Mental Illness
Conditions
Keywords
Veterans, Substance-Related Disorders, Mental Health
Brief summary
The purpose of this research is to test the usefulness of a vocational rehabilitation program for veterans with a history of felonies who also have a mental illness or have substance dependency.
Detailed description
The Department of Justice's Bureau of Justice Statistics (BOJS, 2000) reported in 2000 over 225,000 veterans were incarcerated in the nations' criminal facilities; 1 in 5 of these veterans saw combat during service. Approximately 78,000 veterans annually will be released from incarceration with 30% of those released from incarceration are re-arrested within 3 months, 44.1% re-arrested at one year, and 67.5% within 3 years. These numbers are higher with those with serious mental illnesses: 54.3% re-arrest rates at one year and 72% at 3 years. The living status that many of these veterans with felonies return to is dire. In a survey of dually diagnosed and mentally ill offenders, 22% of mentally ill offenders and 43% of mentally ill offenders with substance addiction believed they would be homeless upon release. Ex-felons often return to more disadvantaged communities where employment is scarce (La Vigne, Mamalian, Travis, & Visher, 2003). Employers are reluctant to hire those with a history of incarceration due to biases against ex-offenders or due to legal liability (Connerley, Arvey, & Bernardy, 2001) or other biases (Holzer, 1996). Overall, employers have been shown to be less likely to hire ex-convicts than those with little work experience or those who are receiving welfare benefits (Holtzer, 1996). The goal of this study is to identify successful vocational re-integration modalities for mental health and/or substance dependent veterans recently released from incarceration and those with felony histories. Specific Goals are 1) test time to employment between manual conditions; 2) test total time employed over the 12 months following training period; and 3) test economic impact between manual conditions The study will be a controlled 3 group randomized design. The independent variable will be the amount of vocational services received. Veterans will be randomly assigned to one of three conditions: 1) Basic vocational services but no manualized vocational program; 2) self-study of the manualized program; and 3) a full program consisting of the manualized program with vocational staff and peer vocational support specialists. All veterans enrolled in the study will have access to a Veteran's Employment Resource Center to provide infrastructure for job search. Three primary dependent variables will be used. The first is the time till employment. The second is the total time employed during the 12 months following training. The third will be the economic impact of the training through differences in services required (e.g. emergency room visits, food stamps, cost of shelters, costs of rearrests) and income earned. Type of job skills, job history, and time incarcerated are some of the variables that potentially will be statistically controlled.
Interventions
Vocational services
OTHERSelf-Study
Veteran receives self-study resources
OTHERGroup Program
Veteran participates in group vocational program
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* underemployed or unemployed * has a mental health or substance dependence diagnosis * desires to enter the workforce through competitive employment. * History of at least one felony conviction Emphasis will be placed on returning OEF/OIF veterans, combat veterans, and women veterans. Veterans entering the study can be recruited regardless of living situation.
Exclusion criteria
* pursuing disability benefits due to unemployability * diagnosis of dementia or evidence of severe cognitive impairment * impaired reality testing due to psychosis * actively suicidal or homicidal.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time Till Employment in Days | 12 months | Number of days until first day of competitive employment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Test Economic Impact Between Manual Conditions (e.g., Cost-benefit Ratio) | 12 months | overall economic impact, in dollars, will be evaluated by the following formula: income - healthcare cost - cost of incarceration |
Countries
United States
Participant flow
Recruitment details
Veterans recruited throughout medical center
Pre-assignment details
Veterans must have completed a one week follow-up after enrollment to be randomized and included in the analyses.
Participants by arm
| Arm | Count |
|---|---|
| Basic Vocational Services Basic vocational services but no manualized vocational program | 42 |
| Self-Study Self-study of vocational materials
comparison of vocational programs: Veterans will be randomly assigned to one of three conditions: 1) Basic vocational services but no manualized vocational program; 2) a self-study of the manualized program materials; and 3) a full program consisting of the manualized program with vocational staff and peer vocational support specialists. All veterans enrolled in the study will have access to a Veteran's Employment Resource Center to provide infrastructure for job search. | 42 |
| Group Program a full program consisting of the manualized program with vocational staff and peer vocational support specialists
comparison of vocational programs: Veterans will be randomly assigned to one of three conditions: 1) Basic vocational services but no manualized vocational program; 2) a self-study of the manualized program materials; and 3) a full program consisting of the manualized program with vocational staff and peer vocational support specialists. All veterans enrolled in the study will have access to a Veteran's Employment Resource Center to provide infrastructure for job search. | 27 |
| Total | 111 |
Baseline characteristics
| Characteristic | Basic Vocational Services | Self-Study | Group Program | Total |
|---|---|---|---|---|
| Age, Continuous | 51.4 years STANDARD_DEVIATION 4.7 | 50.4 years STANDARD_DEVIATION 4.5 | 51.2 years STANDARD_DEVIATION 5.3 | 51.0 years STANDARD_DEVIATION 4.7 |
| Race/Ethnicity, Customized Racial/Ethnic Minority | 39 participants | 38 participants | 24 participants | 101 participants |
| Race/Ethnicity, Customized White/Non-Minority | 3 participants | 4 participants | 3 participants | 10 participants |
| Region of Enrollment United States | 42 participants | 42 participants | 27 participants | 111 participants |
| Sex: Female, Male Female | 1 Participants | 0 Participants | 2 Participants | 3 Participants |
| Sex: Female, Male Male | 41 Participants | 42 Participants | 25 Participants | 108 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 42 | 0 / 42 | 0 / 27 |
| serious Total, serious adverse events | 0 / 42 | 0 / 42 | 0 / 27 |
Outcome results
Primary
Time Till Employment in Days
Number of days until first day of competitive employment
Time frame: 12 months
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Basic Vocational Services | Time Till Employment in Days | 308 number of days to first employment |
| Self-Study | Time Till Employment in Days | 301 number of days to first employment |
| Group Program | Time Till Employment in Days | 214 number of days to first employment |
p-value: <0.05Chi-squared
Secondary
Test Economic Impact Between Manual Conditions (e.g., Cost-benefit Ratio)
overall economic impact, in dollars, will be evaluated by the following formula: income - healthcare cost - cost of incarceration
Time frame: 12 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Basic Vocational Services | Test Economic Impact Between Manual Conditions (e.g., Cost-benefit Ratio) | 944 dollars | Standard Deviation 3548 |
| Self-Study | Test Economic Impact Between Manual Conditions (e.g., Cost-benefit Ratio) | 304 dollars | Standard Deviation 1549 |
| Group Program | Test Economic Impact Between Manual Conditions (e.g., Cost-benefit Ratio) | 4698 dollars | Standard Deviation 11620 |