Recruitment in the Mental Health Treatment Study: A Behavioral Health/Employment Intervention for Social Security Disabled-Worker Beneficiaries

Author:David S. Salkever, Brent Gibbons, William D. Frey, Roline Milfort, Julie Bollmer, Thomas W. Hale, Robert E. Drake, and Howard H. Goldman

The recent development of evidence-based behavioral health and vocational rehabilitation interventions for persons with serious psychiatric impairments created the impetus for exploring the efficacy of those interventions if they were widely available to Social Security Disability Insurance beneficiaries. As a first step in this endeavor—a multisite randomized trial for providing interventions to ... (see full summary)

Social Securit y Bulletin, Vol. 74, No. 2, 2014 27
Although promoting the retur n to work of Social Secu-
 
been an objective of the Social Security Administ ra-
tion’s (SSA’s) policy initiatives, several factors argue
 -
for 29.1 percent of all Social Security disabled-worker
workers with psychiatric impairments te nd to go on
Access to effective behavioral health treatment
psychiatric impairments is also a relevant concern for
SSA and other federal agencies. A number of behav-
ioral health treatment and rehabilitation inter ventions
for persons with severe and persistent mental disorders
 -
receiving concurrent Supplemental Secur ity Income
a result, do not achieve attainable improvements in
their funct ioning.3
In response to available intervention concerns,
 
     
     
    
      
    
This article e xtends work conducted unde r contract no. SS00- 05-60072 between the Social Sec urity Administration (SS A) and Westat;
  
     
source is reques ted. The Bulletin is available on the w eb at http://www.soci 
presented in the Bulle tin are those of the authors and do not ne cessarily represent the vie ws of the Social Security Admin istration or any
 
 
randomized trial that provided access to e ffective treatment and rehabilitation inter ventions for Social Secu-
  
understand the likely take-up rate for MHTS re plications and/or expansions and to identif y characteristics of DI
well above rates for previous Social Secur ity Administration ran-
 
  
  
consider the implications here for generalizing intervention impa cts and modifying recruitment st rategies.
access to effective treatment and rehabilitation inter-
 
treatment group received (1) supported employment
(SE) services following the evidence-based individual
placement and support (IPS) template, (2) systematic
medication management services to monitor and man-
age their pharmacological treatments, (3) enhanced
insurance coverage for behavioral health care, and
(4) reimbursement of out-of-pocket behavioral health
or work-related expenses (transpor tation, copays, and
so forth). In addition, SSA’s requirement for continu-
ing disability reviews was waived for a 3-year period
for the treatment group.
 
 -
vided to all persons in the t reatment group. Those ser-
vices were provided by a local supported employment
agency in each of the 23 study sites. The IPS template
for SE services includes the following critical elements:
Consumer choice through the provision of services
to all consumers interested in employment.
Integration of vocational services with the overall
mental health treatment progra m.
Placement in regular competitive job settings,
with no mandatory requi rements for preemploy-
ment training or prior placement in seg regated/
sheltered work.
and the client beginning job searches shortly after
enrollment in IPS.
On-going follow-up services by the employment
specialist, once the client is placed, for as long as
services are needed.
Service priorities and content based pr imarily on
consumer preferences.
Items 2, 3, and 4 were provided to treatment group
 
were provided to all persons in the treat ment group.4
prehensive manual of available community resources
and services and a total payme nt of $100 for complet-
ing a baseline interview and eight follow-up quarterly
treatment and rehabilitation ser vices were presumed to
 
Because access to evidence-based IPS-SE services
 
to the geographic catchment areas of 23 sites around
the country where agencies providing IPS-SE ser vices
were already in existence. Those sites were selected to
provide geographic and demographic diversity; at least
one site was located in each of the four census regions
of the country, but there was a preponderance of sites
in the eastern and midwestern states because of the
concentration of agencies providing IPS-SE services
in those areas of the countr y.
 
potential effectiveness of a program that makes this
intervention package available on a national basis to
 
 -
ment experience to better under stand the likely
take-up rate for such a program and the chara cter-
Because the potential target population for such a
program is large and heterogeneous, underst and-
ing the differences between st udy participants and
nonparticipants is import ant for generalizing any
results about intervention impacts to other g roups of
tiveness of actual future implementations will depend
 
take-up rates and
from the program.
The overall analysis in this art icle addresses the
 
enrollment procedures and follow with an overview of
our analytic approach. We then discuss data sources
and variables, followed by the results of our statistical
Selected Abbreviations
DI Disability Insurance
IPS individual placeme nt and suppor t
  
 
 research in formation group
SE supported employment
 severe and persist ent mental disorder
SSA Social Securit y Admini stration
SSI Supplemental Securit y Income
TTW Ticket to Work
TWP trial work period

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