Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4095 — Military to Civilian Transition Factors and Interest in Supported Employment Among Veterans with Traumatic Brain Injury: A Mixed Methods Analysis

Lead/Presenter: Ginnifer Mastarone, COIN - Portland
All Authors: Mastarone GL (Center for the Involvement of Veterans in Care (CIVIC), Portland, OR) Gilbert T (CIVIC) Wyse J (CIVIC) Pogoda TK (Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, Boston, MA) Carlson KF (CIVIC)

Objectives:
OEF/OIF/OND Veterans with traumatic brain injury (TBI) experience substantial unemployment. This may be due to difficulties transitioning from military to civilian work environments. Supported employment (SE) is an evidence-based vocational rehabilitation program that has demonstrated positive health and employment outcomes for different Veteran populations, but is not widely accessed by Veterans with TBI. We drew from Schumacher and Meleis' transition theory to: 1)identify transition factors that may impede civilian workforce participation among Veterans with TBI, and 2)examine associations between transition factors and Veterans' interest in SE.

Methods:
Sequential mixed methods design that included interviews and mailed surveys with OEF/OIF/OND Veterans with clinician-confirmed TBI. Phase 1 interviews (n = 37) explored Veterans' experiences while looking for civilian employment. Transcripts were analyzed by conventional content analysis. Phase 2 surveys examined transition factors among a national random sample of 1,800 Veterans (n = 616 respondents). Veterans were presented with an SE description, and indicated if they would be interested in SE if it were offered to them. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression to examine associations between transition factors and SE interest.

Results:
Interviewees described memory, concentration, headaches, pain, balance, and anxiety problems as health transition factors impeding employment. Situational transition factors included work accommodation needs; difficulty translating military experience to civilian work; and lack of job experience, job search skills, and education. Organizational-level transition factors included perceived stigma against Veterans. Among survey respondents, health transition factors associated with interest in SE included loss of balance (aOR = 1.8;CI = 1.1-2.9) and anxiety (aOR = 2.0;CI = 1.1-3.4). Situational transition factors included lack of education/training (aOR = 2.3;CI = 1.4-3.7), job search skills (aOR = 3.5;CI = 1.1-11.3), job skills (aOR = 3.3;CI = 1.6-6.8), and beliefs that military experience was devalued in the workplace (aOR = 1.7;CI = 1.1-2.8). Perceived employer beliefs about Veterans was an organizational-level transition barrier associated with SE interest (aOR = 2.8;CI = 1.5-5.5).

Implications:
This synthesis of interview and survey data suggests that Veterans experience a range of health-related, situational, and organizational-level transition barriers that impact their employment and interest in SE.

Impacts:
SE can increase Veterans' post-deployment health and employment success. This research identifies transition factors that may indicate need for, and interest in, SE among OEF/OIF/OND Veterans with TBI.