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Experiences of VA vocational and education training and assistance services: Facilitators and barriers reported by veterans with disabilities

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Objective: To understand the experiences of veterans with disabilities and caregiving needs who use Department of Veterans Affairs (VA) vocational and education services, including Supported Employment, the Post-9/11 GI Bill, and Vocational Rehabilitation and Employment. Method: We conducted 26 joint semistructured interviews with post-9/11 veterans who had used at least one of three vocational and education services, and their family members who were enrolled in a VA Caregiver Support Program. Results: VA vocational and education services helped veterans with disabilities transition from the military into civilian life by providing skills and incremental exposure to engaging in everyday life tasks. Veteran motivation, caregiver support, and engaged staff at VA and academic institutions were key drivers of veteran success. Veterans who experienced challenges cited the following barriers: health problems, concerns about benefits loss if they became employed, and VA and academic programs that did not accommodate the needs of nontraditional veteran learners. Conclusions and implications for practice: There is a need to bolster VA vocational and educational services for veterans with disabilities in several domains, including modifying the roles of frontline staff and increasing communication between vocational counselors and health care teams to better accommodate the veteran's health-related limitations. Providing a vocational rehabilitation navigator to help veterans identify opportunities within VA and work/educational settings that are a good match for the veteran's goals and abilities could also be beneficial across vocational and educational services. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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Selecting benchmarking system for vocational education informatization, guiding vocational college informatization construction and responding to the demands of the era of “Internet+” are important issues for vocational education informatization construction and also important contents for vocational education development. To that end, the article is given priority to with benchmarking method To thought, to extract the benchmarking standards as the goal, the comprehensive many kinds of research methods, combined with the characteristics of vocational education informationization, established a set of informatization level of business support, information technology, information technology, information management and information technology application performance continuous development ability of five dimensions, depth of coverage, the information technology application of information technology and information technology intensive degree, information technology business synergy degree of 26 observation indexes such as benchmarking system vocational education informatization evaluation standard system, And how to set the observation content of 26 observation indexes is systematically expounded.
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Background: Family caregivers might enhance veteran engagement in health and nonhealth services (i.e., vocational/educational assistance). Purpose: To describe how veterans with disabilities perceive their recovery needs, identify types of social support from caregivers that help veterans engage in Veterans Affairs (VA) health and nonhealth services, and explore participant views of VA institutional support for caregivers to help veterans engage in these services. Methods: Joint in-depth qualitative interviews with U.S. veterans and family caregivers (n = 26). Findings: Caregivers performed social support functions that helped veterans engage in health and vocational/educational services and institutional support from VA enhanced caregivers' capacity. Discussion: Caregivers are well positioned to align health and nonhealth services with patient needs to enhance recovery. Staffing a point person for caregivers within the health system is key to help families develop a coordinated plan of treatment and services to improve patient success across health and nonhealth domains. Nurses are well suited to perform this role.
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Evidence suggests that Iraq and Afghanistan war veterans with polytrauma/traumatic brain injury (TBI) history and neurobehavioral symptoms may face difficulties returning to work, yet also encounter barriers to accessing, navigating, and engaging in Department of Veterans Affairs (VA) vocational rehabilitation programs. This study utilized qualitative interviews and focus groups with veterans with documented polytrauma/TBI history to explore veterans' perceived barriers to employment and vocational rehabilitation program participation, as well as to solicit thoughts regarding interest in an evidence-based vocational rehabilitation program, the Individual Placement and Support model of Supported Employment (IPS-SE). Veterans identified physical, emotional, cognitive, and interpersonal barriers to finding and maintaining work that they described as linked with their polytrauma/TBI symptoms and sequelae. Communication and logistical issues were described as the primary barriers to vocational rehabilitation program access, while barriers to program utilization included eligibility characteristics, fear of losing financial benefits, and a military-cultural belief of self-sufficiency that made help-seeking difficult. Finally, veterans endorsed key aspects of IPS-SE, such as staff serving as translators, advocates, and navigators of the job search and maintenance process. Policy recommendations are addressed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how Veterans’ use of Veteran Affairs health care and total health care costs changed in 6-month intervals up to 3 years after PCAFC enrollment. The control group was an inverse probability of treatment weighted sample of Veterans whose caregivers applied for, but were not accepted into, PCAFC. Veterans in PCAFC had similar acute care utilization postenrollment when compared with those in the control group, but significantly greater primary, specialty, and mental health outpatient care use at least 30, and up to 36, months postenrollment. Estimated total health care costs for PCAFC Veterans were $1,500 to $3,400 higher per 6-month interval than for control group Veterans. PCAFC may have increased Veterans’ access to care.
