Improving Employment Outcomes for People with Psychiatric Disorders and Other Disabilities. Notes

04/01/2014

  1. IPS programs have been formally assessed regarding adherence, or fidelity, to these evidence-based principles. We use "evidence-based SE" rather than "IPS" in this report because programs we examined may not necessarily have been assessed for fidelity, although they are built upon the evidence-based principles (Bond et al. 2012).

  2. See http://www.dartmouth.edu/~ips/page3/page10/page10.html, accessed on January 6, 2013.

  3. The Progressive Goal Attainment Program is a flexible step-based program designed to reduce psychosocial barriers to rehabilitation progress, promote reintegration into life-role activities, increase quality of life, and facilitate return-to-work. See http://www.pdp-pgap.com/pgap/en/index.html, accessed January 7, 2013

  4. Because study participants were not randomly assigned into groups of disclosers and non-disclosers, the study is quasi-experimental and may lead to selection bias.

  5. Because these analyses are based on those who obtained employment or enrolled in school, which depends in part on the randomized group assignment, these results are quasi-experimental and may be subject to selection bias.

  6. See http://store.samhsa.gov/product/Supported-Education-Evidence-Based-Practices-EBP-Kit/SMA11-4654CD-ROM, Building Your Program, accessed July 15, 2013.

  7. The authors do not report whether employees received public or private disability benefits or workers' compensation.

  8. Early contact was not defined.

  9. Early contact was not defined.

  10. In general, ergonomic visits to the worksite consist of an evaluation by an ergonomist or physiotherapist to provide practical instruction to the employee on appropriate ways of using the back or workplace adaptations, but the nature of the ergonomic interventions varied by study site.

  11. Work hardening is defined as an individualized job-specific program using simulated or real work tasks, such as lifting, progressively graded conditioning exercises based upon the individual's measured tolerance, with the goal of RTW. See http://www.lni.wa.gov/ClaimsIns/Files/ReturnToWork/WhStds.pdf.

  12. The Rehabilitation Act defines SE as, "…competitive work in integrated work settings, or employment in integrated work settings in which individuals are working toward competitive work, consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals, for individuals with the most significant disabilities (1) for whom competitive employment has not traditionally occurred; or (2) for whom competitive employment has been interrupted or intermittent as a result of a significant disability; and (3) who, because of the nature and severity of their disability, need intensive supported employment services…in order to perform such work."

  13. At-risk groups are defined below.

  14. We appreciate the support of SSA's Disability Research Consortium, which provided additional funding for this project.

  15. See http://store.samhsa.gov/product/Supported-Education-Evidence-Based-Practices-EBP-Kit/SMA11-4654CD-ROM, Building Your Program, p. 15, accessed July 15, 2013.

  16. Several states have used Medicaid to fund Supported Employment in ways that Supported Education could be incorporated. For example, one state offered employment-related services that included developing skills to reduce or overcome the symptoms of mental illness, planning and managing activities to achieve outcomes, and developing supportive contacts in school. Another state provided employment-related services such as supportive counseling and problem-focused interventions in whatever setting was required to enable consumers to manage the symptoms of their illness. While these examples of using Medicaid are not directly related to Supported Education, they are examples of how providers may define service provision to support the Medicaid mission. See http://aspe.hhs.gov/daltcp/reports/handbook.htm.

  17. 42 CFR 440.130(d).

  18. The ACA extended the MFP demonstration through September 2016, added $2.25 billion in funding ($450 million for each fiscal year from 2010-2016), and broadened the eligibility criteria to include individuals who live in an institution for more than 90 consecutive days (HHS n.d. b).

  19. An "individual with a severe disability" is one who has "a severe physical or mental impairment that seriously limits one or more functional capacities (such as mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of an employment outcome, whose VR can be expected to require multiple VR services over an extended period of time," and who has one or more disabilities resulting from one of a range of conditions (34 CFR § 369.4).

  20. 34 CFR 363.3.

  21. 34 CFR 363.4.

  22. Grandfathered plans are exempt from this provision, meaning that individuals covered by a plan with grandfathered status may remain without mental health benefits.

  23. The ACA exempts employers with fewer than 100 employees from this mandate, replacing the previous exemption of employers with fewer than 50 employees.

  24. Federal regulations define individuals with disabling mental disorders to include: "children with serious emotional disturbances and adults with serious mental illness; individuals with serious and complex medical conditions, individuals with chronic substance abuse disorders; individuals with a physical, intellectual or developmental disability that significantly impairs their ability to perform one or more activities of daily living, or individuals with a disability determination based on Social Security criteria or in States that apply more restrictive criteria than the Supplemental Security Income program, the State plan criteria." See https://s3.amazonaws.com/public-inspection.federalregister.gov/2013-16271.pdf (page 534).

  25. See http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SMD-12-003.pdf.

  26. In most states, eligibility for SSI automatically qualifies an individual for Medicaid. To be eligible for SSI based on disability status, an individual must have a physical or mental impairment which results in an inability to perform any substantial gainful activity (SGA), and can be expected to result in death or has lasted or will be expected to last for at least 12 months (SSA 2012). In 2013, SGA is defined as work that results in earnings averaging more than $1,040 each month. However, some states (known as 209(b) states) use more restrictive eligibility criteria beyond SSI eligibility (HHS n.d.). In general, individuals who do not receive SSI but seek Medicaid coverage based on disability must prove they have some type of impairment that prevents them from performing SGA for at least a year.

  27. 1915(d) waivers provide HCBS to individuals 65 and older who would otherwise require institutionalization. The 1915(e) waivers fund HCBS to children under age 5 who were infected with HIV at birth, currently have AIDS or were dependent on heroin, cocaine, or PCP at birth, as long as those children would otherwise require institutionalization (Social Security Act n.d.). Section 1115 Demonstrations are experimental or pilot Medicaid programs which are approved for a five-year period and can be renewed for an additional three years (HHS, CMS n.d.).

  28. California, Colorado, Connecticut, Iowa, Idaho, Louisiana, Nevada, Oregon, Washington, and Wisconsin have an approved 1915(i) state option. See http://kff.org/medicaid/state-indicator/section-1915i-home-and-community-based-services-state-plan-option/.

  29. Part of a project funded by the National Institute on Disability and Rehabilitation Research, this registry of systematic reviews includes 105 reviews on disability and rehabilitation topics culled from major registries, unpublished sources, and open-access sources. See http://www.ktdrr.org/cgi-bin/lib_systematic_search.cgi.


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