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

OIF/OEF 患者协调护理团队内支持性就业的有效性

• 批准号: 9229481
• 负责人: LORI L. DAVIS
• 金额: --
• 依托单位: TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9229481
• 关键词: Address; Afghanistan; Area; Back; Bipolar I; Caring; Categories; Client satisfaction; Clinic; Communities; Conflict (Psychology); Diagnosis; Diagnostic; Disabled Persons; Disease; Employment; Event; Face; Freedom; Health; Health Services Accessibility; Healthcare; Home environment; Hospital Costs; Individual; Iraq; Life; Link; Location; Major Depressive Disorder; Medical center; Mental Health; Mental disorders; Mentally Ill Persons; Methods; Modeling; Modification; Occupations; Outcome; Participant; Patient Care; Patient-Centered Care; Patients; Persons; Population; Post-Traumatic Stress Disorders; Primary Health Care; Provider; Psychologist; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Rehabilitation Outcome; Research; Role; Schizophrenia; Services; Site; Social Workers; Specialist; Supported Employment; Target Populations; Time; Unemployment; Veterans; Vocational rehabilitation; War; Work; base; cohort; community reintegration; evidence base; follow-up; improved; innovation; operation; patient oriented; primary care setting; programs; prospective; psychiatric symptom; public health relevance; response; satisfaction; self esteem; severe mental illness; standard of care; stem

 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.

 描述（由申请人提供）： OIF/OEF 患者协调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问题。在过去的二十年中，对个人安置和支持（IPS）支持就业的研究已经取得了非常稳健和一致的职业康复成果。然而，IPS 主要仅在心理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进入心理健康机构的时间往往会延迟数月或数年，因此导致转介职业康复计划的时间大大延迟，这使许多退伍军人容易面临持续失业和恶化的轨迹。方法：这是一项单中心、前瞻性、随机对照研究，旨在评估 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联合护理团队 (PACT) 中实施时的疗效。参与者将是在 PACT 中接受护理的 OEF/OIF/OND 退伍军人，他们目前处于失业状态，患有严重精神疾病以外的致残或潜在致残 Axis I 诊断，并且将 以 1:1 的比例随机分配至 IPS 或 VHA 标准护理（称为过渡工作计划）。与过渡性工作计划（对照条件）相比，假设在 PACT 内提供的 IPS 会带来更高的稳定工人率，定义为在 12 个月的随访期内，有超过 50% 的周时间从事竞争性工作（主要）；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），以及降低高强度危机事件/服务的发生率（探索性）。此外，在 PACT 内交付的 IPS 将是可行的，并且会产生非常好的退伍军人满意度。意义：本研究采用创新方法，突破了诊断分类方法和心理健康治疗环境，评估了 IPS 在初级保健环境中的疗效，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 IPS 首次整合到 PACT 中，这是一次重大的范式转变。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。