Supported Employment for Veterans with Traumatic Brain Injury: Needs and Barriers

描述（由申请人提供）： 项目背景/依据：每年有超过20，000名伊拉克和阿富汗战争（OEF/OIF/OND）退伍军人经历创伤性脑损伤（TBI）相关后遗症，由VA照顾。虽然这些TBI中的大多数被归类为轻度，但所有严重程度的TBI都可能导致干扰日常功能并导致残疾的慢性症状。TBI平民的失业率很高，考虑到常见的精神和身体健康状况，TBI退伍军人的失业率可能更高。VA TBI/多创伤护理系统（PSC）旨在为需要康复服务的TBI退伍军人提供服务。VACO计划办公室正在寻求扩大支持就业（SE），这是一个基于证据的职业康复计划，目前提供给患有严重精神疾病的退伍军人，也提供给在TBI/PSC接受治疗的TBI退伍军人。SE相对于其他职业服务是密集的，可能不是所有TBI退伍军人的正确干预规模。有很少的信息需要或职业康复服务的利益，或接受密集的服务，如SE，在退伍军人与轻度与中度或重度TBI。项目目标：关注OEF/OIF/OND退伍军人轻度或中度/重度TBI，我们将：1）量化失业并描述就业挑战; 2）评估社区和VA职业服务的知识和使用; 3）检查VA SE的兴趣和可接受性，以满足退伍军人的职业需求;和4）识别感知的促进者和障碍，以获得和利用VA SE服务。项目方法：这将是一项为期1年的两阶段混合方法试点研究，通过波特兰VAMC HSR&D中心与VACO合作伙伴和波士顿、明尼阿波利斯和圣地亚哥VA中心的研究人员合作进行。在第一阶段，我们将在波特兰和波士顿对患有轻度和中度/重度TBI的退伍军人进行六个焦点小组。参加者将被要求讨论就业困难及其对职业服务的知识和看法，主要侧重于SE模式。定性结果将用于修改第二阶段的调查工具，然后将与多达10名额外的退伍军人进行可读性和相关性的试点，并在全国部署之前根据需要进行修订。在第二阶段，我们将对1,800名随机抽样的OEF/OIF/OND退伍军人进行邮寄调查，这些退伍军人被证实在部署期间发生了一次或多次TBI。中度/重度TBI的退伍军人将过采样。调查受访者将被要求提供详细的就业历史，知识和VA和非VA职业服务的接收，以及访问和利用SE的感知障碍和促进者。预期影响：确保TBI退伍军人能够获得有效的职业康复服务可能有助于防止许多下游健康和功能问题。该项目的知识将确定TBI退伍军人的需求水平，并将告知VACO计划办公室努力将SE扩展到这一人群。此外，该项目将作为后续研究的基础，我们将研究与VA TBI/PSC中退伍军人职业康复和SE服务的启动，保留和成功结果相关的组织和患者因素。

DESCRIPTION (provided by applicant): Project Background/Rationale: Over 20,000 Iraq and Afghanistan War (OEF/OIF/OND) Veterans experiencing traumatic brain injury (TBI)-related sequelae are cared for by the VA each year. Although the majority of these TBIs are classified as mild, TBI of all severity levels can lead to chronic symptoms that interfere with daily functioning and contribute to disability. Unemployment rates are high among civilians with TBI and may be even higher among Veterans with TBI given common co-occurring mental and physical health conditions. The VA TBI/Polytrauma System of Care (PSC) was designed to serve Veterans with TBI in need of rehabilitative services. VACO program offices are seeking to expand Supported Employment (SE), an evidence-based vocational rehabilitation program currently provided to Veterans with serious mental illness, to Veterans with TBI who are treated in the TBI/PSC. SE is intensive relative to other vocational services and may not be the right-sized intervention for all Veterans with TBI. There is little information on the needs for or interests in vocational rehabilitation services, or the acceptability of an intensive service like SE, among Veterans with mild versus moderate or severe TBI. Project Aims: Focusing on OEF/OIF/OND Veterans with mild or moderate/severe TBI, we will: 1) quantify unemployment and describe employment challenges; 2) assess knowledge and use of community and VA vocational services; 3) examine interest in and acceptability of VA SE to meet Veterans' vocational needs; and 4) Identify perceived facilitators and barriers to accessing and utilizing VA SE services. Project Methods: This will be a 1-year, two-phase mixed-methods pilot study conducted through the Portland VAMC HSR&D Center, in collaboration with VACO partners and investigators from VA Centers in Boston, Minneapolis, and San Diego. In Phase 1, we will conduct six focus groups with Veterans with mild and moderate/severe TBI in Portland and Boston. Participants will be asked to discuss employment difficulties and their knowledge and perceptions of vocational services, focusing primarily on the SE model. Qualitative results will be used to modify the Phase 2 survey instrument, which will then be piloted for readability and relevance with up to 10 additional Veterans, and revised as needed prior to fielding nationally. In Phase 2, we will conduct a mailed survey of 1,800 randomly sampled OEF/OIF/OND Veterans who were confirmed to have incurred one or more TBIs during deployment. Veterans with moderate/severe TBI will be oversampled. Survey respondents will be asked to provide a detailed employment history, knowledge and receipt of VA and non-VA vocational services, and perceived barriers and facilitators to accessing and utilizing SE. Anticipated Impact: Ensuring that Veterans with TBI can access effective vocational rehabilitation services may help prevent numerous downstream health and functional problems. Knowledge from this project will identify the level of need in Veterans with TBI and will inform VACO program office efforts to expand SE to this population. Further, this project will serve as a foundation for a subsequent study in which we will examine organizational and patient factors associated with initiation of, retention in, and successful outcomes from vocational rehabilitation and SE services among Veterans in the VA TBI/PSC.