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

2. 2 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).

3. 3 Regional Research Institute 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. 4 Regional Research Institute 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. 5 Regional Research Institute 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. 6 Regional Research Institute 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. 7 Regional Research Institute 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. 8 Regional Research Institute 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. 9 Regional Research Institute 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. 10 Regional Research Institute Average Earnings

11. 11 Regional Research Institute Average Hours Worked

12. 12 Regional Research Institute Employment Rate by Quarter

13. 13 Regional Research Institute 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%)

14. 14 Regional Research Institute Cost Survey: SE Annual Expenses Cost 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%)

15. 15 Regional Research Institute 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. 16 Regional Research Institute Vocational Rehabilitation Services for SE participants

17. 17 Regional Research Institute 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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20. 20 Regional Research Institute 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. 21 Regional Research Institute 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. 22 Regional Research Institute 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. 23 Regional Research Institute 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. 24 Regional Research Institute Contact Information Heidi Herinckx, 503-725-5958 herinckxh@pdx.edu