MedicalResearch.com Interview with:
Dr. Lori Davis, MD
Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center,
Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Symptoms of posttraumatic stress disorder (PTSD) interfere with a person’s ability to function at work, making it harder to stay employed and establish oneself in a career. Veterans with PTSD are uniquely challenged given their motivation to serve others, be leaders and not be generally receptive to reaching out for help.
Conventional wisdom about PTSD and employment has traditionally been to first commit to treatment, learn coping skills, manage one’s symptoms and then reintegrate into mainstream employment. However, this view is being transformed by our research that suggests a more assertive recovery-oriented approach to the treatment of PTSD that involves returning to meaningful competitive employment as soon as possible.
This study compared Evidence-based Supported Employment (also known as Individual Placement and Support or IPS) integrated within PTSD treatment teams to the treatment as usual Transitional Work model offered within the VA. This multisite trial demonstrated significantly greater effectiveness of the IPS-supported employment over stepwise, transitional work vocational rehabilitation for Veterans living with chronic PTSD.
MedicalResearch.com: What should readers take away from your report?
Response: Of the 271 Veterans in the IPS group, 39 percent became steady workers over the 18-month follow-up. By comparison, only 23 percent in the transitional work / treatment as usual group became steady workers. The results show that engaging with Veterans individually and early in treatment and employment improves their chances at integrating successfully in becoming steady workers and establishing careers. The PTSD symptoms were not made worse by either intervention.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We should implement IPS in real-world settings and rigorously evaluate outcomes. Dissemination science has the primary goal to increase access and participation in evidence-based treatments for more Veterans in more places across the country. We are currently in the start-up phase for a uniquely funded public / private partnership, with research elements specific to increased employment and income, to disseminate IPS-supported employment at VA medical centers in Massachusetts and New York City.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study was run by the VA Cooperative Studies Program (CSP), a national clinical research program providing planning and coordination for multisite clinical research projects to improve healthcare for Veterans. The CSP Director and staff, Principal Investigator, Local Site & Co-Investigators, along with all participants in both the primary intervention and control intervention are hopeful this study will provide VA leadership and the field with leverage to create greater access to effective services for the many thousands of Veterans who are not yet utilizing the treatment and employment resources of the VA and/or local, state and federal workforce organizations and advocacy groups.
Davis LL, Kyriakides TC, Suris AM, Ottomanelli LA, Mueller L, Parker PE, Resnick SG, Toscano R, Scrymgeour AA, Drake RE, . Effect of Evidence-Based Supported Employment vs Transitional Work on Achieving Steady Work Among Veterans With Posttraumatic Stress DisorderA Randomized Clinical Trial. JAMA Psychiatry. Published online February 28, 2018. doi:10.1001/jamapsychiatry.2017.4472
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