Absence of conflict of interest.
Citation
Ottomanelli, L., Goetz, L. L., Suris, A., McGeough, C., Sinnott, P. L., Toscano, R., … Thomas, F. P. (2012). Effectiveness of supported employment for veterans with spinal cord injuries: Results from a randomized multisite study. Archives of Physical Medicine and Rehabilitation, 93(5), 740-747.
Highlights
- The study aimed to examine the impact of supported employment on the employment outcomes of veterans with spinal cord injuries.
- The study included a randomized controlled trial and collected self-reported data directly from veterans and chart review data from the spinal cord injury centers in six Veterans Affairs Medical Centers (VAMCs) to obtain demographic information.
- The study found statistically significant positive impacts on employment as a result of supported employment compared to treatment as usual.
- The quality of causal evidence presented in the report is high because it used a well-implemented experimental design. This means that we are confident that the estimated effects are attributable to supported employment and not to other factors.
Intervention Examined
Individual Placement and Support (IPS) model of supported employment
Features of the Intervention
The intervention is an IPS model of supported employment that has an evidence-based approach. This approach integrates vocational rehabilitation with spinal cord injury care and takes the perspective that anyone, regardless of severity of the disability, can find competitive employment. The services were provided in the community, not in mental health treatment or rehabilitation settings. In addition to personalized benefits counseling and medical health care, the intervention provided individuals with immediate support in finding competitive employment based on their preferences. The intervention provided ongoing support for participants even after a person started a job. A trained vocational rehabilitation counselor implemented the services. The VAMCs also provided integrated medical and/or rehabilitation services.
Veterans were eligible for the study if they were between ages 18 and 65, were receiving services at one of the participating VAMCs, and were unemployed or employed but earning less than what was considered “substantial gainful activity” based on the Social Security Administration definition of employment.
Features of the Study
The authors conducted an experimental study that included 249 veterans who received care at one of the participating VAMCs and were randomly assigned to receive the IPS model of supported employment or to continue with treatment-as-usual services.
The authors used a statistical model to compare employment outcomes of treatment and control group members using self-reported data for employment information and VAMC chart review data to obtain demographic information.
There were 81 veterans who were randomly assigned to receive supported employment and 76 veterans randomly assigned to receive treatment-as-usual services. The veterans in the study were, on average, 49 years old and male (96 percent). Most were white (45 percent) or African American (42 percent).
Study Sites
The study was conducted at six VAMCs in Chicago, Cleveland, Dallas, Houston, Milwaukee, San Diego, and St. Louis. In selecting the sites, the study considered several factors, including if the site was near a major city, the economic development of the region, the management support at the VAMC, and the accessibility to public transit.
Findings
Overall employment
- After one year, there were significant, positive impacts of the intervention on overall employment rate. Veterans offered the IPS model of supported employment were 18 percent more likely to be employed than veterans offered the treatment-as-usual services. There were no statistically significant findings after two years or across both years 1 and 2.li>
Competitive employment
- There were significant, positive impacts of the intervention on overall employment rate after one year and after two years. After one year, veterans offered the IPS model of supported employment were 15 percent more likely to be employed than veterans offered the treatment-as-usual services. After two years, veterans offered the IPS model of supported employment were 12 percent more likely to be employed than veterans offered the treatment-as-usual services. There were no statistically significant findings in employment outcomes when examining both years combined.
Causal Evidence Rating
The quality of causal evidence presented in the report is high because of a well-implemented experimental design. This means that we are confident that the estimated effects are attributable to supported employment and not to other factors.
Additional Sources
Ottomanelli, L., Goetz, L., McGeough, C., Suris, A., Sippel, J., Sinnott, P., … Cipher, D. J. (2009). Methods of a multisite randomized clinical trial of supported employment among veterans with spinal cord injury. Journal of Rehabilitation Research & Development, 46(7), 919-930.Ottomanelli, L., Barnett, S. D., & Goetz, L. L. (2013). A prospective examination of the impact of a supported employment program and employment on health-related quality of life, handicap, and disability among veterans with SCI. Quality of Life Research, 22(8), 2133-2141.Ottomanelli, L., Barnett, S. D., & Goetz, L. L. (2014). Effectiveness of supported employment for veterans with spinal cord injury: 2-year results. Archives of Physical Medicine and Rehabilitation, 95(4), 784-790.