3121 — Department of Veterans Affairs Provider Perceptions of Supported Employment Services to Veterans with Traumatic Brain Injury

Pogoda TK, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System; Boston University School of Public Health; Carlson KF, Center to Improve Veteran Involvement in Care, Portland VA Medical Center; Oregon Health and Science University; Pilver CE, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System; Gormley KE, Boston University School of Public Health; Resnick SG, Mental Illness Research, Education and Clinical Center, VA Connecticut Healthcare System; Yale University School of Medicine;

Objectives:
Supported employment (SE) is an evidence-based vocational rehabilitation practice that has been available to select patient populations in VA since the mid-2000s. In 2008, VA funded 13 sites to provide SE services to Veterans with traumatic brain injury (TBI). The objectives of this research were to: 1) determine whether SE program differences currently exist between VA Medical Centers (VAMCs) that have (pilot sites) or have not (non-pilot sites) received pilot funding, and 2) describe current SE program staffing, communication between the SE and TBI teams, and experiences in providing SE services to Veterans with TBI.

Methods:
This was a quasi-experimental mixed-methods design. Web-based surveys sent to VA SE staff included forced-choice and open-ended questions. Independent t-tests and chi-square tests were used to examine differences between pilot and non-pilot sites. Open-ended responses were qualitatively coded for a priori constructs and emerging themes.

Results:
SE supervisors at both pilot (60%) and non-pilot (80%) sites reported having fewer staff than necessary to provide SE services to Veterans with TBI (p = .30). Approximately three-quarters of SE specialists from both site types reported providing SE services to Veterans with TBI, but a higher percentage of pilot site respondents (77.8% vs. 37.5%, p < .03) reported also working with the local Polytrauma/TBI team, and rated their frequency of communication with this team to be better (p = .003) than that reported by non-pilot sites. Qualitative findings on perceived challenges to and needs for providing SE services to Veterans with TBI included (1) Veteran behavioral, cognitive, health, and substance abuse issues, in which SE specialists reported Veteran difficulties with impulse control, memory, organization, and following through with plans, requiring longer SE support, and (2) more training needed on TBI so that SE specialists understood the long-term expectations of the condition and could explain it to potential employers.

Implications:
SE supervisors and frontline staff across all sites reported more staffing and training were needed to adequately provide SE to Veterans with TBI.

Impacts:
VA-wide, SE supervisors and frontline staff perceive a need for more staff and training dedicated to providing SE services to Veterans with TBI. These resources can help Veterans reach their vocational potential.