Total Metacognitive Capacity Predicts Competitive Employment Acquisition Across 6 Months in Adults With Serious Mental Illness Receiving Psychiatric Rehabilitation Services.

ABSTRACT: Deficits in metacognitive capacity are common among people with serious mental illness (SMI), although there is a gap in knowledge regarding how these impairments predict later functioning, especially employment. This study aimed to prospectively examine the relationship between metacognitive capacity and 6-month competitive employment attainment in adults with SMI who were participating in a study testing a cognitive behavioral therapy intervention added to supported employment services. Sixty-seven participants with complete data at baseline and the 6-month follow-up comprised the sample. Data were analyzed using stepwise logistic regression covarying for work history and study assignment. Results indicate that total metacognitive capacity at baseline significantly predicted employment acquisition at 6 months; the final model correctly classified 83.3% of participants who obtained work. In conclusion, these findings suggest that better overall metacognitive capacity may be key for future work functioning. Thus, interventions that target metacognitive capacity may lead to enhancements in community outcomes.

Key stakeholder perspectives on the use of research about supported employment for racially and ethnically diverse patients with mental illness in the United States.

OBJECTIVE: To explore how stakeholders responded to research evidence regarding supported employment (e.g., vocational rehabilitation), and ways evidence could be incorporated into policy and action. DATA SOURCES: Qualitative data were collected from three stakeholder groups-people with lived experience of mental health challenges, community health advocates, and state health policy makers. STUDY DESIGN: This study consisted of two sequential steps. First, three focus groups were conducted after presenting stakeholder groups (inclusive of 22 participants) with simulation data showing that improvement in employment status had a stronger impact on mental health than improvement in education or income for racially/ethnically diverse groups. Second, with guidance from focus group findings, researchers conducted additional in-depth interviews (n = 19) to gain a deeper understanding of the opportunities and challenges related to incorporating these findings into policy and practice. DATA COLLECTION/EXTRACTION METHODS: Focus groups and in-depth interviews were conducted, audio recorded, transcribed, and analyzed using a thematic analysis approach. PRINCIPAL FINDINGS: People with lived experience described the positive effect of employment in their own life while highlighting the need to increase workplace accommodations and social supports for those with mental health challenges. Across stakeholder groups, participants emphasized the need for linguistic and cultural competence to promote equity in delivery of supported employment programs. Stakeholders also underscored that centralizing existing resources and using evidence-based approaches are crucial for successful implementation. CONCLUSION: Implementing effective supported employment programs should focus on meeting the specific needs of target individuals, as many of those needs are not considered in current employment-related programming. Collecting information from diverse users of research demonstrates what other aspects of supported employment are required for the likelihood of successful uptake. Implementation and dissemination efforts need to fortify collaborations and knowledge transfer between stakeholders to optimize supported employment and mental health resources.

[Issues Surrounding Work and School Reintegration for People in the Early Stages of a Psychotic Disorder]. / La réinsertion professionnelle et le retour aux études chez les personnes en début d'évolution d'un trouble psychotique.

Introduction Socio-professional reintegration is an objective that is regularly sought-after by people in the early stages of a psychotic disorder. Despite this, employment rates are low for this population and high school dropout rates remind at a high level. Objectives and method This literature synthesis based on recent meta-analyses and studies aims at presenting the determinants of vocational and school integration for people in the early stages of a psychotic disorder. This will be followed by the presentation of the most studied supported employment and education programs, as well as by complementary interventions to support existing programs. In addition, key concepts are illustrated through clinical vignettes for this clientele. Results. Several barriers to socio-professional reintegration in this population could help explain the lower success rates when compared to the general population, including individual factors (e.g., past employment history, length of absence from the labour market, negative and cognitive symptoms, motivation) and environmental factors (e.g., availability of supported employment or education programs, competence of the employment specialist, social assistance benefits, employer attitude). The program that shows the most accumulated evidence is called Individual Placement and Support (IPS) and is frequently used in Quebec. IPS focuses on competitive job search, rapid placement in the labour market and collaboration between an employment specialist, the client, and the employer. Mowbray's supported education programs, as well as IPS adapted for education, help respond more specifically to the needs of people in the early stages of a psychotic disorder, who often wish to return to school. This article describes two clinical examples of programs offered in Quebec. Despite the interesting results provided by supported programs, socio-professional reintegration and maintaining employment remain difficult for people who are in the early stages of a psychotic disorder. Considering this, several researchers suggest that interventions for people with psychotic disorders should be more individualized, given the great heterogeneity associated with this condition. Combining interventions that are specific to each candidate's pre-existing individual deficits (e.g., cognitive remediation, cognitive-behavioural therapy, social skills training) appears to be an effective solution for optimizing the therapeutic response in supported employment or education programs. Conclusion This article highlights the issues related to the professional or academic reintegration of people in the early stages of a psychotic disorder, in order to guide practitioners in the field and to offer possible solutions to the current limitations of these programs in Quebec, including access to certain interventions.

