Supported Employment Demonstration
State(s) / Location(s) Involved
Individuals from 30 urban and rural-urban mixed catchment areas at community mental health agency sites across the U.S. were recruited for the voluntary study. Staff at agencies participating in SED provide services and the interventions.
SED Sites were located in these states: California, Colorado, Florida, Illinois, Kansas, Kentucky, Massachusetts, Maryland, Michigan, Minnesota, New York, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Washington, and Wisconsin.
Start / Enrollment Date
The Consolidated and Further Continuing Appropriations Act of 2015 (Pub. L. 113-235) appropriated funds to design, develop, and implement an early intervention demonstration to test innovative strategies aimed at helping people with disabilities remain in the workforce.
In August 2016, SSA awarded a contract to Westat, Inc. to implement and evaluate whether offering evidence-based interventions of integrated vocational, medical, and behavioral health services to individuals with behavioral health challenges can significantly reduce the demand for disability benefits and help individuals remain in the labor force.
The Supported Employment Demonstration (SED) used a random assignment design to assign 3,000 participants to one of two treatment groups (Full Services or Basic Services) or to a control group (Usual Services). For 36 months, participants received varying degrees of services based on their assignment. These services included systematic medication management, health care management and care-coordination services, and long-term employment services following the evidence-based Individual Placement and Support (IPS) model.
Individuals aged 18 to 50 years who wanted to work; who applied for disability benefits (DI or SSI) alleging mental impairment in the past 30-60 days; and who received an initial denial decision from SSA.
The SED period of performance was from August 2016 to June 2023.
The Federal Expert Panel Report summarizes the panel’s recommendations from a June 2015 meeting.
- The Final Process Analysis Report presents findings from the process evaluation based on data collected over four years of the Supported Employment Demonstration implementation. The objectives of the process evaluation were to assess whether sites implemented the demonstration as intended; identify challenges in providing services to the previously unstudied population served by this intervention; enhance evaluators’ ability to interpret the demonstration’s outcomes; and make recommendations for future services and demonstrations targeting individuals similar to those served by the SED. The report employs mixed methods, incorporating qualitative and quantitative data analyses techniques.
- The SED Final Impact and Cost Benefit Analysis Report (appendices) provides the overall findings on the impact and cost-benefit analysis (CBA) for the SED. The report details the impacts on outcomes for all study arms, provides net benefits estimation, and discusses challenges, opportunities for further analysis, and highlights overall policy implications.
- The Final Enrollment Analysis Report (appendices) describes the population of eligible individuals who enrolled in the SED and compares this group to the greater study-eligible population of disability applicants alleging a mental impairment who received an initial denial of benefits. The enrollment analysis describes the types of individuals who enrolled, how they compare with non-enrollees, and the factors associated with enrollment.
- The Interim Process Analysis Report (appendices) relies on three sources of data collected during SED implementation. Demonstration implementation began in December 2017 upon enrollment of our first SED participants. Enrollment of the full complement of 3,000 study participants ended in March 2019. Given the three-year participation period for each study participant, demonstration implementation will end in March 2022. The report focuses on the initial 24 months of implementation, from December 2017 through December 2019. The primary source of data derives from on-site interviews (referred to as the Process Evaluation Site Visits) with demonstration site staff and study participants in all three study arms. These interviews occur during each demonstration year, beginning in the early summer months and ending in early fall. The process evaluation also includes an assessment of two complementary aspects of implementation that affect internal validity. One is the assurance that treatment providers deliver services as planned, referred to as fidelity to a treatment model or service. Hence, the process evaluation includes independent assessments of fidelity conducted annually by experienced consultants. The second aspect of internal validity concerns the extent to which treatment group participants engage with the services available to them.
- The NASMHPD Annual 2020 Commissioners Meeting was held virtually via Zoom July 21st – July 29th. The session entitled, “Supported Employment, Crisis Services, and Beyond took place on Monday, July 27th. Dr. Robert Drake provided an overview of the session. The State Mental Health Director and Vocational Rehabilitation Director from the states of Ohio and counterparts regarding their best practice supported employment examples in their respective states. Presenters also discussed and provided examples of the excellent collaboration between the department of mental health and the department of vocational rehabilitation in their respective states. Meighan Haupt coordinated and moderated the session. This session was well received by the participants of the NASMHPD Annual Meeting. This NASMHPD PowerPoint presentation describes and elaborates on the study design and provides some background about the IPS (Individual Placement and Support) supported employment model.
All of the SED services and interventions were implemented and delivered between November 2017 and March 2022, when services to participants ended. Links to the final reports for the SED are available (see the Reports list, above). A Public Use File for the SED will be available to researchers upon its release in FY2023.