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Pay For Success: Incentivizing sustainable Veteran Employment

VA has developed a new initiative to create sustainable employment opportunities for Veterans with a VA service-connected disability of PTSD.

Transitioning from military service to civilian life can be an uncertain time for Veterans. Separated from a military life and the structure and rigor of their service, Veterans can feel adrift as they shape their post-military life. Well-suited, consistent and sustained employment can be hard to find. We have heard of Veterans who are rapidly hired but then soon find themselves back where they had started a year or even months earlier because the job was not a good fit, properly aligned with their skills and goals. The transition from military to civilian life is unique to each Veteran and their circumstances. Regular and supportive employment can provide a necessary enabler for building a “new normal” outside of the military and provide the stability to tackle mental, physical and social challenges.

However, for Veterans returning home with complex PTSD symptoms, sustainable employment can be hard to maintain, and the lack of employment can have compounding consequences for their PTSD symptoms. It can become a taxing cycle. Given these challenges that some Veterans face, VA has developed a new initiative to create sustainable employment opportunities for Veterans with a VA service-connected disability of PTSD. This new pilot will bridge the gap and provide the support and resources needed to assist Veterans in their goal of achieving meaningful and sustained employment.

The wars in Afghanistan and Iraq are the longest combat operations since Vietnam. The length and nature of these conflicts create many stressors that face Veterans who have served, increasing the chances of having PTSD or other mental health problems. Initial research on OEF/OIF Veterans suggest that between 10% and 18% of OEF/OIF troops are likely to have PTSD (in varying severity) after they return. Though the recent overall Veteran unemployment rate is considered to be low, the unemployment rate for OIF/OEF Veterans with PTSD is believed to be considerably higher. Among 18–24 year olds, the unemployment rate is nearly four points higher among those who have served (16.2%) than those who have not (12.5%). Our most recent generation of Veterans — some as young as 21- and 22-years old — who grapple with severe PTSD are most likely to be unemployed, and their employment status can adversely affect their PTSD.

If unemployment is one of biggest predictors for PTSD symptom severity, then employment is one of the biggest protectors.

Unemployment for Veterans with PTSD has been reported to be one of the biggest predictors for symptom severity. Sustained and meaningful employment for Veterans with PTSD provides personal and financial stability. While in service, Veterans had clearly defined roles and responsibilities; their identity was influenced by what they did, who they served with, their uniforms and traditions. Returning home, many of the structures that helped shape their identity, and sense of purpose, may no longer exist. This feeling of losing identity and sense of worth can stress and compound symptoms of PTSD, resulting in increased depression and anxiety. Employment can serve to empower and ground Veterans, enabling them to start redefining their identity and purpose outside of military service. Similarly, employment can provide financial stability, through a regular paycheck and benefits, that both reduce the stressor of bills and financial planning, and enable a healthier home life and marriages in many cases. “It’s a sad story that unfortunately has played out many times. Veteran returns home with PTSD and is unable to find work. The financial and personal stress takes a toll on this Veteran and their family, leading to divorce and separation that further compound symptoms of PTSD and hinder recovery,” recounts a clinician who regularly treats recently returned Veterans.

If unemployment is one of biggest predictors for PTSD symptom severity, then employment is one of the biggest protectors. “I’ve definitely written a prescription for employment before,” Dr. Tapia, Medical Director at the Polytrauma Network site in San Antonio, recalls. “Sometimes, you see a young Veteran, and you just tell them, when you have the right job, you’ll be surprised at how much it can help.” Employment for Veterans with PTSD can be transformative and give them the stability they need to receive the care they need and the structure to enable a healthy transition from service.

Today, we’re taking another step to help Veterans with a service-connected disability of PTSD secure meaningful and sustained employment. The VA Center for Innovation (VACI) and VA’s Vocational Rehabilitation and Employment teams are partnering with the Corporation for National Community Service (CNCS) to launch the Veterans Employment Pay for Success (VEPFS) Program.

Pay for Success (PFS) is a simple but compelling idea. Instead of paying upfront for a social service that may or may not achieve the desired results, the government only pays once an intervention produces specific, measurable, and positive outcomes, generating true positive impact in communities across the country. Traditionally, contracts or grants are based on the volume of services delivered, such as the number of students taught in a job training program. An outcome is a longer-term, and hopefully positive, change in people’s lives, like the number of people who find a job. Pay for Success programs are different because the payout occurs only after a rigorous evaluation determines that the pre-agreed-upon outcomes have been achieved due to the intervention. We are paying for what works. We pay for success.

Using this innovative approach, the Veteran Employment Pay for Success program will pay for tangible positive outcomes for Veterans seeking employment. The outcomes payments will only be issued when improved employment outcomes for Veterans are achieved due to the intervention. Pay for Success incentivizes positive impact — and ensures that taxpayer dollars are used for programs that work. Together, we are taking another step forward today to help unemployed Veterans experiencing PTSD to secure sustainable and meaningful employment.

The Veterans Employment Pay for Success Program is an opportunity for us to bring a transformative model to help tackle unemployment among Veterans who suffer from PTSD.

This Pay for Success program is the first of its kind to be attempted at VA. And we’re eager to get started! If you are interested in applying, please check out the opportunity here.



Ideas within the VHA Innovation Ecosystem are generated through the VA Innovators Network, transformed into reality by the VHA Innovation Program, and then disseminated throughout the VA by the Diffusion of Excellence Initiative.

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