Project Background/Rationale: Over 20,000 Iraq and Afghanistan War (OEF/OIF/OND) Veterans experiencing traumatic brain injury (TBI)-related sequelae are cared for by the VA each year. Although the majority of these TBIs are classified as mild, TBI of all severity levels can lead to chronic symptoms that interfere with daily functioning and contribute to disability. Unemployment rates are high among civilians with TBI and may be even higher among Veterans with TBI given common co-occurring mental and physical health conditions. The VA TBI/Polytrauma System of Care (PSC) was designed to serve Veterans with TBI in need of rehabilitative services. VACO program offices are seeking to expand Supported Employment (SE), an evidence-based vocational rehabilitation program currently provided to Veterans with serious mental illness, to Veterans with TBI who are treated in the TBI/PSC. SE is intensive relative to other vocational services and may not be the right-sized intervention for all Veterans with TBI. There is little information on the needs for or interests in vocational rehabilitation services, or the acceptability of an intensive service like SE, among Veterans with mild versus moderate or severe TBI. Project Aims: Focusing on OEF/OIF/OND Veterans with mild or moderate/severe TBI, we will: 1) quantify unemployment and describe employment challenges;2) assess knowledge and use of community and VA vocational services;3) examine interest in and acceptability of VA SE to meet Veterans'vocational needs;and 4) Identify perceived facilitators and barriers to accessing and utilizing VA SE services. Project Methods: This will be a 1-year, two-phase mixed-methods pilot study conducted through the Portland VAMC HSR&D Center, in collaboration with VACO partners and investigators from VA Centers in Boston, Minneapolis, and San Diego. In Phase 1, we will conduct six focus groups with Veterans with mild and moderate/severe TBI in Portland and Boston. Participants will be asked to discuss employment difficulties and their knowledge and perceptions of vocational services, focusing primarily on the SE model. Qualitative results will be used to modify the Phase 2 survey instrument, which will then be piloted for readability and relevance with up to 10 additional Veterans, and revised as needed prior to fielding nationally. In Phase 2, we will conduct a mailed survey of 1,800 randomly sampled OEF/OIF/OND Veterans who were confirmed to have incurred one or more TBIs during deployment. Veterans with moderate/severe TBI will be oversampled. Survey respondents will be asked to provide a detailed employment history, knowledge and receipt of VA and non-VA vocational services, and perceived barriers and facilitators to accessing and utilizing SE. Anticipated Impact: Ensuring that Veterans with TBI can access effective vocational rehabilitation services may help prevent numerous downstream health and functional problems. Knowledge from this project will identify the level of need in Veterans with TBI and will inform VACO program office efforts to expand SE to this population. Further, this project will serve as a foundation for a subsequent study in which we will examine organizational and patient factors associated with initiation of, retention in, and successful outcomes from vocational rehabilitation and SE services among Veterans in the VA TBI/PSC.
A large number of Iraq and Afghanistan War Veterans have incurred traumatic brain injury (TBI) and are seeking healthcare services in the VA TBI/Polytrauma System of Care (PSC). Unemployment rates are high among civilians with TBI and may be even higher among Veterans with TBI given common co- occurring mental and physical disorders. VACO program offices are seeking to expand evidence-based Supported Employment (SE), a highly effective vocational rehabilitation service provided to Veterans with serious mental illness, to Veterans with TBI who are treated in the TBI/PSC. This pilot project will quantify needs and interest in vocational rehabilitation services like SE among Veterans with mild versus moderate and severe TBI and will identify acceptability of, and perceived barriers and facilitators to, receiving an intensive service like SE. Subsequent work will examine organizational and patient factors associated with initiation, retention, and outcomes of vocational rehabilitation and SE among Veterans in the TBI/PSC.