Effect of Evidence-Based Supported Employment vs Transitional Work on Achieving Steady Work Among Veterans With Posttraumatic Stress Disorder A Randomized Clinical Trial
Effect of Evidence-Based Supported Employment vs Transitional Work on Achieving Steady Work Among Veterans With Posttraumatic Stress Disorder A Randomized Clinical Trial
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DOI：
10.1001/jamapsychiatry.2017.4472
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发表时间：
2018-04-01
期刊：
影响因子：
25.8
通讯作者：
Drake, Robert E.
中科院分区：
文献类型：
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作者：
Davis, Lori L.;Kyriakides, Tassos C.;Drake, Robert E.
重要性创伤后应激障碍（PTSD）通常会干扰一个人获得或维持就业的能力，从而导致过早退出劳动力市场并减少收入。目的确定个人安置和支持（IPS）支持的就业是否比涉及过渡性工作任务的逐步职业康复更有效，以帮助患有创伤后应激障碍的退伍军人获得稳定、有竞争力的就业。设计、环境、退伍军人个人安置和支持促进恢复（VIP-STAR）研究是一项前瞻性、多地点、随机临床试验，包括12个退伍军人事务部医疗中心的541名患有创伤后应激障碍的失业退伍军人。数据收集时间为2013年12月23日至2017年5月3日。Intent-to-treat analysis were performed.INTERVENTIONS个人安置和支持是一种支持就业干预，迅速从事残疾人在社区工作发展，以获得工作的基础上，他们个人的工作偏好。过渡性工作是一个逐步的职业康复干预，分配的人暂时非竞争性的工作，为竞争性就业的准备在community.Main结果和措施先验假设是，与那些在过渡性工作，更多的参与者在IPS组将成为稳定的工人（小学），并赚取更多的收入从竞争性工作（中学）超过18个月。稳定的工人被定义为持有至少50%的18个月的随访period.Results的竞争性工作，共541名参与者（n = 271 IPS; n = 270过渡工作）进行了随机化。平均（SD）年龄为42.2（11）岁; 99例（18.3%）为女性，274例（50.6%）为白色，225例（41.6%）为非洲裔美国人，90例（16.6%）为西班牙裔、西班牙裔或拉丁裔。IPS组比过渡工作组有更多的参与者实现了稳定就业（105 [38.7%] vs 63 [23.3%];比值比，2.14; 95%CI，1.46-3.14）。更高比例的IPS参与者获得了任何竞争性工作（186 [68.6%] vs 154 [57.0%]; P = .005），并且从竞争性工作中获得了更高的累积收入（IPS的中位数[四分位数范围]为7290美元[23 174美元] vs 1886美元[17 167美元]; P = .004）。结论和相关性这个多中心试验证明了IPS支持的就业比逐步过渡工作职业康复对患有慢性PTSD的退伍军人的有效性更大。研究结果为增加患有创伤后应激障碍的退伍军人获得IPS提供了支持证据。
IMPORTANCE Posttraumatic stress disorder (PTSD) often interferes with a person's ability to obtain or sustain employment, which leads to premature exit from the labor force and reduced income.OBJECTIVE To determine whether individual placement and support (IPS)-supported employment is more effective than stepwise vocational rehabilitation involving transitional work assignments at helping veterans with PTSD attain steady, competitive employment.DESIGN, SETTING, AND PARTICIPANTS The Veterans Individual Placement and Support Toward Advancing Recovery (VIP-STAR) study was a prospective, multisite, randomized clinical trial that included 541 unemployed veterans with PTSD at 12 Veterans Affairs medical centers. Data were collected from December 23, 2013, to May 3, 2017. Intent-to-treat analysis was performed.INTERVENTIONS Individual placement and support is a supported employment intervention that rapidly engages people with disabilities in community job development to obtain work based on their individual job preferences. Transitional work is a stepwise vocational rehabilitation intervention that assigns people temporarily to noncompetitive jobs as preparation for competitive employment in the community.MAIN OUTCOMES AND MEASURES A priori hypotheses were that, compared with those in transitional work, more participants in the IPS group would become steady workers (primary) and earn more income from competitive jobs (secondary) over 18 months. Steady worker was defined as holding a competitive job for at least 50% of the 18-month follow-up period.RESULTS A total of 541 participants (n = 271 IPS; n = 270 transitional work) were randomized. Mean (SD) age was 42.2 (11) years; 99 (18.3%) were women, 274 (50.6%) were white, 225 (41.6%) were African American, and 90 (16.6%) were of Hispanic, Spanish, or Latino ethnicity. More participants in the IPS group achieved steady employment than in the transitional work group (105 [38.7%] vs 63 [23.3%]; odds ratio, 2.14; 95% CI, 1.46-3.14). A higher proportion of IPS participants attained any competitive job (186 [68.6%] vs 154 [57.0%]; P = .005) and had higher cumulative earnings from competitive jobs (median [interquartile range] $7290 [$23 174] in IPS vs $1886 [$17 167] in transitional work; P = .004). CONCLUSIONS AND RELEVANCE This multisite trial demonstrated significantly greater effectiveness of IPS-supported employment over stepwise transitional work vocational rehabilitation for veterans living with chronic PTSD. The results provide supporting evidence for increasing access to IPS for veterans living with PTSD.