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