Oregon Supported Employment Center of Excellence 2011

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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

9

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.

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Contact Information

Heidi Herinckx, [email protected]

Oregon Supported Employment Center of Excellence 2011

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