3197 — Supported Employment for Veterans with Traumatic Brain Injury: Needs and Interests

Carlson KF, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System; Pogoda TK, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System; Resnick SG, Mental Illness Research, Education and Clinical Center, VA Connecticut Healthcare System; O'Neil ME, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System; Sayer NA, Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System;

Objectives:
Ensuring that Veterans with traumatic brain injury (TBI) can access effective vocational rehabilitation services may help prevent numerous downstream health and functional problems. Supported Employment (SE) is an evidence-based vocational rehabilitation service offered within the Veterans Health Administration (VHA) Compensated Work Therapy (CWT) program. The purpose of this study was to describe employment challenges and examine interest in VHA CWT/SE services among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans with TBI.

Methods:
This qualitative study was conducted at two VA facilities. Participants were OEF/OIF/OND Veteran VA users with clinician-confirmed TBI diagnoses and a history of employment challenges. A short survey quantified sociodemographic and deployment experiences. Veterans completed a one-hour focus group or individual semi-structured interview. Interviews addressed Veterans' employment challenges and their knowledge, perceptions, and interests in VHA vocational services, focusing on CWT/SE. Interviews were conducted until thematic saturation was reached; data were analyzed using grounded theory methodology.

Results:
We interviewed a total of 35 Veterans (32 men, 3 women), the majority of whom (n = 33) had a history of mild TBI. Veterans ranged in age from 24 to 69 years and had varied educational backgrounds. Many had experienced multiple deployments. Veterans identified posttraumatic stress disorder, other mental health disorders, sleep problems, headaches, and cognitive issues as individual barriers to their productivity. Difficulty translating military skills to civilian settings, and employer/coworker stereotypes of Veteran volatility, were additional contextual factors described as challenges to finding or maintaining employment. Veterans' interests in and use of SE services was limited by: 1) an engrained military culture that perceived asking for help as a weakness; 2) concerns about loss of VA benefits; and 3) lack of awareness of VHA CWT programs.

Implications:
OEF/OIF/OND Veterans with TBI described significant employment challenges, potentially associated with TBI symptoms, comorbid mental health symptoms, reintegration challenges, perceived employer discrimination, difficulty help-seeking, and lack of awareness of CWT programs.

Impacts:
VHA provides TBI-related care for over 20,000 OEF/OIF/OND Veterans annually. CWT/SE services may address TBI-related employment challenges but may not be accessible to Veterans with TBI. Research is needed to help facilitate access in this clinical population.