1. 1 A Summary of Research on Supported Education for Persons with Psychiatric Disabilities 1989-2009 Presented at Alternatives 2010 This presentation was compiled by the Supported Education Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations NIDRR Grant # H133A050006

2. ROOTS OF SUPPORTED EDUCATION IN THE 1980’s Boston University Center for Psychiatric Rehabilitation began a supported education program using a classroom format (Unger et al, 1991). Massachusetts and California Depts. of Mental Health and Community Colleges in the two states developed supported education (Unger 1991; Unger 1993). 2

3. DEFINITION OF SUPPORTED EDUCATION “Supported Education is a specific type of intervention that provides supports and other assistance for persons with psychiatric disabilities for access, enrollment, retention and success in postsecondary education” (Collins & Mowbray, 2005). 3

4. TYPES OF SUPPORTED EDUCATION 1.Classroom model: Students attend closed classes on campus designed for the purpose of providing supported education. 2. Onsite model: Sponsored by a college and provides supported education for an individual rather than a group. 4 Continued...

5. TYPES OF SUPPORTED EDUCATION 3. Mobile Support model: Provides services through a mental health agency helping students to attend the school of their choice 4.Free-standing model: Located at the sponsoring agency such as a rehabilitation agency, a university or other entity (Collins & Mowbray) 5 Continued...

6. SERVICES PROVIDED IN SUPPORTED ED. 1.Coordination of supported ed. with mental health services 2.Use of specialized supported ed. staff 3.Availability of career counseling, vocational counseling and planning 4.Assistance with financial aid Continued... 6

7. SERVICES PROVIDED IN SUPPORTED ED. 5. Assistance to develop skills needed to cope with new academic environment 6. Provision of on-campus information about rights and resources 7. On- or off-campus mentorships and personal support during the educational training period 7 Continued...

8. SERVICES PROVIDED IN SUPPORTED ED. 8. Facilitation of access to courses and within- course assistance 9.Access to tutoring, library assistance and other academic support 10.Access to general support/referrals 8

9. CHALLENGES FOR STUDENTS IN HIGHER EDUCATION 9 Obtaining needed accommodations and supports Coping with school Attendance issues Issues related to the individual’s disability General anxiety and test anxiety Continued...

10. CHALLENGES FOR STUDENTS IN HIGHER EDUCATION Low self-esteem Social skills Personal issues Memory and concentration Conflicts with faculty (Collins & Mowbray, 2005) 10

11. SOME BARRIERS TO GETTING SUPPORT FOR EDUCATIONAL GOALS 1. Fear of disclosure 2.Lack of knowledge of what is available 3.Lack of knowledge of eligibility for Disability Support Services at the school 4. Fear of stigma and discrimination 5. Lack of real supported education interventions (Collins & Mowbray, 2005) 11 Continued...

12. SOME BARRIERS TO GETTING SUPPORT FOR EDUCATIONAL GOALS 6. Unhelpful school policies related to outreach and services 7. Environment that is neither welcoming nor supportive for students with psychiatric disabilities (Collins & Mowbray, 2008) 12

13. Horizon House’s Education Plus Education Plus students stayed in more than 90 percent of the classes they signed up for and had a GPA of 3.1. Both statistics reflected a significantly better performance than that of the general student population. 13 “SAMHSA is planning to adopt supported education as an evidence-based practice.” – Mark Salzer, Ph.D., UPenn Collaborative on Community Integration (now at Temple University) Dr. Mark Salzer

14. 14 Horizon House’s Education Plus graduation and end-of- year celebration at Community College of Philadelphia in May 2009. The program follows a mobile support model.

15. “If you’re talking about people recovering and living their life in the community, education has to be an important part of that.” – Arlene Solomon, director of employment services, Horizon House, Philadelphia 15 “If a student calls and says, ‘I got a bad grade on a test and I want to drop this class,’ we will counsel them about all of their options. Dropping the class might affect their financial aid, for example.” – Arlene Solomon

16. TYPES OF RESEARCH ANALYZED The 21 articles were rated for meaning and rigor – traditional ways of evaluating the quality of research. The first factor analyzed was the degree to which consumers helped to design, conduct or evaluate the research. 16 Continued...

