1 Regional Research Institute Oregon Supported Employment Center of Excellence 2011 Regional Research Institute for Human Services
Feb 24, 2016
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Regional Research InstituteOregon Supported Employment Center of
Excellence2011
Regional Research Institute for Human Services
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Regional Research Institute
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).
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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).
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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.
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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
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Evaluation of OSECEData 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.
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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.
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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.
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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.
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Average Earnings
pre_OSECE post_OSECE010002000300040005000
36254592
Mean total earnings over 24 month period
Mean total earn-ings over 24 month period
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Average Hours Worked
pre_OSECE post_OSECE0100200300400500600
399489
Mean hours worked over 24 month period
Mean total hours worked over 24 month period
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Employment Rate by Quarter
Q-1 2008 (39%)
Q-2 2008 (39%)
Q-3 2008 (38%)
Q-4 2008 (40%)
Q-1 2009 (40%)
Q-2 2009 (43%)
Q-3 2009 (40%)
Q-4 2009 (40%)
Q-1 2010 (38%)
Q-2 2010 (39%)
Q-3 2010 (41%)
Q-4 2010 (38%)
0
100
200
300
400
500
600
700
800
0
2
4
6
8
10
12
14
537
646
748 757735
673660
678648
711 685671
211255
283306 297 288
261274
246
278 278257
5.7 5.5
6.4
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12.112.2
11.111.5 12.3
10.910.3
11.1
OSECE Number Served and Number WorkedJan 1, 2008 - December 31, 2010
Number servedNumber workedUnemployment rate
Unem
ploy
men
t rat
e
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Source of Revenue for SE programs Average Revenue Annualized (%)
# with revenue source, n=13 (%)
Medicaid SE reimbursement $60,861 (35%) 12 (92%)
Service Element 38: Indigent SE $55,050 (32%) 11 (85%)
OHP capitated codes $24,842 (14%) 2 (15%)
Grant or foundation funding $13,799 (8%) 3 (23%)
Vocational Rehabilitation contract funding $16,870 (10%) 8 (62%)
Agency contributions $43,968 (25%) 9 (69%)
Other miscellaneous (MHO, etc.) $47,198 (27%) 5 (38%)
TOTAL* $174,351 (100%)
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Cost Survey: SE Annual ExpensesCost Category
Average Expenses
Annualized (%)SE staff wages $89,514 (50%)SE staff benefits (fringe) $26,086 (15%)SE staff payroll taxes $8,797 (5%)SE office expenses $1,123 (1%)SE program expenses/ client assistance $2,418 (1%)Telephone/communication and Information Technology (IT) $2,407 (1%)Insurance $955 (1%)Travel (vehicle and mileage) $5,893 (3%)Other $3,200 (2%)Administrative Costs $39,460 (22%)TOTAL 178,450 (100%)
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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.
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Vocational Rehabilitation Services for SE participants
VR service Amount VR paid for SE participants
Vocational supports and services $176,229Transportation $68,477Medical or psychological assessment, record acquisition, evaluation $39,998
Assistive technology/computers $23,778Skills building/training $10,275College $10,079Dental, vision $7838
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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.
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1 3 5 7 9 11 13 15 17 19 21 23012345678
Average hours of mental health and supported employment service
per person by month over 24 months
Aver
age
Hou
rs o
f Ser
vice
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1 2 3 4 5 6 7 8 9 1011121314151617181920212223240
200
400
600
800
1000
Average Amount Billed for Mental Health and Supported Employment Services per person
by month over 24 months
Aver
age
Amou
nt B
illed
per
pe
rson
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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 .
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Summary: Employment Outcomes24 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.
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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).
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Increase Medicaid ReimbursementAnother 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.