Employment is a critical mental health intervention.

employment is critically important in mental health care. Unemployment worsens mental health and gaining employment can improve mental health, even for people with the most serious mental illnesses. In this editorial, we argue for a new treatment paradigm in mental health that emphasises employment, because supported employment is an evidence-based intervention that can help the majority of people with mental health disability to succeed in integrated, competitive employment. Unlike most mental health treatments, employment engenders self-reliance and leads to other valued outcomes, including self-confidence, the respect of others, personal income and community integration. It is not only an effective short-term treatment but also one of the only interventions that lessen dependence on the mental health system over time.

Financial incentives promote engagement in employment services for unemployed adults in treatment for opioid use disorder.

BACKGROUND: Promoting employment among unemployed adults with substance use disorder is a difficult challenge for which existing interventions have had limited effects. This study examined whether financial incentives could increase engagement in employment services for unemployed adults in treatment for opioid use disorder. METHODS: The study was conducted from 2014 to 2019 in Baltimore, MD. After a 3-month abstinence initiation and training period, participants (N = 91) were randomly assigned to a Control group or an Incentive group and were invited to work with an employment specialist to seek employment in a community job for 12 months. Participants assigned to the Control group (n = 47) did not receive incentives for working with the employment specialist. Participants assigned to the Incentive group (n = 44) could earn financial incentives for working with the employment specialist, but had to provide opiate- and cocaine-negative urine samples to maximize pay. RESULTS: Incentive participants attended the employment services and worked with the employment specialist on significantly more days than Control participants (41.8 % versus 1.1 % of days; OR = 40.42, 95 % CI = 32.46-48.38, p < .001), and for significantly more hours than Control participants (3.58 versus 1.25 h, on average; OR=2.34, 95 % CI=1.83-2.85, p < .001). Incentive participants were more likely to be retained than Control participants when analyses were based solely on attendance (HR=0.12, 95 % CI=0.06-0.25, p < .001) and attendance and employment combined (HR=0.15, 95 % CI=0.07-0.31, p < .001). CONCLUSIONS: Financial incentives were effective in promoting engagement in employment services for individuals who often do not utilize employment services.

Brief Report: A Job-Based Social Skills Program (JOBSS) for Adults with Autism Spectrum Disorder: A Pilot Randomized Controlled Trial.

Adults with autism spectrum disorder (ASD) have low employment rates; even those who are employed have low wages and limited hours. This study evaluated the effectiveness of the Job-Based Social Skills (JOBSS) curriculum, a manualized, 15-week, group-delivered intervention for adults with ASD. The intervention aimed to increase social-pragmatic skills necessary to obtain and maintain employment. Twenty-two adults were randomly assigned to either JOBSS intervention or wait-list control groups. Results showed significant improvement in social cognition, as reported by caregivers, among JOBSS group participants compared to wait-list control participants. Forty-five percent of intervention participants gained employment in the six months following participation. This curriculum has potential to improve social skills of adults with ASD, thereby increasing successful employment.

Employment and vocational rehabilitation experiences among veterans with polytrauma/traumatic brain injury history.

Evidence suggests that Iraq and Afghanistan war veterans with polytrauma/traumatic brain injury (TBI) history and neurobehavioral symptoms may face difficulties returning to work, yet also encounter barriers to accessing, navigating, and engaging in Department of Veterans Affairs (VA) vocational rehabilitation programs. This study utilized qualitative interviews and focus groups with veterans with documented polytrauma/TBI history to explore veterans' perceived barriers to employment and vocational rehabilitation program participation, as well as to solicit thoughts regarding interest in an evidence-based vocational rehabilitation program, the Individual Placement and Support model of Supported Employment (IPS-SE). Veterans identified physical, emotional, cognitive, and interpersonal barriers to finding and maintaining work that they described as linked with their polytrauma/TBI symptoms and sequelae. Communication and logistical issues were described as the primary barriers to vocational rehabilitation program access, while barriers to program utilization included eligibility characteristics, fear of losing financial benefits, and a military-cultural belief of self-sufficiency that made help-seeking difficult. Finally, veterans endorsed key aspects of IPS-SE, such as staff serving as translators, advocates, and navigators of the job search and maintenance process. Policy recommendations are addressed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Narrative development and supported employment of persons with severe mental illness.

