Employment Outcomes of a Distance Learning System for Formerly Incarcerated Veterans With Mental Illness.

OBJECTIVE: People with previous incarceration and a mental disorder, a substance use disorder, or both are less likely to obtain employment than are those without these characteristics. Distance learning and education (DLE) systems are increasingly being integrated into clinical care and provide a pathway to disseminate vocational services. DLE systems can help reach people with barriers to accessing services, including people without transportation, experiencing homelessness, living in rural areas, or who are homebound. This study evaluated the effectiveness of one DLE system, the COMPASS program, in assisting formerly incarcerated veterans with a mental or substance use disorder to obtain employment. METHODS: The authors used a randomized controlled trial to compare employment outcomes of 39 U.S. veterans receiving the COMPASS intervention with those of 43 veterans receiving a paper self-study vocational manual. All participants had previous legal convictions and had a mental disorder, a substance use disorder, or both. The COMPASS system provided vocational services through asynchronous (online practice assignments, reading, and videos) and synchronous (video and telephone practice interviews and live chats) methods. No in-person vocational services were provided in the COMPASS intervention. RESULTS: At 6 months, participants assigned to receive the COMPASS intervention were more likely to have found employment, defined as 1 day of competitive employment, compared with those assigned to receive the self-study manual (64% vs. 35%, respectively)-and to have found employment faster. CONCLUSIONS: This study's findings provide evidence for the effectiveness of the COMPASS system in providing employment services and suggest that these services may benefit other vulnerable populations.

Development and evaluation of an online vocational program for veterans with legal convictions and psychiatric illness.

PURPOSE: We describe the development and pilot evaluation of an online vocational rehabilitation program, the About Face Online System (AFOS), for veterans with a history of felony convictions and either mental illness and/or substance use disorders. METHOD: Phase One was the development and acceptability testing of the online system. Phase Two was a small, randomized trial comparing the likelihood of obtaining employment among people using the AFOS, compared to people receiving a self-directed hardcopy manual, after 6 months. RESULTS: In Phase One, 17 veterans provided feedback as the system was being developed. The final system allows veterans to receive education on vocational reintegration skills, watch short videos describing the techniques, and communicate with a vocational staff member via chat features. Veterans found the AFOS to be as acceptable as a hardcopy manual that covered similar material. In Phase Two, 38 veterans with a history of felony convictions and either mental illness or substance use disorder were randomized to receive the AFOS or a hardcopy manual. After 6 months, people randomized to the AFOS were more likely to obtain employment than people randomized to the hardcopy manual. CONCLUSION: An online vocational program may help veterans who cannot attend traditional in-person vocational services to successfully obtain employment.

The association between time incarcerated and employment success: Comparing traditional vocational services with a hybrid supported employment program for veterans.

Objective : This study evaluates the effects of time incarcerated on employment outcomes between a manualized vocational program, the About Face Vocational Program (AFVP), and a hybrid program of the AFVP and Individualized Placement and Support, Supported Employment (AFVP + IPS-SE). Method : Eighty-four veterans with the histories of felony convictions and a mental illness or a substance use disorder were randomly assigned to the AFVP or AFVP + IPS-SE conditions and followed for 6 months. The associations between time to employment and months incarcerated were evaluated using nonparametric tests. Findings : The number of months incarcerated was positively associated with time to employment in the hybrid AFVP + IPS-SE condition but not the AFVP condition. In addition, significant differences were found between employment rates of the groups at lower number of months incarcerated, with higher rates of employment in the hybrid AFVP + IPS-SE condition, becoming similar as months incarcerated increased. Conclusion and Implications for Practice : Number of months incarcerated may have a deleterious effect on employment rates when using IPS-SE. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

Substance Use Rates of Veterans with Depression Leaving Incarceration: A Matched Sample Comparison with General Veterans.

Formerly incarcerated military veterans-comprising approximately 8% of the prison population-experience significant barriers to reentry including homelessness, mental illness, and mortality. One of the most consequential barriers is relapsing into substance use. Most justice-involved veterans (JIV) possess histories of substance abuse before imprisonment, and this rate continues upon release. Mental illness-depression in particular-is often comorbid with substance abuse. With high rates of depression and substance use in a JIV population, it is important to determine to what extent release from prison contributes to predicting substance use and negative clinical outcomes. This study compares rates of substance use and negative outcomes between two matched samples of JIV and general veterans, both with depression and a substance use disorder. It is hypothesized that JIV will have a higher rate of substance use and that use will be associated with higher negative outcomes in the JIV condition. Rates of use of veterans released from prison and general veterans were collected during six-year follow-up periods. Use was defined as the use of an illicit substance or alcohol, if an alcohol use disorder was present, and determined by urine drug tests or self-report recorded in medical notes. Results indicate that JIV used substances at a higher rate compared to those not recently incarcerated, and that such use is predictive of several other negative outcomes including homelessness, use of inpatient substance treatment, and reincarceration. Structured drug treatment programs and other interventions should cater to veterans recently released from prison to offer help in these areas.

