Absence of conflict of interest.
LePage, J. P., Bluitt, M., House-Hatfield, T., McAdams, H., Burdick, M., Dudley, D., …& Gaston, C. (2005). Improving success in a veterans homeless domiciliary vocational program: Model development and evaluation. Rehabilitation Psychology, 50(3), 297-304. doi: 10.1037/0090-5518.104.22.1687
- The study’s objective was to examine the relationship between the risk factor-based decision making (RFBDM) program and employment attainment.
- The study used a non-experimental comparison-group analysis. The study’s relied on data collected from the Risk Factor Scale and through data from the Veterans Affairs (VA) North Texas Health Care System. The authors used Pearson’s chi-squared test, a statistical model, to examine the relationship between the RFBDM program and employment.
- 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 the RFBDM program; other factors are likely to have contributed to the study findings.
Risk factor-based decision making intervention.
Features of the Intervention
The RFBDM program was developed to identify risk factors for failure to attain employment and to help in vocational planning.
The RFBDM program provided different levels of vocational support based on the numbers of risk factors individuals presented based on the Risk Factor Scale. The Risk Factor Scale determined if participants had one of the following eight risk factors: (1) mental health issues, (2) mental health diagnoses, (3) legal convictions, (4) served prison time, (5) number of psychiatric hospitalizations, (6) number of suicide attempts, (7) time incarcerated, and (8) length of longest employment. Individuals with two or fewer risk factors engaged in a vocational reintegration assignment at the VA North Texas Health Care System and then received the standard competitive job search support. Individuals with three or more risk factors engaged in a vocational reintegration assignment and then received a more intensive competitive job search support that included working with staff on applying to a minimum of 10 jobs a week and following up about these positions. After three weeks of job searching, individuals who did not attain employment entered a program that provided piecework assignments. An individual who did not attain employment within three more weeks might receive supported employment.
Features of the Study
The study was a non-experimental comparison group analysis. The study consisted of two conditions: the treatment condition was the RFBDM program, which assigned 41 individuals to a type of vocational programming based on the number of risk factors they presented. The comparison condition assigned 41 individuals to a type of vocational programming based on a clinical interview. The sample consisted of 82 homeless veterans receiving treatment at the VA North Texas Health Care System. The study’s data sources were from the Risk Factor Scale and data obtained through chart and team note reviews from the VA North Texas Health Care System. The authors used a statistical model to examine the relationship between RFBDM and employment.
The individuals in the study were veterans who were homeless. They were on average 44 years old, the majority were racial minorities (68 percent), 13 percent were married, 88 percent had substance dependency, and 54 percent had mental health issues.
- The study found a statistically significant, positive relationship between the RFBDM program and attainment of employment, including both competitive and supportive employment. About 81 percent of individuals in the RFBDM group attained employment compared to 59 percent of those in the comparison group. Also, about 84 percent of those identified as high risk (that is, individuals with three or more risk factors) in the RFBDM group attained employment, compared to 42 percent of those identified as high risk in the comparison group.
Considerations for Interpreting the Findings
The authors did not account for existing differences between the groups before program participation. These existing differences between the groups—and not the RFBDM program—could explain the observed differences in outcomes.
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.
Low causal evidence: This means we are not confident that the estimated effects are attributable to the RFBDM program; other factors are likely to have contributed.