Together in Recovery With Veterans Through Employment (THRIVE)

VA Office of Research and Development

Status: Enrolling

Conditions: Veterans With Opioid Use Disorder

Treatments: Other: Treatment As Usual Vocational Rehabilitation (TAU-VR); Other: Individual Placement and Support (IPS)

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT05388812

D3656-R

Details and patient eligibility

About

The purpose of this study is to help Veterans who have opioid use problems with gaining and maintaining meaningful employment. The investigators also want to know employment helps with other aspects of the Veteran's life including starting and staying on necessary medications, mental health needs, and feeling a part of society.

Full description

The primary aim of this study is to evaluate the employment outcomes of Individual Placement and Support (IPS) compared to Treatment-as-Usual Vocational Rehabilitation (TAU-VR) in 120 Veterans who are recovering from opioid use disorder (OUD) over 15 months. Specifically, the investigators will see which treatment yields more weeks worked in a competitive job with the hypothesis that IPS will result in better outcomes than TAU-VR. The investigators will interview Veterans in both IPS and TAU-VR groups to investigate the contextual barriers and facilitators of implementing vocational services among Veterans with OUD with the aim to provide solutions and leverage facilitators of success as the VHA expands supported employment services to a new priority population. Investigators will evaluate the impact of vocational services on adherence to prescribed treatment and OUD relapse rates. This study is especially timely given the societal impact of the COVID-19 pandemic on employment and occupational functioning.

Enrollment: 120 estimated patients

Sex: All

Ages: 19+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• age 19* (<19 year of age in the state of AL is defined minor)
• DSM-5 Axis I diagnosis of OUD
• currently unemployed or underemployed, defined as working <20hrs/week in a meaningful competitive job for a wage, salary, or commission
• expression of interest in competitive employment; and willing and able to give informed consent

Exclusion criteria

• current diagnosis of psychotic disorders since these Veterans already can receive IPS in usual care at TVAMC and BVAMC

• diagnosis of dementia (evidenced in the medical record)

• presence of current severe and unstable medical condition or terminal illness, that would contraindicate study participation or expose them to an undue risk

• unlikely that participant can complete the study

  • e.g., expected deployment, incarceration, long-term hospitalization, or relocation from the vicinity

• active suicidal or homicidal ideation making it unsafe for Veteran to be included

• current participation in another vocational interventional trial

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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120 participants in 2 patient groups

Individual Placement and Support

Experimental group

Description:

The IPS model involves the following important domains: competitive employment, eligibility based on client choice of employment, integration of IPS and treatment team personalized counseling, rapid job search, systematic job development, and time-unlimited and individualized support.

Treatment:

Other: Individual Placement and Support (IPS)

Treatment As Usual Vocational Rehabilitation (TAU-VR)

Active Comparator group

Description:

TAU-VR Services may include 1) Compensated Work Therapy-Transitional Work (CWT-TW) assignment in a set-aside, minimum-wage, short-term job, typically in the VA setting (approximately 50% of the Veterans randomized to TW in past studies conducted by the investigators actually engaged in TW assignment) or 2) CWT-Community-Based Employment Services (CWT-CBES) which involves a community job search, placement in a competitive job, with limited follow-along support that typically ends after the Veteran is working in his/her first job

Treatment:

Other: Treatment As Usual Vocational Rehabilitation (TAU-VR)