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Individual placement and support helps veterans with PTSD obtain employment
More veterans with PTSD who received individual placement and support, or IPS, attained steady employment compared with those who received stepwise work vocational rehabilitation, according to research findings.
“Veterans who screen positive for PTSD are more likely to be unemployed than are those without PTSD. ... Without effective intervention, the growing numbers of unemployed prime working-aged individuals with disabling PTSD could have a substantial economic impact for generations to come,” Lori L. Davis, MD, of Tuscaloosa Veterans Affairs Medical Center, Alabama, and colleagues wrote in JAMA Psychiatry. “For the past decade, as a consequence of limited resources and lack of results from large effectiveness trials in a PTSD population, the VA has prioritized IPS services for veterans with serious mental illness; as such, veterans with PTSD have limited access to IPS-supported employment.”
Davis and colleagues compared the effectiveness of IPS-supported employment and stepwise vocational rehabilitation, which involves transitional work assignments, in helping veterans with PTSD gain steady, competitive employment. IPS, a supported employment intervention, involves engaging people in community job development to get jobs based on their preferences. Transitional work, a stepwise vocational rehabilitation intervention, gives people temporary, noncompetitive jobs to prepare them for competitive employment.
The researchers conducted a prospective, randomized, multisite clinical trial including 541 unemployed veterans with PTSD at 12 VA centers. They assessed whether more participants in the IPS group would become steady workers, defined as holding a competitive job for at least half of the follow-up period, and earn more income from competitive work over 18 months.
Of the participants, 271 were assigned to receive IPS and 270 to receive transitional work. Analysis revealed 105 veterans in the IPS group attained steady employment compared with 63 in the transitional work group (OR = 2.14; 95% CI, 1.46-3.14). Furthermore, more participants in the IPS group achieved competitive work than those in the transitional work group (186 vs.154; P = .005). Veterans who received IPS also had higher cumulative earnings from competitive jobs (median $7,290 in IPS vs. $1,886 in transitional work; P = .004).
“These results are very exciting and show that individual placement and support is very effective for veterans with PTSD in terms of speed in getting the first competitive job and maintaining jobs to achieve steady employment over time,” Davis told Healio Psychiatry.
Veterans who received the IPS intervention also had earlier competitive job acquisition and longer job tenure compared with those in the transitional work group. According to the researchers, higher proportions in the IPS group worked in semiskilled jobs than in the transitional work group. PTSD symptoms improved over 18 months among participants in both groups.
“IPS is very individualized and meets the veteran at whatever point they are at in the recovery process,” Davis continued. “Meaningful employment is not only a means of income, but it is part of the ongoing recovery from trauma that should be integrated in a holistic treatment approach for all who suffer with post-traumatic stress.”
The results of this study are promising for people with PTSD, their family and the clinicians who treat them, Kim T. Mueser, PhD, of the Center for Psychiatric Rehabilitation, Boston University, wrote in a related editorial.
“The time has come to surmount the barriers to funding IPS-supported employment, and to make this effective vocational program available to all people who are struggling with a major mental illness,” Mueser wrote. “Veterans with PTSD, veterans with other serious mental illnesses, and nonveterans who are coping with similar mental health conditions, should have the right to access the most scientifically proven rehabilitation program for helping people with psychiatric challenges gain and keep competitive employment.” – by Savannah Demko
Disclosures: The authors report no relevant financial disclosures. Mueser reports no relevant financial disclosures.