Sprong Matthew E, Hollender Heaven, Blankenberger Bob, Rumrill Stuart, Lee Yu-Sheng, Bland Travis, Bailey Jeremiah, Weber Kenneth, Gilbert James, Kriz Ken, Buono Frank D
Edward Hines Jr. VA Medical Center, Hines, IL, USA.
University of Illinois Springfield, School of Public Management and Policy, Springfield, IL, USA.
Subst Abuse Rehabil. 2024 Jul 25;15:107-123. doi: 10.2147/SAR.S462882. eCollection 2024.
Veterans diagnosed with mental health and/or substance use disorders (SUD) often face significant barriers to employment and reintegration into civilian society. In the current study, we investigated whether how the VA healthcare system for mental health and/or SUD treatment predicted program enrollment into vocational rehabilitation, simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation predicted employment at discharge, and mental health and/or SUD treatment continues and employment remain 60-days-post-vocational-rehabilitation discharge.
An outcome-based, summative program evaluation design to measure quality assurance of vocational rehabilitation services provided to 402 veteran patients enrolled in a VA healthcare located within the Great Lakes Health Care System - Veterans Integrated Services Network.
Multivariable logistic regression analyses showed psychological empowerment (confidence in one's ability to work or find work) is a significant factor determining whether a veteran is enrolled in the vocational rehabilitation program, prior mental health treatment (yes/no) and frequency of mental health treatment did not predict program enrollment, and frequency of SUD VA system treatment 60 days prior did not predict program enrollment. Other findings showed that simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation did not predict employment at discharge, and employment at discharge did not predict continued mental health and/or SUD treatment post-discharge from vocational rehabilitation. However, veterans with both SUD and mental health and continued mental health treatment were less likely to be employed.
Utilization of real-world program evaluation data from an actual VHA vocational rehabilitation program enhances the study's ecological validity, offering practical implications for policymakers and practitioners in the field. The findings support the importance of veterans enrolling in mental health and/or SUD treatment simultaneously while enrolled in vocational rehabilitation services, as integrating vocational rehabilitation with mental health and SUD treatment services can lead to improved vocational and health outcomes for veterans (eg, development of targeted interventions to support veterans' successful reintegration into the workforce and society).
被诊断患有心理健康和/或物质使用障碍（SUD）的退伍军人在就业以及重新融入平民社会方面常常面临重大障碍。在当前研究中，我们调查了退伍军人事务部（VA）针对心理健康和/或SUD的医疗保健系统如何预测职业康复项目的入学情况，在参加职业康复期间同时进行心理健康和/或SUD治疗是否能预测出院时的就业情况，以及心理健康和/或SUD治疗在职业康复出院后60天是否持续，就业情况是否保持。
采用基于结果的总结性项目评估设计，以衡量为大湖医疗系统 - 退伍军人综合服务网络内一家VA医疗保健机构收治的402名退伍军人患者提供的职业康复服务的质量保证。
多变量逻辑回归分析表明，心理赋权（对自己工作或找工作能力的信心）是决定退伍军人是否参加职业康复项目的重要因素，先前的心理健康治疗（是/否）和心理健康治疗频率并不能预测项目入学情况，且前60天SUD VA系统治疗频率也不能预测项目入学情况。其他研究结果表明，在参加职业康复期间同时进行心理健康和/或SUD治疗并不能预测出院时的就业情况，出院时的就业情况也不能预测职业康复出院后心理健康和/或SUD治疗是否持续。然而，同时患有SUD和心理健康问题且持续接受心理健康治疗的退伍军人就业可能性较小。
利用来自实际VHA职业康复项目的真实世界项目评估数据提高了研究的生态效度，为该领域的政策制定者和从业者提供了实际启示。研究结果支持退伍军人在参加职业康复服务的同时同步参加心理健康和/或SUD治疗的重要性，因为将职业康复与心理健康和SUD治疗服务相结合可以改善退伍军人的职业和健康状况（例如，制定有针对性的干预措施以支持退伍军人成功重新融入劳动力市场和社会）。
