Supported Employment vs Transitional Work in Veterans With PTSD

Published in JAMA Psychiatry, new data support the efficacy of individual placement and support (IPS)-supported employment over stepwise transitional vocational rehabilitation for veterans with chronic posttraumatic stress disorder (PTSD).

Investigators conducted a prospective, multisite, randomized controlled trial over an 18-month period to capture the efficacy of certain vocational therapies for veterans with PTSD. A total of 541 unemployed veterans with PTSD were recruited and randomly assigned to either IPS (n=271) or transitional work (n=270). Per the conditions of IPS-supported employment group, participants were provided support from a specialist, including an individualized job search for competitive work; job coaching and advocacy; care coordination; disability benefits counseling; and open-ended follow-up support.

Participants assigned to the transitional work group were assigned noncompetitive time-limited employment as stepwise preparation for future positions, and their vocational intervention was not coordinated with the PTSD or mental health treatment team. Over the 18-month follow-up period, 105 (38.7%) of IPS participants achieved steady employment status, compared with 63 (23.3%) of the transitional work participants (odds ratio 2.14; 95% CI, 1.46-3.14; P <.001).

Additionally, patients in the IPS group had significantly higher earnings from competitive jobs than their transitional counterparts, with mean salary values of $14,642 and $10,989, respectively (P =.004). Those assigned to the IPS intervention also achieved a longer job tenure, earlier competitive job acquisition, and were more likely to perform semiskilled labor compared with the transitional group.

Researchers noted that IPS service implementation was not a mature program when randomization began and that the research cohort was largely male. For those reasons, data should be extrapolated with care. Even so, these data showed a strong correlation between vocational success and IPS and may support future efforts to increase IPS access for veterans living with PTSD.

Reference

Davis LL, Kyraikides TC, Suris AM, et al. Effect of evidence-based supported employment vs transitional work on achieving steady work among veterans with posttraumatic stress disorder: a randomized clinical trial [published online February 28, 2018]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2017.4472