Comments: Long-Term Follow-Up of Supported Employment Recipients 1 - - PowerPoint PPT Presentation

B O B W E A T H E R S S O C I A L S E C U R I T Y A D M I N I S T R A T I O N O C T O B E R 3 0 , 2 0 1 4

Comments: Long-Term Follow-Up of Supported Employment Recipients

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Policy Relevance

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A significant share of SSDI beneficiaries and SSI recipients have mental health conditions

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Among all DI beneficiaries, primary diagnosis: mood disorders (14.1%), schizophrenic and

• ther psychotic disorders (5.1%)

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Among all SSI recipients ages 18-64, primary diagnosis: mood disorders (16.5%), schizophrenic and other psychotic disorders (8.9%)

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SSDI beneficiaries with mental health conditions tend to be younger and stay on the program longer

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Relatively lower incidence rates indicate longer stay on program

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Among all DI awardees: Mood Disorders (9.6%), Schizophrenic and other psychotic disorders (2.2%)

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Among all SSI recipients ages 18-64: Mood Disorders (13.0%), Schizophrenic and other psychotic disorders (5.6%)

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Providing services and supports to individuals with mental impairments may:

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improve functioning, employment, and earnings; and

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reduce reliance on SSDI and SSI programs.

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A unique feature of the Cook et al paper is the analysis of long-term outcomes of individuals who received Supported Employment services

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Paper’s Key Findings

 Among group who received EIDP SE, over 13 yr follow-up:

 no statistically significant difference in any reported earnings (adjusted

OR = 1.27, p=.253)

 more likely to ever be suspended from SSI/DI due to work (adjusted

OR = 2.05, p=.024)

 more total earnings (average about $3,000 more, p=.092)  More likely to collect SSDI benefits, less likely to collect SSI payments  Person-month panel regressions tend to show larger effects

 Result of Supported Employment or sample selection?

 Uses subsample who agreed to additional survey and to merge SSA

records, treatment group member who benefited more likely to agree?

 Persistence of the SE effect on employment is somewhat surprising given

experience with other demonstrations

 Providing additional information on baseline characteristics of each

group might be useful in assessing possible selection bias

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Comparison to MHTS

 SSA/Westat Mental Health Treatment Study (MHTS) included:

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access to supported employment (SE) services and systematic medication management (SMM) services

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begun in November 2006 and ended July 2010

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included 2,238 SSDI beneficiaries in 23 study sites throughout the U. S.

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random assignment of volunteers to either a treatment group or a control group

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primary goal was to examine impact on competitive employment

 MHTS Findings:

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positive impact on health and healthcare outcomes (reduction in hospital days was about

• ne day per year, or approximately $1,800 per year per person);

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positive impact on employment during 24 month intervention period(61% v. 40% control group);

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positive impact on monthly earnings, conditional on having earnings ($251.12 vs. $227.93) ;

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no effect on SGA (SGA amount was $900/month in 2007, $1000/month in 2010); and

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no effect on benefit suspense/termination

 Goal of competitive employment may not translate into reduced reliance on

benefits

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What Next?

 MHTS and EIDP long-term outcomes analyses:

 both focused on SSDI beneficiaries and SSI recipients  application and program participation might have negative effects on

labor market outcomes

 Can a focus earlier in the impairment process (before

DI/SSI receipt) increase employment, earnings, and economic well-being?

 Is the SE focus on competitive employment too limiting?

 should the focus be on Substantial Gainful Activity (SGA)? or  maximizing a person’s employment and earnings potential?

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Opportunities to Build on SE Findings

 Early intervention demonstration authority:

 Focus on SE services to denied applicants with mental impairments?  Focus on SE services on SSI/DI applicants with mental impairments before SSA

disability determination?

 Affordable Care Act (ACA) Health Homes:

 ACA established Health Homes to coordinate care for people with

Medicaid who have chronic conditions

 Conditions include “one serious and persistent mental health condition”  Health Homes providers integrate and coordinate all primary, acute,

behavioral health, and long-term services and supports to treat the whole person

 Supports could include Supported Employment services?  ACA expands Medicaid to those with incomes up to 138% of poverty line  State Medicaid “buy-in” option may cover individuals with a disability

and incomes up to 400% of poverty line

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