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U.S. universities are witnessing an influx of student veterans who have been under chronic stress, have suffered injuries, and currently exhibit symptoms of Post Traumatic Stress Disorder (PTSD). This study utilized quantitative survey data to test a model of what causes alienation on campus among student veterans. We then present quotations from student veterans describing the types of situations they find alienating. The results have direct implications for how student affairs professionals may help veterans succeed in college.
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The unemployment rate is currently higher among women Veterans than among male Veterans and civilian women. Employment is a key social determinant of health, with unemployment being strongly associated with adverse health. To identify military-related and health-related characteristics associated with unemployment in women Veterans. Secondary analysis of workforce participants (n=1605) in the National Survey of Women Veterans telephone survey. Demographics, mental health conditions, health care utilization, and military experiences and effects. Unemployment was defined as being in the labor force but unemployed and looking for work. The χ analyses to identify characteristics of unemployed women Veterans; logistic regression to identify independent factors associated with unemployment. Ten percent of women Veterans were unemployed. Independent correlates of unemployment were screening positive for depression [odds ratio (OR)=4.7; 95% confidence interval [CI], 1.8-12.4], military service during wartime (OR=2.9; 95%, CI 1.1-7.3), and service in the regular military (vs. in the National Guards/Reserves only) (OR=6.8; 95% CI, 2.2-20.5). Two postactive duty perceptions related to not being respected and understood as a Veteran were each independently associated with unemployment. Whether depression underlies unemployment, is exacerbated by unemployment, or both, it is critical to identify and treat depression among women Veterans, and also to investigate women Veterans' experiences and identities in civilian life. Community-based employers may need education regarding women Veterans' unique histories and strengths. Women who served in the regular military and during wartime may benefit from job assistance before and after they leave the military. Gender-specific adaptation of employment services may be warranted.
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Unemployment is a primary functional deficit for the majority of adults with schizophrenia. Research indicates that over two-thirds of adults living in the community with schizophrenia are unemployed. Despite effective programs to assist with job identification and placement, the ability to attain and maintain employment remains a pressing concern. Neurocognitive functioning is widely acknowledged to be a determinant of work outcome; however, effect sizes tend to be in the small to medium range. The present study sought to further understand the determinants of work outcome among a sample of 104 veterans with schizophrenia enrolled in a supported employment program. A small percentage of veterans in the study got competitive jobs; 53% who secured jobs maintained employment for longer than 6 months. Cognition, social cognition, and symptoms were unrelated to job attainment. However, speed of processing and social cognition were significant predictors of work outcomes such as wages and tenure. These findings suggest that cognitive abilities including processing speed and the ability to accurately interpret and respond to social cues are significant determinants of whether individuals with schizophrenia remain employed. The results are discussed in light of current available treatment options and domains to target in synergy with work rehabilitation efforts.
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To identify the prevalence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain in Veterans from Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND), Veterans who received any inpatient or outpatient care from Veterans Health Administration (VHA) facilities from 2009 to 2011 were studied. A subset of Veterans was identified who were diagnosed with TBI, PTSD, and/or pain (head, neck, or back) as determined by their International Classification of Diseases-9th Revision-Clinical Modification codes. Between fiscal years 2009 and 2011, 613,391 Veterans accessed VHA services at least once (age: 31.9 +/- 9.6 yr). TBI diagnosis in any 1 year was slightly less than 7%. When data from 3 years were pooled, 9.6% were diagnosed with TBI, 29.3% were diagnosed with PTSD, and 40.2% were diagnosed with pain. The full polytrauma triad expression (TBI, PTSD, and pain) was diagnosed in 6.0%. Results show that increasing numbers of Veterans from OIF/OEF/OND accessed VHA over a 3 year period. Among those with a TBI diagnosis, the majority also had a mental health disorder, with approximately half having both PTSD and pain. While the absolute number of Veterans increased by over 40% from 2009 to 2011, the proportion of Veterans diagnosed with TBI and the high rate of comorbid PTSD and pain in this population remained relatively stable.
