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功效

• 批准号: 8862128
• 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/8862128
• 关键词: Address; Afghanistan; Area; Back; Bipolar I; Caring; Categories; Client satisfaction; Clinic; Communities; Conflict (Psychology); Diagnosis; Diagnostic; Disabled Persons; Employment; Event; Face; Freedom; Health; Health Services Accessibility; Healthcare; Home environment; Hospital Costs; Individual; Iraq; Left; Life; Link; Location; Major Depressive Disorder; Medical; Mental Health; Mental disorders; Mentally Ill Persons; Methods; Modeling; Modification; Occupations; Outcome; Participant; 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; Symptoms; Target Populations; Time; Unemployment; Veterans; Vocational rehabilitation; War; Work; base; cohort; community reintegration; evidence base; follow-up; improved; innovation; meetings; operation; patient oriented; primary care setting; programs; prospective; 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）： 在OIF/OEF患者一致的护理团队背景下，支持就业的疗效：从伊拉克和阿富汗战争中返回的退伍军人在重新融入平民生活时通常会遇到失业。在过去的二十年中，个人安置和支持（IPS）支持就业的研究产生了非常强大且一致的投票康复结果。但是，IPS主要仅在心理健康环境和严重精神疾病的人群中研究。最近部署退伍军人的心理健康环境通常会延迟数月或数年，因此导致投票康复计划的转介大幅度延迟，这些计划使许多退伍军人容易受到持续失业和恶化的轨迹。方法：这是一个单一的站点，前瞻性，随机，对照研究，可评估IPS在初级护理患者对齐护理团队（PACT）中的有效性，该小组旨在持久运营，持久自由，伊拉克自由运营和运营新黎明（OEF/OIF/OIF/OND）退伍军人。参与者将是OEF/OIF/OND退伍军人在协议中接受护理的人，他们目前失业，有残疾或潜在的轴心I诊断，除了严重的精神疾病外， 将1：1随机分配给IPS或称为过渡工作计划的VHA护理标准。与过渡工作计划（控制条件）相比，假设在协议内交付的IP会导致稳定工人的率更高，这是由在竞争性工作（主要）中12个月的随访期（主要）中的12个月随访期（初级）的工作定义的；生活质量和自尊（次要），改善社区重新融合（探索性），改善精神病症状（探索性）和较低的高强度危机事件/服务率（探索性）。此外，在协议内交付的IP是可行的，并产生非常好的退伍军人满意度。意义：在一种创新的方法中，这项研究从诊断性的分类方法和心理健康治疗环境中脱颖而出，并评估在初级保健环境中交付IPS的有效性，特别是为从伊拉克或阿富汗冲突中返回的退伍军人服务的协定。进行大量的范式转变，这项研究将首次将IPS纳入协议。该研究直接与改善选民成果和促进OEF/OIF/OND退伍军人恢复的RR＆D优先领域有关。