Trial Outcomes & Findings for Assessing the Effect of Distance Learning Vocational Rehabilitation on Employment Outcomes of Veterans With Psychiatric Illness and Histories of Legal Convictions (NCT NCT03331354)
NCT ID: NCT03331354
Last Updated: 2024-06-28
Results Overview
Competitive Employment within 6 months of randomization. Competitive employment is defined as a paid position open to anyone, at least at minimum wage, and not a sheltered work position such as the VA's Compensated Work Therapy program. Additionally, day labor type activities were not counted as success.
Recruitment status
COMPLETED
Study phase
NA
Target enrollment
136 participants
Primary outcome timeframe
6 months
Results posted on
2024-06-28
Participant Flow
Recruitment occurred between 5/13/2019 and 4/28/2022 (during COVID). Recruitment was initially performed on site at the main hospital in VANTHCS (Dallas) but due to COVID, and with IRB approval, remote consenting was allowed.
The procedures were to review with the Veteran enrollment criteria (inclusion and exclusion), then consent Veteran. After consent, a detailed history (including confirmation of criteria) was scheduled on a different date. If the Veteran did not, they were withdrawn. Of those consented but withdrawn, 12 had no legal history and 2 had no interest in employment. Additionally, 25 Veterans did not return after consenting for the detailed history. A total of 39 Veterans (28%) were not randomized.
Participant milestones
| Measure |
Self-help Resources
Basic vocational services using the About Face Vocational self-help manual: Those receiving the hardcopy manual received a self-guided manual developed and described in previous studies. Briefly, the manual consisted of a series of modules which guide the Veteran through determining their vocational skills, answering interview questions, and addressing their legal and employment histories. Veterans' participation was self-paced. Three weeks after receiving the manual, staff contacted the participants and reviewed and recorded the percentage of the manual completed. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
Compass
A distant learning vocational program
Distant vocational learning: Veterans assigned to COMPASS were given access to the online Compass system with content modeled after the About Face Manual of condition 1. Veterans were assigned a vocational rehabilitation specialist (VRS) whom they were never physically in the same room.
Compass incorporated both asynchronous and synchronous learning. Asynchronous components, accessible at any time, were videos focused on the concepts of successful job search and handling legal history, as well as the ability to interact with Compass by entering personalized information needed for job search into Compass through fillable fields, similar to the About Face Manual. VRS's were also able review of the information inputted into Compass, making comments directly to the system for the Veteran to review through messages in the system, to suggest better phrasing, more details, etc. Synchronous components were 1) a live chat feature allowing Veterans to ask questions directly to the VRS monitoring the system; 2) telephone coaching where veterans may phone a Hot-Line during office hours to review difficult concepts, discuss progress, discuss upcoming interviews, and problem solve barriers; and 3) practice interviews with feedback via telehealth or phone. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
|---|---|---|
|
Overall Study
STARTED
|
47
|
50
|
|
Overall Study
COMPLETED
|
43
|
40
|
|
Overall Study
NOT COMPLETED
|
4
|
10
|
Reasons for withdrawal
| Measure |
Self-help Resources
Basic vocational services using the About Face Vocational self-help manual: Those receiving the hardcopy manual received a self-guided manual developed and described in previous studies. Briefly, the manual consisted of a series of modules which guide the Veteran through determining their vocational skills, answering interview questions, and addressing their legal and employment histories. Veterans' participation was self-paced. Three weeks after receiving the manual, staff contacted the participants and reviewed and recorded the percentage of the manual completed. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
Compass
A distant learning vocational program
Distant vocational learning: Veterans assigned to COMPASS were given access to the online Compass system with content modeled after the About Face Manual of condition 1. Veterans were assigned a vocational rehabilitation specialist (VRS) whom they were never physically in the same room.
