• Kristen M Abraham, Matheos Yosef, Sandra G Resnick, and Kara Zivin.
• Dr. Abraham is with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs (VA), Ann Arbor, Michigan. She is also with the Department of Psychology, University of Detroit Mercy, Detroit. Dr. Yosef and Dr. Zivin are with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Zivin is also with the VA Center for Clinical Management Research, Ann Arbor. Dr. Resnick is with the Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 1, West Haven Connecticut, and with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
• Psychiatr Serv. 2017 Sep 1; 68 (9): 938-946.

ObjectiveThe study assessed whether receiving specific types of Veterans Health Administration (VHA) Therapeutic and Supported Employment Services (TSES) between fiscal years (FYs) 2006 and 2010 (a time frame that encompasses the Great Recession) was associated with obtaining competitive employment among veterans with mental illnesses.MethodsThe sample included 38,199 veterans discharged from the VHA's TSES program in FY 2006 through FY 2010. On the basis of program monitoring forms completed by TSES clinicians and workload data, veterans were classified as having received one main type of employment service: supported employment (SE), transitional work in the community (TW-community), transitional work in a Department of Veterans Affairs medical center (TW-VA), incentive therapy or sheltered workshop (IT/SW), and no main type of employment service.ResultsCompared with veterans who received TW-VA, those who received SE (odds ratio [OR]=1.25) or TW-community (OR=1.24) were more likely to be competitively employed (p<.001), and veterans who received IT/SW were less likely (OR=.85) (p<.001). The predicted probabilities for obtaining competitive employment ranged from 27.2% (IT/SW) to 34.9% (SE). Odds of achieving competitive employment (ORs=.60-.97) were significantly lower during the years of the Great Recession (2007-2009) and in the subsequent year (2010), compared with the year prior (p<.001 to <.05).ConclusionsAlthough rates of competitive employment were modest across all types of services, community-based employment services were associated with higher odds of achieving competitive employment, compared with services based in a medical center. The Great Recession negatively affected the likelihood of achieving competitive employment, regardless of the employment service received.

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