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. [CONTRAST 1: Non-experimental study]
Highlights
- The study examined the impact of supported employment on the employment outcomes for veterans with spinal cord injuries.
- The authors used statistical comparisons in a non-experimental analysis to estimate the relationship between supported employment services and employment, drawing on self-reported data for employment information and chart review data from the spinal cord injury centers in six Veterans Affairs Medical Centers to obtain demographic information .
- The study found statistically significant positive relationships between supported employment and veterans’ employment outcomes compared to treatment as usual.
- The quality of causal evidence presented in the report is low because there are preexisting differences between the intervention and comparison groups. This means we are not confident that the estimated effects are attributable to supported employment; other factors are likely to have contributed.
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 the VAMC, and were unemployed or employed but earning less than what was considered “substantial gainful activity” based on the Social Security Administration definition.
Features of the Study
The authors conducted a nonexperimental study. People at some participating VAMCs were randomly assigned to the intervention to receive supported employment or to continue with business-as-usual services. People at other VAMCs were nonrandomly assigned to use business-as-usual services. This profile focuses on people who received the intervention compared with people who were nonrandomly assigned to a comparison group.
The authors used a statistical model to compare the employment outcomes of treatment and comparison group members using self-reported data for employment information and VAMC chart review data to obtain demographic information.
There were 81 people in the intervention group and 76 people in the comparison group. People in the study were, on average, 49 years old and male (96 percent). Most were white (54 percent) or African American (32 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. p>
Findings
Overall employment
- After one year, there were statistically significant, positive relationships between the IPS model of supported employment and veterans’ overall employment rate. Veterans offered the IPS model of supported employment were 25 percent more likely to be employed than the veterans offered the business-as-usual services. There were no statistically significant findings after two years or across both years 1 and 2.li>
Competitive employment
- There were statistically significant, positive relationships between the IPS model of supported employment and veterans’ competitive employment rates after one year and across both years 1 and 2. After one year, veterans offered the IPS model of supported employment were 24 percent more likely to be employed than veterans offered the business-as-usual services. Across both years combined, veterans offered the IPS model of supported employment were 29 percent more likely to be employed than veterans offered the business-as-usual services.
Causal Evidence Rating
The quality of causal evidence presented in the report is low because there are preexisting differences between the intervention and comparison groups. This means we are not confident that the estimated effects are attributable to supported employment; other factors are likely to have contributed.
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.