Compass incorporated both asynchronous and synchronous learning. Asynchronous components, accessible at any time, were videos focused on the concepts of successful job search and handling legal history, as well as the ability to interact with Compass by entering personalized information needed for job search into Compass through fillable fields, similar to the About Face Manual. VRS's were also able review of the information inputted into Compass, making comments directly to the system for the Veteran to review through messages in the system, to suggest better phrasing, more details, etc. Synchronous components were 1) a live chat feature allowing Veterans to ask questions directly to the VRS monitoring the system; 2) telephone coaching where veterans may phone a Hot-Line during office hours to review difficult concepts, discuss progress, discuss upcoming interviews, and problem solve barriers; and 3) practice interviews with feedback via telehealth or phone. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
|---|---|---|
|
Overall Study
Withdrawal by Subject
|
1
|
3
|
|
Overall Study
Lost to Follow-up
|
3
|
3
|
|
Overall Study
Found employment before initiated active intervention
|
0
|
4
|
Baseline Characteristics
Assessing the Effect of Distance Learning Vocational Rehabilitation on Employment Outcomes of Veterans With Psychiatric Illness and Histories of Legal Convictions
Baseline characteristics by cohort
| Measure |
Self-help Resources
n=43 Participants
a self-help vocational manual
Basic vocational services: self-help manual
|
Compass
n=40 Participants
a distant learning vocational program
Distant vocational learning: use of hybrid distance learning to facilitate successful employment outcomes
|
Total
n=83 Participants
Total of all reporting groups
|
|---|---|---|---|
|
Age, Continuous
|
58.3 years
STANDARD_DEVIATION 8.1 • n=99 Participants
|
55.3 years
STANDARD_DEVIATION 8.6 • n=107 Participants
|
56.8 years
STANDARD_DEVIATION 8.5 • n=206 Participants
|
|
Sex: Female, Male
Female
|
5 Participants
n=99 Participants
|
4 Participants
n=107 Participants
|
9 Participants
n=206 Participants
|
|
Sex: Female, Male
Male
|
38 Participants
n=99 Participants
|
36 Participants
n=107 Participants
|
74 Participants
n=206 Participants
|
|
Ethnicity (NIH/OMB)
Hispanic or Latino
|
2 Participants
n=99 Participants
|
5 Participants
n=107 Participants
|
7 Participants
n=206 Participants
|
|
Ethnicity (NIH/OMB)
Not Hispanic or Latino
|
41 Participants
n=99 Participants
|
35 Participants
n=107 Participants
|
76 Participants
n=206 Participants
|
|
Ethnicity (NIH/OMB)
Unknown or Not Reported
|
0 Participants
n=99 Participants
|
0 Participants
n=107 Participants
|
0 Participants
n=206 Participants
|
|
Race (NIH/OMB)
American Indian or Alaska Native
|
0 Participants
n=99 Participants
|
0 Participants
n=107 Participants
|
0 Participants
n=206 Participants
|
|
Race (NIH/OMB)
Asian
|
0 Participants
n=99 Participants
|
0 Participants
n=107 Participants
|
0 Participants
n=206 Participants
|
|
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
|
0 Participants
n=99 Participants
|
0 Participants
n=107 Participants
|
0 Participants
n=206 Participants
|
|
Race (NIH/OMB)
Black or African American
|
38 Participants
n=99 Participants
|
26 Participants
n=107 Participants
|
64 Participants
n=206 Participants
|
|
Race (NIH/OMB)
White
|
5 Participants
n=99 Participants
|
14 Participants
n=107 Participants
|
19 Participants
n=206 Participants
|
|
Race (NIH/OMB)
More than one race
|
0 Participants
n=99 Participants
|
0 Participants
n=107 Participants
|
0 Participants
n=206 Participants
|
|
Race (NIH/OMB)
Unknown or Not Reported
|
0 Participants
n=99 Participants
|
0 Participants
n=107 Participants
|
0 Participants
n=206 Participants
|
|
Region of Enrollment
United States
|
43 Participants
n=99 Participants
|
40 Participants
n=107 Participants
|
83 Participants
n=206 Participants
|
|
Months of incarceration lifetime
|
67.9 Months
STANDARD_DEVIATION 91.9 • n=99 Participants
|
58.4 Months
STANDARD_DEVIATION 77.2 • n=107 Participants
|
63.8 Months
STANDARD_DEVIATION 84.8 • n=206 Participants
|
|
Substance Use Disorder
|
39 Participants
n=99 Participants
|
33 Participants
n=107 Participants
|
72 Participants
n=206 Participants
|
|
PTSD
|
15 Participants
n=99 Participants
|
19 Participants
n=107 Participants
|
34 Participants
n=206 Participants
|
|
Depression Diagnosis
|
15 Participants
n=99 Participants
|
17 Participants
n=107 Participants
|
32 Participants
n=206 Participants
|
|
Comorbid Substance Use Disorder and Mental Illness
|
27 Participants
n=99 Participants
|
24 Participants
n=107 Participants
|
51 Participants
n=206 Participants
|
PRIMARY outcome
Timeframe: 6 monthsCompetitive Employment within 6 months of randomization. Competitive employment is defined as a paid position open to anyone, at least at minimum wage, and not a sheltered work position such as the VA's Compensated Work Therapy program. Additionally, day labor type activities were not counted as success.
Outcome measures
| Measure |
Self-help Resources
n=43 Participants
Basic vocational services using the About Face Vocational self-help manual: Those receiving the hardcopy manual received a self-guided manual developed and described in previous studies. Briefly, the manual consisted of a series of modules which guide the Veteran through determining their vocational skills, answering interview questions, and addressing their legal and employment histories. Veterans' participation was self-paced. Three weeks after receiving the manual, staff contacted the participants and reviewed and recorded the percentage of the manual completed. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
Compass
n=40 Participants
A distant learning vocational program
Distant vocational learning: Veterans assigned to COMPASS were given access to the online Compass system with content modeled after the About Face Manual of condition 1. Veterans were assigned a vocational rehabilitation specialist (VRS) whom they were never physically in the same room.
