TWE followed by CE provided up to one year of vocational activities, work placements, and case management to help veterans experiencing homelessness and mental health or substance use disorders 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, IPS, in order to better understand which of the two interventions might be more effective; the distinctive features of TWE followed by CE are structured vocational rehabilitation services and therapeutic work placements.

TWE followed by CE provided up to one year of vocational activities, work placements, and case management to help veterans experiencing homelessness and mental health or substance use disorders 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, IPS, in order to better understand which of the two interventions might be more effective; the distinctive features of TWE followed by CE 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. After their participation in TWE, participants moved into CE, during which they could receive standard VA services (including 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 of TWE followed by CE 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 followed by CE was implemented in nine VA medical centers across the United States.

The effectiveness of TWE followed by CE when compared with the effectiveness of IPS indicates the effect of a set of services that includes those unique to TWE followed by CE; the comparison indicates how much better TWE followed by CE meets participants’ needs than IPS. Participants in TWE followed by CE received structured vocational rehabilitation services and therapeutic work placements without integrated health services, and then obtained competitive employment, during which they could receive standard VA 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 evaluated IPS only, TWE only, and CE only.

Year evaluation began: 2001
Populations and employment barriers: Homelessness, Military veteran
Intervention services: Case management, Substance use disorder treatment and mental health services, Individual Placement and Support, Transitional jobs, Work experience, Work readiness activities, Job search assistance
Setting(s): Tested in multiple settings

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