TWE provided vocational activities, work placements, and case management to help homeless veterans struggling with mental health or substance use issues find and maintain competitive employment. This evaluation directly compared TWE to a separate intervention, CE, in order to better understand which of the two interventions might be more effective; the distinctive features of TWE are employment supportive services.
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. 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. The length of the TWE program depended on participants’ vocational goals and needs but did not exceed one year. As of 2020, the VA continues to offer similar services to eligible participants. The target population for TWE 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 was implemented in nine VA medical centers across the United States.
The effectiveness of TWE when compared with CE indicates the effect of the services that are unique to TWE, or how much better TWE meets participants’ needs than CE. TWE participants received up to a year of structured vocational rehabilitation services and therapeutic work placements. CE participants received standard VA services but no specific employment-focused intervention (although all participants were competitively employed at some point in the follow-up period by design). This study was part of the Therapeutic Employment Placement and Support demonstration, which also evaluated the Individual Placement and Support program, TWE followed by CE, and CE only.