Implementation of supported employment for homeless veterans with psychiatric or addiction disorders: two-year outcomes.
OBJECTIVE
There has been growing interest in the dissemination of supported employment, but few studies have used a control group to examine the benefits of multisite dissemination efforts for clients or have addressed the needs of homeless persons with psychiatric disorders, addiction disorders, or both. This study examined a low-intensity training approach for implementing the individual placement and support (IPS) model at nine Department of Veterans Affairs (VA) programs and compared client outcomes before (phase 1) and after (phase 2) the program was implemented (phase 1).


METHODS
Special funds and sustained training, which was based primarily on teleconferencing, were used to support implementation of the IPS model of supported employment at nine VA programs for homeless veterans. A comparison cohort (phase 1) (N=308) was recruited from the nine sites before IPS was implemented. A postimplementation cohort (phase 2) (N=321) was recruited at the same sites and offered IPS. Mixed models were used to compare quarterly employment outcomes over two years in phase 1 and phase 2, adjusting for significant baseline differences (N=629).


RESULTS
Measures of both client-level service delivery and site-level fidelity to IPS suggest that implementation was successful at most, but not all, sites. Overall, compared with veterans in the phase 1 group, those in the phase 2 group had a better long-term work history at the time of program entry. When the analyses controlled for baseline differences, the mean number of competitive employment days per month over the two-year follow-up period was 15% higher for veterans in phase 2 (8.4 days compared with 7.3 days; p<.001) and the mean number of days housed during follow-up was also higher in phase 2 (34.1 days compared with 29.8 days; p=.04), but there were no differences for other outcome measures.


CONCLUSIONS
A sustained training program can be used to implement IPS in systems that have had little past experience with this approach. This effort was associated with improved employment outcomes and more rapid housing placement.
Rosenheck
Robert A
RA
Northeast Program Evaluation Center (182), Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, and Department of Psychiatry, Yale Medical School, New Haven, USA. robert.rosenheck@yale.edu
Mares
Alvin S
AS
D000328:Adult; D003710:Demography; D017831:Diagnosis, Dual (Psychiatry); D016832:Employment, Supported / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012944:Social Support; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy; D013663:Teaching; D013685:Telecommunications; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data