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High rates of mental health conditions and unemployment are significant problems facing Veterans of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF). We examined two national Veterans Health Administration (VHA) databases from fiscal years 2008-2009: a larger database (n = 75,607) of OIF/OEF Veterans with posttraumatic stress disorder, depression, substance use disorder, or traumatic brain injury (TBI) and a smaller subset (n = 1,010) of those Veterans whose employment was tracked during their participation in VHA vocational services. Only 8.4% of Veterans in the larger database accessed any vocational services and retention was low, with most Veterans attending one or two appointments. Veterans with TBI and with more mental health conditions overall were more likely to access vocational services. Only 2.2% of Veterans received evidence-based supported employment. However, supported employment was effective, with 51% of those Veterans receiving it obtaining competitive work. Effect sizes quantifying the effect of supported employment provision on competitive work attainment, number of jobs, job tenure, and retention in vocational services were large. Given the high success rate of supported employment for these Veterans, additional supported employment specialists for this population would be expected to improve work outcomes for post-9/11 Veterans who want assistance returning to work.
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When the Post-9/11 Veterans Educational Assistance Act--better known as the Post-9/11 GI (Government Issue) Bill--was signed into law on June 20, 2008, it represented the largest expansion of veterans' education benefits since passage of the original GI Bill in 1944. The new GI Bill took effect on August 1, 2009, thereby increasing the higher education benefits available to individuals who served on active duty in the U.S. armed forces after September 10, 2001. One year later, more than half a million current and former service members had applied for eligibility certification (Carter, 2010) and just over 300,000 had used the benefits to enroll in higher education (White House, 2010). Because a student's Post-9/11 GI Bill benefits depend on the state and location of the educational institution and are paid to both institutions and students, and because the U.S. Department of Veterans Affairs (VA) had only a little more than a year to upgrade its claims processing systems, early implementation posed several challenges, especially with regard to delayed and erroneous payments (Maze, 2010a; McBain, 2009; Philpott, 2009). Given these challenges, many of which had been anticipated (Wilson, 2009), the American Council on Education (ACE) asked the RAND Corporation to study students' experiences using the Post-9/11 GI Bill in its first year of availability. The study set out to understand early Post-9/11 GI Bill implementation challenges from the perspective of both college students and higher education institutions and to gain insight into how higher education institutions can more effectively support returning veterans. The research was carried out between February and August of 2010 and therefore reflects participants' experiences during only the initial year of GI Bill implementation.
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Posttraumatic stress disorder (PTSD) is a potentially disabling mental illness that can cause occupational dysfunction. Although vocational rehabilitation is often prescribed for patients with PTSD, standard vocational services are far from adequate in helping them obtain and maintain competitive employment. This study is the first to examine the outcome of evidence-based supported employment for veterans with PTSD. Unemployed veterans with PTSD were randomly assigned to either individual placement and support (IPS) supported employment (N = 42) or a Veterans Health Administration Vocational Rehabilitation Program (VRP) treatment as usual (N = 43). Employment rates and occupational outcomes were followed for 12 months. During the 12-month study, 76% of the IPS participants gained competitive employment, compared with 28% of the VRP participants (number needed to treat = 2.07; χ(2) = 19.84, df = 1, p<.001). Veterans assigned to IPS also worked substantially more weeks than those assigned to VRP (42% versus 16% of the eligible weeks, respectively; Mann-Whitney z test p<.001) and earned higher 12-month income (mean ± SD income of $9,264 ± $13,294 for IPS versus $2,601 ± $6,009 for VRP; Mann-Whitney z test p<.001) during the 12-month period. Veterans with PTSD who received IPS were 2.7 times more likely to gain competitive employment than those who received VRP. Because work is central to recovery, these results should assist stakeholders in planning improved services for veterans with PTSD.
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Occupational functioning represents both an important outcome for military service members returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom and a predictor for long-term mental health functioning. We investigated the role of mental health diagnoses, determined by structured clinical interviews, on occupational functioning in a group of 262 National Guard/Reserve service members within 1 year of returning from a 16-month OIF combat deployment. We assessed occupational functioning at the time of diagnostic interviews and 1 year later. We hypothesized that service members with diagnoses of posttraumatic stress disorder (PTSD), depression, and/or alcohol abuse or dependence would exhibit lower rates of employment at both time points and lower rates of reported work and/or school role functioning. Service members with a diagnosis of PTSD (5%, n = 13), subthreshold PTSD (6%, n = 15), a major depressive disorder (11%, n = 29), or alcohol abuse or dependence (11%, n = 28) did not differ on employment status from service members without a diagnosis at either time point. However, those with a diagnosis of PTSD, depression, and/or alcohol abuse or dependence reported lower levels of work role functioning. In addition, service members with a diagnosis of PTSD reported greater rates of deterioration in work role functioning over time.