Blending Traditional Vocational Services and Individualized Placement and Support for Formerly Incarcerated Veterans.

OBJECTIVE: This study compared two vocational programs: the About Face Vocational Program (AFVP), a traditional group-based vocational program created for formerly incarcerated veterans, and a hybrid program combining the AFVP with principles of individual placement and support-supported employment. METHODS: The study evaluated 111 veterans with at least one felony conviction who had a mental illness, substance use disorder, or both. Veterans were randomly assigned to either vocational condition. RESULTS: Veterans in the hybrid condition, compared with the AFVP alone, were more likely to find employment, had higher rates of full-time employment, and earned significantly more money over the course of the study. A comparison of only participants who found employment showed higher rates of full-time employment for veterans in the hybrid condition but similarities between the two groups in other measures of employment success. CONCLUSIONS: Blended models of vocational services for veterans with mental illness, substance use disorders, or both are effective at returning formerly incarcerated veterans to competitive employment.

Predictors of dropout from a randomized clinical trial of cognitive processing therapy for female veterans with military sexual trauma-related PTSD.

Many veterans do not complete evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD). Veterans with military sexual trauma (MST)-related PTSD were shown to have higher than average rates of dropout from PTSD treatment in a national study of EBT implementation. Although predictors of dropout from EBTs have been identified, these factors are largely unmodifiable (e.g., age, service era). The purpose of the present study was to identify dynamic psychosocial predictors of dropout among female veterans from cognitive processing therapy (CPT). Data were utilized from 56 female veterans who participated in a randomized clinical trial investigating the effectiveness of CPT for MST-related PTSD. Dropout was defined continuously (i.e., number of sessions attended) and dichotomously (i.e., attending six or more sessions). Potential predictors included sociodemographic factors, psychotherapist fidelity, PTSD-related service connection, psychiatric symptom severity (i.e., PTSD, depression), trauma-related negative cognitions (about self, self-blame, world), and treatment expectations. Higher trauma-related negative cognitions about self-blame and lower trauma-related negative cognitions about self were protective against dropout. The current study generated testable hypotheses for further research on dynamic predictors of dropout from CPT in female veterans with MST-related PTSD. With replication, results may assist with identifying pre-treatment strategies to reduce dropout in this clinical population.

The association between time incarcerated and the search for employment in a veteran sample with substance use disorders.

OBJECTIVE: Incarceration and substance use disorders/mental illness can have a significant negative impact on finding employment. However, it is unclear in what phase of the search for employment, that is, applying for jobs, obtaining interviews, being offered employment, does time incarcerated have the most effect. This study will determine how time incarcerated in the past 10 years is associated with negative job search process outcomes. METHOD: This study evaluates 84 (81 men and 3 women) veterans with substance use disorders and histories of felony convictions. Four path analyses were conducted to evaluate models that incorporated time incarcerated at the different phases. RESULTS: The superior model incorporated time incarcerated negatively affecting the number of interviews obtained. Models that assessed the association between time incarcerated with applications submitted and likelihood of being offered employment did not demonstrate adequate goodness-of-fit. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Overall, the findings demonstrate the ex-offenders enrolled exhibited similar effort in searching for employment across time incarcerated. Also, employers are equally likely to hire those with felony histories, regardless of the time incarcerated, once the applicant has been met and interviewed. The results highlight the need for services focusing on breaking down stigma and reducing barriers that screen out ex-offenders from being interviewed by employers. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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

Individual Placement and Support in Spinal Cord Injury: A Longitudinal Observational Study of Employment Outcomes.

OBJECTIVE: To determine the effects of a 24-month program of Individual Placement and Support (IPS) supported employment (SE) on employment outcomes for veterans with spinal cord injury (SCI). DESIGN: Longitudinal, observational multisite study of a single-arm, nonrandomized cohort. SETTING: SCI centers in the Veterans Health Administration (n=7). PARTICIPANTS: Veterans with SCI (N=213) enrolled during an episode of either inpatient hospital care (24.4%) or outpatient care (75.6%). More than half the sample (59.2%) had a history of traumatic brain injury (TBI). INTERVENTION: IPS SE for 24 months. MAIN OUTCOME MEASURE: Competitive employment. RESULTS: Over the 24-month period, 92 of 213 IPS participants obtained competitive jobs for an overall employment rate of 43.2%. For the subsample of participants without TBI enrolled as outpatients (n=69), 36 obtained competitive jobs for an overall employment rate of 52.2%. Overall, employed participants averaged 38.2±29.7 weeks of employment, with an average time to first employment of 348.3±220.0 days. Nearly 25% of first jobs occurred within 4 to 6 months of beginning the program. Similar employment characteristics were observed in the subsample without TBI history enrolled as outpatients. CONCLUSIONS: Almost half of the veterans with SCI participating in the 24-month IPS program as part of their ongoing SCI care achieved competitive employment, consistent with their expressed preferences at the start of the study. Among a subsample of veterans without TBI history enrolled as outpatients, employment rates were >50%. Time to first employment was highly variable, but quite long in many instances. These findings support offering continued IPS services as part of ongoing SCI care to achieve positive employment outcomes.

