Absence of Conflict of Interest.
Citation
Highlights
- The study's objective was to examine the impact of individual placement and support (IPS)-supported employment on employment and earnings outcomes for Veterans with posttraumatic stress disorder (PTSD).
- The study was a randomized controlled trial. Using follow-up outcome assessments, the authors conducted statistical models to compare the outcomes of the IPS supported employment group and control group members.
- The study found that the IPS-supported employment participants had significantly higher rates of “steady worker” status, took significantly less time to attain first competitive job, and had significantly higher cumulative earnings from competitive jobs, as compared to the control group.
- This study receives a high evidence rating. This means we are confident that the estimated effects are attributable to individual placement and support (IPS)-supported employment, and not to other factors.
Intervention Examined
Individual Placement and Support (IPS) model of supported employment
Features of the Intervention
Individual placement and support (IPS)-supported employment involves job development for obtaining competitive work that aligns with the participant's preferences, skills, and abilities. The IPS specialists are located within the PTSD or mental health clinic to provide integrated services, including: a vocational assessment; individualized job search related to the participant's preferences and skills; job coaching and advocacy; care coordination with the treatment team; counseling for disability benefits; and additional open-ended follow-up supports. The IPS model focuses on rapidly searching for and identifying competitive employment opportunities in the community for each participant. The IPS specialists' job development activities include learning about the needs of potential employers and developing relationships with them; building employer networks according to participants' interests; facilitating relationships between veterans and employers; advocating for participants with disabilities; matching participants’ skills to jobs; and maintaining follow-up with the veteran and employer after job placement. The program serves Veterans with PTSD who are 65 years or younger and currently unemployed.
Features of the Study
The study was a randomized controlled trial that assigned Veterans with PTSD to the intervention group or control group. The sample was recruited from 12 Veterans Administration (VA) medical centers across the U.S. between December 2013 and April 2015. Of the 541 eligible veterans, 271 were randomly assigned to the intervention group to receive IPS-supported employment services while 270 were randomly assigned to the control group to receive transitional work assignments. Transitional work offers temporary positions with no opportunities for advancement, does not involve a job application or competitive selection process as work assignments are prearranged with contracted employers, and is not integrated with the PTSD or mental health treatment team like the IPS-supported employment services. Of the sample participants, the mean age was 42.2 years old and 18.3% were women. About half of the sample were White (50.6%), 41.6% were African American, and 16.6% were of Hispanic, Spanish, or Latino ethnicity.
The primary data source was follow-up outcome assessments of participants. The authors used statistical models to estimate the effects of IPS-supported employment on achievement of “steady worker” status, time to employment, and cumulative earnings. “Steady worker” was defined as someone who held a competitive job for at least 50% of the weeks during the 18-month follow-up period (i.e., at least 39 of the 78 weeks).
Findings
Employment
- The study found that a significantly higher proportion of IPS-supported employment participants (38.7%) achieved "steady worker" status relative to the participants in the control group (23.3%). The study also found that the average time to attain an individual’s first competitive job was significantly lower for IPS-supported employment participants (18.4 weeks) relative to participants in the control group (28.2 weeks).
Earnings and wages
- The study found that IPS-supported employment participants had significantly higher average cumulative earnings from competitive jobs ($14,642) than the participants in the control group ($10,989).
Considerations for Interpreting the Findings
Although the study was a well-implemented randomized controlled trial, when interpreting the findings, it should be noted that after the randomization took place, eleven participants receiving IPS-supported employment services crossed over, on their own volition, to receive transitional work assignments instead during the 18-month follow-up period.
Causal Evidence Rating
The quality of causal evidence presented in this report is high because it was based on a well-implemented randomized controlled trial. This means we are confident that the estimated effects are attributable to individual placement and support (IPS)-supported employment, and not to other factors.