Implementing Supported Employment for Veterans with Traumatic Brain Injury: Facilitators and Barriers

Thursday, October 22, 2020

3:50 PM – 4:07 PM EST

Presenting Author(s)

Terri K. Pogoda, PhD

Research Health Scientist
VA Boston Healthcare System
Boston, Massachusetts

Presentation Slides Presentation + Audio

Non-presenting Author(s)

KM

Katelyn Marchany, MPH

Senior Project Manager
VA Boston Healthcare System
Boston, Massachusetts
JY

Jonathan Yee, M.A.

Social Science Program Specialist
VA Boston Healthcare System
Jamaica Plain, Massachusetts
AZ

Anna Zogas, PhD

Postdoctoral Fellow
Center for Healthcare Organization and Implementation Research
Boston, Massachusetts
CG

Christopher Gillespie, PhD

research health scientist
CHOIR
bedford, Massachusetts
MB

Madisen Brown, MS

Researcher
VA CHOIR
Jamaica plain, Massachusetts
Kathleen Carlson, MS, PhD

Core Investigator
VA Portland Healthcare System
Portland, Oregon
NW

Nancy Wewiorski, PhD

Health Research Scientist
Bedford VA Medical Center
Bedford, Massachusetts
RT

Richard Toscano, MEd

IPS Implementation Expert
Tuscaloosa VA Medical Center
Tuscaloosa, Alabama
LD

Lori Davis, MD

ACOS/Research
Tuscaloosa VA Medical Center
Tuscaloosa, Alabama
SR

Sandra Resnick, PhD

Deputy Director, NEPEC
VA Connecticut Healthcare System
West Haven, Connecticut

Research

Objective: To conduct a pre-implementation assessment of anticipated facilitators and barriers to implementing Supported Employment (SE) for Veterans with traumatic brain injury (TBI) (hereafter, SE-TBI services), and identify lessons learned from sites with established SE-TBI services.
Design: Purposive sampling to recruit Department of Veterans Affairs (VA) employees at sites with and without (pre-implementation sites) established SE-TBI services. Applied thematic analysis was used to analyze participant responses.
Setting: VA medical centers (VAMCs).
Participants: 41 employees across 14 VAMCs (10 pre-implementation, 4 established): SE supervisors (n=11), SE specialists (n=16), and TBI clinicians (n=14).
Interventions: None.
Main Outcome Measure(s): Interview responses regarding facilitators and barriers to SE-TBI implementation.

Results: Pre-implementation sites anticipated the following barriers: low referrals due to lack of relationship between the SE and TBI teams, clinicians questioning whether Veterans with TBI are ready for employment, and SE staff needing TBI education. Staff from established SE-TBI services noted several key facilitators to their implementation, including the SE-TBI specialist attending interdisciplinary TBI team meetings, having shared decision-making with treatment planning, and sharing Veteran success stories to motivate SE-TBI referrals.

Conclusions: Pre-implementation assessment allowed us to identify anticipated barriers to SE-TBI services implementation at pre-implementation sites, including fears of low referrals because of a lack of an established relationship with TBI teams, TBI clinician concerns about Veterans’ work readiness, and the need for reciprocal education between SE specialists and TBI clinicians. These aligned with the barriers that established SE-TBI services successfully navigated. In the next study phase, we will implement SE-TBI services through a mentor training process. Our implementation will be guided by the successful practices and lessons learned from established SE-TBI services and include actionable strategies to address the anticipated barriers described in the pre-implementation interviews.
Learning Objectives:
Describe evidence suggesting an unmet need for providing Supported Employment (SE) to Veterans with TBI.
Identify key elements of established SE-TBI services that contribute to implementation success.
Identify anticipated barriers to SE-TBI services implementation that VA employees at pre-implementation sites describe.