17. TYPES OF RESEARCH ANALYZED The research analyzed by Boston University Center for Psychiatric Rehabilitation included 21 articles on Supported Education research that included:  Pre-test/Post-test  Correlational  Experimental  Quasi-experimental  Observational cohort designs  Survey research 17

18. CONSUMER INVOLVEMENT IN RESEARCH DESIGN 72% of the time consumers were NOT involved in the conduct or design. 95% of the time they were NOT involved in determining research questions or reviewing the results. 18

19. CHALLENGE OF THE ANALYSIS: RIGOR Little rigorous research was available (only two real experimental studies and one of these had diagnostic differences in the control group). Other studies had weak research methodology or did not qualify as research. 19

20. CHALLENGE OF THE ANALYSIS: MEANING The largest studies evaluated only segregated group models. They do not reflect the programs most common today. Additional non-experimental studies were more promising but the methodology was weak. Results are therefore not as useful. 20

21. CHALLENGE OF THE ANALYSIS: HOW THE DATA WAS ANALYZED Michigan authors did not conduct statistical analyses that accounted for multiple time points and correlations among those time points. The inpatient study reported no baseline data so it is not clear if the analysis accounted for the baseline differences. 21

22. Summary of Research Review Results There are limited effectiveness data for supported education programs. There is information to suggest that individuals with psychiatric disabilities, when compared to the general population, have a lower rate of post-secondary degree completion. 22 Continued...

23. Summary of Research Review Results There is also information to suggest that individuals with psychiatric disabilities who are enrolled in supported education programs are younger, more highly educated and less functionally impaired when compared to individuals with psychiatric disabilities in general. 23 CONTINUED...

24. Summary of Research Review Results Evidence from existing studies suggests that individuals with significant psychiatric disabilities can enroll in and pursue educational opportunities in integrated settings in the community. 24 CONTINUED...

25. Summary of Research Review Results There is preliminary evidence that supported education can assist individuals to identify educational goals, find and link to resources needed to complete their education and assist them in coping with barriers to completing their education. 25 CONTINUED...

26. Summary of Research Review Results There is very preliminary but insufficient information that supported education can increase the educational attainment of individuals with psychiatric disabilities. 26

27. CLASSROOM VS. CONTROL GROUP A supported education intervention (classroom model) was more effective than a control group in improving empowerment and school efficacy (Collins et al., 1998). 27

28. LACK OF RIGOROUS EVIDENCE Because many studies are short term and focus on course completion, there is no rigorous evidence to suggest that supported education will lead to a greater number of individuals with psychiatric disabilities possessing advanced degrees or certificates. Further, there is no rigorous evidence that supported education leads to higher employment rates among participants. 28

29. NEED FOR MORE RESEARCH If supported education is to become a viable alternative and widespread intervention and if mental health policies are to emphasize educational attainment, more effectiveness research on supported education models is critically needed. 29

30. IMPORTANCE OF PROMOTING NEW RESEARCH IN SUPPORTED EDUCATION High unemployment rates among those with psychiatric disabilities: Education = Hope. Difficulty “graduating” from benefits to full-time work without training and education. Knowledge from Supported Housing and Supported Employment shows the value of the right supports in effecting positive outcomes. 30

31. VALUE OF PROMOTING NEW RESEARCH IN SUPPORTED EDUCATION Limitations of the existing research in methodology Need to evaluate the current/ common, individually based Supported Education interventions 31

32. 32 For more information: Boston University Disability Research Right to Know Supported Education information http://drrk.bu.edu/research- syntheses/psychiatric-disabilities/supported- education Presenter: Joseph A. Rogers, Executive Director National Mental Health Consumers’ Self- Help Clearinghouse 1211 Chestnut Street, #1100, Philadelphia, PA 19107 800-553-4539, ext. 3844, 267-507-3844 jrogers@mhasp.org