Background: While the relationship between objective recovery and work among persons with severe mental illness (SMI) is well-established, few studies have examined the link between subjective recovery and employment.Aims: The study investigated the prospective relationship between narrative development at the start of supported employment (SE) and positive work outcomes.Methods: The authors employed a time-limited, mixed-method longitudinal design to examine the relationship between the baseline narrative development of 38 SE participants with SMI and employment outcomes eight months later, as well as whether narratives evolved over the course of the study.Results: While narrative development was unrelated to work for the 59% of participants who were employed at the end of the study, unemployed individuals showed more developed baseline narratives overall, as well as enriched baseline emotional connectedness and social worth. Higher emotional connectedness at the start of SE programs was predictive of fewer hours worked eight months later, controlling for executive functioning, negative symptoms and self-esteem. Although workers showed no narrative changes over time, those without work demonstrated increased agency over the eight months of the study.Conclusion: Further research is warranted to clarify the relationship between richer personal narratives and unemployment.

Perspectives of key stakeholders on employment of autistic adults across the united states, australia, and sweden.

Despite efforts to improve employment outcomes for autistic individuals, internationally their employment rates remain low. There is a need to better understand the factors influencing successful employment for autistic adults in the labor market from the perspectives of multiple key stakeholders. This study represents the second in a series of papers conducted as part of an International Society for Autism Research policy brief aimed at improving employment outcomes for autistic individuals. A community consultation methodology using focus groups, forums, and interviews was applied with autistic individuals (n = 19), family members (n = 18), service providers (n = 21), employers (n = 11), researchers (n = 5), and advocacy group representatives (n = 5) in Australia, Sweden, and the United States, aiming to identify the factors perceived to determine gaining and maintaining employment for autistic individuals. Directed content analysis, guided by the International Classification of Functioning, Disability and Health (ICF), was conducted to investigate the key factors influencing employment outcomes for autistic individuals. Meaningful verbal concepts, or units of text with common themes, were also derived from the qualitative data and then linked and compared to the ICF Autism Spectrum Disorder (ASD) Core-sets. Across countries, activity and participation and environmental factor categories of the ICF were the most associated with employment outcomes. Results suggest that removal of environmental barriers and enhancing environmental facilitators may assist to remediate ASD-related difficulties in the workplace. Autism Res 2019, © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study sought to understand the perspectives of autistic individuals and key stakeholders on factors influencing if autistic adults get and keep jobs. Across Australia, Sweden, and the United States, focus groups and interviews were conducted to understand international perspectives on what helps and hinders getting and keeping a job for autistic individuals. The environment, including supports, relationships, attitudes, and services, were perceived to be the most important for workplace success. Intervention targeting barriers and facilitators in the workplace environment may support autistic adults to be successful in the labor market.

Predictors of work outcomes following supported employment in veterans with a history of traumatic brain injury.

BACKGROUND: The effects of traumatic brain injury (TBI) on return to work have been the focus of many clinical studies in recent years. Veterans with a history of TBI may be at increased risk of unemployment. OBJECTIVE: We sought to understand predictors of work outcomes for Veterans with a history of TBI who received evidence-based supported employment. METHODS: Fifty unemployed Veterans with a history of mild-to-moderate TBI and current neuropsychological impairment participated in a 12-month supported employment intervention. Demographic data and baseline assessments of neuropsychological impairment, functional capacity, and psychiatric and post-concussive symptom severity were investigated as predictors of work outcomes (job attainment, weeks worked, and wages earned). RESULTS: Bivariate analyses showed that lower disability ratings, more recent work history, more months worked in the past 5 years, lower PTSD symptom severity, worse verbal memory, and better cognitive flexibility were all associated with better work outcomes. In multivariate regression analyses, better cognitive flexibility and worse verbal memory performance predicted better work outcomes. CONCLUSIONS: Further research is needed to determine how treatment of cognitive impairments and psychiatric symptoms is related to return to work in Veterans with a history of TBI.

