Citation
Resnick, S., Neale, M., & Rosenheck, R. (2003). Impact of public support payments, intensive psychiatric community care, and program fidelity on employment outcomes for people with severe mental illness. The Journal of Nervous and Mental Disease, 191(3), 139-144.
Highlights
- The study’s objective was to evaluate the one-year impacts of a Department of Veterans Affairs (VA) model of assertive community treatment for veterans with serious mental illnesses known as Intensive Psychiatric Community Care (IPCC).
- The study was based on a randomized controlled trial. Roughly half of the 528 veterans participating in the study were randomly assigned to receive the IPCC treatment while the other half received standard VA services. The authors analyzed self-reported employment data collected from participants one year after random assignment.
- The study found that veterans in the IPCC group were three times more likely to be employed one year after random assignment than veterans in the control group.
- The quality of the causal evidence presented in this report is high because it is based on a well-conducted randomized controlled trial. This means we have confidence that the estimated effects are attributable to the IPCC program, and not other factors.
Intervention Examined
Intensive Psychiatric Community Care (IPCC)
Features of the Intervention
The IPCC program1, later known as Mental Health Intensive Case Management, was an assertive community treatment model of care for veterans with psychiatric disabilities. The program included a range of rehabilitative services and was primarily staffed by masters-level social workers, nurses, and psychiatrists. The key features of the program were frequent patient-clinician contact, flexibility and community orientation, training in practical problem solving and adaptive skill building, and continuity of care. The IPCC teams assertively maintained contact with patients, including those reluctant to engage.
Features of the Study
The IPCC evaluation was a randomized controlled trial that originally included programs in 10 VA hospitals from 1987 to 1990. This report reanalyzes the one-year impacts of the program on employment for participants in the six general medical and surgical hospitals. To be eligible, veterans had to be hospitalized in a psychiatric inpatient unit at the time of recruitment, have been hospitalized at least 40 days or at least twice in the prior year, and have a psychiatric diagnosis other than substance abuse.
The 528 eligible veterans were randomly assigned to either a treatment group that received the IPCC intervention or a control group that received standard VA services including inpatient psychiatric and psychopharmacologic treatment, outpatient psychiatric treatment, and rehabilitation services such as work therapy.
The authors estimated the impact of IPCC on self-reported employment one year after random assignment. Participants who reported that they had either worked at least five days or earned at least $100 in competitive employment in the prior month were classified as employed.
Findings
- The study found that veterans in the IPCC group were three times more likely to be employed one year after random assignment than veterans in the control group. This difference was statistically significant.
Considerations for Interpreting the Findings
In the model used to estimate program effects, the authors included an indicator for whether a site’s fidelity to the IPCC model was low and that indicator interacted with treatment status. The presence of these terms in the impact model influences the interpretation of the employment impact estimates; specifically, the overall impact of IPCC may be overstated. In addition, although the impact of IPCC was large relative to the control group, the absolute rate of employment in the sample was low, at 8.8 percent.
Causal Evidence Rating
The quality of the causal evidence presented in this report is high because it is based on a well-conducted randomized controlled trial. This means we have confidence that the estimated effects are attributable to the IPCC program, and not other factors.