Vignette #1 A case randomized to Individual Placement and Support

A veteran enrolled in treatment for OUD 2 years ago after using heroine for about 2 months. He had been treating his pain from lupus with prescribed opioid medication and his attending physician lessened his dosage and he begin using heroine. His provider at the VA referred him to this study when he indicated to provider that he had been living in a hotel room for 8 years and was temporarily living in a basement of a former romantic partner. After screening, the veteran was randomized to IPS services. During the vocational assessment, he communicated a fear of jeopardizing his social security disability income (SSDI) due to employment. The employment specialist drove the veteran to Social Security Services Administration to meet with a representative that informed him of the amount he could make monthly without jeopardizing his benefits. The employment specialist located a job that would enable him to stay under this amount; however, in collaboration with the VA provider a decision was made to wait until the veteran received his new residence so that the veteran would not be faced with too many major life changes at one time. Once the veteran moved into his residence, the employment specialist located another job as a meat cutter (a transitional skill that he developed in the military) at a grocery store. The veteran was offered two jobs as this skill is in high demand. During this time the employment specialist referred the veteran to State Vocational Rehabilitation agency to assist the veteran with securing transportation and clothing for his new position. The Veteran has been employed for six weeks and can work 15 h/week to stay under his income limitation to maintain SSDI. The employment specialist has visited his work location several times and both the veteran and his manager have indicated that he is doing well and enjoying the work.