Exploring Barriers and Facilitators of Employment in Veterans with Opioid Use Disorders

意义：患有阿片类药物使用障碍（OUD）的人可以获得和维持就业 一个重大的挑战。目前有OUD的成年人失业的可能性更大 与过去OUD或没有终身OUD的人相比，收入更少。对于大多数 在治疗OUD的过程中，就业是他们康复之旅的重要组成部分。 就业有几个好处，包括减少对症状的关注，社会孤立， 自杀、绝望和经济不稳定的风险，这往往导致无家可归。然而，在这方面， 随着COVID-19大流行的到来，大量退伍军人失去了工作， 目前正在寻找有意义和有竞争力的工作。个人安置和支持（IPS） 一个基于证据的支持就业干预，被认为是黄金标准， 职业康复只有一项小型研究检查了IPS在个人中的有效性 OUD接受美沙酮维持治疗（n=45），发现50%的IPS参与者获得了 6个月时，竞争性就业与5%的等待名单对照参与者相比（p<0.001）。之前 为OUD启动一项有充分理由的大规模IPS研究，更好地了解障碍， 在这个独特的患者群体中，需要促进者、偏好和就业便利， 更好地为从OUD中恢复的退伍军人定制IPS交付。 具体目标：审查持续就业的障碍和促进因素，包括评估 就业挑战、职业功能、社区融合和生活质量， 退伍军人对OUD诊断的满意度。 方法和程序：这项试点研究主要采用定性设计，具体来说， 现象学还将收集定量数据，以更好地了解患者人群， 将包括（a）社会人口信息，如年龄、教育水平、就业历史， 收入和收入来源、住房和无家可归经历（B）药物使用史， (c)心理健康-特别是抑郁症，（d）职业功能，（e） 生活相关的信息。利用现象学方法，定性访谈将进行与 50名退伍军人，其中至少6人正在或将从事IPS服务，6人职业康复 专家（包括4名IPS专家），6名心理健康或成瘾康复提供者，以及至少6名 雇主/潜在雇主，他们可能已经或愿意雇用OUD患者。的 参与者必须在参与前阅读并签署IRB批准的知情同意书。开展 数据分析，现象学研究中程序数据分析的七个步骤将被使用。 这种方法检查参与者对所调查现象的相关含义， 为研究人员提供了识别新兴主题的能力。Priestion，一个归纳主题 方法将被用作数据分析的主要方法。 结论：该SPiRE提案解决了一个缺乏初步数据的领域， 紧急需求的知识，为OUD量身定制的IPS干预的改进提供信息， 早期职业调查员进行小型研究，允许高级调查员探索新的研究 利用调查人员的优势和专业知识，并提高所需的知识， 促进从OUD中康复的退伍军人成功康复和重返社会，特别是 于2019冠状病毒病大流行期间及之后。

Significance: Living with an opioid use disorder (OUD) can make obtaining and sustaining employment a significant challenge. Adults who have a current OUD are significantly more likely to be unemployed and make less income compared to those with past OUD or those without lifetime OUD. For most individuals in treatment for an OUD, being employed is an important part of their recovery journey. Employment has several benefits, including reductions in preoccupation with symptoms, social isolation, risk of suicide, hopelessness, and economic instability, which often results in homelessness. However, with the advent of the COVID-19 pandemic, a significant number of Veterans have lost their jobs are currently seeking meaningful and competitive employment. Individual Placement and Support (IPS) is an evidenced-based supported employment intervention that is considered the gold standard of vocational rehabilitation. Only one small study has examined the effectiveness of IPS among individuals with OUD on methadone maintenance (n=45) and found that 50% of the IPS participants gained competitive employment compared to 5% of the waitlist control participants at 6 months (p<0.001). Prior to launching a well-warranted large-scale study of IPS for OUD, a better understanding of the barriers, facilitators, preferences, and employment accommodations in this unique patient population is needed to better tailor IPS delivery for Veterans recovering from OUD. Specific Aim: Examine the barriers and facilitators of sustained employment, including evaluation of employment challenges, occupational functioning, community integration, and quality of life and satisfaction among Veterans with OUD diagnosis. Methods and Procedures: This pilot study primarily utilizes a qualitative design, specifically phenomenology. Quantitative data will also be collected to better understand the patient population and will include (a) socio-demographic information such as age, level of education, employment history, income and source of income, housing and experiences with homelessness (b) history of substance use, (c) mental health- specifically depressive symptomology, (d) occupational functioning, and (e) quality of life related information. Utilizing phenomenology approach, qualitative interviews will be conducted with 50 Veterans, at least 6 of whom are or will be engaged in IPS services, 6 vocational rehabilitation specialists (includes 4 IPS specialists), 6 mental health or addiction recovery providers, and at least 6 employers/potential employers who may have or would be willing to employ persons with OUD. The participants must read and sign an IRB-approved informed consent prior to participating. To conduct the data analyses, the seven steps to procedural data analysis in phenomenological studies will be utilized. This approach examines participants associated meanings to the phenomenon under investigation and provides researchers the ability to identify the emerging themes. Primarily, an inductive thematic approach will be utilized as the primary method of data analysis. Conclusion: This SPiRE proposal addresses an area that lacks preliminary data, gathers new knowledge for an urgent need, informs the refinement of a tailored IPS intervention for OUD, allows an early career investigator to conduct a small study, allows a senior investigator to explore a new research area, leverages the investigators’ strengths and expertise, and advances the knowledge needed to promote successful recovery and reintegration into society for Veterans recovering from OUD, especially during and after the COVID-19 pandemic.