Regional Research Institute
Oregon Supported Employment
Center of Excellence
2011
Regional Research Institute
for Human Services
1
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).
2
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).
3
Regional Research Institute
OSECE goals
 OSECE was awarded a grant (RFP #2509)
to implement and evaluate evidencedbased 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.
4
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
5
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.
6
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 programprovided 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.
7
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.
8
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.
9
Regional Research Institute
Average Earnings
Mean total earnings over 24 month
period
5000
4000
4592
3625
3000
Mean total
earnings over 24
month period
2000
1000
0
pre_OSECE
post_OSECE
10
Regional Research Institute
Average Hours Worked
Mean hours worked over 24 month
period
600
500
400
489
399
Mean total hours
worked over 24
month period
300
200
100
0
pre_OSECE
post_OSECE
11
Regional Research Institute
Employment Rate by Quarter
OSECE Number Served and Number Worked
Jan 1, 2008 - December 31, 2010
757
748
14
735
673
700
12.1
646
12.2
711
678
660
11.5
671
648
12.3
12
11.1
11.1
600
685
10.9
537
10
10.3
9
500
8
6.4
400
5.7
5.5
6
306
300
283
297
288
200
278
274
261
255
278
257
246
Number served
Number worked
Unemployment rate
4
211
2
100
0
Unemployment rate
800
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
12
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%)
13
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
SE office expenses
SE program expenses/ client assistance
Telephone/communication and Information Technology (IT)
Insurance
Travel (vehicle and mileage)
Other
Administrative Costs
TOTAL
$8,797 (5%)
$1,123 (1%)
$2,418 (1%)
$2,407 (1%)
$955 (1%)
$5,893 (3%)
$3,200 (2%)
$39,460 (22%)
178,450 (100%)
14
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.
15
Regional Research Institute
Vocational Rehabilitation Services for SE
participants
VR service
Vocational supports and services
Transportation
Medical or psychological assessment,
record acquisition, evaluation
Assistive technology/computers
Skills building/training
College
Dental, vision
Amount VR paid
for SE participants
$176,229
$68,477
$39,998
$23,778
$10,275
$10,079
$7838
16
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.
17
Average Hours of Service
Regional Research Institute
Average hours of mental health and
supported employment service per
person by month over 24 months
8
7
6
5
4
3
2
1
0
1
0
MH 7 6 5 5 5 4 4 5 5 5
SE 6 5 4 4 3 4 4 4 4 4
1 2 3 4 5 6 7 8 9
1
1
4
3
1
2
5
3
1
3
6
3
1
4
5
4
1
5
6
3
1
6
5
3
1
7
5
3
1
8
5
3
1
9
5
3
2
0
4
3
2
1
5
3
2
2
5
4
2
3
6
3
2
4
2
2
18
Average Amount Billed per
person
Regional Research Institute
Average Amount Billed for Mental Health and
Supported Employment Services per person by
month over 24 months
1000
900
800
700
600
500
400
300
200
100
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
MH 719 813 725 716 711 764 706 773 799 704 811 846 940 861 885 806 748 837 822 804 841 776 905 564
SE 426 563 465 414 372 440 401 389 427 449 382 337 365 406 378 367 344 358 373 393 362 401 346 290
19
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 .
20
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.
21
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).
22
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.
23
Regional Research Institute
Contact Information
Heidi Herinckx, 503-725-5958
herinckxh@pdx.edu
24