Compass incorporated both asynchronous and synchronous learning. Asynchronous components, accessible at any time, were videos focused on the concepts of successful job search and handling legal history, as well as the ability to interact with Compass by entering personalized information needed for job search into Compass through fillable fields, similar to the About Face Manual. VRS's were also able review of the information inputted into Compass, making comments directly to the system for the Veteran to review through messages in the system, to suggest better phrasing, more details, etc. Synchronous components were 1) a live chat feature allowing Veterans to ask questions directly to the VRS monitoring the system; 2) telephone coaching where veterans may phone a Hot-Line during office hours to review difficult concepts, discuss progress, discuss upcoming interviews, and problem solve barriers; and 3) practice interviews with feedback via telehealth or phone. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
|---|---|---|
|
Competitive Employment Within Six Months of Random Assignment.
|
15 Participants
|
25 Participants
|
PRIMARY outcome
Timeframe: one monthPopulation: Due to COVID restrictions, not all Veterans could return to the VA to complete the second interview or did not have access to video connection to conduct the interview online.
Changes in Veterans scores on an interviewing rating form (the Veteran Interview Scale) were compared one month after entry into the study. Scores range from 0 to 30. Higher values are better.
Outcome measures
| Measure |
Self-help Resources
n=34 Participants
Basic vocational services using the About Face Vocational self-help manual: Those receiving the hardcopy manual received a self-guided manual developed and described in previous studies. Briefly, the manual consisted of a series of modules which guide the Veteran through determining their vocational skills, answering interview questions, and addressing their legal and employment histories. Veterans' participation was self-paced. Three weeks after receiving the manual, staff contacted the participants and reviewed and recorded the percentage of the manual completed. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
Compass
n=37 Participants
A distant learning vocational program
Distant vocational learning: Veterans assigned to COMPASS were given access to the online Compass system with content modeled after the About Face Manual of condition 1. Veterans were assigned a vocational rehabilitation specialist (VRS) whom they were never physically in the same room.
Compass incorporated both asynchronous and synchronous learning. Asynchronous components, accessible at any time, were videos focused on the concepts of successful job search and handling legal history, as well as the ability to interact with Compass by entering personalized information needed for job search into Compass through fillable fields, similar to the About Face Manual. VRS's were also able review of the information inputted into Compass, making comments directly to the system for the Veteran to review through messages in the system, to suggest better phrasing, more details, etc. Synchronous components were 1) a live chat feature allowing Veterans to ask questions directly to the VRS monitoring the system; 2) telephone coaching where veterans may phone a Hot-Line during office hours to review difficult concepts, discuss progress, discuss upcoming interviews, and problem solve barriers; and 3) practice interviews with feedback via telehealth or phone. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
|---|---|---|
|
Interviewing Skills
|
1.0 Change in raw interview scores
Standard Deviation 4.6
|
4.4 Change in raw interview scores
Standard Deviation 5.1
|
SECONDARY outcome
Timeframe: 30 daysPopulation: The number of participants in this evaluation was lower than number recruited. Participants needed to complete the job-search efficacy scale at the 30 day post group assignment point plus or minus 3 days. However, not all participants provided the data within the time constraints due to onsite restrictions due to COVID-19 and inability to access online data collection systems.
Change in job-search efficacy scores were compared between systems at enrollment (point 1) and after 30 days using the systems (point 2). The Job Search Efficacy Scale was used (Cronbach's alpha= .93). Range 10 - 50; higher scores indicate more job search efficacy.
Outcome measures
| Measure |
Self-help Resources
n=22 Participants
Basic vocational services using the About Face Vocational self-help manual: Those receiving the hardcopy manual received a self-guided manual developed and described in previous studies. Briefly, the manual consisted of a series of modules which guide the Veteran through determining their vocational skills, answering interview questions, and addressing their legal and employment histories. Veterans' participation was self-paced. Three weeks after receiving the manual, staff contacted the participants and reviewed and recorded the percentage of the manual completed. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
Compass
n=28 Participants
A distant learning vocational program
Distant vocational learning: Veterans assigned to COMPASS were given access to the online Compass system with content modeled after the About Face Manual of condition 1. Veterans were assigned a vocational rehabilitation specialist (VRS) whom they were never physically in the same room.
