Supported Employment for Veterans With Traumatic Brain Injury: Patient Perspectives

Objectives: To quantify the need for, and interest in, supported employment (SE) among recent military veterans with traumatic brain injury (TBI); and to examine characteristics associated with veterans’ interest in SE. Design: Stratified random sample of Iraq and Afghanistan War veterans confirmed to have TBI through the Veterans Health Administration (VHA) screening and evaluation system. Setting: Community-based via mailed survey. Participants: We recruited 1800 veterans with clinician-confirmed TBI (mild TBI: n=1080; moderate/severe TBI: n=720) through multiple mailings. Among 1451 surveys that were not returned undeliverable, N=616 (42%) responded. Interventions: Not applicable. Main Outcome Measures: Veterans rated their interest in SE after reading a script describing the program. Additional measures assessed mental health and pain-related comorbidities, employment, financial/housing difficulties, demographics, and military service characteristics. Estimates were weighted to represent the population of veterans with VHA clinician-confirmed TBI. Results: Unemployment was reported by 45% (95% confidence interval [CI], 43–47) of veterans with TBI. Although 42% (95% CI, 40–44) reported they would be interested in using SE if it were offered to them, only 12% had heard of SE (95% CI, 11–14) and <1% had used it. TBI severity and comorbidities were not associated with veterans’ interest in SE. However, those who were unemployed, looking for work, experiencing financial strain, or at risk for homelessness were more likely to be interested in SE. Conclusions: Our research highlights an important gap between veterans’ vocational needs and interests and their use of SE. Systematically identifying and referring those with employment and financial/housing difficulties may help close this gap.