Spinal Cord Injury Vocational Integration Program (SCI-VIP)
| Status: | Completed |
|---|---|
| Conditions: | Hospital, Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 4/21/2016 |
| Start Date: | April 2006 |
| End Date: | September 2011 |
A Spinal Cord Injury Vocational Integration Program: Implementation and Outcomes
This study involves research about how to help Veterans with spinal cord injury (SCI) gain
employment. During the first couple of years following SCI, many people are concentrating on
their rehabilitation and are unable to afford the time for return to work. However, studies
have shown people often regain the necessary strength and function about two years after SCI
to resume activities of daily living very similar to what they experienced prior to the SCI.
Even though many social and legal efforts have been made in the last decade to improve
chances for people with disabilities to return to work, Veterans with SCI are sometimes
hindered in finding employment because of age, past work history, and many other factors.
Other Veterans with SCI are very successful at finding employment either working for
themselves or working for a company. The investigators know very little about what issues
Veterans with SCI face when they attempt to find employment after SCI. The study will
analyze both quantitative and qualitative measures to maximize its findings.
employment. During the first couple of years following SCI, many people are concentrating on
their rehabilitation and are unable to afford the time for return to work. However, studies
have shown people often regain the necessary strength and function about two years after SCI
to resume activities of daily living very similar to what they experienced prior to the SCI.
Even though many social and legal efforts have been made in the last decade to improve
chances for people with disabilities to return to work, Veterans with SCI are sometimes
hindered in finding employment because of age, past work history, and many other factors.
Other Veterans with SCI are very successful at finding employment either working for
themselves or working for a company. The investigators know very little about what issues
Veterans with SCI face when they attempt to find employment after SCI. The study will
analyze both quantitative and qualitative measures to maximize its findings.
Legal mandates, such as the Rehabilitation Act of 1973 and the Americans with Disabilities
Act, have been implemented to improve employment opportunities for disabled persons and yet
the proportion of persons with spinal cord injury (SCI) who are employed remains about 9%.
For the Veteran population with SCI, the return to work rate is most likely much lower. This
study will be conducted to evaluate whether a vocational rehabilitation program patterned
after the VA Community Employment and Support approach improves rehabilitation outcomes for
the SCI Veteran population as compared with vocational rehabilitation practices currently
used in most Veteran Affairs Medical Centers (VAMCs). The vocational rehabilitation program
developed for the SCI Veterans is referred to as SCI-VIP and it will be implemented at the
Dallas VA Medical Center (VAMC), Houston VAMC, San Diego VAMC, and Cleveland VAMC. A five
year evaluative research will be conducted to test the following hypothesized outcomes (HO)
from the subjects who participate in the SCI-VIP program and a control group of subjects who
receive conventional methods of vocational rehabilitation:
Primary HO: Veterans with SCI who participate in the SCI-VIP will demonstrate significantly
greater changes in vocational rehabilitation after twelve months than those who do not
receive this intervention. Vocational rehabilitation will be a measure of change from
baseline to one-year in the subject's scores on instruments which measure employment
indices, perceived barriers to employment, level of handicap, quality of life, depression,
and sustaining care needs.
Secondary HO 1: Veterans with SCI who participate in the SCI-VIP will exhibit lower VA and
non-VA costs for medical, non-rehabilitation treatment, offsetting the higher SCI-VIP
program costs.
Secondary HO 2: The program fidelity will be equally adequate in terms of accomplishing
program objectives relative to operations, cost-benefit balance, subject and stakeholder
satisfaction, and outcomes when comparing the four SCI-VIP programs and when comparing
conventional vocational rehabilitation approaches applied at six different VAMCs.
Program evaluation and cost-benefit analysis will be conducted using a fidelity instrument
developed by the researchers and patterned after fidelity instruments conventionally used to
evaluate psychiatric rehabilitation programs. Veterans at each VAMC who express an interest
in vocational rehabilitation and consent to participate in this study will be randomized to
either the experimental or the control group. It is expected that at least 96 subjects will
participate in the SCI-VIP approach to vocational rehabilitation and 144 Veterans who
receive conventional vocational rehabilitation will form the control group.