Disclosure of mental illness to prospective employers: Clinical, psychosocial, and work correlates in persons receiving supported employment.

Deciding whether to disclose one's psychiatric disorder to a prospective employer is a complex decision for people with severe mental illness seeking to return to work, with potential advantages and disadvantages. The present study examined the rates, patterns, and correlates of disclosure in 51 participants (74.5% schizophrenia or schizoaffective disorder) receiving high fidelity Individual Placement Support (IPS) who obtained competitive work over a two-year study period. Most participants (64.7%) disclosed their psychiatric disorder in their first job, and there was a tendency for those with multiple jobs who did not disclose initially to shift to disclosure in subsequent jobs. Participants who disclosed for their first job had worse baseline cognitive scores on the Positive and Negative Syndrome Scale (PANSS), lower self-esteem, and poorer psychosocial functioning than those who did not disclose. However, participants who disclosed to their first employer were more likely to obtain jobs that matched their interests, and worked significantly longer than those who did not disclose (32.55 vs. 12.50 weeks, respectively). The findings suggest that individuals receiving supported employment who disclose their mental illness to prospective employers may have better work outcomes.

Enabling the return-to-work process among people with affective disorders: A multiple-case study.

BACKGROUND: The Individual Enabling and Support (IES) model is an adapted, supported employment program developed to meet motivational, cognitive and time-use needs of people with affective disorders. Vocational programs for this target group have been developed but more knowledge is needed about the important characteristics and perceived usefulness of the programs. The aim of this study was to illustrate the IES model and process from multiple perspectives. METHODS: Five participants were included in this multiple-case study. The material comprised interviews with participants, intervention documents, memos and interviews with employment specialists. Within and cross-case analyzes and an analytical generalization were performed. RESULTS: The cases illustrated different IES processes, and the theme; Enabling engagement in return to work (RTW) was formulated. Continuous support from the employment specialist and a focus on personal resources and motivation were essential to overcome low self-confidence regarding RTW. Motivational, cognitive and time-use strategies gave an opportunity to learn new behavior and coping strategies for job seeking, getting employed and working. CONCLUSION: Providing a combination of these strategies integrated with supported employment could promote self-efficacy and engagement in the RTW process among people on sick leave due to an affective disorder.

Disability disclosure and workplace accommodations among youth with disabilities.

Purpose: Many youths with disabilities find it challenging to disclose their medical condition and request workplace accommodations. Our objective was to explore when and how young people with disabilities disclose their condition and request workplace accommodations. Methods: We conducted 17 in-depth interviews (11 females, six males) with youth with disabilities aged 15-34 (mean age 26). We analyzed our data using an interpretive, qualitative, and thematic approach. Results: Our results showed the timing of when youth disclosed their disability to their employer depended on disability type and severity, comfort level, type of job, and industry. Youth's strategies and reasons for disclosure included advocating for their needs, being knowledgeable about workplace rights, and accommodation solutions. Facilitators for disclosure included job preparation, self-confidence, and self-advocacy skills, and having an inclusive work environment. Challenges to disability disclosure included the fear of stigma and discrimination, lack of employer's knowledge about disability and accommodations, negative past experiences of disclosing, and not disclosing on your own terms. Conclusions: Our findings highlight that youth encounter several challenges and barriers to disclosing their condition and requesting workplace accommodations. The timing and process for disclosing is complex and further work is needed to help support youth with disclosing their condition. Implications for rehabilitation Clinicians, educators, and employers should emphasize the importance of mentoring and leadership programs to give youth the confidence and self-advocacy skills needed to disclose and ask for accommodations in the workplace. Clinicians should advocate for the inclusion of youth with disabilities in the workforce and educate employers on the importance of doing so. Youth with disabilities need more opportunities for employment training and particularly how to disclose their disability and request workplace accommodations.

Youth and young adults with acquired brain injury transition towards work-related roles: a qualitative study.

