Veterans' Disability Claims
Conditions
Keywords
Rehabilitation, Vocational, Compensation and Redress, disability evaluation
Brief summary
This study will address the problem that claimants with psychiatric disabilities who apply for and receive disability benefits go on to work less than those whose claims are denied.
Detailed description
The objective of this research is to conduct a 6-month randomized clinical trial comparing participants assigned to Benefits Counseling and to those assigned to the control condition, VA Orientation. Benefits Counseling is an adaptation of two counseling approaches to foster veterans' involvement in work and work-related activity compared to the control condition, VA Orientation. The first approach helped recipients of Social Security disability benefits for psychiatric illness return to work in part by alleviating beneficiaries' concerns that they would lose their benefits if they worked. The second approach is a Motivational Interviewing approach that showed great promise in engaging veterans with psychiatric disabilities in compensated work therapy.
Interventions
BEHAVIORALBenefits Counseling
Benefits counseling is designed to improve the quality of life of disability applicants by accomplishing two functions: 1) Providing information concerning what vocational rehabilitation services are available and how they will affect receipt of disability payments, 2) Amplifying applicants' existing motivation to engage in work and related-activities, using a Motivational Interviewing approach.
BEHAVIORALVA Orientation
VA Orientation is designed to provide the Veteran with information regarding the services available, how to access the services and where the service is located on the VA campus.
Sponsors
Yale University
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Has never received VBA benefits * Able to provide valid consent * Expresses willingness to discuss benefits with a counselor * Difficulty working as evidenced by a Yes to either (a), (b), or (c) of the question below about work-related difficulties: During the past 4 weeks, have you had any of the following problems (such as feeling depressed and anxious): * Cut down on the amount of time you spent on work or other activities? * Accomplished less than you would like? * Didn't do work or other activities as carefully as usual? * Expresses willingness to try Benefits Counseling if assigned to it * An evaluation by a psychiatrist or psychologist is scheduled
Exclusion criteria
* Already receiving VA payments * Already receiving SSI or SSDI payments * Has a conservator
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Days of Work and Work-related Activity | Baseline | Number of days in the past 28 spent engaged in any kind of work or related activity. Measured using a timeline follow-back calendar. |
Countries
United States
Participant flow
Recruitment details
Participants were recruited from December 2008 to December 2011. Veterans were eligible for participation if they were seeking service-connection for a psychiatric disability and they indicated that emotional problems had interfered with work in the past 28 days.
Participants by arm
| Arm | Count |
|---|---|
| Benefits Counseling Four 50-minutes sessions of individual counseling using motivational interviewing to increase veterans' desire to engage in work and related activities | 42 |
| VA Orientation Four sessions of VA orientation that taught veterans about the VA health care system generally and about the specific general medical and mental health services available to veterans | 42 |
| Total | 84 |
Baseline characteristics
| Characteristic | VA Orientation | Benefits Counseling | Total |
|---|---|---|---|
| Age, Continuous | 40 years STANDARD_DEVIATION 14 | 37 years STANDARD_DEVIATION 4 | 38.5 years STANDARD_DEVIATION 14 |
| Attitudes and beliefs: If a person is receiving VA benefits and starts working for pay ... Income benefits will be reduced or stopped | 3.5 Likert scale STANDARD_DEVIATION 1.2 | 3.4 Likert scale STANDARD_DEVIATION 1.4 | 3.45 Likert scale STANDARD_DEVIATION 1.4 |
| Attitudes and beliefs: If a person is receiving VA benefits and starts working for pay ... Medical benefits will remain the same | 2.8 Likert scale STANDARD_DEVIATION 1.3 | 3.1 Likert scale STANDARD_DEVIATION 1.4 | 2.95 Likert scale STANDARD_DEVIATION 1.4 |
| Attitudes and beliefs: If a person is receiving VA benefits and starts working for pay ... Would rather turn down job than lose benefits | 3.6 Likert scale STANDARD_DEVIATION 1 | 3.3 Likert scale STANDARD_DEVIATION 1 | 3.45 Likert scale STANDARD_DEVIATION 1 |
| Psychiatric diagnosis Major depression | 10 participants | 15 participants | 25 participants |
| Psychiatric diagnosis PTSD | 15 participants | 9 participants | 24 participants |
| Psychiatric diagnosis Schizophrenia type/Bipolar | 2 participants | 3 participants | 5 participants |
| Psychiatric diagnosis Substance abuse | 6 participants | 11 participants | 17 participants |
| Psychiatric diagnosis TBI | 3 participants | 1 participants | 4 participants |
| Race/Ethnicity, Customized African American | 5 participants | 6 participants | 11 participants |
| Race/Ethnicity, Customized Latino | 5 participants | 8 participants | 13 participants |
| Race/Ethnicity, Customized Other | 4 participants | 3 participants | 7 participants |
| Race/Ethnicity, Customized White | 28 participants | 25 participants | 53 participants |
| Sex: Female, Male Female | 4 Participants | 10 Participants | 14 Participants |
| Sex: Female, Male Male | 38 Participants | 32 Participants | 70 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 42 | 0 / 42 |
| serious Total, serious adverse events | 0 / 42 | 0 / 42 |
Outcome results
Primary
Days of Work and Work-related Activity
Number of days in the past 28 spent engaged in any kind of work or related activity. Measured using a timeline follow-back calendar.
