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Enrollment in the Supported Employment Demonstration: An Employment Intervention for Denied Disability Benefits Applicants with a Mental Impairment

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Abstract

The Supported Employment Demonstration enrolled denied Social Security Disability Benefits applicants with alleged or documented mental impairment into an employment and health intervention. Recruiters attempted to contact 21,003 applicants located near participating community mental health agencies, and enrolled 2960 eligible applicants from November 2017 through March 2019. Among potentially eligible enrollees, 26.2% enrolled. We use regression analysis incorporating disability application data, local area economic characteristics, and benefits receipt information to assess probability of enrollment. Complementary qualitative data were drawn from ethnographic interviews with enrollees and non-enrollees. Quantitative results suggest males, people with limited work experience, and people with higher educational attainment were more likely to enroll. SSA denial based on assessment that the applicant could find alternative work in the national economy also strongly predicted enrollment. Denied applicants were also more likely to enroll if their local unemployment rate was high and if average wages in their county were rising rapidly. Qualitative interviews suggest that enrollees joined because they felt the study would improve their lives, although some enrollees reported they enrolled for the financial incentives of interview participation. Key reasons for non-enrollment include (1) lack of interest in work and (2) the perception that subjects’ health prevented them from working. Comparisons between the sample selected for contact and the sample not selected for contact showed the two groups were largely identical. The SED achieved considerably higher recruitment rates than comparable studies. Applicant and local economic characteristics relate to the likelihood of enrollment. Clinical Trials Registration: This study is registered with ClinicalTrials.gov: registration number NCT03682263. This study follows the Mixed Methods guidelines.

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Notes

  1. In this analysis, and in the demonstration, “mental impairment” does not include intellectual disabilities in the absence of a mental disorder.

  2. Section I of the Online Appendix describes the information used to identify applicants who alleged a mental impairment.

  3. If an applicant provides enough medical documentation, SSA may assign a diagnosis to denied applicants. See the Online Appendix for a summary of the mental health diagnoses assigned to some denied applicants.

  4. To each enrollee opting to participate in the study, the recruiter administered a competency screener to verify their mental capacity to provide informed consent; applicants failing to pass the screener were ineligible.

  5. The latter date accounted for the lag between denial date and initial contact attempt.

  6. We did not include race and ethnicity because SSA does not collect reliable administrative data on race and ethnicity information for all disability applicants (Martin, 2016). Therefore, it would not be possible to measure reliably the race and ethnicity of the broader group of potential and possibly potential enrollees who did not enroll in the study.

  7. The first line of Table 3 shows the means for enrollment rates, which = 0 for possible potential enrollees.

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Funding

This study was conducted for the United States Social Security Administration.

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Contributions

All authors contributed to the study conception and design. Quantitative data analyses were performed by David S. Salkever and Jeffrey A. Taylor. Qualitative data analyses were performed by Jocelyn Marrow. All authors commented on previous versions of the manuscript and read and approved the final manuscript.

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Correspondence to Jeffrey A. Taylor.

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Conflicts of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Westat Institutional Review Board reviewed and approved this study (IRB approval FWA 00005551).

Consent to Participate

Informed consent was obtained from all qualitative interview participants. Quantitative data for the population of denied applicants were obtained from existing administrative databases and personally identifiable information were removed prior to analysis.

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Taylor, J.A., Salkever, D.S., Frey, W.D. et al. Enrollment in the Supported Employment Demonstration: An Employment Intervention for Denied Disability Benefits Applicants with a Mental Impairment. Adm Policy Ment Health 49, 909–926 (2022). https://doi.org/10.1007/s10488-021-01159-x

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