PURPOSE: The purpose of this research was to explore the experiences of youth and young adults with acquired brain injury as they transition towards work-related roles. Little is known about employment experiences among this age group. Understanding their perspectives can inform programs and clinical practice. MATERIALS AND METHODS: A descriptive qualitative design, including semi-structured interviews with 14 participants (8 females; 6 males) was used. Interviews were transcribed verbatim and analyzed using an open-coding, thematic approach. RESULTS: Three major themes emerged related to the experience of work-related roles: (1) getting to know the new me; (2) navigating support systems; and (3) taking control of my experience. Some participants used coping strategies to acquire and/or maintain work-related roles, while others felt limited by their condition. CONCLUSIONS: A variety of work-related roles, people, and environments directly and indirectly influenced the work-related transition of youth and young adults with acquired brain injury. Individuals expressed the importance of acquired brain injury awareness in informing others about their impairments. In fact, a lack of acquired brain injury awareness was often a main reason for receiving less than adequate support and accommodations. Without an understanding of acquired brain injury, people in the lives of these individuals were unable to perceive the legitimacy of acquired brain injury-related impairments. Implications for rehabilitation The purpose of this study is to understand the experiences of youth and young adults with acquired brain injury as they transition into work-related roles. Using these experiences as a guideline can promote acquired brain injury awareness, and contribute to how current interventions are designed and delivered. Clinicians should ensure that youth and young adults with acquired brain injury have access to the resources they need to maximize their independence. Healthcare professionals can play a pivotal role in relaying important acquired brain injury-related education, implementing suitable treatment plans, and providing them with effective tips to help them through their transition. A healthy transition to work-related roles should include ample social support and communication, acquired brain injury-related information that informs the community of acquired brain injury impairments, needs, and recovery trajectory, as well as adequate and consistent coordination within and between the person and the environment.

Measuring perceived outcomes from participating at a clubhouse for persons with mental illness: Psychometric properties and associated factors.

BACKGROUND: The clubhouses are part of a growing international movement concerned with providing work-oriented psychosocial rehabilitation for people with a history of mental illness. Instruments used for measuring outcomes from clubhouse participation is in a developing phase. AIMS: This study aimed to assess psychometric properties of an outcome survey tool used at a Norwegian clubhouse, and to explore factors associated with members' perceived outcomes from participation at the clubhouse. METHODS: A cross-sectional design was used. The instrument's factor structure was examined with Principal Components Analysis (PCA), and internal consistency was assessed with Cronbach's α. Associations with the derived outcome scale score were examined with linear regression analysis. RESULTS: All scale items belonged to the same latent factor, and internal consistency of the items was α = 0.81. Members, who used the clubhouse more frequently perceived the outcomes from participating to be better, compared to their counterparts. CONCLUSION: The outcome scale was unidimensional and the items fit well together. Active members were likely to evaluate outcomes of clubhouse participation as more positive, compared to less active members. SIGNIFICANCE: The scale can be useful for exploring clubhouse members' perceptions of the outcomes they relate to their participation at the clubhouse.

Barriers and facilitators to employment for young adults with mental illness: a scoping review.

OBJECTIVES: The issue of gaining employment for those with mental illness is a growing global concern. For many in the young adult population, who are at a transitional age, employment is a central goal. In response, we conducted a scoping review to answer the question, 'What are the barriers and facilitators to employment for young adults with mental illness?' DESIGN: We conducted a scoping review in accordance to the Arksey and O'Malley framework. We performed a thorough search of Medline, EMBASE, CINAHL, ABI/INFORM, PsycINFO and Cochrane. We included studies that considered young adults aged 15-29 years of age with a mental health diagnosis, who were seeking employment or were included in an employment intervention. RESULTS: Our search resulted in 24 research articles that focused on employment for young adults with mental illness. Four main themes were extracted from the literature: (1) integrated health and social services, (2) age-exposure to employment supports, (3) self-awareness and autonomy and (4) sustained support over the career trajectory. CONCLUSIONS: Our review suggests that consistent youth-centred employment interventions, in addition to usual mental health treatment, can facilitate young adults with mental illness to achieve their employment goals. Aligning the mental health and employment priorities of young adults may result in improved health and social outcomes for this population while promoting greater engagement of young adults in care.

Relationship Between Comorbidities and Employment Among Veterans with Spinal Cord Injury.

Objective: To determine the relationship between medical and mental health comorbidities in a large cohort of veterans with spinal cord injury (SCI). Methods: Data were collected from interviews and electronic medical records of veterans with SCI (N = 1,047) who received care at 7 geographically diverse SCI centers within the Department of Veterans Affairs across the country (https://clinicaltrials.gov/ct2/show/NCT01141647). Employment, medical, functional, and psychosocial data underwent cross-sectional analysis. Results: Lack of any documented mental health diagnosis correlated strongly with being employed at the time of enrollment. No single comorbidity was associated with employment at enrollment, but an increased number of medical and/or mental health comorbidities ("health burden") were associated with a decreased likelihood of employment at the time of enrollment. Conclusion: Further investigation is needed to clarify whether comorbidity severity or combinations of specific comorbidities predict rehabilitation outcome, including employment.

