Remotely-Delivered Benefits Counseling for Service Connection Applicants
Condition: Job Satisfaction; Unemployment
Study type: Interventional

Summary: 
      A significant portion of Veterans who apply for disability benefits have difficulty finding
      and sustaining employment, and are concerned that working for pay will jeopardize their
      receipt of service-connection benefits. In a completed clinical trial, Veterans who received
      Motivational Interview-formatted counseled about opportunities to work and receive
      service-connection went on to work for pay significantly more often than controls. The
      proposed clinical trial will test this counseling's efficacy when it is delivered by an
      automated computer program.
    

Detailed description: 
      Current application rates suggest that more than half of Operation Enduring Freedom/Operation
      Iraqi Freedom (OEF/OIF) Veterans will eventually apply for some form of service-connection,
      with approximately 100,000 Veterans per year being evaluated for psychiatric conditions.
      Veterans applying for service-connection for psychiatric conditions are in distress, and
      often are having occupational difficulties, but these are unaddressed during a typical
      Compensation and Pension evaluation. Counseling that addresses beneficiaries' concerns about
      losing compensation payments if working for pay, when supplemented by vocational supports,
      has been associated with increased employment among people disabled by chronic psychiatric
      conditions. This group has developed an online Benefits Counseling intervention tailored to
      help Veterans applying for service-connection engage in work-related activities. The
      investigators have demonstrated the efficacy of a face-to-face version of Benefits Counseling
      in a completed Rehabilitation Research & Development-funded six-month clinical trial in which
      Veterans assigned to Benefits Counseling worked significantly more days than controls,(p<.05,
      effect size = 0.69), reflecting an average of three more days of employment at six month
      follow-up. The investigators then used a supplement from Rehabilitation Research &
      Development to develop a web-based version of this counseling, so that the counseling could
      be delivered without a counselor on-site. The web-based intervention was modified based on
      user feedback, but the extent to which it will be used by Veterans at home and how it will
      impact their behavior is unknown. In the proposed clinical trial, Veterans working two or
      fewer days per week who are presenting for a Compensation & Pension examination for a
      psychiatric disorder will be assessed at baseline and then urged to log in afterwards to a
      website for random assignment to either Remotely-Delivered Benefits Counseling (n=65) or
      Veterans Benefits Administration web sites (n=65), and will then be assessed at 4, 12, and 24
      weeks after randomization in order to calculate standardized group mean differences between
      the slopes over time. The primary outcome measure will be the treatment-by-time slope of
      hours of paid work. Exploratory analyses will estimate associations of potential mediators of
      treatment response with this outcome. The proposed study will provide estimates of the
      efficacy of remotely-delivered Benefits Counseling initiated at Compensation and Pension
      examinations, a widely-used point of contact with VA.
    

Intervention name(s): Remotely-Delivered Benefits Counseling; Control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Veterans will complete three intervention modules online. For the first module, Veterans will be instructed on how to use the website and its purpose; will be asked about their perception of the relationship between disability benefits and work. An explanation of relationship between disability benefits and work will be provided. For the second module, Veterans' feelings and attitudes towards employment will be solicited. Motivational Interviewing exercises will be implemented; barriers to work including the disabling condition and consideration of treatment for disabling conditions will be reviewed. An action plan will be developed. For the third module, inquiries will be made regarding the Veteran's reaction to the service-connection decision; information will be provided on how to appeal the decision. Veterans will be asked to reconsider work and financial goals in light of service-connection award. Their action plan will be reviewed. Follow-up resources will be provided.; The control condition will involve referrals to VA websites and represents enhanced treatment-as-usual. A Veteran who completes a Compensation examination ordinarily has no further treatment or referral as part of the Compensation examination. The information about benefits-related websites controls for having information available about benefits and receiving encouragement to pursue that information. The control condition involves being urged to explore links to three VA websites with Compensation & Pension-related information: (a) the VBA website with links about VA disability compensation, (b) the VBA site with fact sheets about the different types of benefits available to Veterans, and (c) the VBA websites for the local C&P office where issues pertaining to an individual Veteran's specific application are addressed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Veterans; world wide web; Counseling; Workman's Compensation