Efficacy of Supported Employment within the OIF/OEF Patient Aligned Care Team

 描述(由申请人提供)： OIF/OEF患者定向护理团队支持就业的效果背景：从伊拉克和阿富汗战争返回的退伍军人在重新融入平民生活时经常面临失业。在过去的二十年里，对个人安置和支持(IPS)支持的就业的研究已经产生了非常强劲和一致的职业康复结果。然而，IPS主要只在精神健康环境和严重精神疾病人群中进行研究。最近部署的退伍军人获得心理健康环境的机会往往被推迟数月或数年，因此，转介到职业康复方案的时间大大延误，使许多退伍军人容易受到持续失业和不断恶化的轨迹的影响。方法：这是一项单点、前瞻性、随机、对照研究，旨在评估IPS在初级保健患者定向护理团队(PACT)中的疗效，该团队被指定为持久自由行动、伊拉克自由行动和新黎明行动(OEF/OIF/OND)退伍军人。参与者将是在该公约中接受护理的OEF/OIF/OND退伍军人，他们目前处于失业状态，除严重精神疾病外，有残疾或可能残疾Axis I诊断，并将 按1：1随机分为IPS或VHA标准护理，称为过渡期工作计划。与过渡性工作计划(控制条件)相比，在协议内提供的IPS假设会导致更高的稳定工作率，如在竞争性工作(主要)的12个月随访期内50%的周工作定义；生活质量和自尊(次要)，改善社区重新融入(探索性)，改善精神症状(探索性)，以及较低的高强度危机事件/服务的比率(探索性)。此外，在协议内交付的IPS将是可行的，并产生非常好的退伍军人满意度。意义：在一种创新的方法中，这项研究打破了诊断分类方法和精神健康治疗环境，并评估了在初级保健环境中提供IPS的效果，特别是在服务于从伊拉克或阿富汗冲突中返回的退伍军人的协议。这项研究进行了重大的范式转变，将有史以来第一次将IPS纳入协定。这项研究与改善职业成果和促进OEF/OIF/OND退伍军人恢复的RR&D优先领域直接相关。

 DESCRIPTION (provided by applicant): Efficacy of Supported Employment within the OIF/OEF Patient Aligned Care Team Background: Veterans returning from Iraq and Afghanistan wars often confront unemployment as they reintegrate into civilian life. Over the past two decades, studies of Individual Placement and Support (IPS) supported employment have yielded remarkably robust and consistent vocational rehabilitation outcomes. However, IPS has predominantly only been studied in mental health settings and in the seriously mentally ill populations. Access to a mental health setting for recently deployed Veterans is often delayed by months or years, and thus, result in substantial delay of referrals to vocational rehabilitation programs which leave many Veterans vulnerable to continued unemployment and a deteriorating trajectory. Methods: This is a single site, prospective, randomized, controlled study to evaluate the efficacy of IPS when delivered within a primary care Patient Aligned Care Team (PACT) designated for Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) Veterans. Participants will be OEF/OIF/OND Veterans receiving care in the PACT who are currently unemployed and have a disabling or potentially disabling Axis I diagnosis, other than a serious mental illness and will be randomized 1:1 to either IPS or the VHA standard of care called Transitional Work Program. Compared to Transitional Work Program (control condition), IPS delivered within a PACT is hypothesized to result in a higher rate of steady workers, as defined by working >50% of the weeks in the 12-month follow-up period in a competitive job (primary); quality of life, and self esteem (secondary), improved community re-integration (exploratory), improved psychiatric symptoms (exploratory), and lower rates of high intensity crisis events/services (exploratory). In addition, IPS delivered within a PACT will be feasible and yield very good Veteran satisfaction. Significance: In an innovative approach, this study breaks from the diagnostic categorical approach and the mental health treatment setting and evaluates the efficacy of IPS when delivered in a primary care setting, specifically a PACT that serves Veterans who have returned from the Iraq or Afghanistan conflicts. Making a substantial paradigm shift, this study will integrate IPS within a PACT for the first time ever. The research is directly linked to the RR&D priority areas of improving vocational outcomes and promoting recovery in OEF/OIF/OND Veterans.