Absence of conflict of interest.
Citation
Twamley, E., Baker, D., Norman, S., Pittman, J., Lohr, J., & Resnick, S. (2013). Veterans Health Administration vocational services for Operation Iraqi Freedom/Operation Enduring Freedom Veterans with mental health conditions. Journal of Rehabilitation Research & Development, 50(5), 663-670.
Highlights
- This study examined the impact of supported employment encounters on competitive employment for Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans with mental health conditions.
- The study used statistical tests to examine differences between groups of OIF/OEF veterans with specified mental health conditions who had at least one supported employment encounter versus those who did not. The data for this study came from two nationwide Veterans Health Administration (VHA) databases for fiscal years 2008 and 2009.
- The study showed that having at least one supported employment encounter was associated with obtaining competitive employment.
- The quality of causal evidence presented in this report is low because the authors were not able to establish that the treatment and comparison groups were similar before the intervention. This means we are not confident that the estimated effects are attributable to VHA-supported employment encounters; other factors likely contributed to the effects.
Features of the Study
The study used statistical tests of raw means to check for differences between OIF/OEF veterans with mental health conditions who had at least one supported employment encounter versus those who did not have an encounter. The data for this study came from two VHA sources from fiscal years 2008 and 2009, which the Northeast Program Evaluation Center used a common identifier to link together. The first source included data from the VHA Austin Information Technology Center’s data encounter files on veterans who accessed vocational services. The second source included a registry of OIF/OEF veterans with post-traumatic stress, depressive, or substance use disorders or sequelae of traumatic brain injury.
The study included 1,010 OIF/OEF veterans with one of these four mental health conditions. Of those, 479 veterans had at least one supported employment encounter, and 531 did not. The study team assessed whether at least one of the encounters affected the acquirement of competitive work and the number of days enrolled in vocational services. A separate analysis tested the impact on competitive employment when controlling for the length of stay in vocational services.
Findings
Employment
- The study showed that having at least one supported employment encounter was associated with obtaining competitive employment. Fifty-one percent of the veterans with at least one supported employment encounter were employed, whereas only 21 percent of the veterans in the comparison group were employed. These results were statistically significant and held when controlling for the length of stay in vocational services.
Considerations for Interpreting the Findings
The authors did not account for pre-existing differences between the groups before the intervention. Such differences—and not the intervention itself—could explain the observed differences in outcomes.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors could not establish that the treatment and comparison groups were similar before the intervention. This means we are not confident that the estimated effects are attributable to VHA-supported employment encounters; other factors likely contributed to the effects.