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The authors sought to determine the relationship between receipt of disability compensation and participants' success in a vocational rehabilitation program. Administrative data for 22,515 individuals who participated in the Veterans Health Administration compensated work therapy program between 1993 and 1998 were analyzed. Six dependent variables were compared between participants who were receiving disability compensation and those who were not: duration of participation in compensated work therapy, number of hours worked per week, mean hourly earnings, total income from compensated work therapy, dropout rate, and competitive employment status at discharge. Regression equations were determined for each dependent variable to assess associations with the degree of disability, the amount of disability compensation, and the type of compensation program. Participants who were receiving disability benefits worked fewer hours in compensated work therapy each week, earned less income, had a higher dropout rate, and were less likely to be competitively employed at discharge. The amount of compensation and the type of program were modestly but significantly associated with participation in compensated work therapy and with outcome. Unintended effects of disability compensation programs discourage full participation in vocational rehabilitation and result in poorer rehabilitation outcomes.
Background: Individual Placement and Support (IPS) is an evidence-based practice that helps persons with mental and/or physical disabilities, including spinal cord injury, find meaningful employment in the community. While employment is associated with positive rehabilitation outcomes, more research is needed on the impact of IPS participation on non-vocational outcomes, particularly quality of life (QOL). Objective: To identity QOL outcomes experienced with (1) IPS participation and (2) IPS participation leading to employment. Methods: Using a mixed method design, data on quality of life outcomes were collected from 151 interviews and 213 surveys completed by veterans with SCI participating in IPS. Results: At 12 months, participants who obtained competitive employment (CE) and those who did not (no-CE) showed improvement on most measures. In months 12-24, the CE group showed improvements on all study measures while the no-CE group declined on many indices. Statistically significant changes were observed between participants who obtained CE versus no-CE on several measures. Themes were identified from interview data related to productivity and well-being. Productivity themes were (1) contributing to society, (2) earning an income, and (3) maintaining employment. Themes for well-being were (1) mental health/self-confidence, (2) physical health, and (3) goal setting. Themes were associated with IPS participation irrespective of employment outcomes. Conclusion: IPS participants who were competitively employed report consistent improvement in handicap, health-related QOL, and life satisfaction measures across time. Qualitative findings revealed improved QOL outcomes in productivity and well-being for veterans participating in IPS overall, regardless of employment outcomes.
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Objective: Veterans Health Administration vocational services assist veterans with mental illness to acquire jobs; one major component of these services is job development. The purpose of this study was to characterize the nature of effective job development practices and to examine perceptions and intensity of job development services. Method: A national mixed-methods online survey of 233 Veterans Health Administration vocational providers collected data regarding frequency of employer contacts, perceptions of job development ease/difficulty, and effective job development practices when dealing with employers. Qualitative responses elucidating effective practices were analyzed using content analysis. Results: Vocational providers had a modest number of job development employer contacts across 2 weeks (M = 11.0, SD = 10.6) and fewer were face-to-face (M = 7.6, SD = 8.4). Over 70% of participants perceived job development to be difficult. Six major themes emerged regarding effective job development practices with employers: using an employer-focused approach; utilizing a targeted marketing strategy; engaging in preparation and follow-up; going about the employer interaction with genuineness, resilience, and a strong interpersonal orientation; serving as an advocate for veterans and educator of employers; utilizing specific employer-tailored strategies, such as arranging a one-on-one meeting with a decision maker and touring the business, individualizing a prescripted sales pitch, connecting on a personal level, and engaging in ongoing communication to solidify the working relationship. Conclusions and implications for practice: Respondents highlight several potentially effective job development strategies; tools and resources may be developed around these strategies to bolster job development implementation and allow opportunities for fruitful employer interactions. (PsycINFO Database Record
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Traumatic brain injury (TBI) has been called the signature injury of the post-9/11 wars in Iraq, Afghanistan, and neighboring countries. Although similarities exist between veterans and service members with TBI, levels of severity and different constellations of coexisting comorbid conditions affect them differently. These conditions affect physical, cognitive, and emotional function, which in turn can complicate community reintegration (CR), or the ability to return to family, vocational, and community life. This special supplement of the Archives of Physical Medicine and Rehabilitation consists of articles written by accomplished teams from multiple disciplines, including anthropology, neuropsychology, nursing, occupational therapy, psychology, and rehabilitation sciences. Each article brings a different perspective to bear on what CR means for veterans and service members from examination of predictors and perceptions of veterans and service members and others to measurement studies. Collectively, this group of articles represents current thinking about CR and lays the groundwork for testing interventions to improve CR outcomes for veterans and service members (eg, employment, living situation, family life).
