Supported Employment Demonstration

Study Overview
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Brief Summary
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The purpose of this study is to determine whether offering an evidence-based package of employment supports integrated with mental health services has a positive impact on employment and clinical recovery, and delays or diminishes the need for disability benefits.

Detailed Description
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SSA contracted with Westat to implement and evaluate the Supported Employment Demonstration (SED). The SED provides integrated mental health and vocational services to people with mental illness who were recently denied Social Security disability benefits. The evaluation will determine the impact of the SED on employment, clinical recovery, and receipt of disability payments. The evaluation is using a randomized controlled trial design to compare the outcomes of two treatment groups and a control group. In the full-service arm (n = 1,000), participants receive services from an Individual Placement and Support employment specialist, a care manager, and a nurse care coordinator (NCC) who provides medication management support, as well as modest funding for out-of-pocket prescriptions, essential work-related expenses, and other services in the participant's treatment plan. The basic-service arm (n=1,000), which is expected to cost about 50 percent less than the full-service arm, provides all services and funds except the NCC. Participants in the usual services (control) group (n = 1,000) seek services as they normally would but receive a comprehensive guide to local, state, and national resources. Data collection includes computer-assisted baseline (in-person) and blinded quarterly (telephone) interviews with participants, collection of SSA administrative and site-level program data, site visits (including fidelity assessments), qualitative interviews with site administrators and service providers, focus groups with study participants, and person-centered ethnographic interviews with participants and nonparticipants.

Official Title
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Supported Employment Demonstration

Conditions
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Mental Impairment

Intervention / Treatment
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* Behavioral: Full Service
* Behavioral: Basic Service


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Individuals denied Social Security disability benefits (SSDI or SSI) Individuals alleging a mental impairment Live in Community Mental Health Agency (CMHA) catchment area Legally competent Express desire to improve work situation Exclusion Criteria: Intellectual disability Reside in a nursing home or custodial institution Already receiving supported employment services from CMHA site

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 49 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Full Service Treatment<br>The Full Service Arm receives the Individual Placement and Support (IPS) model of employment services integrated with behavioral health services and care management services, as well as Medication Management Support (MMS) from a Nurse Care Coordinator (NCC). | Behavioral: Full Service<br>* Receive Individual Placement and Support (IPS) model of employment services, behavioral health services, care management services, and Medication Management Support provided by a Nurse Care Coordinator (NCC).<br>|
| Experimental: Basic Service Treatment<br>The Basic Service Arm receives the Individual Placement and Support (IPS) model of employment services integrated with behavioral health services and care management services. | Behavioral: Basic Service<br>* Receive Individual Placement and Support (IPS) model of employment services, behavioral health services, and care management services.<br>|
| No Intervention: Usual Services<br>Members of the Usual Service group seek services as they normally would (or would not) in their community. At the time of randomization, each Usual Services group member receives a comprehensive manual describing mental health and employment services in their local community, as well as state and national resources. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Employment | Whether participant is employed in a paying job at any time during the 36 month study period. Assessed via quarterly computer-assisted telephone interviews. | 36 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Employment (Competitive) | Whether a participant is employed in a community job that pays at least minimum wage (as defined by the resident state) and is owned by the employer rather than a mental health center or rehabilitation agency at any time during the 36 month study period. Assessed via quarterly computer-assisted telephone interviews. | 36 months | 
| Total Hours Worked | The reported total number of hours worked for pay during the 36-month study period. Assessed via quarterly computer-assisted telephone interviews. | 36 months | 
| Days to First Job | The number of days from enrollment date to first job during the 36-month study period, for those not employed at enrollment. Assessed via quarterly computer-assisted telephone interviews. | 36 months | 
| Months Employed | The number of months employed during the 36-month study period. Assessed via quarterly computer-assisted telephone interviews. | 36 months | 
| Job Tenure | The longest number of consecutive months employed for any single job during the 36-month study period. Assessed via quarterly computer-assisted telephone interviews. | 36 months | 
| Total Earnings | Total amount of reported earnings over the 36-month study period. Assessed via quarterly computer-assisted telephone interviews. | 36 months | 
| Months above SGA | The number of months the participant reported earnings above Substantial Gainful Activity (SGA) levels over the 36-month study period. Assessed via quarterly computer-assisted telephone interviews. | 36 months | 
| Short-Form 12 Health Survey (SF-12) Mental Component Score (MCS) | The difference between the Short-Form 12 Health Survey (SF-12) Mental Component Score (MCS) measured at baseline (Baseline Survey) and at study exit (final quarterly follow-up survey). Higher values of the SF-12 MCS indicate better outcomes. A higher SF-12 MCS at study exit than at baseline indicates a positive change. Assessed via computer-assisted telephone interviews. | 36 months | 
| Time Until Award | The number of study days to disability award. Assessed using Social Security Administration administrative data. | 36 months |