Incorporating Individualized Placement and Support Principles Into Vocational Rehabilitation for Formerly Incarcerated Veterans.

OBJECTIVE: This study evaluated the six-month outcomes of incorporating the principles of supported employment, specifically Individual Placement and Support (IPS), into the About Face program, an existing standardized group-based vocational program for previously incarcerated veterans. METHODS: Participants (N=84) with a history of at least one felony conviction and a substance use disorder (88%) or mental illness or combination (59%) were recruited from a large urban veterans hospital. Veterans were randomly assigned to either the About Face program (AF) or to that program plus a modification of IPS (AF+IPS). Veterans were followed for six months. Employment outcomes, including time to employment, hours worked, and income earned, were evaluated with survival analyses and nonparametric tests. RESULTS: Rates of employment over the follow-up period were significantly higher for those receiving AF+IPS, with 21 of 46 (46%) finding employment, compared with only eight of 38 (21%) who received AF alone. As a group, those receiving AF+IPS worked more hours and earned more wages than those receiving AF alone. CONCLUSIONS: Incorporating many of the principles and techniques of IPS into an existing vocational program was associated with improved employment outcomes over the six-month follow-up period and should be considered a viable rehabilitation option when working with this vulnerable population.

Redesign of a Screening Process for VA Homeless Housing.

Standardizing the screening processes for homeless housing among VA facilities can make programs more accessible to veterans experiencing homelessness and improve provider knowledge of existing and available services.

Rapid HIV testing experience at Veterans Affairs North Texas Health Care System's Homeless Stand Downs.

In the USA, 21% of the estimated 1.1 million people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) are unaware they are HIV-infected. In 2011, Veterans Health Administration (VHA)'s Office of Public Health in conjunction with VHA's Health Care for Homeless Veterans Program funded grants to support rapid HIV testing at homeless outreach events because homeless populations are more likely to obtain emergent rather than preventive care and have a higher HIV seroprevalence as compared to the general population. Because of a Veterans Affairs North Texas Health Care System (VANTHCS)'s laboratory testing requirement, VANTHCS partnered with community agencies to offer rapid HIV testing for the first time at VANTHCS' 2011 Homeless Stand Downs in Dallas, Fort Worth, and Texoma, Texas. Homeless Stand Downs are outreach events that connect Veterans with services. Veterans who declined testing were asked their reasons for declining. Comparisons by Homeless Stand Down site used Pearson χ², substituting Fisher's Exact tests for expected cell sizes <5. Of the 910 Veterans attending the Homeless Stand Downs, 261 Veterans reported reasons for declining HIV testing, and 133 Veterans were tested, where 92% of the tested Veterans obtained their test results at the events - all tested negative. Veterans' reported reasons for declining HIV testing included previous negative result (n=168), no time to test (n=49), no risk factors (n=36), testing is not a priority (n=11), uninterested in knowing serostatus (n=6), and HIV-infected (n=3). Only "no time to test" differed significantly by Homeless Stand Down site. Nonresponse rate was 54%. Offering rapid HIV testing at Homeless Stand Downs is a promising testing venue since 15% of Veterans attending VANTHCS' Homeless Stand Downs were tested for HIV, and majority obtained their HIV test results at point-of-care while further research is needed to determine how to improve these rates.

Effects of structured vocational services in ex-offender veterans with mental illness: 6-month follow-up.

With more than 200,000 veterans incarcerated, a significant need exists for the development of technologies that help veterans with felony histories return to employment. This study evaluated the effect of three methods of vocational assistance on competitive employment over a 6 mo follow-up period: (1) basic vocational services, (2) self-study using a vocational manual designed for formerly incarcerated veterans, and (3) a group led by vocational staff using the vocational manual. We evaluated 111 veterans for time to obtain and total time of competitive employment. The group format was expected to be superior to the self-study and the self-study superior to basic services. Findings indicated that the group format was associated with quicker employment and more total employment than the basic and self-study conditions. Limitations and directions for future refinement are discussed.

Lifestyle coaching's effect on 6-month follow-up in recently homeless substance dependent veterans: a randomized study.

