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Enhanced vocational rehabilitation for veterans with mild traumatic brain injury and mental illness: Pilot study (O'Connor et al. 2016)

Absence of conflict of interest.

Citation

O’Connor, M. K., Mueller, L., Kwon, E., Drebing, C. E., O’Connor, A. A., Semiatin, A., & Daley, R. (2016). Enhanced vocational rehabilitation for veterans with mild traumatic brain injury and mental illness: Pilot study. Journal of Rehabilitation Research & Development, 53(3), 307-319.

Highlights

  • The study’s objective was to examine the impact of an embedded cognitive rehabilitation intervention on employment and earnings.
  • The study was a randomized controlled trial with the authors using administrative data.
  • The study found no statistically significant relationships between an embedded cognitive rehabilitation intervention and employment and earnings after one year.
  • 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 an embedded cognitive rehabilitation intervention; other factors are likely to have contributed.

Intervention Examined

The cognitive rehabilitation intervention

Features of the Intervention

The embedded cognitive rehabilitation intervention provided enhanced vocational support to veterans with mild traumatic brain injury and mental health issues by adding an embedded cognitive rehabilitation intervention to vocational rehabilitation services. The cognitive rehabilitation intervention is a 12-session program designed to help these veterans obtain employment. During the sessions, veterans who were offered to participate in the intervention met with a cognitive rehabilitation specialist to (1) discuss strategies to help manage cognitive difficulties in a work environment, (2) build skills to identify and manage negative emotions and work behaviors, and (3) develop supportive relationships with employers and coworkers. Participating veterans also received a laptop containing software that provided work readiness and training and vocational rehabilitation modules, which were assigned as homework between sessions. In addition, they could meet jointly with the vocational rehabilitation specialist and the cognitive rehabilitation specialist.

The study took place at a U.S. Department of Veterans Affairs medical center. To be eligible for the intervention, veterans had to meet a number of criteria, including being age 18 or older, having a history of mild traumatic brain injury and a co-occurring mental illness, having impairment in cognitive functioning, not having a history of nontraumatic brain injury neuropsychological disorder that would result in being nonresponsive to the intervention, being enrolled in a vocational rehabilitation program, being unemployed or underemployed, speaking English, having more than 10 years of education, and having the potential to return to competitive employment within six months.

Features of the Study

The authors conducted a randomized controlled trial that used administrative data to compare three key outcomes after one year: (1) employment rate, (2) number of weeks the individual worked at least one day, and (3) earnings. Veterans in the control group completed 12 sessions of therapy that did not focus on employment or cognitive rehabilitation. In all, 18 veterans were included in the final analysis sample: 10 in the intervention group and 8 in the control group. The authors also used a satisfaction interview to collect qualitative data on the veterans’ opinions of the intervention.

All study participants were men. The majority of the veterans were White, had a high school diploma, and served in the military after the Vietnam era. All study participants had at least one diagnosed psychiatric disorder, and most had at least one substance use disorder.

Findings

Employment

  • The study found no statistically significant relationships between the embedded cognitive rehabilitation intervention and employment. 

Earnings

  • The study found no statistically significant relationships between the embedded cognitive rehabilitation intervention and earnings.

Considerations for Interpreting the Findings

This is a small study of 18 people that the authors used as a pilot study preceding a larger randomized controlled trial study.

In addition, the authors did not establish that the intervention and comparison groups were similar before the intervention. Specifically, the authors did not account for differences in terms of race, employment, and earnings between the groups. Existing differences between the groups—and not the intervention— could explain any 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. This means we are not confident that the estimated effects are attributable to an embedded cognitive rehabilitation intervention; other factors are likely to have contributed.

Reviewed by CLEAR

January 2020

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