Citation
Bond, G., Xie, H., & Drake, R. (2007). Can SSDI and SSI beneficiaries with mental illness benefit from evidence-based supported employment? Psychiatric Services, 58(11), 1412-1420.
Highlights
- The study’s objective was to determine whether supported employment programs improved employment outcomes for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) recipients with psychiatric disabilities. Supported employment interventions use a combination of employment and health services and supports to improve employment and other outcomes.
- This study aggregated data from randomized controlled trials in four sites: New Hampshire, Connecticut, Illinois, and Washington, D.C. Study data sources included baseline interviews and 18-month follow-up data from each site.
- The study found that, across all recipient types, the programs increased the probability of employment, the number of weeks worked, and the number of weeks worked at a single job by a statistically significant margin.
- The quality of causal evidence provided in this study is low. This means that we cannot be confident that the estimated effects are attributable to the support employment interventions; other factors are likely to have contributed.
Intervention Examined
Supported Employment Programs
Features of the Intervention
Supported employment programs use a combination of employment and health services and supports to improve employment and other outcomes for people with psychiatric conditions. The supported employment interventions examined in this study—referred to as individual placement and support (IPS) programs—aimed to address the many barriers those ages 18 to 64 with psychiatric disabilities face when seeking employment. The services provided varied by site, but typical IPS programs combine mental health services, vocational services, benefits counseling, client input regarding preferred positions, expedited job search, and ongoing personal support.
Features of the Study
This study relied on findings from randomized controlled trials conducted in New Hampshire, Connecticut, Illinois, and Washington, D.C., during the 1990s and early 2000s. Each trial site assigned adults with psychiatric disabilities who had volunteered to participate to either the treatment group, which received IPS services, or the control group, which received existing vocational services. The researchers collected data from baseline interviews and 18-month follow-up surveys.
The authors used generalized linear models to estimate impacts of supported employment programs relative to the control condition among four mutually exclusive recipient statuses—SSDI-only recipients, SSI-only recipients, concurrent SSDI/SSI recipients, and nonrecipients. The authors examined impacts by programmatic group because SSDI and SSI program rules create different, potentially overlapping work incentives for their recipients.
Study Sites
- Connecticut
- Illinois
- New Hampshire
- Washington, D.C.
Findings
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The study found that, for all four recipient statuses examined, treatment group members were significantly more likely than control group members to be employed and worked considerably more weeks over the 18-month follow-up period.
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In addition to working more overall, treatment group members tallied significantly more weeks worked at a single job.
Considerations for Interpreting the Findings
Although the analyses in this report were conducted by recipient status, the number of study participants randomly assigned to the treatment and control groups within each recipient status type was unknown. Therefore, attrition could not be computed and the study was not eligible to receive a high causal evidence rating. Moreover, the analysis did not include controls for a number of baseline variables required to demonstrate that the two groups being analyzed were similar before the intervention, making it ineligible for a moderate causal evidence rating.
In addition, the authors cautioned that the SSDI and SSI subsamples might not be representative of SSDI and SSI recipients more broadly or SSDI and SSI recipients with psychiatric conditions.
Causal Evidence Rating
The quality of causal evidence provided in this study is low. This means that we cannot be confident that the estimated effects are attributable to the support employment interventions; other factors are likely to have contributed.