Supported Employment Demonstration

Eligibility:
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.

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 provided 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.

The Final Impact and Cost-Benefit Analysis Report revealed that Full-Service and Basic-Service treatment groups had significantly higher employment rates than control group participants. Treatment group members worked more and earned more during the study compared to usual services recipients. Cost-benefit findings showed the benefits did not outweigh costs during the intervention period for either the Full-Service or Basic-Service participants. However, analyses do suggest that the net benefit figure may not adequately capture the net benefits of the intervention, given findings that showed declining trends in service costs and increasing trends in earnings over time. A longer follow-up period would facilitate confirmation of this dynamic. Final analyses of application or entry into SSDI/SSI programs found no significant differences in SSDI/SSI allowance rates among the Full-Service, Basic-Service, or Usual Services groups; Allowance rates were roughly 15% in each of the three study groups during the study and appeals to denials were documented for nearly 50% of participants in each of the three study groups. A number of journal articles have been published about the demonstration thus far.

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 and Cost Benefit Analysis Appendices provide 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 and Final Enrollment Analysis Report Appendixes describe 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 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.

Public Use Data Files and documentation may be found on the Supported Employment Public Use Files page.

The Federal Expert Panel Report summarizes the panel’s recommendations from a June 2015 meeting.