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

探索患有阿片类药物使用障碍的退伍军人就业的障碍和促进因素

• 批准号: 10252451
• 负责人: Mercy N Mumba
• 金额: --
• 依托单位: TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10252451
• 关键词: Address; Adult; Age; Alabama; Alcohols; Area; Attention; COVID-19 pandemic; Capital; Cessation of life; Client; Communities; Community Integration; County; Criminal Justice; Data; Data Analyses; Deterioration; Diagnosis; Economic Burden; Economic Recession; Economics; Educational Background; Effectiveness; Emotional; Employment; Employment Opportunities; Employment Status; Evaluation; Feeling hopeless; Geography; Gold; Health; Health Care Costs; Health Personnel; Homelessness; Hour; Housing; Income; Individual; Informed Consent; Institutional Review Boards; Intervention; Interview; Investigation; Knowledge; Left; Measurable; Medical; Mental Depression; Mental Health; Methods; Occupational; Occupational Status; Occupations; Opioid; Outcome; Overdose; Pain; Participant; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Post-Traumatic Stress Disorders; Poverty; Predisposition; Prevention; Procedures; Productivity; Professional counselor; Provider; Public Health; Quality of life; Recommendation; Recording of previous events; Recovery; Relapse; Research; Research Personnel; Resources; Services; Social Well-Being; Social isolation; Societies; Source; Specialist; Substance Use Disorder; Suicide; Supported Employment; Symptoms; Testing; Unemployment; Uninsured; United States; Veterans; Vocational rehabilitation; Waiting Lists; Work; addiction; base; career; chronic painful condition; community reintegration; comorbidity; cost; depressive symptoms; design; disorder later incidence prevention; evidence base; experience; experimental study; health care availability; health care service utilization; improved; methadone treatment; middle age; mortality; opioid epidemic; opioid overdose; opioid use; opioid use disorder; pandemic disease; patient oriented; patient population; phenomenological models; preference; prescription opioid; professor; programs; rehabilitation service; rural area; satisfaction; sociodemographics; substance use; substance use treatment; suicidal risk; treatment program

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.

意义：患有阿片类药物使用障碍 (OUD) 可以使获得和维持就业变得困难 拥有当前 OUD 的成年人失业的可能性明显更大。 对于大多数人来说，与过去拥有 OUD 或没有终生 OUD 的人相比，收入较少。 对于正在接受 OUD 治疗的人来说，就业是他们康复过程中的重要组成部分。 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，往往导致无家可归。 随着 COVID-19 大流行的到来，大量退伍军人失去了工作 个人安置和支持 (IPS) 目前正在寻找有意义且有竞争力的就业机会。 被认为是黄金标准的基于证据的支持性就业干预措施 只有一项小型研究检验了 IPS 对个人的有效性。 与 OUD 进行美沙酮维持治疗 (n=45)，发现 50% 的 IPS 参与者获得了 与 6 个月时 5% 的候补对照参与者相比，竞争性就业（p<0.001）。 为 OUD 发起一项有充分依据的 IPS 大规模研究，更好地了解障碍， 需要针对这一独特患者群体的促进者、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、社区融合以及生活质量和 退伍军人对 OUD 诊断的满意度。 方法和程序：该试点研究主要采用定性设计，特别是 还将收集定量数据，以更好地了解患者群体和 将包括 (a) 社会人口统计信息，例如年龄、教育水平、工作经历、 收入和收入来源、住房和无家可归的经历 (b) 药物使用史， (c) 心理健康——特别是抑郁症状，(d) 职业功能，以及 (e) 工作质量 利用现象学方法，进行定性访谈。 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 可能已经或愿意雇用 OUD 人员的雇主/潜在雇主。 参与者在参与之前必须阅读并签署 IRB 批准的知情同意书。 数据分析，将利用现象学研究中程序数据分析的七个步骤。 这种方法检查参与者与所调查现象的相关含义，并 主要为研究人员提供识别新兴主题的能力。 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，收集了新的数据 紧急需求的知识，为 OUD 定制 IPS 干预的完善提供信息，允许 早期职业调查员进行小型研究，允许高级调查员探索新研究 领域，利用研究人员的优势和专业知识，并推进所需的知识 促进从 OUD 中康复的退伍军人成功康复并重新融入社会，特别是 COVID-19 大流行期间和之后。