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DeTore NR, Balogun-Mwangi O, Mueser KT, McGurk SR. Comparison of Black and White participants with severe mental illness in response to cognitive remediation as an augmentation of vocational rehabilitation. Schizophr Res 2023; 253:60-67. [PMID: 34772592 PMCID: PMC9088896 DOI: 10.1016/j.schres.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite evidence that cognitive remediation improves cognitive and employment outcomes in persons with severe mental illnesses (SMI), its effects have not been systematically compared between Black and White participants. Considering that Black adults have more negative experiences receiving mental health treatment, providers may have greater difficulty engaging and retaining Black Americans in cognitive remediation. Due to the effects of structural racism on reducing employment opportunities for Black Americans, it is unclear whether Black participants will reap the same benefits of cognitive remediation on work outcomes as White Americans. This paper addressed this question. METHODS A secondary analysis was conducted of five randomized controlled trials comparing cognitive remediation (the Thinking Skills for Work program: TSW) and vocational rehabilitation vs. vocational rehabilitation only in 137 Black and 147 White Americans (64.2% schizophrenia-schizoaffective disorder) who were followed up for two years. RESULTS Comparable proportions of Black and White participants were engaged and retained in TSW (>75%). Participants who received TSW improved significantly more in cognition than those receiving vocational services alone, with no racial differences in benefit. Participants in TSW obtained more work, earned more wages, and worked more weeks than those receiving vocational services alone, with no differences between the races. CONCLUSIONS The findings indicate that Black Americans with SMI receiving vocational services could be successfully engaged in and benefit from cognitive remediation, highlighting the vital role of healthcare service systems in giving credence to structural racism to more effectively mitigate racial disparities in treatment outcomes.
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Affiliation(s)
- N R DeTore
- Massachusetts General Hospital, United States of America; Department of Psychiatry, Harvard Medical School, United States of America
| | | | - K T Mueser
- Center for Psychiatric Rehabilitation, Boston University, United States of America; Department of Occupational Therapy, Boston University, United States of America.
| | - S R McGurk
- Center for Psychiatric Rehabilitation, Boston University, United States of America; Department of Occupational Therapy, Boston University, United States of America
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Bond GR, Mascayano F, Metcalfe JD, Riley J, Drake RE. Access, retention, and effectiveness of individual placement and support in the US: Are there racial or ethnic differences? JOURNAL OF VOCATIONAL REHABILITATION 2023. [DOI: 10.3233/jvr-230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND: Increased federal attention to advancing racial equity and support for underserved communities suggests the need for data on racial and ethnic differences in evidence-based employment services for people with serious mental illness. Individual Placement and Support (IPS) is an evidence-based model of supported employment for this population. OBJECTIVE: The objective was to identify differences based on race and ethnicity in IPS services. METHODS: This narrative review examined the empirical literature on IPS services in the U.S., assessing evidence of differences in access, retention, and outcomes for Black and Hispanic IPS clients, relative to non-Hispanic Whites. RESULTS: We identified 12 studies examining racial and ethnic differences in access (4 studies), retention (3 studies), and effectiveness (6 studies). The findings for access to IPS were mixed, with two studies showing no differences, one finding less access for Blacks, and another finding greater access for Blacks but less access for Hispanics. Three studies found better retention rates for clients enrolled in IPS regardless of race or ethnicity. Compared to clients receiving usual vocational services, all studies found better employment outcomes for IPS clients regardless of race or ethnicity. CONCLUSION: Unlike for most of health care, few racial and ethnic differences have been found for IPS employment services in the U.S. Access to IPS is inadequate for all groups, with conflicting evidence whether Blacks and Hispanics have even less access. Based on the available evidence, Black and Hispanic clients have comparable retention and employment outcomes in IPS as non-Hispanic White clients. State and local mental health leaders responsible for monitoring IPS outcomes should routinely report statistics on race and ethnicity. They should also give active attention to client needs and equity. Research designs should answer multifaceted questions regarding disparities for historically underserved populations.
