Effectiveness of Supported Employment for Veterans With Spinal Cord Injury: 2-Year Results

Abstract

ObjectiveTo examine if supported employment (SE) remains more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI) at 2-year follow-up. DesignProspective, randomized, controlled, multisite trial of SE versus TAU with 24 months of follow-up. SettingSCI centers. ParticipantsSubjects (N=201) were enrolled and completed baseline interviews. At interventional sites, subjects were randomized to SE (n=81) or TAU (n=76). At observational sites, 44 subjects were enrolled in a nonrandomized TAU condition. InterventionThe intervention was a SE program called the SCI Vocational Integration Program, which followed the principles of the individual placement and support model of SE for persons with mental illness. Main Outcome MeasuresCompetitive employment in the community within 2 years. ResultsFor the entire 2-year follow-up period, SE subjects were significantly more likely to achieve employment (30.8%; 95% confidence interval [CI], 21.8–41.6) than either the TAU subjects at the intervention sites (10.5%; 95% CI, 5.2–19.7; P<.001) or the TAU subjects at the observational sites (2.3%; 95% CI, 0.0–12.9; P<.002). Most subjects who obtained competitive employment did so in year 1, and the average time to first employment was about 17 weeks. ConclusionsSE was better than usual practices in improving employment outcomes for veterans with SCI across a 2-year follow-up period. Although SE continued to be superior to traditional practices over the entire study, the first year of participation in SE may represent a critical window for achieving employment after SCI.