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IIR 16-089 – HSR&D Study

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IIR 16-089
Improving Access to Supported Employment for Veterans with Polytrauma/Traumatic Brain Injury
Terri Krangel Pogoda PhD
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: May 2018 - September 2022

Many Post-9/11 Veterans have experienced polytrauma/traumatic brain injury (TBI), which can result in functional limitations and challenges to employment. Pogoda et al. (2016) found that among Veterans evaluated in Veterans Health Administration (VHA) polytrauma/TBI clinics, approximately 20% reported that they were unemployed and looking for work, and of these, 71.6% had a TBI diagnosis and were in their prime working years. Supported Employment (SE) is an evidence-based practice that helps individuals with disabilities find and maintain competitive employment through job coaching and unlimited support. Carlson et al. (2018) reported that Veterans with polytrauma/TBI have an interest in receiving supported employment (SE) services, yet are not routinely informed of vocational rehabilitation programs. Though SE is targeted to Veterans with serious mental illness (SMI), up to 25% of the SE caseload may be used for non-SMI clinical populations. However a recent VHA administrative review found that more than one-half of VA SE programs were working below their caseload capacity and were able to serve more Veterans. Moreover, very few polytrauma/TBI clinics were referring Veterans to SE.

This research aims to increase access to SE for Veterans with polytrauma/TBI. This will be achieved by (1) identifying actionable barriers and facilitators to referring Veterans to SE, providing SE services to and retaining these clients, and integrating the SE and polytrauma/TBI clinic teams, (2) developing and refining an intervention package/toolkit for an SE-TBI program, and (3) implementing the intervention and conducting qualitative and quantitative assessment of its effectiveness at local VA Medical Centers (VAMCs) that are below SE caseload capacity.

This longitudinal mixed methods study will be guided by the integrated-Promoting Action Research on Implementation in Health Services (i-PARIHS) framework. For Aim 1, we will identify barriers and facilitators to SE-TBI by interviewing SE vocational rehabilitation specialists and polytrauma/TBI providers at (a) 4 VAMCs that have a successful SE-TBI program, and (b) 12 VAMCs that are below SE caseload capacity. Based on findings from Aim 1, for Aim 2 we will adapt and refine current toolkit materials to develop a customizable intervention package that includes menu-based choices (e.g., educational materials, marketing practices to facilitate integration between the SE and polytrauma/TBI clinic teams) to maximize success in SE referral and implementation. Finally, for Aim 3, at the 12 VAMCs from Aim 1 that are below SE caseload capacity, through external and internal facilitation, we will implement an intervention package to enhance polytrauma/TBI participation in SE and document: (a) its effectiveness for change in number of Veterans with polytrauma/TBI referrals and SE caseload size from pre- to post-intervention, (b) stakeholder (SE vocational rehabilitation specialists, polytrauma/TBI providers, Veterans with polytrauma/TBI) perceptions of implementation and SE program progress, (c) Veteran vocational and nonvocational outcomes, and (d) SE program fidelity. We will follow each site's progress over an 18-month implementation and evaluation period.


Ensuring that Veterans with polytrauma/TBI can access effective vocational rehabilitation services may help prevent numerous downstream health and functional problems.

None at this time.

DRA: Acute and Combat-Related Injury, Brain and Spinal Cord Injuries and Disorders, Other Conditions
DRE: Prevention, Technology Development and Assessment, TRL - Development
Keywords: Implementation, Reintegration Post-Deployment, TBI
MeSH Terms: none

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