Multiple-Impact Effectiveness of a State Supported Employment Policy Initiative

国家支持就业政策举措的多重影响有效性

• 批准号: 8442291
• 负责人: David Salkever
• 金额: $ 33.24万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE COUNTY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-15 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8442291
• 关键词: Accounting; Address; Area; Benchmarking; Characteristics; Data; Databases; Diffusion; Dimensions; Effectiveness; Emergency treatment; Employment; Ethnic Origin; Evaluation; Evaluation Research; Funding; Geographic Locations; Goals; Health; Health Services; Health Services Accessibility; Health Services Research; Health Status; Health system; Healthy People 2010; Hospitalization; Individual; Institutes; Intervention; Literature; Maryland; Measures; Medicaid; Mental Health; Mental Health Services; Mental disorders; Meta-Analysis; Methods; Modeling; Monitor; Observational Study; Outcome; Outcomes Research; Persons; Pilot Projects; Policies; Population Group; Procedures; Provider; Public Sector; Race; Regression Analysis; Relative (related person); Research; Services; Site; Supported Employment; Testing; Time; Training; Treatment Cost; Variant; base; cohort; cost; evidence base; experience; financial incentive; geographic difference; medical specialties; meetings; operation; racial and ethnic; severe mental illness

DESCRIPTION (provided by applicant): We propose an observational study to examine a broad range of impacts produced by a state policy initiative that increased accessibility and availability of the evidence-based individual placement and support (IPS) model of supported-employment (SE) services for persons with severe mental illness (SMI) in Maryland. We will study the experience of Maryland's public mental health system (PMHS) in facilitating the diffusion of IPS-SE services in the state. Our research exploits inter-temporal and geographic variations in accessibility and availability of IPS-SE services 1) over time in the period 2002-2010 and 2) across geographic areas of Maryland. We also examine variations across providers in fidelity to the IPS-SE model. We propose to study the observed effectiveness of this state policy initiative in its actual operation and impact. This study will extend evaluative research on IPS-SE beyond the current focus on efficacy/effectiveness in small-scale RCT trials of a limited number of sites. We also propose to combine data from multiple public sector databases to expand the range of SE impacts studied, beyond the current research focus on employment outcomes, to include impacts on mental health status, and on mental health and somatic health treatment costs. The policy initiative that promoted the implementation and diffusion of IPS-SE services, undertaken by the Maryland Mental Hygiene Administration (MHA), began as a pilot project in 2002. MHA provided funding for training service providers and for monitoring providers for fidelity with the IPS-SE model. Beginning in 2006, financial incentives were given to providers for offering IPS-SE services, and for meeting fidelity benchmarks. This MHA initiative increased accessibility and availability of IPS-SE services for persons with SMI, with major increases, occurring in the period from 2004 to 2010, that also varied by geographic area. We plan to use data on individuals with SMI from several large, defined cohorts 1) of Maryland Medicaid recipients and 2) of other non-Medicaid-covered users of PMHS services, followed over the 2002-2010 period. Using these data, we will assess the impacts of the MHA policy initiative on (1) the take-up rate of IPS-SE services, (2) disparities by race and ethnicity in the rate of IPS-SE service use, (3) the mental health status of IPS-SE users relative to non-users, (4) costs of treatment for mental health specialty services and other health services for users vs. non-users of IPS-SE services, and (5) employment and earnings of users vs. non-users of IPS-SE services. We also will examine the impact of varying IPS-SE provider fidelity levels on these outcomes. A variety of regression analysis methods are proposed for estimating these policy impacts, including instrumental variables-generalized method of moments (IV-GMM) procedures, reduced-form regression models, models based on pooling of data on individuals over time, and analyses based on sequences of cross- sectional regressions. We propose IV-GMM methods to account for unobservable factors influencing selection into use of IPS-SE services, as well as tests for our assumption of endogeneity of the indicator of IPS-SE use.

描述（由申请人提供）：我们提出了一项观察性研究，以研究由国家政策倡议产生的广泛影响，以增加对支持雇佣服务（SE）服务的基于证据的个人安置和支持（IPS）模型的可访问性和可用性，对马里兰州严重精神疾病（SMI）的人（SMI）服务。我们将研究马里兰州公共心理健康系统（PMHS）在促进该州IPS-SE服务扩散方面的经验。我们的研究利用了IPS-SE服务的可访问性和可及性的时期和地理变化1）随着时间的流逝，在2002 - 2010年期间和2）整个马里兰州的地理区域。我们还研究了提供者对IPS-SE模型的保真度的变化。我们建议研究该国家政策倡议在其实际运营和影响方面的有效性。这项研究将将对IPS-SE的评估研究扩展到当前对有限数量站点的小规模RCT试验中的疗效/有效性的关注。我们还建议将来自多个公共部门数据库的数据结合起来，以扩大所研究的SE影响范围，而当前的研究重点关注就业结果，包括对心理健康状况以及心理健康和体细胞健康治疗费用的影响。 马里兰州精神卫生管理局（MHA）承担的IPS-SE服务的实施和扩散的政策倡议始于2002年。从2006年开始，为提供IPS-SE服务的提供商提供了经济激励措施，并符合Fidelity Benchmarks。 这项MHA倡议提高了SMI的IPS-SE服务的可及性和可用性，并在2004年至2010年期间发生了重大增加，这也随着地理区域而异。我们计划使用来自Maryland Medicaid接受者的几个大型，定义的同类群体的SMI的数据，以及2）其他非医疗服务覆盖的PMHS服务用户的数据，随后在2002 - 2010年期间。 Using these data, we will assess the impacts of the MHA policy initiative on (1) the take-up rate of IPS-SE services, (2) disparities by race and ethnicity in the rate of IPS-SE service use, (3) the mental health status of IPS-SE users relative to non-users, (4) costs of treatment for mental health specialty services and other health services for users vs. non-users of IPS-SE services, and (5) employment and earnings of users与IPS-SE服务的非用户。我们还将研究不同IPS-SE提供者保真度水平对这些结果的影响。 提出了各种回归分析方法来估计这些政策影响，包括仪器变量的矩（IV-GMM）程序（IV-GMM）程序，降低形式的回归模型，基于随着时间的时间数据汇集数据的模型，以及基于跨截面回归序列的分析。我们提出了IV-GMM方法，以说明影响选择IPS-SE服务中选择的不可观察的因素，并为我们假设IPS-SE使用指标的内生性进行测试。