Kimberly Burrowes
Urban Institute
Research Associate II

Pay for Success offers support for unemployed veterans with PTSD

November 7, 2018 - 5:18pm

Twenty percent of America’s 20.4 million veterans suffer from either major depression or post-traumatic stress disorder (PTSD), yet only about half seek treatment, and the ones who do have limited access to high-quality care. Some may be unaware of the services available to them, while others may require help navigating the federal and local systems to receive services. These mental health challenges may hinder veterans’ ability to find adequate employment. Without specialized support for mental health, the long-term financial stability of veterans could be threatened.

To provide this support, last month, the US Department of Veteran Affairs (VA) launched the Veterans Coordinated Approach to Recovery and Employment (Veterans CARE) project, in partnership with the  pay for success (PFS) intermediary Social Finance, to improve both health and employment outcomes for veterans with PTSD. It is the first multi-state PFS project to focus on the veteran population. This is significant because many veterans with PTSD either remain undiagnosed or do not seek treatment. Veterans CARE seeks to bridge the gap in offering services to this hard-to-reach group.  

How Veterans CARE operates

Veterans CARE improves the outcomes of unemployed veterans with PTSD through the evidence-based Individual Placement and Support (IPS) model. Tuscaloosa VA Medical Center, the primary service provider, will support local VA medical centers to deliver the intervention to 480 veterans over three years in New York, New York; Boston, Massachusetts; Brockton, Massachusetts; and Central and Western Massachusetts. The goals of the project are to enable unemployed or underemployed veterans with PTSD to secure competitive and compatible employment while also expanding high-quality, evidence-based employment services to veterans who currently cannot access these services. The project also hopes to serve as a demonstration project for the use of PFS within the VA. 

Veterans CARE is being financed through a $5.1 million investment made by five funders: BNP Paribas, Northern Trust, The Dakota Foundation, Deutsche Bank, and the Robin Hood Foundation. Westat will conduct the evaluation, which will determine the achievement of outcomes and payment thresholds. 

Evidence for IPS-supported employment

Program strength is a key indicator to assess the potential effectiveness of a PFS project. A solid evidence base establishes the expected outcomes from the intervention and highlights potential factors that should be considered when designing a project–such as sample size, suitability of outcome measures, and type of research design.

Several studies suggest that IPS-supported employment is an effective intervention for people with mental illness. IPS increases the rate of competitive employment and improves the rate at which a person gets a job and for how long they keep it. Studies comparing veteran populations who receive IPS-supported employment with transitional work assignments mirror these results. A recent randomized controlled trial demonstrated competitive and stable employment outcomes for 541 unemployed veterans with PTSD at 12 VA centers. In addition, the veterans in the program saw improved PTSD symptoms during the project period.

Veteran unemployment rates in Massachusetts and New York (2.4 and 3.9 percent respectively) rank between those of other states. Veterans CARE presents an opportunity to further explore whether supported employment can help veterans with PTSD in these states overcome barriers to finding adequate employment, and study other ancillary benefits that might stem from the intervention. 

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