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

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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.