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This article applies a hazard-based approach to the identification of physical, mental, and psychosocial health needs of post-9/11 veterans. The weaponry, survival, and population of servicemen and women by the military have evolved over time, particularly during the post-9/11 era. It is evident that military hazards and potential exposures vary depending on not only the deployment era but also the specific location and role. Many individual factors may affect the development of health problems. Recent evidence-based literature about post-9/11 veterans’ long-term complex health issues is summarized, so occupational health nurses can advocate for the provision of veteran-sensitive care.
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Objective: To quantify the need for, and interest in, Supported Employment (SE) among recent military Veterans with traumatic brain injury (TBI), and to examine characteristics associated with Veterans' interest in SE. Design: Stratified random sample of Iraq and Afghanistan War Veterans confirmed to have TBI through the Veterans Health Administration (VHA) screening and evaluation system. Setting: Community-based via mailed survey. Participants: We recruited 1,800 Veterans with clinician-confirmed TBI (1,080 mild TBI; 720 moderate/severe TBI) through multiple mailings. Among 1,451 whose surveys were not returned undeliverable, 616 (42%) responded. Interventions: Not applicable. Main outcome measures: Veterans rated their interest in SE after reading a script describing the program. Additional measures assessed mental health and pain-related comorbidities, employment, financial/housing difficulties, demographics, and military service characteristics. Estimates were weighted to represent the population of Veterans with VHA clinician-confirmed TBI. Results: Unemployment was reported by 45% (95% confidence interval [CI]: 43, 47) of Veterans with TBI. Although 42% (95% CI: 40, 44) reported they would be interested in using SE if it were offered to them, only 12% had heard of SE (95% CI: 11, 14) and <1% had used it. TBI severity and comorbidities were not associated with Veterans' interest in SE. However, those who were unemployed, looking for work, experiencing financial strain, or at risk for homelessness were more likely to be interested in SE. Conclusions: Our research highlights an important gap between Veterans' vocational needs and interests and their use of SE. Systematically identifying and referring those with employment and financial/housing difficulties may help close this gap.
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Objective: Utilization of the GI Bill and attendance at higher education institutions among student veterans have significantly increased since passage of the Post-9/11 GI Bill. Campus counseling centers should be prepared to meet the mental health needs of student veterans. This study identified the mental health resources and services that colleges provide student veterans and the education needs of clinical staff on how to serve student veterans. Methods: Directors of mental health services from 80 California colleges completed a semistructured phone interview. Results: Few schools track the number, demographic characteristics, or presenting needs of student veterans who utilize campus mental health services or offer priority access or special mental health services for veterans. Directors wanted centers to receive education for an average of 5.8 veteran-related mental health topics and preferred workshops and lectures to handouts and online training. Conclusions: Significant training needs exist among clinical staff of campus mental health services to meet the needs of student veterans.
Article
Objective: Veterans with posttraumatic stress disorder (PTSD) exhibit high levels of unemployment. The Department of Veterans Affairs' Veterans Health Administration (VHA) offers a variety of employment services; however, few veterans with PTSD use these services. Because many veterans with mental health conditions are seen in primary care clinics, employment service needs may be best addressed in this setting. The current study was designed to assess employment status and support needs in VHA primary care patients who screen positive for PTSD. Method: In the study, 287 working-age VHA patients with recent primary care use completed web-based surveys that assessed employment status, PTSD symptoms, employment support preferences, and barriers to service usage. Results: Individuals who screened positive for PTSD were less likely to be employed than were those without PTSD (55% vs. 69%; p = .03). After adjusting for sociodemographic characteristics, individuals with PTSD had higher barriers to employment (β = 3.52, p < .001) and higher barriers to employment service use (β = 0.57, p = .02). Only 14% of those with PTSD had used VHA employment services, but 86% said they would use those services. Conclusions: Although the single site included in the study may not be representative of all VHA primary care clinics, our results suggest that there is high need for and substantial interest in VHA employment services among VHA patients with PTSD. Future work should focus on implementing employment support services for individuals with PTSD in primary care settings. (PsycINFO Database Record
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An increasing number of U.S. military veterans are entering postsecondary education with problems attributed to deployed military service. The primary objective of this research was to describe the lived experiences of student veterans transitioning from active military service to postsecondary education. Phenomenological interviews were performed with 13 student veterans who had transitioned from military deployment to postsecondary education. An overall essential meaning of "emerging in college culture" was manifested from three themes, supported by rich textural and structural descriptions of student veterans' experiences: (1) repurposing military experiences for life as a student veteran, (2) reconstructing civilian identity, and (3) navigating postsecondary context and interactions. These findings highlight implications that may facilitate occupational therapists' efforts in supporting the needs of student veterans.
