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Effective Health Care Program

Impact of Employment Interventions for Persons with Serious Mental Illnesses (SMI) on Non-Employment Patient-Centered Outcomes

Abstract Archived

Topic Abstract

Background: Competitive employment is a highly desired outcome among persons disabled by serious mental illness. Individual Placement and Support (IPS) has demonstrated efficacy in achieving this goal in multiple studies as compared to traditional vocational services emphasizing vocational training, some including sheltered work settings. IPS integrates employment support and mental health care, with continuing employment support over time as needed. However, non-employment outcomes have received little scrutiny, including the effects of IPS on patterns of medical and mental health care and patient-reported functional status, use of alcohol and drugs, and interactions with law enforcement.

Research Objective: The effectiveness of IPS will be assessed with regard to patient-centered, non-employment outcomes as compared to “traditional” vocational services.

Study Design: Two different approaches to vocational services will be compared: IPS and traditional vocational services (TVS). However, not all IPS programs available in communities have high fidelity to the original model. Three groups of individuals who have initiated vocational services will be studied: (1) those in a high-fidelity IPS program (IPS-F), (2) those in an IPS program not meeting high-fidelity criteria (IPS-NF), and (3) those receiving “traditional” vocational services (TVS) . Baseline observations on each will cover the two years prior to starting vocational services, and follow-up will include two to three years after starting vocational services. At least 2,000 participants will be studied, with 750 in each of the IPS groups and 500 TVS participants.

Methods: Three categories of outcome variables will be used to assess the effect of the different vocational services : (1) Patterns of care indicative of failure to coordinate/integrate care, including hospital admission for ambulatory sensitive conditions, hospital readmissions within 7 and 30 days of hospital discharge, ER visits post-hospital discharge within 7 and 30 days, and not having a follow-up doctor visit within 7 and 30 days of hospital discharge; (2) Coordination and continuity of care, including continuity of medications for selected mental illness and somatic chronic conditions, continuity of visits (and providers) for mental health and somatic chronic care; and (3) patient-reported outcomes, including functional status, alcohol and drug use, arrests, and interactions with law enforcement. Data will come from person-level Medicaid service claims and from the Maryland Public Mental Health System’s Outcomes Measurement System which routinely collects patient-reported outcomes of care.

Expected Outputs: Two reports will be produced, one addressing variations in patient-reported outcomes and the other variations in continuity and coordination of medical and mental health care. Findings will be based on comparisons between individuals receiving IPS or TVS vocational services and, within IPS programs, individuals receiving vocational services with and without high fidelity.

Expected Date of Project Completion: Summer 2013

Priority Conditions: Mental Illness