Assessing the Effect of Distance Learning Vocational Rehabilitation on Employment Outcomes of Veterans With Psychiatric Illness and Histories of Legal Convictions

Study Overview
=================
Brief Summary
-----------------
64,000 Veterans are released annually from jails and prisons. These Veterans have a weekly unemployment rate of up to 40-55%. However, many are unable to access traditional vocational rehabilitation, not to mention specialized vocational rehabilitation for those with felony histories. Distance learning may be effective in improving access to rehabilitation as well as improving employment outcomes. The Compass system was developed to incorporate both synchronous and asynchronous distance learning to provide effective services. This study will evaluate 150 Veterans with histories of legal convictions and mental illness and/or a substance use disorder. Veterans will be randomly assigned to either a basic vocational resources condition or the the Compass condition. In the basic condition, Veterans will be provided with basic information about where they can access vocational services and a paper version of a vocational reintegration manual, specifically the About Face Vocational Manual. Veterans assigned to the Compass condition will be given access to the online instruction through Videos, live chat features, and tele-health practice interviews with feedback. Veterans will be followed for 6 months. The primary outcomes are employment and interview skills.

Detailed Description
-----------------
At this time, there are over 131,000 Veterans in US prisons and over 50,000 in US jails. When discharged, these Veterans will be forced to cope with high rates of psychosocial and health issues including homelessness, divorce, mental illness, and infectious diseases. One of the most significant consequences of incarceration is a high rate of unemployment. Evaluations of employment find those with felony histories worked, on average, between 10% and 23% fewer hours than those without felony histories. These negative employment outcomes are caused by a combination of eroded skills, poor social connections, legal restrictions, and stigma. Though the VA offers a number of vocational rehabilitation and reintegration services, these services are typically not targeted towards Veterans with criminal histories. Also the programs have limitations restricting the range of Veterans that can be served. For example, Veterans living a great distance from a major medical center, rural Veterans, homeless Veterans, and Veterans without transportation may have difficulty accessing services. To reach the most Veterans, tele-health and distance learning methods must be developed to bring services to the Veterans rather than bring the Veterans to the services. Already well integrated into many educational classrooms, distance learning can be a very effective method of imparting training, skills, and information while mitigating many of the logistical limitations encountered by Veterans with histories of incarceration. To be successful distance learning should incorporate a number of different best practices. Distance learning should be engaging, avoiding long periods of reading. It should focus on small 'chunks' of information to improve learning and retention. Due to differences in learning, a multiple modality approach is most likely to be successful. Questions, short quizzes, and problem based activities with immediate feedback should be used to keep participants both engaged and to assess progress. An important aspect to effectively implementing distance learning is to provide blended learning or a hybrid between asynchronous learning, where the participant and teacher are not interacting in real-time, and synchronous learning, where the participant and teacher are interacting directly with each other either in person or across some type of medium. Used effectively, hybrid distance learning can bring a number of positives aspects to the learning environment, including the ability to review information and lessons, practice and role playing, more time to reflect on answers, and less pressure to respond in a group. Based on effective distance learning principles, the Compass system was developed. Compass builds on a previous pilot online system, the About Face Online System (AFOS), which placed a vocational manual into an online fillable format; however, though Veterans engaged the AFOS, a number of limitations were identified that limited Veterans' enthusiasm, including use of extended reading passages, no direct interaction with a person, and not enough focus on interviews. Compass uses distance learning best practices including the use of both synchronous and asynchronous learning. The asynchronous components of Compass use video and online content. Veterans are also quizzed at each step of the process on what responses should be given through a multiple choice method. Synchronous components of Compass include tele-health practice interviews, phone coaching sessions, and live-chat features that are used to assist Veterans tailor their information and improving their interview skills. This study is a four-year project to compare the effectiveness of the Compass system to basic resources. 150 Veterans with legal convictions and mental illness and/or substance use disorders will be followed for six months. Half will receive access to the Compass system and half will receive only basic resources (i.e. a hard copy vocational manual). Outcomes evaluated are employment and interview skills. The goals of the study are: Compare rates of employment of Compass to those receiving basic resources. Compare improvements in interviewing skills between those receiving an online program to those receiving basic resources. Hypotheses/expected results 1) Veterans using Compass will have superior rates of employment and improved interviewing skills compared to those receiving basic services.

Official Title
-----------------
Assessing the Effect of Distance Learning Vocational Rehabilitation on Employment Outcomes of Veterans With Psychiatric Illness and Histories of Legal Convictions

Conditions
-----------------
Unemployment, Mental Illness, Substance Use Disorder, Legal History

Intervention / Treatment
-----------------
* Behavioral: Distant vocational learning
* Other: Basic vocational services


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: mental illness or substance use disorder history of a felony conviction or non-traffic related misdemeanor Exclusion Criteria: cognitive impairment which prohibits active participation in study

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Patients will be randomly assigned to either a distance learning program (COMPASS) or basic vocational services.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Self-help resources<br>a self-help vocational manual | Other: Basic vocational services<br>* self-help manual<br>* Other names: Basic services;|
| Experimental: Compass<br>a distant learning vocational program | Behavioral: Distant vocational learning<br>* use of hybrid distance learning to facilitate successful employment outcomes<br>* Other names: Compass;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Employment | Employment will be defined as 'obtaining employment' or 'not obtaining employment' in the six month follow-up. | 6 months | 
| Interviewing skills | Veterans scores on an interviewing rating form will be compared one month after entry into the study. | one month | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
employment, distance learning, incarceration