Online Program

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

Tuesday, November 5, 2013 : 3:10 p.m. - 3:30 p.m.

Brent Gibbons, Ph.D, Maryland Institute for Policy Analysis and Research, University of Maryland, Baltimore County, Baltimore, MD
David Salkever, Ph.D, Department of Public Policy, University of Maryland, Baltimore County, Baltimore, MD
Mustafa Karakus, Ph.D, Westat, Rockville, MD
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.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Describe the positive earnings effects of a multi-faceted evidence-based intervention for SSDI recipients with schizophrenia or mood disorders. Demonstrate the importance of covariate controls in randomized trials. Demonstrate methods to test for attrition bias in evaluating the time-varying effects of an intervention.

Keyword(s): Mental Health Services, Mental Illness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been an analyst with Dr. David Salkever for the duration of the Mental Health Treatment Study, initially studying participation in the MHTS and later examining both vocational and non-vocational outcomes. I am working on several publications along with the MHTS team. I am also generally knowledgable about vocational rehabilitation from my dissertation work and from continuing work on an NIMH grant studying supported employment in Maryland.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.