Benefits Counseling to Preserve Function Among Disability Applicants

Study Overview
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Brief Summary
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This study will address the problem that claimants with psychiatric disabilities who apply for and receive disability benefits go on to work less than those whose claims are denied.

Detailed Description
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The objective of this research is to conduct a 6-month randomized clinical trial comparing participants assigned to Benefits Counseling and to those assigned to the control condition, VA Orientation. Benefits Counseling is an adaptation of two counseling approaches to foster veterans' involvement in work and work-related activity compared to the control condition, VA Orientation. The first approach helped recipients of Social Security disability benefits for psychiatric illness return to work in part by alleviating beneficiaries' concerns that they would lose their benefits if they worked. The second approach is a Motivational Interviewing approach that showed great promise in engaging veterans with psychiatric disabilities in compensated work therapy.

Official Title
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Benefits Counseling to Preserve Function Among Disability Applicants

Conditions
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Veterans' Disability Claims

Intervention / Treatment
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* Behavioral: Benefits Counseling
* Behavioral: VA Orientation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Has never received VBA benefits Able to provide valid consent Expresses willingness to discuss benefits with a counselor Difficulty working as evidenced by a Yes to either (a), (b), or (c) of the question below about work-related difficulties: During the past 4 weeks, have you had any of the following problems (such as feeling depressed and anxious): Cut down on the amount of time you spent on work or other activities? Accomplished less than you would like? Didn't do work or other activities as carefully as usual? Expresses willingness to try Benefits Counseling if assigned to it An evaluation by a psychiatrist or psychologist is scheduled Exclusion Criteria: Already receiving VA payments Already receiving SSI or SSDI payments Has a conservator

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm 1<br>This counseling consists of four sessions each approximately 60 minutes each. The four sessions are organized as follows: a) Orientation to Benefits Counseling: Your Benefits and Your Goals b) Work and Claims c) Financial Review: Implications of Your Work Plan and d) Your Plans After the Benefits Notice. The first session focuses on the disability application process as a non-confrontational way to explore attitudes towards work. The second session more directly addresses the claimant's attitudes about work and beliefs about whether work will prevent receipt of disability benefits. The third session addresses the same issue as the second, ambivalence about work and disability, from a financial perspective. The fourth session occurs after the disability determination has been made, and it is possible the veteran may feel differently about a benefit that has been awarded. | Behavioral: Benefits Counseling<br>* Benefits counseling is designed to improve the quality of life of disability applicants by accomplishing two functions: 1) Providing information concerning what vocational rehabilitation services are available and how they will affect receipt of disability payments, 2) Amplifying applicants' existing motivation to engage in work and related-activities, using a Motivational Interviewing approach.<br>* Other names: Motivational Interviewing;|
| Active Comparator: Arm 2<br>This will consist of four-session orientation with the sessions organized as follows: a) overview of VHA services, b) Primary Care c) Pharmacy and laboratory services and d) specialty services. After the description of each service, participants will be invited to discuss which services they plan to utilize. The counselor will provide telephone numbers and directions to the sites at which these services are provided. | Behavioral: VA Orientation<br>* VA Orientation is designed to provide the Veteran with information regarding the services available, how to access the services and where the service is located on the VA campus.<br>* Other names: New patient orientation;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Days of Work and Work-related Activity | Number of days in the past 28 spent engaged in any kind of work or related activity. Measured using a timeline follow-back calendar. | Baseline | 
| Days of Work and Work-related Activity | Number of days in the past 28 spent engaged in any kind of work or related activity. Measured using a timeline follow-back calendar. | Month 1 | 
| Days of Work and Work-related Activity | Number of days in the past 28 spent engaged in any kind of work or related activity. Measured using a timeline follow-back calendar. | Month 3 | 
| Days of Work and Work-related Activity | Number of days in the past 28 spent engaged in any kind of work or related activity. Measured using a timeline follow-back calendar. | Month 6 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rehabilitation, Vocational, Compensation and Redress, disability evaluation