Achieving competitive, customized employment through specialized services for Veterans with spinal cord injuries (ACCESS-Vets): A randomized clinical trial protocol

BACKGROUND: To date, the Individual Placement and Support (IPS) model is the only vocational intervention that has been rigorously studied and shown to be effective with Veterans with spinal cord injury (SCI). Customized Employment (CE) is an innovative vocational intervention with promising results among people with disabilities which has yet to be tested in persons with SCI. OBJECTIVE: To determine whether a Customized Employment (CE) intervention adapted for SCI rehabilitation is more effective than the standard care (IPS) for helping Veterans with SCI obtain and maintain employment. METHODS: A 4-year, 2-site randomized clinical trial (RCT) with concurrent mixed methods using an intent-to-treat (ITT) approach. The primary outcome is competitive integrated employment as defined by the Work Innovation and Opportunity Act. Secondary outcomes are employment indicators, quality of life (QOL), and participation. RESULTS: This is a methods paper so there are no results to present at this time. CONCLUSION: The proportion of Veterans who attain employment will be greater for the CE group than the IPS group and they will outperform the IPS group on other employment-related metrics (e.g., higher job satisfaction, wages, and retention). Employed Veterans will demonstrate significant improvements in self-sufficiency, QOL, and participation. Qualitative data obtained from interviews will assist with adaptation strategies and will identify barriers to implementing CE.