Absence of conflict of interest.
Citation
Highlights
- The study's objective was to examine the impact of the Mental Health Treatment Study (MHTS) intervention on earnings.
- The study was a randomized controlled trial. Using interview and administrative data, the authors conducted statistical models to compare the outcomes of treatment and control group members.
- The study found that the treatment group had significantly higher earnings than the control group.
- This study receives a high causal evidence rating. This means we are confident that the estimated effects are attributable to Mental Health Treatment Study (MHTS) intervention, and not to other factors.
Intervention Examined
Mental Health Treatment Study (MHTS)
Features of the Intervention
The Mental Health Treatment Study (MHTS), funded by the Social Security Administration (SSA) arose from a need to study evidence-based behavioral-health interventions aimed towards increasing the earnings of Social Security Disability Insurance (SSDI) beneficiaries with persistent mental disorders. The core intervention components were individual placement and support (IPS); supported employment (SE); systematic medication management (SMM); and expanded access to other behavioral health or related services. The program also served to reduce financial barriers through the provision of medical insurance, payments of premiums for Part D Medicare drug coverage, wrap-around payments for non-insured behavioral health care costs and certain employment-related costs. Participating in the intervention also suspended medical disability reviews for three years after enrolling. The MHTS intervention was delivered at 23 community-based sites across the U.S.
The program served disabled SSDI beneficiaries with diagnosed schizophrenia or affective disorder, who were between the ages of 18 and 55, and lived within a three-mile radius of one of the study sites. Participants could not reside in a nursing home or custodial setting, be employed in a competitive job, be receiving supported employment services from the study site, have a legal guardian, or life-threatening physical illness.
Features of the Study
The study was a randomized controlled trial. Eligible participants were identified from SSA administrative records. Of the 2,238 eligible participants, 1,004 were randomly assigned to the treatment group and 1,051 were randomly assigned to the control group. The treatment group received the MHTS intervention, while the control group continued with services as usual provided by each of the community-based sites. More than half of the study sample were women (53%), the majority were White (62%), with an average age of 45 years, and less than a quarter had some college education (19%). Data were drawn from a baseline interview, seven follow-up quarterly interviews, a final follow-up interview, and SSA administrative data. The authors used statistical models to compare earnings outcomes between treatment and control group members.
Findings
Earnings and wages
- The study found that the overall average past 30-day earnings were significantly greater for the treatment group than the control group.
- The study found that the treatment group’s average past 30-day earnings were significantly greater than those of the control group for the first four follow-up interviews, the last four follow-up interviews, and the 3 months prior to the final follow-up interview.
Considerations for Interpreting the Findings
Outcome data were based on self-reported earnings, which are less reliable than administrative records. Participants in the treatment group may have exaggerated their self-reported earnings to please the evaluation team member who interviewed them.
Causal Evidence Rating
The quality of causal evidence presented in this report is high because it was based on a well-implemented randomized controlled trial. This means we are confident that the estimated effects are attributable to the MHTS intervention, and not to other factors.