Effectiveness of supported employment for veterans with spinal cord injury: 2-year results

Objective: To examine if supported employment (SE) remains more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI) at 2-year follow-up.

Design: Prospective, randomized, controlled, multisite trial of SE versus TAU with 24 months of follow-up.

Setting: SCI centers.

Participants: Subjects (N=201) were enrolled and completed baseline interviews. At interventional sites, subjects were randomized to SE (n=81) or TAU (n=76). At observational sites, 44 subjects were enrolled in a nonrandomized TAU condition.

Intervention: The intervention was a SE program called the SCI Vocational Integration Program, which followed the principles of the individual placement and support model of SE for persons with mental illness.

Main Outcome Measures: Competitive employment in the community within 2 years.

Results: For the entire 2-year follow-up period, SE subjects were significantly more likely to achieve employment (30.8%; 95% confidence interval [CI], 21.8-41.6) than either the TAU subjects at the intervention sites (10.5%; 95% CI, 5.2-19.7; P.001) or the TAU subjects at the observational sites (2.3%; 95% CI, 0.0-12.9; P.002). Most subjects who obtained competitive employment did so in year 1, and the average time to first employment was about 17 weeks.

Conclusions: SE was better than usual practices in improving employment outcomes for veterans with SCI across a 2-year follow-up period. Although SE continued to be superior to traditional practices over the entire study, the first year of participation in SE may represent a critical window for achieving employment after SCI.