Engaging Veterans with Spinal Cord Injury in Vocational Rehabilitation: What Works, What Doesn’t in the Early Phase of Job Seeking

Research Objectives: To identify facilitators and barriers to early implementation of vocational rehabilitation services for Veterans with spinal cord injury.

Design: Randomized controlled trial.

Setting: Two spinal cord injury centers with the Department of Veterans’ Affairs.

Participants: Veterans with SCI randomized into either individualized placement and support (IPS) or customized employment (CE) and their vocational and clinical providers (n=10).

Interventions: IPS is an evidence-based vocational program that has been found to be 2.5 times more effective than business as usual vocational services.1,2 CE is a promising practice for Veterans with spinal cord injury.3

Main Outcome Measures: Semi-structured qualitative virtual interviews to identify facilitators and barriers to job seeking by Veterans with SCI.

Results: Site differences emerged at the early implementation phase of the interventions. At one site, vocational providers for IPS and CE described conducting initial vocational assessment activities according to the intervention but expressed difficulty contacting their caseload Veterans. Veterans from this site concurred, stating lack of communication from their vocational provider led to lack of job seeking activities. In contrast, at the other site, more consistent, frequent communication was established between the CE vocational provider and caseload Veterans, while turnover of the IPS vocational provider limited enrollment of Veterans for that intervention. Veterans felt supported by vocational providers who understands SCI and adapts activities to their individual needs.

Conclusions: Early implementation of both interventions found that keeping Veterans engaged with job seeking is facilitated by frequent communication. Strategies to improve communication include keeping a weekly schedule and adapting to Veterans’ needs. To support knowledge of SCI by vocational providers, attending SCI team meetings and involving clinical providers in the job seeking process to address health issues that may arise.

Author(s) Disclosures: None