Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112909

Judith A. Cook, PhD, Department of Psychiatry/Mental Health Services Research Program, University of Illinois at Chicago, 104 South Michigan Ave, Suite 900, Chicago, IL 60603, Richard Goldberg, PhD, Psychiatry, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Building, Suite 300, Baltimore, MD 21201, William McFarlane, MD, Department of Psychiatry, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, Michael S. Shafer, PhD, Community Rehabilitation Division, University of Arizona, 721 N. Fourth Avenue, #107, Tucson, AZ 85705-8445, and Paul B. Gold, PhD, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Division of Public Psychiatry, P.O. Box 250861, Charleston, SC 29425, 843-792-6892, goldpb@musc.edu.

The 1999 Ticket to Work and Work Incentives Improvement Act was intended to give people with disabilities increased options for obtaining vocational services in order to re-enter the workforce. It uses an outcome based payment mechanism whereby service providers are paid according to whether their clients achieve certain pre-determined levels of employment. The purpose of this study was to simulate outcomes for hypothetical “Ticket service providers” based on outcomes achieved by subjects in a large clinical trial of evidence-based practice (EBP) supported employment (SE) services. Longitudinal data were collected during 1996-2000 from 506 subjects with psychiatric disabilities assigned to the experimental condition at 7 sites nationwide. Earnings were adjusted to 1999 dollars and examined to determine whether they met thresholds for “success,” defined as generating payments from the Ticket program to hypothetical providers. Based on 2 years of initial earnings, and using the 1999 Substantial Gainful Activity level of $500, a total of $734 per person for 2 years of service delivery would have been generated under the milestone-outcome system, with 48% of clients reaching the first milestone, 37% the second, 21% the third, and 10% the fourth. Under the outcome payment system, a total of $151 per person would have been generated, with 12% completing their trial work period and exiting the rolls. Study results suggest wide disparity between definitions of successful outcomes in EBP research versus federal policies in the Ticket to Work program, with implications for Ticket holders, service providers, policy makers, and researchers.

Learning Objectives:

• Participants will be able to describe two payment mechanisms under which providers are reimbursed in the Ticket to Work Program.
• Participants will be able to define an Employment Network as recognized under the Ticket to Work Program.
• Participants will be able to describe how Substantial Gainful Activity influences provider payment mechanisms in the Ticket to Work Program.

Keywords: Mental Health Services, Disability Policy

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.