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Taylor JA, Salkever DS, Frey WD, Riley J, Marrow J. Enrollment in the Supported Employment Demonstration: An Employment Intervention for Denied Disability Benefits Applicants with a Mental Impairment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:909-926. [PMID: 34405312 DOI: 10.1007/s10488-021-01159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 06/01/2023]
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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Affiliation(s)
| | | | | | | | - Jocelyn Marrow
- Westat, Rockville, USA.,University of Maryland Baltimore County, Baltimore, USA
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Fortune N, Curryer B, Badland H, Smith-Merry J, Devine A, Stancliffe RJ, Emerson E, Llewellyn G. Do Area-Level Environmental Factors Influence Employment for People with Disability? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159082. [PMID: 35897452 PMCID: PMC9330484 DOI: 10.3390/ijerph19159082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022]
Abstract
Employment is an important social determinant of health and wellbeing. People with disability experience labour market disadvantage and have low labour force participation rates, high unemployment rates, and poor work conditions. Environmental factors are crucial as facilitators of or barriers to participation for people with disability. Understanding how the physical, social, and economic characteristics of local areas influence employment for people with disability can potentially inform interventions to reduce employment inequalities. We conducted a scoping review of research investigating associations between area-level environmental factors and employment for people with disability. Eighteen articles published between 2000 and 2020 met the inclusion criteria, and data were extracted to map the current evidence. Area-level factors were categorised into six domains relating to different aspects of environmental context: socioeconomic environment, services, physical environment, social environment, governance, and urbanicity. The urbanicity and socioeconomic environment domains were the most frequently represented (15 and 8 studies, respectively). The studies were heterogeneous in terms of methods and data sources, scale and type of geographic units used for analysis, disability study population, and examined employment outcomes. We conclude that the current evidence base is insufficient to inform the design of interventions. Priorities for future research are identified, which include further theorising the mechanisms by which area-level factors may influence employment outcomes, quantifying the contribution of specific factors, and interrogating specific factors underlying the association between urbanicity and employment outcomes for people with disability.
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Affiliation(s)
- Nicola Fortune
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Correspondence:
| | - Bernadette Curryer
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
| | - Hannah Badland
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Centre for Urban Research, RMIT University, Melbourne, VIC 3000, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
| | - Alexandra Devine
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Roger J. Stancliffe
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
| | - Eric Emerson
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Centre for Disability Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
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Gibbons BJ, Salkever DS. Working with a Severe Mental Illness: Estimating the Causal Effects of Employment on Mental Health Status and Total Mental Health Costs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:474-487. [PMID: 30815767 DOI: 10.1007/s10488-019-00926-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Employment is an important goal for persons who have a severe mental illness (SMI). The current literature finds some evidence for a positive relationship between employment and measures of mental health (MH) status, however study design issues have prevented a causal interpretation. This study aims to measure the causal effect of employment on MH status and total MH costs for persons with SMI. In a quasi-experimental prospective design, self-reported data measured at baseline, 6-months, and 12-months, on MH status and employment are paired with Public Mental Health System (PMHS) claims data. The study population (N = 5162) is composed of persons with a SMI who received PMHS services for a year or more. Outcome variables are MH status symptom scores from the BASIS-24 instrument and total MH costs. The estimation method is full information maximum likelihood, which allows for tests of employment endogeneity. Outcomes with an insignificant test of endogeneity are estimated using tobit or ordinary least square (OLS). Employment has modest but meaningful effects on MH status (including overall MH status, functioning, and relationships) and reduces total mental health costs on average by $538 in a 6-month period. Tests of endogeneity were largely insignificant, except for the depression score that tested marginally statistically significant. Interaction terms between baseline MH scores and employment indicated larger employment effects for individuals with worse baseline scores. This study demonstrates the non-vocational benefits of employment for individuals with SMI. Results have high generalizability and should be of interest to federal and state governments in setting appropriate disability policy and funding vocational programs. From a methodological perspective, future research should still be concerned with potential endogeneity problems, especially if employment status and MH outcomes are simultaneously measured and/or baseline measures of MH are not adequately controlled for future research should continue to examine the multi-dimensional nature of MH status and costs. Our analyses also demonstrate the practical use of a state-wide outcomes measurement program in assessing the factors that influence the recovery trajectories of individuals with SMI.
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Affiliation(s)
- Brent J Gibbons
- The National University of Singapore, School of Public Health, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
| | - David S Salkever
- The University of Maryland, Baltimore County (UMBC), Baltimore, USA
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