Absence of conflict of interest.
Citation
Highlights
- The study's objective was to examine the impact of Transitional Work (TW) on competitive employment outcomes for Veterans with Posttraumatic Stress Disorder (PTSD).
- This study was a nonexperimental comparison group analysis. The study data were collected directly from participants during follow-up appointments. The authors used a statistical model to compare employment outcomes between TW participants and non-participants.
- The study found that Veterans who engaged in their TW assignment were significantly less likely to gain competitive employment within the first six months than those who did not engage in their TW assignment.
- This study received a low causal evidence rating. This means we are not confident that the estimated effects are attributable to Transitional Work (TW); other factors are likely to have contributed.
Intervention Examined
Transitional Work
Features of the Intervention
The Veterans Health Administration (VHA) has primarily used Transitional Work (TW) for the vocational rehabilitation of Veterans with serious psychological disabilities. Transitional Work is temporary, non-competitive work that is intended to lead to permanent competitive employment. At the VHA, TW participants are paid minimum wage to do grounds maintenance, housekeeping, food service, or laundry service at the institution itself. In addition to the temporary job, participants are paired with a vocational rehabilitation specialist who helps them with their job search.TW is available to all Veterans suffering from a mental health illness, but this study focuses particularly on those with PTSD.
Features of the Study
The study was a nonexperimental comparison group analysis. A total of 270 VHA patients, ages 18-65 with a lifetime diagnosis of PTSD, were classified into a treatment group or comparison group by engaging or not engaging in their transitional work assignment. The treatment group included Veterans who engaged in their transitional work assignment for at least one day during the 18-month study period. The comparison group was comprised of Veterans who were assigned transitional work but did not engage with their work assignment. The authors collected employment data directly from participants during follow-up appointments at one of the 12 sites in the study, all of which were VHA Medical Centers. To ensure data integrity, the participants kept an "employment calendar diary" and brought pay and tax forms to follow-up appointments. The authors used a statistical model to compare competitive employment outcomes between TW participants and non-participants.
Findings
Employment
- The study found that veterans who engaged in their Transitional Work (TW) assignment were significantly less likely to gain competitive employment within the first six months than those who did not engage in their TW assignment.
Considerations for Interpreting the Findings
The authors did not account for preexisting differences between the groups before program participation or include sufficient control variables. According to the baseline data presented by the authors, the veterans that engaged in their Transitional Work assignment were significantly more likely than those that did not to be a racial minority, to be homeless, and to have limited transportation. The treatment group was also more likely to have been treated for their PTSD and had a longer average unemployment period before the study began. These differences in baseline characteristics between the treatment and comparison groups were not properly accounted for in the statistical analysis. Therefore, the study is not eligible for a moderate causal evidence rating, the highest rating available for nonexperimental designs.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to Transitional Work (TW); other factors are likely to have contributed.