The meaning of work for young adults diagnosed with serious mental health conditions.

OBJECTIVE: Despite the increased recognition of the importance of work for social and psychological well-being, the meaning of work for young adults with serious mental health conditions is understudied. This study uses a participatory action research approach to explore the economic, social and psychological significance of work for young adults diagnosed with psychiatric disabilities. METHOD: We conducted 57 one-hour semistructured interviews with young adults between the ages of 18 to 30 enrolled in 3 well established vocational support programs. NVivo 8 software was used to sort and systematically organize the interview data. RESULTS: Young adults with psychiatric disabilities work in part for financial independence from their family but also for additional reasons. Work provides the opportunity for social engagement and feelings of contributing to society as a whole. For some young adults, work provides the opportunity to enhance their self-esteem, self-confidence, and a positive self-image. For Latino young adults, work provides a way to cope with their mental illness. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Our findings provide pertinent information for vocational rehabilitation services, recovery programs, and even parents on the importance of connecting young adults to jobs that enhance self-esteem and self-efficacy and are in line with their personal interests. Future research is needed to understand potential cultural and age differences in the meaning of work. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Supported Employment for Veterans With Traumatic Brain Injury: Patient Perspectives.

OBJECTIVES: To quantify the need for, and interest in, supported employment (SE) among recent military veterans with traumatic brain injury (TBI); and to examine characteristics associated with veterans' interest in SE. DESIGN: Stratified random sample of Iraq and Afghanistan War veterans confirmed to have TBI through the Veterans Health Administration (VHA) screening and evaluation system. SETTING: Community-based via mailed survey. PARTICIPANTS: We recruited 1800 veterans with clinician-confirmed TBI (mild TBI: n=1080; moderate/severe TBI: n=720) through multiple mailings. Among 1451 surveys that were not returned undeliverable, N=616 (42%) responded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Veterans rated their interest in SE after reading a script describing the program. Additional measures assessed mental health and pain-related comorbidities, employment, financial/housing difficulties, demographics, and military service characteristics. Estimates were weighted to represent the population of veterans with VHA clinician-confirmed TBI. RESULTS: Unemployment was reported by 45% (95% confidence interval [CI], 43-47) of veterans with TBI. Although 42% (95% CI, 40-44) reported they would be interested in using SE if it were offered to them, only 12% had heard of SE (95% CI, 11-14) and <1% had used it. TBI severity and comorbidities were not associated with veterans' interest in SE. However, those who were unemployed, looking for work, experiencing financial strain, or at risk for homelessness were more likely to be interested in SE. CONCLUSIONS: Our research highlights an important gap between veterans' vocational needs and interests and their use of SE. Systematically identifying and referring those with employment and financial/housing difficulties may help close this gap.

Supported Employment for Veterans With Traumatic Brain Injury: Provider Perspectives.

OBJECTIVE: To identify any pilot and nonpilot site differences regarding current (1) provision of supported employment (SE) to veterans with traumatic brain injury (TBI); (2) staffing and communication between the SE and polytrauma/TBI teams; and (3) provider perceptions on facilitators and barriers to providing, and suggestions for improving, SE. DESIGN: Mixed methods cross-sectional survey study. SETTING: Veterans Health Administration SE programs. PARTICIPANTS: Respondents (N=144) included 54 SE supervisors and 90 vocational rehabilitation specialists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Web-based surveys of forced-choice and open-ended items included questions on SE team characteristics, communication with polytrauma/TBI teams, and experiences with providing SE to veterans with TBI history. RESULTS: SE was provided to veterans with TBI at 100% of pilot and 59.2% of nonpilot sites (P=.09). However, vocational rehabilitation specialists at pilot sites reported that communication with the polytrauma/TBI team about SE referrals was more frequent than at nonpilot sites (P=.003). In open-ended items, suggestions for improving SE were similar across pilot and nonpilot sites, and included increasing staffing for vocational rehabilitation specialists and case management, enhancing communication and education between SE and polytrauma/TBI teams, and expanding the scope of the SE program so that eligibility is based on employment support need, rather than diagnosis. CONCLUSIONS: These findings may contribute to an evidence base that informs SE research and clinical directions on service provision, resource allocation, team integration efforts, and outreach to veterans with TBI who have employment support needs.