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

恢复就业是脊髓损伤退伍军人的重要康复目标 因为就业既影响生活质量(QOL)又影响寿命。由于医疗上的复杂性 然而，这些退伍军人面临着独特的就业障碍，这些障碍没有得到充分的解决 由现任退伍军人事务部(VA)职业服务部提供。为退伍军人提供职业服务 SCI需要解决这些就业障碍，这些障碍涉及身体健康、财务、时间 找工作和照顾者的问题。定制就业(CE)，一种创新的战略 量身定做职业服务以满足复杂残疾人的个人需求，可能是 适用于脊髓损伤的康复。这项研究将评估CE干预对退伍军人的帮助 与SCI一起发现自己的优势，定制就业计划，找到具有竞争力的一体化 在他们所在的社区就业。建议的干预，实现有竞争力的定制 通过专业化服务就业(Access)是一项由用户驱动的标准化CE计划 由训练有素的就业专家提供，适用于非临床、基于社区的 残疾成年人的人口。需要此研究来测试访问，作为对 为临床确定的人群提供临床服务，并评估CE在未来 在退伍军人事务部实施。 这项建议回应了退伍军人对个性化职业康复的报道 以及强调以退伍军人为中心的现代化计划和使命法， 以社区为基础的护理方法。提案目标与转型计划保持一致 心理健康和自杀预防办公室，其优先考虑的是循证、社区- 以就业为基础的服务。认识到州和联邦机构迅速采用CE，弗吉尼亚州 正在与残疾和就业政策办公室(劳工部)合作推出 并对退伍军人职业人员进行CE培训，作为一种有前途的做法；然而，将CE整合到标准中 退伍军人管理局临床服务尚未实施。支持退伍军人管理局帮助退伍军人 实现有竞争力的就业和重新融入平民生活，这项建议将评估行政长官 在现有退伍军人管理局职业服务的范围内。 该提案的目的是评估CE干预对患有脊髓损伤的退伍军人的影响 (Access-Vets)关于就业结果的。短期目标是确定以下措施的有效性 有SCI的退伍军人的访问-兽医。长期目标是指导对CE的研究和采用 作为退伍军人健康管理局(VHA)循证职业服务的一部分， 改善患有脊髓损伤的退伍军人的就业结果。拟议的4年期、混合方法、多年期 现场，随机临床试验将在患有脊髓损伤的退伍军人样本中测试Access-Vets干预 已经或正在接受个人安置和支持(IPS)服务的人 (照常治疗)。具体目标是：(目标1)确定准入兽医在#年的效力 VHA临床环境。(目标2)研究就业对生活质量和参与度的影响。(目标3) 确定IPS和Access-Vet中用于解决就业障碍的策略。样本 将由佛罗里达州坦帕市退伍军人协会的退伍军人(N=100)和从业者(N=20)组成， 弗吉尼亚州里士满。目标1和目标2的数据收集将包括对就业的评估， 心理上和社会上的结果。目标2和目标3的数据收集将包括电话采访 资深参与者和他们的提供者检查使用和调整干预措施的经验 解决就业障碍。

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.