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APHA Scientific Session and Event Listing

Marsha Langer Ellison, PhD, Center for Health Policy and Research, University of Mass. Medical School, 222 Maple Ave., Shrewsbury MA, MA 01545, 508 8566 1531, Marsha.Ellison@umassmed.edu and Asya Lyass, PhD (Cand), Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215.

This study hypothesized changes in service utilization and gains in community integration for a sample of public mental health service recipients in Iowa who participated in an intensive program of psychiatric rehabilitation (a required component of the state behavioral health service contract). A case-control methodology was employed using propensity scores to draw a one to one match for the intervention participants from a pool of recipients of public mental health services. This method permits creation of a comparison group for an existing intervention where randomization of participants is not permitted. The program involves the client first choosing an overall rehabilitation goal and then identifying and acquiring skills and support to achieve this goal with the help of a practitioner. First, pre to post comparisons were performed for the experimental group only. Significant gains in residential status, monthly earnings and employment status are found within the experimental group. There were significant differences found as well when the change scores for these outcomes were compared between those who completed and those who dropped out of the intervention, with completers showing larger gains. Experimental and control groups were then compared on service utilization and spending using state Medicaid claims data. All sub-groups decreased their use of mental health services, but controls showed significantly greater decreases in use and cost of mental health services. This pattern is largely maintained when the types of service are analyzed separately. Results suggest an increase in “service savvy” among experimentals.

Learning Objectives: At the conclusion of the session the participants in this session will be able to

• Articulate the overall use and method of propensity scores in case control methodologies
• Identify characteristics of the psychiatric rehabilitation process used in Iowa
• Describe the outcomes of this psychiatric rehabilitation process in Iowa for wages, housing and employment.

Keywords: Mental Health Care, Medical Care

Presenting author's disclosure statement:

Not Answered

Handout (.ppt format, 112.0 kb)