Data will be collected from subjects upon enrollment into either the experimental or control
group and every three months for one year. Descriptive analysis will be used to compare
differences between groups of subjects drawn from each VAMC and to compare participants in
the experimental and control groups. Analysis of variance will be computed to determine
degree of difference between experimental group and control group subjects' scores on each
dependent variable. The study hypotheses will be tested using the Mann-Whitney U,
Chi-square, and odds ratio statistical procedures. The Cochran-Mantel-Haenszel along with
relative risk scores will indicate the likelihood that any change in performance between
baseline and program completion for ether experimental or control group subjects could be
attributed to the subjects' degree of participation in the SCI-VIP, which VAMC vocational
rehabilitation services were received, SCI factors, and age.
Act, have been implemented to improve employment opportunities for disabled persons and yet
the proportion of persons with spinal cord injury (SCI) who are employed remains about 9%.
For the Veteran population with SCI, the return to work rate is most likely much lower. This
study will be conducted to evaluate whether a vocational rehabilitation program patterned
after the VA Community Employment and Support approach improves rehabilitation outcomes for
the SCI Veteran population as compared with vocational rehabilitation practices currently
used in most Veteran Affairs Medical Centers (VAMCs). The vocational rehabilitation program
developed for the SCI Veterans is referred to as SCI-VIP and it will be implemented at the
Dallas VA Medical Center (VAMC), Houston VAMC, San Diego VAMC, and Cleveland VAMC. A five
year evaluative research will be conducted to test the following hypothesized outcomes (HO)
from the subjects who participate in the SCI-VIP program and a control group of subjects who
receive conventional methods of vocational rehabilitation:
Primary HO: Veterans with SCI who participate in the SCI-VIP will demonstrate significantly
greater changes in vocational rehabilitation after twelve months than those who do not
receive this intervention. Vocational rehabilitation will be a measure of change from
baseline to one-year in the subject's scores on instruments which measure employment
indices, perceived barriers to employment, level of handicap, quality of life, depression,
and sustaining care needs.
Secondary HO 1: Veterans with SCI who participate in the SCI-VIP will exhibit lower VA and
non-VA costs for medical, non-rehabilitation treatment, offsetting the higher SCI-VIP
program costs.
Secondary HO 2: The program fidelity will be equally adequate in terms of accomplishing
program objectives relative to operations, cost-benefit balance, subject and stakeholder
satisfaction, and outcomes when comparing the four SCI-VIP programs and when comparing
conventional vocational rehabilitation approaches applied at six different VAMCs.
Program evaluation and cost-benefit analysis will be conducted using a fidelity instrument
developed by the researchers and patterned after fidelity instruments conventionally used to
evaluate psychiatric rehabilitation programs. Veterans at each VAMC who express an interest
in vocational rehabilitation and consent to participate in this study will be randomized to
either the experimental or the control group. It is expected that at least 96 subjects will
participate in the SCI-VIP approach to vocational rehabilitation and 144 Veterans who
receive conventional vocational rehabilitation will form the control group.
Data will be collected from subjects upon enrollment into either the experimental or control
group and every three months for one year. Descriptive analysis will be used to compare
differences between groups of subjects drawn from each VAMC and to compare participants in
the experimental and control groups. Analysis of variance will be computed to determine
degree of difference between experimental group and control group subjects' scores on each
dependent variable. The study hypotheses will be tested using the Mann-Whitney U,
Chi-square, and odds ratio statistical procedures. The Cochran-Mantel-Haenszel along with
relative risk scores will indicate the likelihood that any change in performance between
baseline and program completion for ether experimental or control group subjects could be
attributed to the subjects' degree of participation in the SCI-VIP, which VAMC vocational
rehabilitation services were received, SCI factors, and age.
Inclusion Criteria:
- Between the ages of 18 and 65 years old - Spinal cord injured as a result of trauma
or disease
- Medically and neurologically stable
- Lives within the metropolitan area that is proximal to the VAMC (Cleveland, Dallas,
Houston, San Diego, St. Louis)
- Has access to transportation
- Expresses an interest in competitive employment as an outcome of participation
- Willingly signs a consent form indicating voluntary and informed participation in the
study
Exclusion Criteria:
- Medically and/or surgically unstable
- Unwilling to complete the consenting process
- Mentally impaired such that independent reasoning and judgment jeopardize safety of
self and others
- Currently involved in untreated alcohol and/or drug dependency
- Employed in a compensated job at the time of recruitment and earning above SGA
($940/month in 2008) - Lives more than approximately 100 miles from the participating
VAMC SCI Center
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