Achieving Competitive Customized Employment through Specialized Services - Veterans: ACCESS-VETS

恢复就业是脊髓损伤（SCI）退伍军人的重要康复目标 因为就业影响生活质量（QOL）和寿命。由于医疗的复杂性 然而，在SCI中，这些退伍军人面临着独特的就业障碍，这些障碍没有得到充分解决 退伍军人事务部（VA）职业服务。退伍军人职业服务 SCI患者需要解决这些就业障碍，这些障碍涉及身体健康，财务，时间 找工作和照顾孩子的问题定制就业（CE），一项创新战略， 定制职业服务，以满足复杂残疾人的个人需求， 适用于SCI康复。这项研究将评估CE干预，以帮助退伍军人 与SCI发现自己的优势，定制就业计划，并找到有竞争力的综合 在他们的社区就业。建议的干预措施，实现竞争定制 就业通过专业服务（访问），是一个用户驱动的，标准化的CE计划 由受过培训的就业专家提供，对非临床，基于社区的 成年残疾人。这项研究是需要测试访问作为一个补充， 为临床定义的人群提供临床服务，并评估CE用于后续 在VA中执行。 这项建议是响应退伍军人的报告的愿望，个性化的职业康复 服务和现代化计划和使命法，强调以退伍军人为中心， 以社区为基础的护理方法。该提案的目标与 心理健康和自杀预防办公室，优先考虑证据知情，社区- 基于就业服务。认识到州和联邦机构迅速采用CE，VA 正在与残疾和就业政策办公室（劳工部）合作， 并培训VA职业人员对CE作为一个有前途的做法;然而，CE纳入标准， VA临床服务尚未实施。为了支持VA努力帮助退伍军人， 实现有竞争力的就业和重返平民生活，这项建议将评估行政长官 在现有的职业服务中。 该提案旨在评估CE干预对SCI退伍军人的影响 （ACCESS-Vets）就业结果。短期目标是确定 SCI患者的ACCESS-Vets。长期目标是指导CE的研究和采用 作为退伍军人健康管理局（VHA）循证职业服务的一部分， 改善SCI退伍军人的就业结果。建议的4年期、混合方法、多 临床试验机构随机临床试验将在SCI退伍军人样本中测试ACCESS-Vets干预 曾接受或现正接受个别就业及支援服务的人士 （治疗照常）。具体目标是：（目标1）确定ACCESS-Vets在以下方面的有效性： VHA临床环境。(Aim 2）研究就业对生活质量和参与的影响。(Aim第三章 确定IPS和ACCESS-VET中用于解决就业障碍的战略。样品 将由退伍军人（N = 100）和从业人员（N = 20）组成，他们来自佛罗里达坦帕的退伍军人机构，以及 弗吉尼亚州的里士满。目标1和目标2的数据收集将包括就业评估， 心理和社会后果。目标2和目标3的数据收集将包括电话访谈， 资深参与者及其提供者审查使用和调整干预措施的经验， 解决就业障碍。

Restoring employment is an important rehabilitation goal for Veterans with spinal cord injury (SCI) because employment impacts both quality of life (QOL) and longevity. Due to the medical complexity of SCI, however, these Veterans face unique employment barriers that are not adequately addressed by current Department of Veterans Affairs (VA) vocational services. Vocational services for Veterans with SCI need to address these employment barriers, which relate to physical health, finances, time for job search, and caregiver issues. Customized employment (CE), an innovative strategy for tailoring vocational services to meet individual needs of people with complex disabilities, could be adapted for use in SCI rehabilitation. This research will evaluate a CE intervention to help Veterans with SCI discover their strengths, customize employment plans, and find competitive integrated employment in their communities. The proposed intervention, Achieving Competitive Customized Employment through Specialized Services (ACCESS), is a user-driven, standardized CE program delivered by a trained employment specialist and is effective for a non-clinical, community-based population of adults with disabilities. This research is needed to test ACCESS as a complement to clinical services for a clinically defined population and to assess the potential of CE for subsequent implementation in the VA. This proposal is responsive to Veterans’ reported desire for individualized vocational rehabilitation services and to the Modernization Plan and the MISSION Act, which emphasize Veteran-centered, community-based approaches to care. The proposal goals align with the Transformation Plan of the Office of Mental Health and Suicide Prevention, which prioritizes evidence-informed, community- based employment services. Recognizing the rapid adoption of CE in state and federal agencies, VA is partnering with the Office of Disability and Employment Policy (Department of Labor) to introduce and train VA vocational staff on CE as a promising practice; however, integration of CE into standard VA clinical services has not yet been implemented. In support of VA efforts to assist Veterans to achieve competitive employment and reintegration into civilian life, this proposal will evaluate CE within the context of existing VA vocational services. The purpose of the proposal is to evaluate the impact of a CE intervention for Veterans with SCI (ACCESS-Vets) on employment outcomes. The short-term goal is to determine effectiveness of ACCESS-Vets for Veterans with SCI. The long-term goal is to guide research on and adoption of CE as part of evidence-informed vocational services in the Veterans Health Administration (VHA) to improve employment outcomes for Veterans with SCI. The proposed 4-year, mixed-methods, multi- site, randomized clinical trial will test the ACCESS-Vets intervention in a sample of Veterans with SCI who have received or are currently receiving Individual Placement and Support (IPS) services (treatment as usual). The specific aims are: (Aim 1) Determine the effectiveness of ACCESS-Vets in a VHA clinical setting. (Aim 2) Examine the impact of employment on QOL and participation. (Aim 3) Identify strategies used in IPS and ACCESS-Vets for addressing barriers to employment. The sample will consist of Veterans (N = 100) and practitioners (N = 20) at VA facilities in Tampa, Florida, and Richmond, Virginia. Aim 1 and 2 data collection will include assessments of employment, psychological, and social outcomes. Aim 2 and 3 data collection will include telephone interviews of Veteran participants and their providers to examine experiences using and adapting interventions to address employment barriers.