Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1056 — What Makes Vocational Rehabilitation Effective? Program Elements and Employment Outcomes Nationally

Author List:
Resnick SG (Northeast Program Evaluation Center)
Drebing C (Bedford VA)
Rosenheck RA (Northeast Program Evaluation Center)

Objectives:
With the focus on well-defined service models for people with severe mental illness, there is interest in the identification of program elements that predict successful outcomes. This study uses data from the national VA Compensated Work Therapy (CWT) program to examine the association between programmatic features and success at discharge, adjusting for differences in individual characteristics.

Methods:
In 2001, a survey of all CWT program directors was conducted, providing data on programmatic elements. Client-level data from 2001 was selected from administrative data collected by the Northeast Program Evaluation Center. A merge of these data sources created a sample of 92 CWT programs and 6891 veterans. Three separate GEE analyses were conducted with each of three dependent variables representing program success: 1) competitive employment at discharge, 2) any constructive activity at discharge, and 3) clinician’s perception of a “successful discharge” from the program.

Results:
Participation in community-based work during CWT was positively and significantly associated with all three measures of success. Use of assertive outreach for engagement of veterans was significantly and positively associated with a greater likelihood of both competitive employment and any constructive activity at discharge. Greater amounts of assertive outreach and less integration of mental health and vocational staff were both associated with a greater likelihood of constructive activity at discharge.

Implications:
The strongest predictor of success was participation in community-based as contrasted with VAMC-based work. Few programmatic elements were significantly associated with success at discharge, with two notable exceptions. Assertive outreach, in which staff work to engage clients who may at first seem resistant and re-engage those who have lost contact with the program, was associated with superior outcomes. Second, integration between mental health and vocational staff was unexpectedly associated with poorer outcomes.

Impacts:
In the past decade VA’s CWT program has moved away from institution-based workshop programs towards community-based vocational services. In the last year $16 million was allocated to develop supported employment in VHA, a further expansion in this direction. The data presented here lend further support to these developments showing that the best outcomes are achieved by community-oriented programs which incorporate assertive outreach.