The Impact of Supported Employment Versus Standard Vocational Rehabilitation in Veterans with PTSD

Abstract

Abstract : Unemployed Veterans with posttraumatic stress disorder (PTSD) were prospectively randomized into a multi-site study comparing Individual Placement and Support (IPS), an evidenced-based model of supported employment, to VA vocational rehabilitation treatment-as-usual (VRP-TAU). Over the course of the 52-week follow-up, 25 of the 48 IPS participants (52%) gained competitive employment, compared with 15 of the 46 VRP-TAU participants (33%) ( 2= 3.64, df=1, p=.056). That is, Veterans with PTSD who participated in IPS were 1.7 times more likely to gain competitive employment than those who received VRP-TAU. The number-needed-to-treat (NNT) was 5.26. The IPS and VRP-TAU participants worked in a competitive job an average of 23% and 13% of the eligible weeks, respectively (Mann-Whitney z test, p=0.10). There were no statistically significant between-group differences in terms of number of weeks, days, or hours worked, or the amount of income earned. The IPS group achieved competitive employment significantly more quickly than VRP-TAU (log-rank 2= 4.25, p=0.04). Most job acquisition in IPS group occurred within the first 25 weeks. There were no significant differences between groups in terms of PTSD, depression, or quality of life rating scales. A large-scale randomized controlled study of IPS has been launched by the VA Cooperative Studies Program to further evaluate the effectiveness of IPS in Veterans with PTSD.