Time frame: Month 3
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Benefits Counseling | Days of Work and Work-related Activity | Classes | 3.7 days | Standard Deviation 7 |
| Benefits Counseling | Days of Work and Work-related Activity | Any work activity | 11.6 days | Standard Deviation 8.9 |
| Benefits Counseling | Days of Work and Work-related Activity | Work for pay | 9.3 days | Standard Deviation 9.3 |
| Benefits Counseling | Days of Work and Work-related Activity | Work for no pay | 1.7 days | Standard Deviation 5.2 |
| Benefits Counseling | Days of Work and Work-related Activity | Vocational rehabilitation | .4 days | Standard Deviation 2.1 |
| VA Orientation | Days of Work and Work-related Activity | Vocational rehabilitation | .4 days | Standard Deviation 2.5 |
| VA Orientation | Days of Work and Work-related Activity | Work for no pay | .5 days | Standard Deviation 2.1 |
| VA Orientation | Days of Work and Work-related Activity | Any work activity | 11.6 days | Standard Deviation 9.5 |
| VA Orientation | Days of Work and Work-related Activity | Classes | 1.0 days | Standard Deviation 3.1 |
| VA Orientation | Days of Work and Work-related Activity | Work for pay | 10.3 days | Standard Deviation 10.3 |
Primary
Days of Work and Work-related Activity
Number of days in the past 28 spent engaged in any kind of work or related activity. Measured using a timeline follow-back calendar.
Time frame: Month 1
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Benefits Counseling | Days of Work and Work-related Activity | Work for pay | 7.0 days | Standard Deviation 9.3 |
| Benefits Counseling | Days of Work and Work-related Activity | Classes | 3.7 days | Standard Deviation 3.7 |
| Benefits Counseling | Days of Work and Work-related Activity | Work for no pay | 1.4 days | Standard Deviation 1.7 |
| Benefits Counseling | Days of Work and Work-related Activity | Vocational rehabilitation | 4.5 days | Standard Deviation 0.4 |
| Benefits Counseling | Days of Work and Work-related Activity | Any work activity | 8.6 days | Standard Deviation 9.1 |
| VA Orientation | Days of Work and Work-related Activity | Vocational rehabilitation | 0 days | Standard Deviation 0.4 |
| VA Orientation | Days of Work and Work-related Activity | Any work activity | 9.8 days | Standard Deviation 10 |
| VA Orientation | Days of Work and Work-related Activity | Work for pay | 10.0 days | Standard Deviation 10.3 |
| VA Orientation | Days of Work and Work-related Activity | Work for no pay | 3.3 days | Standard Deviation 0.5 |
| VA Orientation | Days of Work and Work-related Activity | Classes | 4.6 days | Standard Deviation 1 |
Primary
Days of Work and Work-related Activity
Number of days in the past 28 spent engaged in any kind of work or related activity. Measured using a timeline follow-back calendar.
Time frame: Baseline
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Benefits Counseling | Days of Work and Work-related Activity | Work for pay | 6.6 days | Standard Deviation 8.8 |
| Benefits Counseling | Days of Work and Work-related Activity | Classes | 2.6 days | Standard Deviation 6.2 |
| Benefits Counseling | Days of Work and Work-related Activity | Work for no pay | .3 days | Standard Deviation 1.2 |
| Benefits Counseling | Days of Work and Work-related Activity | Vocational rehabilitation | .1 days | Standard Deviation 0.3 |
| Benefits Counseling | Days of Work and Work-related Activity | Any work activity | 8.3 days | Standard Deviation 8.1 |
| VA Orientation | Days of Work and Work-related Activity | Vocational rehabilitation | .0 days | Standard Deviation 0.2 |
| VA Orientation | Days of Work and Work-related Activity | Any work activity | 8.7 days | Standard Deviation 9.4 |
| VA Orientation | Days of Work and Work-related Activity | Work for pay | 9.0 days | Standard Deviation 10.1 |
| VA Orientation | Days of Work and Work-related Activity | Work for no pay | .1 days | Standard Deviation 0.2 |
| VA Orientation | Days of Work and Work-related Activity | Classes | 1.6 days | Standard Deviation 4.9 |
Primary
Days of Work and Work-related Activity
Number of days in the past 28 spent engaged in any kind of work or related activity. Measured using a timeline follow-back calendar.
Time frame: Month 6
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Benefits Counseling | Days of Work and Work-related Activity | Work for pay | 10.5 days | Standard Deviation 9.6 |
| Benefits Counseling | Days of Work and Work-related Activity | Classes | 4.8 days | Standard Deviation 8.5 |
| Benefits Counseling | Days of Work and Work-related Activity | Work for no pay | 2.6 days | Standard Deviation 6.1 |
| Benefits Counseling | Days of Work and Work-related Activity | Vocational rehabilitation | .6 days | Standard Deviation 3 |
| Benefits Counseling | Days of Work and Work-related Activity | Any work activity | 12.7 days | Standard Deviation 8.4 |
| VA Orientation | Days of Work and Work-related Activity | Vocational rehabilitation | .3 days | Standard Deviation 1.7 |
| VA Orientation | Days of Work and Work-related Activity | Any work activity | 10.5 days | Standard Deviation 9.4 |
| VA Orientation | Days of Work and Work-related Activity | Work for pay | 7.8 days | Standard Deviation 9.6 |
| VA Orientation | Days of Work and Work-related Activity | Work for no pay | 1.4 days | Standard Deviation 4.7 |
| VA Orientation | Days of Work and Work-related Activity | Classes | 2.5 days | Standard Deviation 5.9 |