Article

Individualized Placement and Support Supported Employment for Justice-involved Homeless and Unemployed Veterans

Authors:
  • U.S. Department of Veterans Affairs/VA North Texas Health Care System
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Abstract

Background: Homelessness is a significant issue affecting the general US population. Two subsets of the population overrepresented in the US homeless population are justice involved individuals and Veterans. However, relatively little research has addressed alleviating homelessness in justice-involved Veterans (JIV). One direction for addressing homelessness in this population is facilitating employment. Objective: This study examined differences in housing and employment outcomes between homeless JIV enrolled in 2 different vocational rehabilitation conditions. Methods: This study evaluates vocational outcomes of Veterans experiencing homelessness enrolled in a larger US Department of Veterans Affairs-funded study. Participants were randomized into 2 groups: those who participated in a job search group, the About Face Vocational Program (AFVP) and those who received AFVP plus Individualized Placement and Support, Supported Employment (AFVP+IPS-SE). Results: Participants who received supported employment plus group were significantly more likely to secure employment compared with group alone. This significant difference was also found in individuals who identified as chronically homeless. Furthermore, participants who secured employment were significantly more likely to exit homelessness and secure housing, suggesting group membership had an indirect effect on housing status though improved employment outcomes. Conclusions: Vocational rehabilitation groups combined with supported employment is appropriate and effective for homeless, JIV seeking employment and may also improve downstream housing outcomes.

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Work and Opportunity Before and After Incarceration
  • A Looney
  • N Turner
Looney A, Turner N. Work and Opportunity Before and After Incarceration. Washington, DC: Brookings Institution; 2018.