Supporting Education Goals of OIF/OEF Veterans with PTSD: Pilot Process & Outcome
Marsha Langer Ellison Ph.D. PhD MSW
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
Funding Period: September 2010 - November 2011
The Post 9/11 G.I. Bill provides recently separated Veterans with expanded benefits for post-secondary education tuition. However, those with PTSD or related mental health conditions are challenged to successfully engage in and retain post-secondary education. We proposed that civilian based supported education practices could provide Veterans with these disabilities the skills and assistance necessary to attempt and succeed in educational participation.
The goal of this project is to gather data necessary for a full scale trial of a supported education service for OIF/OEF veterans with PTSD.
Aim 1: Using a randomized controlled design, assess the magnitude of the effect of a supported education service on hours of participation in educational activities.
H1. Veterans who receive supported education services will have more number of hours of participation in activities related to acquiring an educational goal compared to a control group who receives services as usual plus attention.
Aim 2. To examine whether the supported education intervention has secondary effects for improving PTSD symptoms and attitudes on recovery.
H2. Veterans who receive weekly supported education will have better recovery attitudes and improved PTSD symptoms compared to a control group who receives services as usual plus attention.
Aim 3. To acquire additional process information on the design and implementation of a supported education service necessary for a successful larger trial.
Objective: Conduct a process evaluation of the implementation.
Implementation Assessment. Supplemental funds were provided to further investigate implementation issues of a supported education service in the VA, and in particular its appropriate organizational "home".
Supported Education (SEd) was provided by Veteran peers in individual sessions over a six months with the objective of choosing an educational goal and then providing the information and support to get and keep that goal. Control subjects received Veteran health care as usual plus matched attention from a Veteran peer who provided generalized peer support excluding educational help. We proposed a randomized pilot with self-report assessments at baseline, end-point, and a weekly process measure indicating the amount of time spent in various activities related to the educational goal.
The study enrolled 31 Veterans: mean age of 29.31; 80% (n = 27) Caucasian, 76% (n = 25) single; 67% (n = 22) had some college , 27% (n = 9) had a high school diploma only, and 6% (n = 2) had a Bachelor's degree.
Findings for Aim 1:
Analysis of the impact of supported education services on time spent pursuing educational goals.
A mixed model of treatment over time was conducted comparing the average total amount of time spent (in quarter hours) in all activities related to an educational goal over the course of the study. First, average time spent was collapsed into four segments for the experimental and control group. Segment values were included in a mixed model procedure and were adjusted for baseline values. A significant group effect was found indicating that across the time segments, the treatment group had significantly more time spent in educational activities than did the control group ( t=-3.38, df=31, p=.002).
Changes in selected education Outcomes
Percent change (increase, decrease or no change) in the time spent in pursuit of an educational goal was tabulated for participants who received at least one peer visit post baseline in the control (N=15) and experimental groups (N=8). Data indicate that larger proportions among the experimental group had increases in the amount of time spent working towards selected educational outcomes compared to the control group. For example, 62% (n = 5) of the experimental group registered for classes over the course of the study compared to 13% (n = 2) among Veterans in the control group.
Magnitude of the effect.
A Cohen's D statistic was calculated for the effect size for time spent in educational activities. The average amount of time reported and the standard deviation (SD) was calculated for both groups for the four time segments. Resulting effect sizes are .25 for time segment 2; .17 for time segment 3, and .31 for time segment four.
Results for Aim 2
We compared and tested baseline values for a PTSD and for a measure of recovery attitudes. T tests of group comparisons of PCL and RAS were non significant, thus our randomization was successful in these dimensions. We were not able to complete pre-post assessments for the PCH or RAS because we were unable to obtain 6 month exit interviews for most participants.
Results for Aim 3.
Attrition in the study
Of the 31 who were enrolled, only 23 continued to have a first visit with a peer provider, an attrition rate from baseline interview of 32%. Peer providers attributed the large attrition rate due to Veterans being enrolled while they were "early" in their recovery journey, and had not yet stabilized in community living.
Data show that the 8 participants from the experimental group that had at least one visit with their peer provider, met on average 8 times throughout their participation in the study, over 4 months (on average).
Use of the VetSEd training manual. During discussion with peer providers at the close of the study peers indicated that they used the manual and worksheets and that they were satisfied with their training. They did note that some of the worksheets were redundant.
Results for the Implementation Assessment
A brief survey was conducted with CWT managers across the VHA system, All fifty-six respondents indicated having an interest in supported education included in their programming, six commented that this was a "strong" need and five indicated they were already providing SEd in some form. Ten indicated needing additional resources to implement SEd within CWT.
Interviews were conducted with members of homelessness and mental health services VHA leadership about its organizational home. Suggestions included incorporation of SEd activities within: Homelessness Prevention Demonstration Programs, Veteran Outreach Centers, VHA PRRCs, CWT programs, VBA Vetsuccess on campus, and the US Department of Labor.
Findings show sufficient evidence for further testing and development of this model. Potential long term impact is anticipated for educational completion and later employment.
DRA: Health Systems, Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational, Prevention
Keywords: Access, Adjustment Disorders, Education (patient), PTSD
MeSH Terms: none