Article
Background: Psychiatric symptoms typically cut across traditional diagnostic categories. In order to devise individually tailored treatments, there is a need to identify the basic mechanisms that underlie these symptoms. Behavioral economics provides a framework for studying these mechanisms at the behavioral level. Here, we utilized this framework to examine a widely ignored aspect of trauma-related symptomatology-individual uncertainty attitudes-in combat veterans with and without posttraumatic stress disorder (PTSD). Methods: Fifty-seven combat veterans, including 30 with PTSD and 27 without PTSD, completed a risk and ambiguity decision-making task that characterizes individual uncertainty attitudes, distinguishing between attitudes toward uncertain outcomes with known ("risk") and unknown ("ambiguity") probabilities, and between attitudes toward uncertain gains and uncertain losses. Participants' choices were used to estimate risk and ambiguity attitudes in the gain and loss domains. Results: Veterans with PTSD were more averse to ambiguity, but not risk, compared to veterans without PTSD, when making choices between possible losses, but not gains. The degree of aversion was associated with anxious arousal (e.g., hypervigilance) symptoms, as well as with the degree of combat exposure. Moreover, ambiguity attitudes fully mediated the association between combat exposure and anxious arousal symptoms. Conclusions: These results provide a foundation for prospective studies of the causal association between ambiguity attitudes and trauma-related symptoms, as well as etiologic studies of the neural underpinnings of these behavioral outcomes. More generally, these results demonstrate the potential of neuroeconomic and behavioral economic techniques for devising objective and incentive-compatible diagnostic tools, and investigating the etiology of psychiatric disorders.
Article
Objective: Veterans with mental illness are at serious risk of poor work outcomes and career stagnation. Supported employment (SE) is an evidence-based model of vocational services that assists persons with mental illness to obtain competitive employment. The purpose of this study was to gain a rich understanding of barriers and facilitators related to competitive work success from the perspective of a nationwide sample of U.S. Department of Veterans Affairs (VA) SE staff, supervisors, and managers. Methods: This study utilized a mixed-methods approach in which 114 VA SE personnel completed an online questionnaire consisting of a survey of work barriers and facilitators; open-ended questions elicited additional factors affecting work success. Descriptive statistics characterized factors affecting work success, and an emergent, open-coding approach identified qualitative themes describing other key elements influencing employment. Results: The most prominent work facilitators were perceived veteran motivation, job match, the assistance of SE services, and veteran self-confidence. The highest rated barriers were psychological stress and a range of health-related problems. Qualitative findings revealed additional areas affecting work success, notably, the availability of resources, the capacity of frontline staff to form strong relationships with veterans and employers, the ability of staff to adapt and meet the multifaceted demands of the SE job, and the need for additional staff and supervisor training. The impact of employer stigma was also emphasized. Conclusions: An array of elements influencing work success at the level of the veteran, staff, SE program, and employer was recognized, suggesting several implications for VA services.
Article
Employment is the highest priority for many people with severe mental illness and it is a central aspect of recovery. Over the past two decades, the Individual Placement and Support (IPS) model of supported employment has emerged as the prominent evidence-based approach to vocational rehabilitation. This book synthesizes the research and experience on IPS supported employment: historical context, core principles, effectiveness, long-term outcomes, non-vocational outcomes, cost-effectiveness, generalizability, fidelity, implementation, policy, and future research. This book relates to areas of work with populations with psychiatric disabilities and in community mental health and social service settings. In tracing the evolution of IPS, readers are equipped with an elegant example of the transition from needs assessment, to model development, to testing, and to dissemination.
Article
Literature on posttraumatic stress disorder (PTSD) prevalence among Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans report estimates ranging from 1.4% to 60%. A more precise estimate is necessary for projecting healthcare needs and informing public policy. This meta-analysis examined 33 studies published between 2007 and 2013 involving 4,945,897 OEF/OIF veterans, and PTSD prevalence was estimated at 23%. Publication year and percentage of Caucasian participants and formerly active duty participants explained significant variability in prevalence across studies. PTSD remains a concern for a substantial percentage of OEF/OIF veterans. To date, most studies have estimated prevalence among OEF/OIF veterans using VA medical chart review. Thus, results generalize primarily to the prevalence of PTSD in medical records of OEF/OIF veterans who use VA services. Additional research is needed with randomly selected, representative samples administered diagnostic interviews. Significant financial and mental health resources are needed to promote recovery from PTSD. Published by Elsevier Ltd.
