Clinicians have long been aware that mental health issues can result in reduced occupational functioning and lower employment rate for Veterans. This was a problem the Tuscaloosa VA Medical Center’s Research and Development Department sought to address this with its recent study, “Evaluating the Effectiveness of Supported Employment Integrated in Primary Care” that was recently published online in Psychiatric Services (ps.psychiatryonline.org).
For many years, VA has offered the evidence-based Individual Placement and Support (IPS) within its mental health services. In fact, the Tuscaloosa VA Medical Center operates a successful supported employment program within the facility that has matched Veterans with gainful employment for over 15 years. However, employment supports integrated within the Primary Care service has not been attempted until now.
“We were the first to offer employment referrals and supports at the ‘front door’ so to speak.” says Dr. Lori Davis, Associate Chief of Staff for Research and Development. “For many of our Veterans, the words ‘mental health’ can be stigmatizing. We wanted to identify Veterans at their first point of care in Primary Care and offer them immediate access in a less stigmatizing environment which aims to restore disabled Veterans to sustained, meaningful employment.”
The study, which included 119 Veterans, utilized IPS specialists co-located in the Primary Care setting to work with the Veteran to match them with jobs based on their interests and continue follow-up utilizing the traditional job-skills coaching and methods used in a typical IPS services. The results of the study were amazing: There was a significantly higher percentage (45%) of the IPS participants that achieved steady worker status compared to just 25% in the traditional Vocational Rehabilitation (VR) program. To further solidify the effectiveness, the IPS participants worked significantly more weeks and earned more income from competitive jobs than the comparison group.
These results serve as the evidence of the effectiveness of integrating IPS within the Primary Care setting. As Dr. David MacVicar, chief of Psychology Service and IPS study clinician states, “When Veterans experience sustained unemployment, it’s a source of personal hardship and stress, and we know it negatively impacts both physical and mental health. Bringing the highest quality vocational support into the primary care setting, where unemployment status is often first identified, can create easy, hassle free access to these services. This exciting study lends support to this idea and shows that offering individualized placement and support employment services in the primary care setting is highly effective at helping Veterans find and maintain meaningful work.”
The IPS clinical trial team included Lori Davis, M.D.; Mercy N. Mumba, Ph.D.; Richard Toscano, M.Ed.; Patricia Pilkinton, M.D.; Catherine Blansett, Ph.D.; Kimberly McCall, Ph.D.; David MacVicar, Ph.D.; and Al Bartolucci, Ph.D. The full story is at https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202000926.