TWE provided vocational activities, work placements, and case management to help veterans experiencing homelessness and mental health or substance use disorders find and maintain competitive employment. This evaluation directly compared TWE to a separate intervention, IPS, in order to better understand which of the two interventions might be more effective; the distinctive features of TWE are structured vocational rehabilitation services and therapeutic work placements.
TWE, part of the VA’s Compensated Work Therapy Program, helped participants develop work restoration plans and provided a 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. Length of participation in TWE depended on the participants’ vocational goals and needs but did not exceed one year. As of 2020, TWE continues to offer similar services to eligible participants. The target population for TWE included veterans experiencing homelessness who met all three of the following criteria: (1) they were not receiving VA health services; (2) they expressed a desire to participate in competitive employment; and (3) they were diagnosed with a psychiatric disability or substance use disorder. TWE was implemented in nine VA medical centers across the United States.
The effectiveness of TWE when compared with the effectiveness of IPS indicates the effect of a set of services that includes those unique to TWE; the comparison indicates how much better TWE meets participants’ needs than IPS. TWE participants received structured vocational rehabilitation services and therapeutic work placements without integrated health services. In contrast, IPS addressed participants’ mental and physical health issues while facilitating a rapid job-search process and job placement.
This study was part of the Therapeutic Employment Placement and Support demonstration, which also examined IPS only, TWE followed by Typical Services for Competitively Employed Veterans (CE), and CE only.