Article
Objective: To examine the relations among demographic characteristics, traumatic brain injury (TBI) history, suspected psychiatric conditions, current neurobehavioral health symptoms, and employment status in Veterans evaluated for TBI in the Department of Veterans Affairs. Study design: Retrospective cross-sectional database review of comprehensive TBI evaluations documented between October 2007 and June 2009. Participants: Operation Enduring Freedom/Operation Iraqi Freedom Veterans (n = 11 683) who completed a comprehensive TBI evaluation. Main measures: Veterans Affairs clinicians use the comprehensive TBI evaluations to obtain information about TBI-related experiences, current neurobehavioral symptoms, and to identify suspected psychiatric conditions. Results: Approximately one-third of Veterans in this sample were unemployed, and of these, the majority were looking for work. After simultaneously adjusting for health and deployment-related variables, significant factors associated with unemployment included one or more suspected psychiatric conditions (eg, posttraumatic stress disorder, anxiety, depression), neurobehavioral symptom severity (ie, affective, cognitive, vestibular), former active duty status, injury etiology, age, lower education, and marital status. The associations of these factors with employment status varied by deployment-related TBI severity. Conclusions: Simultaneously addressing health-related, educational, and/or vocational needs may fill a critical gap for helping Veterans readjust to civilian life and achieve their academic and vocational potential.
Article
The purpose of this review was to systematically summarise the literature on the health effects of employment. A search for prospective studies investigating the effect of employment on health was executed in several electronic databases, and references of selected publications were checked. Subsequently, the methodological quality of each study was assessed by predefined criteria. To draw conclusions about the health effect of employment, a best evidence synthesis was used, and if possible, data were pooled. 33 prospective studies were included, of which 23 were of high quality. Strong evidence was found for a protective effect of employment on depression and general mental health. Pooled effect sizes showed favourable effects on depression (OR=0.52; 95% CI 0.33 to 0.83) and psychological distress (OR=0.79; 95% CI 0.72 to 0.86). Insufficient evidence was found for general health, physical health and mortality due to lack of studies or inconsistent findings. This systematic review indicates that employment is beneficial for health, particularly for depression and general mental health. There is a need for more research on the effects of employment on specific physical health effects and mortality to fill the knowledge gaps.
Article
Veterans deemed disabled for conditions resulting from, or aggravated by, their service in the military are eligible for service-connected disability payments. Despite many positive effects of disability payments, one concern is that Veterans with psychiatric conditions who receive disability payments are less likely to be employed compared to those who are denied benefits. Little is known about the attitudes of substance using Veterans, for whom work is a particularly important part of recovery, toward work and disability compensation. This study compared the responses of Veterans with (n=33) and without substance use problems (n=51) to questions about work's significance and its relationship to disability payments. T- and chi-square tests were conducted to determine if Veterans with substance use problems differed from the others on work-related attitudes and perceptions of the relation between work and Veterans' benefits. Veterans endorsed high levels of agreement with statements that working would lead to loss of benefits. Veterans with substance use agreed more strongly that they would rather turn down a job offer than lose financial benefits. The greater preference for disability payments among substance-using Veterans may reflect a realistic concern that they are particularly likely to have difficulty maintaining employment. The widespread concern among Veterans that work will lead to loss of VA disability payments is striking given the ambiguity about how likely loss of benefits actually is, and should be addressed during the service-connection application process.
