Absence of conflict of interest.
Citation
Rosen, M. I., Ablondi, K., Black, A. C., Mueller, L., Serowik, K. L., Martino, S., . . . Rosenheck, R. A. (2014). Work outcomes after benefits counseling among veterans applying for service connection for a psychiatric condition. Psychiatric Services, 65(12), 1426-1432.
Highlights
- The study examined the impact of benefits counseling on employment and earnings.
- The study was a randomized controlled trial and collected self-reported data directly from veterans.
- At one month, the study did not find a statistically significant relationship between benefits counseling and employment. Looking at data across all time periods, the study found a statistically significant relationship between benefits counseling and the number of days of paid work.
- For the outcomes at one month, 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 any estimated effects would be attributable to benefits counseling and not to other factors. However, the study did not find statistically significant effects at one month. For all other outcomes, the quality of causal evidence presented in this study is low because the study had high attrition and the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to benefits counseling; other factors are likely to have contributed.
Intervention Examined
Benefits Counseling
Features of the Intervention
The benefits counseling occurred in four, 50-minute individual sessions between the counselor and veteran. The first three sessions were generally conducted weekly, and the fourth session was conducted after the participant’s disability determination was made. The first session focused on the claims process and the veteran’s valuation of work, and the second session focused on the veteran’s feelings about work. The third session focused on the financial implications of working. The impact of the claims decision was the focus of the final session.
Features of the Study
This study was a randomized controlled trial. Forty-seven veterans were assigned to receive benefits counseling (the treatment condition), and 45 veterans were assigned to the control condition (four sessions of orientation covering the Department of Veterans Affairs (VA’s) health care system and services). Four clinicians delivered both the benefits counseling and the control condition’s orientation sessions. Data were collected directly from the study participants via timeline follow-back calendars. The authors used a statistical model to compare the outcomes of treatment and control group members at one, three, and six months after baseline.
Findings
Employment
- At one month, the difference in the number of days worked for pay between the veterans who received benefits counseling and veterans who received VA orientation was not statistically significant.
- Looking at data across all time periods, the study found a statistically significant relationship between benefits counseling and the number of days of paid work.
Earnings
- The study found no statistically significant relationship between the intervention and earnings.
Considerations for Interpreting the Findings
Although the study was a randomized controlled trial, follow-up data were not available for a large portion of the sample at three months and six months. In addition, the authors did not account for differences in employment between the groups before the study. These existing differences between the groups—and not the intervention—could explain the observed differences in outcomes across all time periods.
Causal Evidence Rating
For the one-month outcomes, 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 any estimated effects would be attributable to benefits counseling and not to other factors. However, the study did not find statistically significant effects.
For all other outcomes, the quality of causal evidence presented in this report is low because the study had high attrition and the authors did not ensure that the groups being compared had similar employment characteristics before the intervention. This means we are not confident that the estimated effects are attributable to benefits counseling; other factors are likely to have contributed.