Compass incorporated both asynchronous and synchronous learning. Asynchronous components, accessible at any time, were videos focused on the concepts of successful job search and handling legal history, as well as the ability to interact with Compass by entering personalized information needed for job search into Compass through fillable fields, similar to the About Face Manual. VRS's were also able review of the information inputted into Compass, making comments directly to the system for the Veteran to review through messages in the system, to suggest better phrasing, more details, etc. Synchronous components were 1) a live chat feature allowing Veterans to ask questions directly to the VRS monitoring the system; 2) telephone coaching where veterans may phone a Hot-Line during office hours to review difficult concepts, discuss progress, discuss upcoming interviews, and problem solve barriers; and 3) practice interviews with feedback via telehealth or phone. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
|---|---|---|
|
Change in Job Search Self-Efficacy
|
1.7 score on a scale
Standard Deviation 6.0
|
1.2 score on a scale
Standard Deviation 5.7
|
POST_HOC outcome
Timeframe: 30 daysPopulation: Due to COVID restrictions, not all Veterans could return to the VA to complete the second interview or did not have access to video connection to conduct the interview online.
The percent of the COMPASS program completed was evaluated to determine its association with improved interview scores.
Outcome measures
| Measure |
Self-help Resources
n=34 Participants
Basic vocational services using the About Face Vocational self-help manual: Those receiving the hardcopy manual received a self-guided manual developed and described in previous studies. Briefly, the manual consisted of a series of modules which guide the Veteran through determining their vocational skills, answering interview questions, and addressing their legal and employment histories. Veterans' participation was self-paced. Three weeks after receiving the manual, staff contacted the participants and reviewed and recorded the percentage of the manual completed. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
Compass
n=37 Participants
A distant learning vocational program
Distant vocational learning: Veterans assigned to COMPASS were given access to the online Compass system with content modeled after the About Face Manual of condition 1. Veterans were assigned a vocational rehabilitation specialist (VRS) whom they were never physically in the same room.
Compass incorporated both asynchronous and synchronous learning. Asynchronous components, accessible at any time, were videos focused on the concepts of successful job search and handling legal history, as well as the ability to interact with Compass by entering personalized information needed for job search into Compass through fillable fields, similar to the About Face Manual. VRS's were also able review of the information inputted into Compass, making comments directly to the system for the Veteran to review through messages in the system, to suggest better phrasing, more details, etc. Synchronous components were 1) a live chat feature allowing Veterans to ask questions directly to the VRS monitoring the system; 2) telephone coaching where veterans may phone a Hot-Line during office hours to review difficult concepts, discuss progress, discuss upcoming interviews, and problem solve barriers; and 3) practice interviews with feedback via telehealth or phone. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
|---|---|---|
|
Association Between Percent of COMPASS Completed and Improvement in Interview Skills
|
48 Percent of program completed
Standard Deviation 41
|
47 Percent of program completed
Standard Deviation 40
|
Adverse Events
Self-help Resources
Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths
Compass
Serious events: 1 serious events
Other events: 0 other events
Deaths: 0 deaths
Serious adverse events
| Measure |
Self-help Resources
n=43 participants at risk
Basic vocational services using the About Face Vocational self-help manual: Those receiving the hardcopy manual received a self-guided manual developed and described in previous studies. Briefly, the manual consisted of a series of modules which guide the Veteran through determining their vocational skills, answering interview questions, and addressing their legal and employment histories. Veterans' participation was self-paced. Three weeks after receiving the manual, staff contacted the participants and reviewed and recorded the percentage of the manual completed. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
Compass
n=40 participants at risk
A distant learning vocational program
Distant vocational learning: Veterans assigned to COMPASS were given access to the online Compass system with content modeled after the About Face Manual of condition 1. Veterans were assigned a vocational rehabilitation specialist (VRS) whom they were never physically in the same room.
Compass incorporated both asynchronous and synchronous learning. Asynchronous components, accessible at any time, were videos focused on the concepts of successful job search and handling legal history, as well as the ability to interact with Compass by entering personalized information needed for job search into Compass through fillable fields, similar to the About Face Manual. VRS's were also able review of the information inputted into Compass, making comments directly to the system for the Veteran to review through messages in the system, to suggest better phrasing, more details, etc. Synchronous components were 1) a live chat feature allowing Veterans to ask questions directly to the VRS monitoring the system; 2) telephone coaching where veterans may phone a Hot-Line during office hours to review difficult concepts, discuss progress, discuss upcoming interviews, and problem solve barriers; and 3) practice interviews with feedback via telehealth or phone. To determine employment outcomes, veterans were contacted monthly after enrollment and chart notes reviewed.
|
|---|---|---|
|
Social circumstances
Incarcerated
|
0.00%
0/43 • Adverse events were collected over the six month follow-up period
|
2.5%
1/40 • Number of events 1 • Adverse events were collected over the six month follow-up period
|
Other adverse events
Adverse event data not reported
Additional Information
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place