Book
"This book provides step-by-step instructions on how to analyze text generated from in-depth interviews and focus groups - i.e., transcripts. The book is primarily designed for research studies with an applied focus, but is also useful for theoretically oriented qualitative research. The book covers all aspects of the qualitative data analysis process including planning, data preparation, identification of themes, codebook development and code application, reliability and inter-coder agreement, data reduction techniques, comparative techniques, integration with quantitative data, and software considerations. The book describes what the authors call "applied thematic analysis", because it is the approach predominantly used in applied qualitative studies (and increasingly in academic contexts). The method employs a phenomenological approach to data analysis which has a primary aim of describing the experiences and perceptions of research participants. The approach presented is similar to Grounded Theory - in that it is inductive, content-driven, and searches for themes within textual data - and is complementary to Grounded Theory on many levels. However, within an applied context a phenomenological approach is primarily concerned with characterizing and summarizing perceptions and lived experiences and applying the results to a particular research problem, rather than building and assessing theoretical models"--
Article
The dissemination of complex innovative practices is one of the major challenges of mental health service organizations. Although substantial progress has been made in the development of evidence-based practices for people with severe mental illness, development of approaches for the large-scale dissemination of such practices has lagged. In 2004, the Veterans Health Administration began a national dissemination effort of supported employment (SE). Concomitant with the clinical initiative, a research project was funded to study the factors that promote successful program implementation through an evaluation of the effectiveness and cost-effectiveness of two levels of training in the evidence-based practice of SE. This article reviews the dissemination effort and associated research project. This initiative represents the largest dissemination effort of any psychosocial rehabilitation model to date in any single healthcare system in the United States. We review the dissemination plan, including development of a mentor-trainer system at two intensity levels, regular on-site and telephone training and supervision, ongoing fidelity evaluation, and national outcomes monitoring with a Web-based data collection system.
After the wars in Iraq and Afghanistan: Veterans' adjustment and the use of benefits in postsecondary education (Unpublished doctoral dissertation). School of Medicine
  • G L Bell
Bell, G. L. (2015). After the wars in Iraq and Afghanistan: Veterans' adjustment and the use of benefits in postsecondary education (Unpublished doctoral dissertation). School of Medicine, Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Where failure is not the option-The military friendly college: Exploring student service members' and student veterans' perceptions of climate, transition, and camaraderie (Unpublished doctoral dissertation). Department of Curriculum and Instruction/ Literacy Studies
  • L T R Browning
Browning, L. T. R. (2015). Where failure is not the option-The military friendly college: Exploring student service members' and student veterans' perceptions of climate, transition, and camaraderie (Unpublished doctoral dissertation). Department of Curriculum and Instruction/ Literacy Studies, West Virginia University, Morgantown, WV.
Prevalence, assessment, and treatment of mild traumatic brain injury and posttraumatic stress disorder: A systematic review of the evidence
  • K F Carlson
  • S M Kehle
  • L A Meis
  • N Greer
  • R Macdonald
  • I Rutks
  • . . Wilt
Carlson, K. F., Kehle, S. M., Meis, L. A., Greer, N., Macdonald, R., Rutks, I.,... Wilt, T. J. (2011). Prevalence, assessment, and treatment of mild traumatic brain injury and posttraumatic stress disorder: A systematic review of the evidence. The Journal of Head Trauma Rehabilitation, 26, 103-115. http://dx.doi.org/10.1097/HTR.0b013e3181e50ef1
Student veterans' college experiences: Demographic comparisons, differences in academic experiences, and on-campus service utilization (Unpublished doctoral dissertation). University of California
  • C A Cate
Cate, C. A. (2011). Student veterans' college experiences: Demographic comparisons, differences in academic experiences, and on-campus service utilization (Unpublished doctoral dissertation). University of California, Santa Barbara, CA.
Psychometric assessment of the Neurobehavioral Symptom Inventory-22: The structure of persistent postconcussive symptoms following deployment-related mild traumatic brain injury among veterans
  • M Meterko
  • E Baker
  • K L Stolzmann
  • A M Hendricks
  • K D Cicerone
  • H L Lew
Meterko, M., Baker, E., Stolzmann, K. L., Hendricks, A. M., Cicerone, K. D., & Lew, H. L. (2012). Psychometric assessment of the Neurobehavioral Symptom Inventory-22: The structure of persistent postconcussive symptoms following deployment-related mild traumatic brain injury among veterans. The Journal of Head Trauma Rehabilitation, 27, 55-62. http://dx.doi.org/10.1097/HTR.0b013e318230fb17
Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care
  • N A Sayer
  • S Noorbaloochi
  • P Frazier
  • K Carlson
  • A Gravely
  • M Murdoch
Sayer, N. A., Noorbaloochi, S., Frazier, P., Carlson, K., Gravely, A., & Murdoch, M. (2010). Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatric Services, 61, 589 -597. http://dx.doi.org/10.1176/ps .2010.61.6.589
Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery
  • T L Tanielian
  • L Jaycox
Tanielian, T. L., & Jaycox, L. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery (Vol. 1). Santa Monica, CA: RAND.
VA caregiver support
  • Shepherd-Banigan Et Al
U.S. Department of Veterans Affairs. (2019c). VA caregiver support. Retrieved from https://www.caregiver.va.gov/support/support_benefits .asp 8 SHEPHERD-BANIGAN ET AL.