TWE followed by CE provided up to one year of vocational activities, work placements, and case management to help homeless veterans struggling with mental health or substance use issues find and maintain competitive employment, after which participants received standard VA services indefinitely. This evaluation directly compared TWE followed by CE to a separate intervention, CE only, in order to better understand which of the two interventions might be more effective; the distinctive features of TWE followed by CE were vocational rehabilitation activities and therapeutic work placements.
TWE, part of the VA Compensated Work Therapy Program, helped participants develop work restoration plans and provided a real, rehabilitative work setting within the VA, other federal agencies, or private businesses in the community. After their participation in TWE, participants moved into CE, during which they could receive standard VA services (including the VA health care, education benefits, home loan assistance, disability compensation, and vocational rehabilitation and employment assistance). TWE participants received at least 30 hours per week of structured vocational rehabilitation activities and were assigned to therapeutic work placements for six months to one year. Participants also received case management to help them gain and enhance their employment skills and find and maintain competitive employment. Length of participation in TWE depended on participants’ vocational goals and needs but did not exceed one year, though once in CE, participants could receive standard VA services indefinitely. As of 2020, the VA continues to offer similar services to eligible participants. The target population for TWE followed by CE included homeless veterans who (1) were not receiving VA health services, (2) expressed a desire to participate in competitive employment, and (3) were diagnosed with a psychiatric disability or substance use problem. TWE followed by CE was implemented in nine VA medical centers across the United States.
The effectiveness of TWE followed by CE when compared with CE only indicates the effect of the services that are unique to TWE followed by CE, or how much better TWE followed by CE meets participants’ needs than CE only. Participants in TWE followed by CE received structured vocational rehabilitation services and therapeutic work placements, whereas participants in CE only did not. This study was part of the Therapeutic Employment Placement and Support demonstration, which also evaluated the Individual Placement and Support program, TWE only, and CE only.