Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1038 — Dissemination of Supported Employment for Homeless Veterans: Impact on Two-Year Client Outcomes

Author List:
Rosenheck RA (VA NEPEC)
Mares AS (VA NEPEC)

Objectives:
There is growing interest in disseminating supportive employment (SE) since it has emerged as an evidence based practice for helping people with serious mental illness (SMI) participate in competitive employment. This study evaluated the dissemination of SE to 9 VA programs for homeless veterans with mental illness.

Methods:
A dissemination project was implemented within 9 VA programs for homeless veterans to implement supported employment and thereby improve employment outcomes. A structured training program included on-site training, monthly conference calls, and weekly supervision of selected cases by telephone. A pre-implementation (Phase 1) cohort (N=309) was recruited at the 9 sites before SE was implemented and a post-implementation cohort (Phase 2) was recuited after SE implementation and was offered access to SE. Mixed models were used to compare employment outcomes in Phase 1 and Phase 2, net of baseline difference between clients in the two phases.

Results:
The implementation succeeded by measures of both client service delivery and formal assessments of site level fidelity to SE. At baseline, Phase II veterans had better work histories than Phase I clients. Controlling for these differences, veterans in Phase II had 13.7% more days per month of competitive employment on average (p<.0001) and 6% greater days in either competitive or transitional employment (11.6 vs. 11.0 days; F=4.5, p=.04). Veterans in Phase II also had a greater average number of days housed (34.0 vs. 29.6; F=4.5; p=.03), but there were no differences on other clinical or social adjustment measures.

Implications:
This study provides evidence that a sustained 2 year training program based on teleconferencing more than face-to-face contacts can effectively implement supported employment with good model fidelity, in systems that have no past experience with this approach. It also showed that such dissemination efforts can yield improved employment outcomes as well as more rapid housing placement with no increase in substance abuse.

Impacts:
As part of the VA Strategic Mental Health Plan, the approach illustrated here is being rolled out to the entire VA system, through 21 mentor/training sites, one in each VISN, that are receiving intensive training in SE, and that will, in turn, train other facilities in their VISN to implement SE.