Individualized Placement and Support Supported Employment for Justice-involved Homeless and Unemployed Veterans.

BACKGROUND: Homelessness is a significant issue affecting the general US population. Two subsets of the population overrepresented in the US homeless population are justice involved individuals and Veterans. However, relatively little research has addressed alleviating homelessness in justice-involved Veterans (JIV). One direction for addressing homelessness in this population is facilitating employment. OBJECTIVE: This study examined differences in housing and employment outcomes between homeless JIV enrolled in 2 different vocational rehabilitation conditions. METHODS: This study evaluates vocational outcomes of Veterans experiencing homelessness enrolled in a larger US Department of Veterans Affairs-funded study. Participants were randomized into 2 groups: those who participated in a job search group, the About Face Vocational Program (AFVP) and those who received AFVP plus Individualized Placement and Support, Supported Employment (AFVP+IPS-SE). RESULTS: Participants who received supported employment plus group were significantly more likely to secure employment compared with group alone. This significant difference was also found in individuals who identified as chronically homeless. Furthermore, participants who secured employment were significantly more likely to exit homelessness and secure housing, suggesting group membership had an indirect effect on housing status though improved employment outcomes. CONCLUSIONS: Vocational rehabilitation groups combined with supported employment is appropriate and effective for homeless, JIV seeking employment and may also improve downstream housing outcomes.

Implementation of the Chronic Care Model to Reduce Disparities in Hypertension Control: Benefits Take Time.

BACKGROUND: The Chronic Care Model (CCM) has been endorsed by experts to reduce disparities in chronic disease outcomes but benefits may be slow to appear in low-income populations. OBJECTIVE: To evaluate the effect of CCM implementation on systolic blood pressure (SBP) control in minority patients with diabetes mellitus (DM). DESIGN: Retrospective study from 2012 to 2016 in two primary care clinics with primarily uninsured, Hispanic patients. PATIENTS: Four 2-year cohorts of patients aged 18-75 with DM and SBP ≥ 140 mmHg on HTN drugs in year 1 and SBP measured 1 year later in year 2. INTERVENTION: Implementation of CCM for DM in January 2014 involved: electronic medical record revision, a DM registry, hypertension (HTN) treatment protocol, team education, performance feedback, and case management. MAIN MEASURE: SBP < 140 mmHg in year 2. KEY RESULTS: Of 2354 patients, the mean age was 56.2 (SD 9.5), baseline SBP 153.8 (SD 14.9) mmHg, and 79.8% Hispanic. Last SBP < 140 mmHg was 58.4% for cohort 1 (2012-2013) and 68.5% for cohort 4 (2015-2016). Adjusted odds ratios (AORs) for SBP control versus cohort 1 were 1.35 (95% CI 1.07, 1.69) for cohort 3 (2014-2015) and 2.13 (95% CI 1.60, 2.80) for cohort 4. AORs for SBP control were reduced by 15% per HTN drug at baseline (P = 0.001), 9% per HTN drug added at last SBP (P = 0.024), and 22% for multi-dose HTN drugs (P = 0.004). Among patients with persistent elevated SBP and represented in multiple cohorts, AORs for control were still over 2-fold higher for cohort 4 versus cohort 1. CONCLUSIONS: After adopting the CCM for primarily Hispanic patients with DM, SBP control increased significantly despite treatment with fewer HTN drugs. Yet improvement took 3-4 years, suggesting that financial rewards for using the CCM to achieve improved clinical outcomes for low-income, minority patients may be delayed.

Vocational rehabilitation for veterans with felony histories and mental illness: 12-month outcomes.

Lack of employment is an important barrier to successful reintegration encountered by those released from prison with mental illnesses and/or substance use disorders. This study compares 3 different vocational reintegration modalities for a veteran population: (a) basic services; (b) self-study using the About Face Vocational Manual; and (c) the About Face Vocational Program, a standardized group program focused on the About Face Vocational Manual. One-hundred eleven veterans with a history of at least one felony conviction and a mental illness and/or substance use disorder were recruited from a large urban Veterans Affairs (VA) medical center. Veterans were assigned to 1 of the 3 conditions and followed for 12 months. At the end of the 1-year follow-up period, veterans in the group condition had superior competitive and stable employment rates, as well as faster times to employment compared with both the basic and self-study conditions. The self-study condition was generally indistinguishable from the basic services condition. Overall, new employment during the last 6 months of the follow-up period was relatively low. The findings support the use of standardized group vocational reintegration programs such as the About Face Vocational Program. Limitations and implications are discussed. (PsycINFO Database Record