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

 描述（由申请人提供）： OIF/OEF患者护理团队内支持就业的功效背景：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，个人安置和支持（IPS）支持就业的研究已经取得了非常强大和一致的职业康复成果。然而，IPS主要只在精神卫生环境和严重精神疾病人群中进行了研究。最近部署的退伍军人获得心理健康环境往往被推迟数月或数年，因此，导致转介到职业康复计划的大量延迟，使许多退伍军人容易受到持续失业和恶化的影响。研究方法：这是一项单中心、前瞻性、随机、对照研究，旨在评价IPS在指定用于持久自由行动、伊拉克自由行动和新黎明行动（OEF/OIF/OND）退伍军人的初级保健患者对齐护理团队（PACT）内提供的疗效。参与者将是OEF/OIF/OND退伍军人，他们目前失业，患有严重精神疾病以外的致残或潜在致残Axis I诊断，并将在PACT中接受治疗。 以1：1的比例随机分配至IPS或VHA标准治疗（称为过渡性工作计划）。与过渡工作计划相比（对照条件），假设在PACT内提供的IPS导致稳定工人的比率更高，如在12个月随访期内在竞争性工作（主要）中工作>50%的周所定义的;生活质量和自尊（次要），改善社区重新融合（探索性），改善精神症状（探索性），降低高强度危机事件/服务的发生率（探索性）。此外，在PACT内提供的IPS将是可行的，并产生非常好的退伍军人满意度。重要性：在一种创新的方法中，本研究打破了诊断分类方法和心理健康治疗环境，并评估了IPS在初级保健环境中提供的疗效，特别是为从伊拉克或阿富汗冲突返回的退伍军人提供服务的PACT。这项研究将有史以来第一次将IPS整合到PACT中，这是一个重大的范式转变。该研究与改善职业成果和促进OEF/OIF/OND退伍军人康复的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.