Absence of conflict of interest.
Citation
Highlights
- The study’s objective was to examine the impact of Individual Placement and Support (IPS) supported employment on mental well-being as it pertains to everyday functioning (work or school life and social and interpersonal relationships) for veterans with posttraumatic stress disorder (PTSD).
- The study was a randomized controlled trial that used self-reported assessments to measure the level of work and school, lifestyle, and relationship functioning (Posttraumatic Stress Related Functioning Inventory (PRFI)) and severity of PTSD symptoms (PTSD Checklist for DSM-5 (PCL-5)) after 18 months.
- Over the 18-month follow-up period, the study found statistically significant, positive impacts of IPS participants’ overall functioning compared to the comparison group.
- The quality of causal evidence presented in this report is high because it was based on a well-implemented randomized controlled trial. This means we are confident that the estimated effects are attributable to IPS, and not to other factors.
Intervention Examined
Individual Placement and Support (IPS) model of supported employment
Features of the Intervention
Posttraumatic stress disorder (PTSD) can have major negative effects on a person’s occupational, interpersonal, and social functioning, including higher rates of unemployment. IPS serves veterans between the ages of 18 and 65 who are unemployed. IPS provides personalized career development assistance and support to unemployed veterans with the goal of gaining and sustaining competitive employment. Services provided include personalized vocational assessments, help with job search and career development specific to the participant’s interests and skills, as well as job coaching and employer advocacy. To fully serve the needs of the participant, care coordination with mental health clinicians, disability benefits navigation, and other supports are provided as needed. Veterans receive support before and after obtaining competitive employment.
Features of the Study
The authors used a randomized controlled trial to compare the outcomes of those randomly assigned to the intervention to a comparison group. The comparison group participated in the usual services offered by the veterans’ affairs (VA) medical centers which included a transitional work (TW) program that places participants in a set-aside, pre-employment minimum wage work assignment such as maintenance or housekeeping services, and provides one-time guidance on obtaining competitive employment.
To be eligible for the study, participants needed to be diagnosed with PTSD, be interested in obtaining competitive work, and eligible for VA transitional work. The analytical sample consisted of 218 participants in the intervention group and 219 participants in the comparison group. The study included 12 VA medical centers. The overall sample was predominately male (82%), and diverse (51% White, 42% African American, and 17% of Hispanic ethnicity). The majority did not hold a college degree (Associates’ degree or higher; 60%).
The study used two self-report measures—the Posttraumatic Stress Related Functioning Inventory (PRFI) and the PTSD Checklist for DSM-5 (PCL-5)—to collect information on the severity of PTSD symptoms and how those symptoms impact occupational, social and lifestyle functioning. The authors used a statistical model to analyze differences between the intervention and comparison groups over 18 months.
Findings
Health and safety
- The study found that the IPS group had a larger statistically significant improvement in overall functioning (PRFI scores) as well as relationship/lifestyle functioning compared to the comparison group.
- The study found no statistically significant difference in the severity of PTSD symptoms (PCL-5 scores) between the IPS and comparison groups by the end of the 18-month period. However, the IPS group showed a statistically significant improvement at month 9 and month 12, relative to the comparison group.
Considerations for Interpreting the Findings
To be eligible for the study, participants needed to be interested in gaining competitive employment, so the study results may not extend to all veterans with PTSD.
Causal Evidence Rating
The quality of causal evidence presented in this report is high because it was based on a well-implemented randomized controlled trial. This means we are confident that the estimated effects are attributable to IPS, and not to other factors.