Supported employment outcomes for transition age youth and young adults.

TOPIC: Supported Employment (SE) can help transition age youth and young adults to obtain employment and develop meaningful careers and financial security. PURPOSE: The purpose of this analysis is to examine the role of SE in achieving employment outcomes for youth (ages 18-24) and young adults (ages 25-30), compared to outcomes for older adults. Given the importance of employment to the quality of life of young people in establishing work histories and starting careers, it is important to have a better understanding of what client and program characteristics result in better employment outcomes. SOURCES USED: Data are from the Employment Intervention Demonstration Program (EIDP), a multisite randomized controlled trial of SE among 1,272 individuals with psychiatric disabilities in 7 states. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Among all study participants, youth and young adults had significantly better outcomes in terms of any employment and competitive employment than older (>30 years) adults. However, in multivariable models of participants randomly assigned to SE, young adults had significantly better outcomes than youth or older adults. Other significant predictors of employment and competitive employment were future work expectations, not receiving Supplemental Security Income, and receipt of more hours of SE services. Characteristics of youth, young adults and SE programs that enhance employment are discussed in terms of policy and practice.

Consumer-Operated Service Programs: monetary and donated costs and cost-effectiveness.

OBJECTIVE: Examine cost differences between Consumer Operated Service Programs (COSPs) as possibly determined by a) size of program, b) use of volunteers and other donated resources, c) cost-of-living differences between program locales, d) COSP model applied, and e) delivery system used to implement the COSP model. METHODS: As part of a larger evaluation of COSP, data on operating costs, enrollments, and mobilization of donated resources were collected for eight programs representing three COSP models (drop-in centers, mutual support, and education/advocacy training). Because the 8 programs were operated in geographically diverse areas of the US, costs were examined with and without adjustment for differences in local cost of living. Because some COSPs use volunteers and other donated resources, costs were measured with and without these resources being monetized. Scale of operation also was considered as a mediating variable for differences in program costs. RESULTS: Cost per visit, cost per consumer per quarter, and total program cost were calculated separately for funds spent and for resources donated for each COSP. Differences between COSPs in cost per consumer and cost per visit seem better explained by economies of scale and delivery system used than by cost-of-living differences between program locations or COSP model. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Given others' findings that different COSP models produce little variation in service effectiveness, minimize service costs by maximizing scale of operation while using a delivery system that allows staff and facilities resources to be increased or decreased quickly to match number of consumers seeking services.

Supporting business owners with psychiatric disabilities: An exploratory analysis of challenges and supports.

OBJECTIVE: Self-employed individuals with psychiatric disabilities may face unique challenges to running small businesses. This study aims to identify business-related challenges and examine whether supports designed to alleviate those challenges are associated with positive business milestones and self-employment satisfaction. METHODS: Data were collected via a survey of 60 participants with a history of psychiatric disability who were operating a U.S.-based small business. This exploratory study used descriptive statistics to look at the relationship between business challenges, business development supports, business milestones, and satisfaction with self-employment. RESULTS: Although most participants reported experiencing business challenges and using supports, relatively few supports were helpful in the context of specific challenges. The number of challenges was positively correlated with the amount of supports used. Respondents used interpersonal or informal supports more often than help from organizations or institutions and tended to find these more helpful. The satisfaction of owning a business was generally high and positively correlated with the age of the business. Satisfaction was not necessarily tied to normative reasons such as business gross or percent of income. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: In this study, self-employed individuals with a psychiatric disability appear to prefer-or have greater access to-informal or interpersonal support, compared to institutional support. This may indicate that these owners have different needs for support, or that they do not use mainstream institutional resources that facilitate sustainability and growth, and therefore targeted efforts to provide formal support may be needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Long-Term Follow-Up of a Randomized Trial of Supported Employment for SSDI Beneficiaries With Mental Illness.

