Assessing the Effect of Distance Learning Vocational Rehabilitation on Employment Outcomes of Veterans With Psychiatric Illness and Histories of Legal Convictions

At this time, there are over 131,000 Veterans in US prisons and over 50,000 in US jails. When
discharged, these Veterans will be forced to cope with high rates of psychosocial and health
issues including homelessness, divorce, mental illness, and infectious diseases.

One of the most significant consequences of incarceration is a high rate of unemployment.
Evaluations of employment find those with felony histories worked, on average, between 10%
and 23% fewer hours than those without felony histories. These negative employment outcomes
are caused by a combination of eroded skills, poor social connections, legal restrictions,
and stigma.

Though the VA offers a number of vocational rehabilitation and reintegration services, these
services are typically not targeted towards Veterans with criminal histories. Also the
programs have limitations restricting the range of Veterans that can be served. For example,
Veterans living a great distance from a major medical center, rural Veterans, homeless
Veterans, and Veterans without transportation may have difficulty accessing services.

To reach the most Veterans, tele-health and distance learning methods must be developed to
bring services to the Veterans rather than bring the Veterans to the services. Already well
integrated into many educational classrooms, distance learning can be a very effective method
of imparting training, skills, and information while mitigating many of the logistical
limitations encountered by Veterans with histories of incarceration.

To be successful distance learning should incorporate a number of different best practices.
Distance learning should be engaging, avoiding long periods of reading. It should focus on
small 'chunks' of information to improve learning and retention. Due to differences in
learning, a multiple modality approach is most likely to be successful. Questions, short
quizzes, and problem based activities with immediate feedback should be used to keep
participants both engaged and to assess progress.

An important aspect to effectively implementing distance learning is to provide blended
learning or a hybrid between asynchronous learning, where the participant and teacher are not
interacting in real-time, and synchronous learning, where the participant and teacher are
interacting directly with each other either in person or across some type of medium. Used
effectively, hybrid distance learning can bring a number of positives aspects to the learning
environment, including the ability to review information and lessons, practice and role
playing, more time to reflect on answers, and less pressure to respond in a group.

Based on effective distance learning principles, the Compass system was developed. Compass
builds on a previous pilot online system, the About Face Online System (AFOS), which placed a
vocational manual into an online fillable format; however, though Veterans engaged the AFOS,
a number of limitations were identified that limited Veterans' enthusiasm, including use of
extended reading passages, no direct interaction with a person, and not enough focus on
interviews.

Compass uses distance learning best practices including the use of both synchronous and
asynchronous learning. The asynchronous components of Compass use video and online content.
Veterans are also quizzed at each step of the process on what responses should be given
through a multiple choice method. Synchronous components of Compass include tele-health
practice interviews, phone coaching sessions, and live-chat features that are used to assist
Veterans tailor their information and improving their interview skills.

This study is a four-year project to compare the effectiveness of the Compass system to basic
resources. 150 Veterans with legal convictions and mental illness and/or substance use
disorders will be followed for six months. Half will receive access to the Compass system and
half will receive only basic resources (i.e. a hard copy vocational manual). Outcomes
evaluated are employment and interview skills.

The goals of the study are:

1. Compare rates of employment of Compass to those receiving basic resources.

2. Compare improvements in interviewing skills between those receiving an online program to
those receiving basic resources.

Hypotheses/expected results

1) Veterans using Compass will have superior rates of employment and improved interviewing
skills compared to those receiving basic services.

Inclusion Criteria:

- mental illness or substance use disorder

- history of a felony conviction or non-traffic related misdemeanor

Exclusion Criteria:

- cognitive impairment which prohibits active participation in study