Oregon Supported Employment Center of Excellence 2011

1. Oregon Supported Employment Center of Excellence 2011 Regional Research Institute for Human Services

2. Introduction • Numerous randomized trials have demonstrated the individual placement and support model consistently produces better competitive employment outcomes over other vocational interventions such as prevocational training and sheltered workshops. • Supported employment typically achieves 59% competitive employment on average compared to 21% in comparison vocational programs (Bond, 2004, a,b; Twamley, Bartels, Becker & Jeste, 2004; Lamier et al., 2005).

3. OSECE • In January 2008, the state office of Addiction and Mental Health funded the creation of the Oregon Supported Employment Center for Excellence (OSECE). • OSECE has been a collaboration between Options for Southern Oregon, Lifeworks NW, and the Regional Research Institute (RRI) of Portland State University (PSU).

4. OSECE goals • OSECE was awarded a grant (RFP #2509) to implement and evaluate evidenced-based supported employment in community mental health centers serving individuals with severe mental illness in 12 sites across the state of Oregon. • OSECE surpassed its goal and has implemented supported employment in 16 mental health agencies, with plans to continue to add new sites.

5. Collaboration • Options for Southern Oregon and Lifeworks NW have been providing evidence based supported employment since 1998 when both agencies received grants from the Substance Abuse and Mental Health Services Administration. • The RRI assisted Lifeworks in writing these early grants and evaluated the early IPS Plus program. • RRI conducted evaluation of OSECE

6. Evaluation of OSECE • Data included: • Competitive employment rate. • Competitive employment wages. • Competitive employment hours worked. • Funding (revenue and expenditures) per program. • SE service hours paid by Medicaid. • Services provided by the Office of Vocational Rehabilitation Services. • Length of time enrolled in the SE program.

7. Evaluation Design and Data Sources • 24 months pre and post-enrollment in SE services within individual. • Comparison group data was not provided by the state. • Employment data from the State of Oregon Unemployment Insurance Records (wages, hours worked- reported quarterly) • Funding (revenue and expenditures) per program- provided by financial department at each mental health agency. • SE services and mental health services paid for by Medicaid. • Services and expenditures from the Office of Vocational Rehabilitation Services.

8. Sample • 504 individuals enrolled in OSECE from January 1, 2008, through December 31, 2008 • Gender 224 (45%) identified as female and 277 (55%) as male. • Education One-third of SE participants had less than 12 years of education. The largest percentage (40%) had graduated from high school; 21% had some college; and 6% had a baccalaureate degree or higher. • Diagnosis 49% were diagnosed with schizophrenia; 23% with affective disorder (bipolar or depression); other diagnoses included anxiety, psychosis NOS, and post traumatic stress.

9. Employment Outcomes: • Of the 504 individuals, 245 (49%) had recorded hours worked and wages for at least one quarter of the 8 quarters prior to enrollment in OSECE supported employment. • In the 24 months post enrollment in OSECE 284 (56%) individuals had recorded hours worked and wages.

10. Average Earnings

11. Average Hours Worked

12. Employment Rate by Quarter

14. Cost Survey: SE Annual Expenses

15. Hourly cost to provide SE service • The average hourly cost for SE programs to deliver SE services is $104.14. • However, the state Medicaid reimbursement rate for SE services is only $68.00 per hour- a deficit of $36.00 per hour.

16. Vocational Rehabilitation Services for SE participants

17. VR services paid to MH agencies • While VR data indicates that $176,229 was paid out in vocational services, annually, mental health agencies report $118,090 in revenue from VR. • Five programs of 13 (38%) did not receive any VR dollars. • MH agencies report having difficulty paying for transportation for SE participants, yet the second largest category of VR expenditures was transportation.

20. Summary: Employment History • In the present study, we found that 49% of individuals had held a job in the 24 months prior to enrollment in an SE program. • In the SE literature, prior work history among individuals enrolled in SE programs is not always reported, however, work history has been shown to be a strong predictor of future employment outcomes .

21. Summary: Employment Outcomes • 24 months post enrollment in OSECE provided SE services, participants earned more wages, worked more hours over more quarters. • State employment data consistent with employment rate reported by SE sites over evaluation period. • SE sites maintained 40% employment even during worst recession in decades.

22. Summary: Cost • Many SE program directors expressed concern over the cost to the agency to provide SE services that are not completely covered by revenues generated by the SE program. • Mental health agencies are subsidizing SE programs by 25% on average. • It may be possible for SE programs to increase their revenue by more effectively leveraging resources from other community and state agencies (dual enrollment with VR).

23. Increase Medicaid Reimbursement • Another way to fully support evidence based SE programs to increase the Medicaid reimbursement rate so that it covers the true cost to deliver SE services estimated at $104.14 per hour versus $68.00 per hour.

24. Contact InformationHeidi Herinckx, 503-725-5958herinckxh@pdx.edu