OBJECTIVE: In this study, the authors assessed the long-term impact of the Mental Health Treatment Study (MHTS), a randomized controlled trial testing the effects of providing 2 years of employment services based on the evidence-based individualized placement and support model to Social Security Disability Insurance (SSDI) recipients with serious mental illness. Treatment recipients also received systematic medication management, supplemental health care supports, and short-term relief from medical continuing disability review by the Social Security Administration (SSA). METHODS: MHTS site data for 2,160 participants were linked to SSA administrative data from 2011 to 2015, 1 to 5 years after the original study concluded. Univariate and multivariate models were used to assess the MHTS effects on employment, earnings, and disability benefit suspension-termination up to 7 years after services ended. RESULTS: The analyses showed that the treatment group was more likely than the control group to work, and average earnings among the treatment group increased more over time than earnings among the control group. Disability benefit suspension/termination did not differ between groups. CONCLUSIONS: Providing the demonstration's package of services and support to SSDI beneficiaries with psychiatric disabilities for up to 2 years may have a long-term impact on employment and earnings. Under the SSDI program as currently structured, however, even after receiving 2 years of evidence-based supported employment and high-quality mental health services, SSDI beneficiaries with psychiatric conditions are unlikely to achieve economic independence within 5 years.

The employment intervention demonstration program: major findings and policy implications.

This article summarizes the published results of the Employment Intervention Demonstration Program (EIDP), a federally-funded, multi-site study examining the effectiveness of supported employment programs for 1273 unemployed individuals with psychiatric disabilities in the U.S. Findings confirm the effectiveness of supported employment across different models, program locations, and participant populations. The study's results are discussed in the context of public policies designed to encourage return to work for those with a severe mental illness.

Care Coordinators in Integrated Care: Burnout Risk, Perceived Supports, and Job Satisfaction.

INTRODUCTION: This study examined burnout risk and job satisfaction reported by care coordinators in three programs integrating physical and behavioral health care; it also assessed the relationship between job support and burnout and the organizational supports helpful to care coordinators. METHODS: As part of an evaluation of the Centers for Medicare & Medicaid Services' Health Care Innovation Awards, the research team performed secondary data analysis of interviews conducted with staff (including care coordinators) in three integrated behavioral health models in 2014 and 2015 (n=88, n=69); focus groups with care coordinators in 2015 (n=3); and a survey of care coordinators in 2015 (n=231) that included the Maslach Burnout Inventory. RESULTS: Analysis of survey data completed in 2017 indicated that although care coordinators felt stressed, they also experienced high levels of job satisfaction, perceived job support, and personal accomplishment, and low levels of disconnection from participants; as a result, risk of burnout was low. Analyses of interview and focus group data identified factors that may have contributed to lowered risk, including (1) appropriate training, particularly on coordinator roles and participants' complex conditions and diverse needs; (2) supportive supervisors and managers; and (3) support from care team members and other coordinators. CONCLUSIONS: Results have implications regarding how organizations can support care coordinators to prevent burnout among these vital members of the integrated care workforce. SUPPLEMENT INFORMATION: This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

The Effectiveness of a Peer-Staffed Crisis Respite Program as an Alternative to Hospitalization.

OBJECTIVE: This study assessed whether peer-staffed crisis respite centers implemented in New York City in 2013 as an alternative to hospitalization reduced emergency department (ED) visits, hospitalizations, and Medicaid expenditures for individuals enrolled in Medicaid. METHODS: This study used Medicaid claims and enrollment data for January 2009 through April 2016 to estimate impacts on ED visits, hospitalizations, and total Medicaid expenditures by using a difference-in-differences model with a matched comparison group. The study sample included 401 respite center clients and 1,796 members of the comparison group. RESULTS: In the month of crisis respite use and the 11 subsequent months, Medicaid expenditures were on average $2,138 lower per Medicaid-enrolled month and there were 2.9 fewer hospitalizations for crisis respite clients than would have been expected in the absence of the intervention (p<.01). CONCLUSIONS: Peer-staffed crisis respite services resulted in lowered rates of Medicaid-funded hospitalizations and health expenditures for participants compared with a comparison group. The findings suggest that peer-staffed crisis respites can achieve system-level impacts.

