Earnings impacts of a multi-faceted randomized trial on SSDI beneficiaries with mental disorder

Background: Beneficiaries with psychiatric impairments account for a large share of SSDI costs and report very low levels of work activities. The US SSA recently conducted a randomized trial of evidence-based supported employment and mental health treatments aimed at increasing these beneficiaries' work levels. Method: 2,055 SSDI beneficiaries with schizophrenia or mood disorders, recruited from 23 cities, were studied in a 2-year trial. Treatment participants received team-based supported employment, medication management, and other behavioral health services and insurance, and suspension of continuing disability reviews. Control participants received usual services. Participants interviewed at baseline and in 8 quarterly follow-ups reported past-month's earnings. The intervention effect on follow-up earnings was estimated using GLM regression methods, controlling for baseline earnings and other baseline covariates. Results: Significantly positive treatment effects on average monthly earnings were found for the 2-year follow-up ($94), for the first 12-months ($67), and for the last 12-months ($120). Significantly positive treatment effects were also found for 1) probability of positive past-month's earnings and 2) probability of any past-month's earnings exceeding the SSA substantial gainful monthly activity level (SGA) (approximately $1,000); treatment effect on frequency of past-month's earnings exceeding the SSA SGA was marginally significant. (However, the latter two effects were small in magnitude.) Conclusions: The intervention demonstrated significant effects on earnings that were albeit modest in size. Larger effects in year two may illustrate the need to exclude start-up-phase results in projecting longer-term impacts.