify strategies used in IPS and ACCESS-Vets for addressing barriers to employment and how practitioners adapt the ACCESS-Vets intervention for use in a VA clinical setting. Significance: This study is responsive to Veterans' reported desire for individualized vocational rehabilitation services and to the Modernization Plan and the MISSION Act, which emphasize Veteran-centered, community-based approaches to care. The proposal goals align with the Transformation Plan of the Office of Mental Health and Suicide Prevention, which prioritizes evidence-informed, community-based employment services. Recognizing the rapid adoption of CE in state and federal agencies, VA is partnering with the Office of Disability and Employment Policy (U.S. Department of Labor) to introduce and train VA vocational staff on CE as a promising practice; however, integration of CE into standard VA clinical services has not yet been implemented. In support of VA efforts to assist Veterans to achieve competitive employment and reintegration into civilian life, this proposal will evaluate CE within the context of existing VA vocational services.

Stato generale Not yet recruiting
Data d'inizio 2021-12-01
Data di completamento 2025-06-01
Data di completamento principale 2024-09-01
Fase N/A
Tipo di studio Interventional
Il risultato principale
Misurare Lasso di tempo
Change in Employment Status 6, 9 12 months
Esito secondario
Misurare Lasso di tempo
Change in Employment Satisfaction, Wages, Retention 6, 9, 12 months
Change in Quality of Life- Ability to Participate in Social Roles and Activities (SRA) Baseline, 6, 9 12 months
Change in Quality of Life- Satisfaction with SRA Baseline, 6, 9, 12 months
Changes in Quality of Life- Independence Baseline, 6, 9, 12, months
Change in Quality of Life- Positive Affect and Well-being Baseline, 6, 9, 12 months
Change in Quality of Life- Self Esteem Baseline, 6, 9, 12 months
Change in Self-sufficiency - Employment Hope Scale (EHS) SF-14 Baseline, 6, 9, 12 months
Change in Self-Sufficiency- Perceived Barrier Scale (PEBS) Baseline, 6, 9, 12 months
Change in Impact on Quality of Life and Participation- Qualitative Interviews Veteran participants baseline, 6-months, & 12 months
Change in Employment Barriers- Employment Questionnaire 6, 9, 12 months
Change in Employment Barriers- Qualitative Interview -Veteran participants baseline, 6-months, & 12 months
Adaption of Intervention- Benchmarks of Quality Checklist (BQC) Study Months 12, 18, 24 & 30.
Change in Impact on Quality of Life and Participation- Qualitative Interviews Provider participants After the intervention begins, interviews will occur during the following 3 time periods 0- 9 months, 10-21 months, and 22-33 months
Change in Employment Barriers- Qualitative Interview -Provider participants After the intervention begins, interviews will occur during the following 3 time periods 0- 9 months, 10-21 months, and 22-33 months
Iscrizione 100
Condizione
Intervento

Tipo di intervento: Behavioral

Nome intervento: ACCESS

Descrizione: ACCESS-Vets is a customized employment intervention adapted for use in VA healthcare to help Veterans with SCI achieve competitive integrated employment. ACCESS-Vets includes the following elements: discovery, customized employment planning, job development, customized employment negotiation, and accommodations and job retention supports.

Etichetta del gruppo del braccio: ACCESS-Vets Intervention Group

Tipo di intervento: Behavioral

Nome intervento: IPS

Descrizione: IPS is an evidenced-based practice of supported employment that helps persons with disabilities find and maintain integrated competitive employment. IPS follows eight standardized principles: zero exclusion, integrated services, rapid job search, competitive employment, worker preferences, systematic job development, benefits planning, and time-unlimited supports.

Etichetta del gruppo del braccio: IPS (Usual Care) Group

Eleggibilità

Criteri:

Inclusion Criteria: Veteran inclusion criteria - Community-dwelling, English-Speaking Veterans - 18-65 years old - Want to find work in their community - Have received or are currently receiving IPS VA provider inclusion criteria - CE providers and other clinical providers on the SCI interdisciplinary team and other stakeholders. Exclusion Criteria: Veteran exclusion criteria - Living more than an hour's drive from the VAMC - Progressive spinal cord disorder or terminal diagnosis, e.g., multiple sclerosis - Moderate to severe traumatic brain injury or Rancho Level of 6 or less on discharge from acute rehabilitation, - Diagnosis of or documented treatment for psychosis in previous 6 months - Untreated substance use disorder - Visual, hearing, or cognitive impairment preventing consent or ability to participate in essential elements of the intervention VA provider exclusion criteria - Providers who do not meet inclusion criteria

Genere: All

Età minima: 18 Years

Età massima: 65 Years

Volontari sani: Accepts Healthy Volunteers

Ufficiale generale
Cognome Ruolo Affiliazione
Lisa Ottomanelli, PhD Principal Investigator James A. Haley Veterans' Hospital, Tampa, FL
Contatto generale

Cognome: Lisa Ottomanelli, PhD

Telefono: (813) 558-3917

E-mail: [email protected]

Posizione
Servizio, struttura: Contatto: Contatta il backup: Investigatore:
James A. Haley Veterans' Hospital, Tampa, FL | Tampa, Florida, 33612, United States Lisa Ottomanelli, PhD 813-558-3917 [email protected] Lisa Ottomanelli, PhD Principal Investigator
Hunter Holmes McGuire VA Medical Center, Richmond, VA | Richmond, Virginia, 23249, United States Scott McDonald, PhD 804-675-5000 3633 [email protected]
Paesi di posizione

United States

Data di verifica

2021-04-01

Parte responsabile

Genere: Sponsor

parole
Ha accesso esteso No
Condizione Sfoglia
Numero di armi 2
Braccio di gruppo

Etichetta: ACCESS-Vets Intervention Group

Genere: Experimental

Descrizione: This group will receive ACCESS-Vets, a customized employment intervention adapted for use in VA healthcare.

Etichetta: IPS (Usual Care) Group

Genere: Active Comparator

Descrizione: This group will receive IPS (Individual Placement and Support), the usual evidence-based supported employment program in VA.

Acronimo ACCESS-Vets
Dati del paziente No
Informazioni sul design dello studio

Assegnazione: Randomized

Modello di intervento: Parallel Assignment

Descrizione del modello di intervento: The investigators will use a 4-year, 2-armed, multi-site randomized controlled study design with concurrent mixed methods data collection at two VAMCs (Tampa and Richmond), to compare ACCESS-Vets intervention to treatment-as-usual (TAU), which is IPS.

Scopo principale: Health Services Research

Mascheramento: None (Open Label)

Fonte: ClinicalTrials.gov

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