The application and importance of disability policy research to the mental health field.

This editorial provides an introduction to this unique special issue of the Psychiatric Rehabilitation Journal. Rather than focusing on a particular type of rehabilitative services, it more broadly addresses the subject, methods, and results of disability policy research. This special issue is meant to start a conversation about the role of psychiatric rehabilitation researchers, professionals, and consumers in shaping future policies affecting and affected by mental illness. In particular, this issue focuses on the application of rigorous research methodologies to answer policy-relevant questions to help ensure that decisions affecting our field are evidence-based and address the issues that matter most in the lives of consumers. (PsycINFO Database Record

Preventing unemployment and disability benefit receipt among people with mental illness: Evidence review and policy significance.

OBJECTIVE: We identify effective services to assist 3 groups of people with mental illnesses become or remain employed and prevent dependence on disability cash benefits: (a) individuals, including youth, who are experiencing an initial episode of psychosis; (b) employed individuals at risk of losing jobs due to mental illness; and (c) individuals who are or may become long-term clients of mental health services and are likely to apply for disability benefits. METHOD: We searched for articles published between 1992 and 2015 using key word terminology related to employment support services and each subgroup, and prioritized articles by study design. RESULTS: The individual placement and support model of supported employment is more effective than traditional vocational programs in helping people with serious mental illnesses who are engaged in treatment or receiving disability benefits obtain competitive employment. Some early intervention programs effectively serve people who experience a first episode of mental illness, but more research is needed to demonstrate long-term outcomes. Less is known about the effectiveness of employment interventions in preventing unemployment and use of disability benefits among individuals at risk for job loss or long-term mental illness. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: States can fund employment supports to help prevent the need for disability benefit receipt by creatively combining federal sources, but the funding picture is imperfect. Medicaid expansion and other provisions of the Affordable Care Act may fund employment supports and assist in reducing dependence on disability benefits. (PsycINFO Database Record

Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness.

CONTEXT: National probability surveys indicate that most individuals with schizophrenia and other severe mental illnesses are not employed. This multisite study tested the effectiveness of supported employment (SE) models combining clinical and vocational rehabilitation services to establish competitive employment. METHODS: We randomly assigned 1273 outpatients with severe mental illness from 7 states in the United States to an experimental SE program or to a comparison or a services-as-usual condition, with follow-up for 24 months. Participants were interviewed semiannually, paid employment was tracked weekly, and vocational and clinical services were measured monthly. Mixed-effects random regression analysis was used to predict the likelihood of competitive employment, working 40 or more hours in a given month, and monthly earnings. RESULTS: Cumulative results during 24 months show that experimental group participants (359/648 [55%]) were more likely than those in the comparison programs (210/625 [34%]) to achieve competitive employment (chi(2) = 61.17; P<.001). Similarly, patients in experimental group programs (330/648 [51%]) were more likely than those in comparison programs (245/625 [39%]) to work 40 or more hours in a given month (chi(2) = 17.66; P<.001). Finally, participants in experimental group programs had significantly higher monthly earnings than those in the comparison programs (mean, US 122 dollars/mo [n=639] vs US 99 dollars/mo [n=622]); t(1259) = -2.04; P<.05). In the multivariate longitudinal analysis, experimental condition subjects were more likely than comparison group subjects to be competitively employed, work 40 or more hours in a given month, and have higher earnings, despite controlling for demographic, clinical, work history, disability beneficiary status, and study site confounders. Moreover, the advantage of experimental over comparison group participants increased during the 24-month study period. CONCLUSION: The SE models tailored by integrating clinical and vocational services were more effective than services as usual or unenhanced services.