OBJECTIVE: Behaviors and activities consistent with "healthy" lifestyles (i.e., leisure and recreational activities, social and family interactions, coping behaviors) have been shown to be related to prolonged substance dependence recovery. However, there has been little focus on systematically capitalizing on this association in treatment to improve relapse rates. The goal of this study was to determine if the inclusion of healthy lifestyle coaching, that is the encouragement of specific behaviors in a therapeutic setting, could impact time to relapse. METHODS: Fifty-six veterans who were recently discharged from a Veterans Administration (VA) homeless Domiciliary Residential Rehabilitation and Treatment Program and were substance dependent were evaluated over a 6-month follow-up period. Using a partially randomized design, three groups were evaluated: 1) those followed by a therapist and coached to increase healthy behaviors, 2) those followed by a therapist and receiving only emotional support, and 3) those not followed by a therapist. Survival analyses and nonparametric evaluations were performed. RESULTS: Coached consumers had longer latency to relapse than noncoached and relapsed at a lower rate than those not followed by a therapist. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Therapeutic interventions which focus on increasing healthy behaviors chosen by the consumer can be an important component of sustained recovery from substance dependence.

Effects of structured vocational services on job-search success in ex-offender veterans with mental illness: 3-month follow-up.

With the high number of incarcerated veterans with mental illness and substance dependence returning to the community annually, a significant need exists for technologies that will help them return to employment. This study evaluates three methods of assistance: (1) basic vocational services, (2) self-study of a vocational manual designed for formerly incarcerated veterans, and (3) a group led by vocational staff using the vocational manual. We evaluated 69 veterans to determine the number finding employment within 3 months after enrollment in the study. The group format was expected to be superior to self-study, and self-study was expected to be superior to basic services. Though the group format was found to be superior to both self-study and basic services, the results for self-study and basic services were statistically similar. Limitations and directions for future refinement are discussed.

A comparison of the behavioral observation system (BOS) with clinician ratings of psychosis and mania.

This study investigated the relationship of the behavioral observation system (BOS; LePage & Mogge, 2001) and clinician ratings of psychosis and mania. Fifty interviews with psychiatric inpatients using the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, and the Young Mania Rating scale were completed. Paraprofessionals completed a BOS on the patient during the same day of the clinician's interview. The results of the study demonstrate the convergent validity of the BOS scales and support the use of the BOS by paraprofessionals to assess behaviors associated with psychosis and mania.

Effects of hemodialysis on profound memory deficits in renal insufficiency due to multiple myeloma: a case study.

Multiple myeloma, a rare cancer for individuals less than 65 years of age, and its pathophysiological effects have a profound impact on neurocognitive function. Specific transient deficits in patients with renal failure secondary to multiple myeloma have been noted to improve with hemodialysis. We present a complex case of an individual with multiple myeloma, renal insufficiency, treated seizure disorder, and schizophrenia, paranoid type, who experienced functional improvements in memory and visuospatial function with short- and long-term administration of hemodialysis. Within weeks of treatment, memory impairments resolved. With continued hemodialysis, some areas of neurocognitive function were in the superior range, indicating an overall improvement of more than three standard deviations. Implications and recommendations for clinicians treating individuals with similar challenges are offered.

Detecting random responding using the Assessment of Depression Inventory: a brief screening measure of depression.

BACKGROUND: Traditionally, the assessment of random responding in psychological assessment tools has been the primary domain of large multi-scale inventories. However, the ability of clinicians to assess random responding when using short symptom inventories is also an important facet of reliably assessing psychopathology and psychological distress. METHODS: This study assesses the effectiveness of a short symptom inventory, the Assessment of Depression Inventory (ADI), to assess random responding. RESULTS: The responses of 335 clinical patients, 150 responses from a feigning population, and 1,000 generated random profiles were compared to determine if the Random and Reliability scales of the ADI could detect adequately random responses. CONCLUSIONS: Findings indicate that even scales as short as four items can be used to detect random responses in symptom inventories at levels equivalent to or better than longer multi-scale inventories.

Reliability and validity of World Health Organization Quality of Life-100 in homeless substance-dependent veteran population.

The number of homeless individuals and specifically homeless veterans is increasing. Accurate assessment of quality of life is an important need in working with this population because of the myriad problems encountered. However, the reliability and validity of quality-of-life instruments have not been assessed in this population. This study evaluated the psychometric properties of the U.S. version of the World Health Organization Quality of Life-100 in a homeless veteran population. Results found adequate internal consistency for all domain and most facet scores, while test-retest stability varied for the facet scores. We confirmed validity by using subsamples with physical, emotional, and social problems and by comparing scores from populations that returned to the community with employment and housing. Limitations and directions for future study are discussed.