Study Details | Pathways to Work

28522-Study of Demonstrati

Study quality: Low

Low

Reason for the rating: This study received a low study quality rating because the implementation of the randomized controlled trial was compromised and it does not adjust estimated impacts for potentially important differences between the intervention and comparison groups.

Intervention: Demonstration to Maintain Independence and Employment (DMIE)

Population and employment barriers:

Educational attainment (At least a high school diploma or equivalent), Employment status (Employed), Specific employment barriers (Disability(ies), Mental health condition)

Services provided:

Case management, Job readiness, Job search assistance, Mental health services, Physical health services, Post-employment participant follow-up, Transportation assistance

Setting: Tested in multiple settings

Study design

Design:

Randomized controlled trial

Study group formation:

Individuals determined eligible to participate were randomly assigned to the intervention or comparison group. Participants were eligible for the study if they were ages 18-62, had a mental illness, worked at least 40 hours per month, were not receiving other public benefits, and were not receiving Supplemental Security Income or Social Security Disability Insurance Benefits. DMIE enrollment in Minnesota focused on eligible workers with a behavioral health diagnosis who were participating in a means-tested public insurance program, and Texas enrollment focused on eligible workers who were members of a safety net program in the Houston area and had a behavioral health diagnosis co-occurring with a physical impairment. In Minnesota, participants were randomly assigned with a 3:1 ratio to the intervention and comparison groups, using a stratified random sample based on age, functional status, geographic location, and income. In Texas, participants were randomly assigned with equal probability of being in the intervention or comparison group.

Time period of study:

Random assignment was conducted between January 2007 and July 2008, and participant outcomes were measured for two years after enrollment in the study.

Pathways only reports results from studies with a study quality rating of high or moderate.

Sample characteristics

Age

Older adults (age 50+)

19%

Participant race and ethnicity

Black or African American	19%
White, not Hispanic	46%
Hispanic or Latino of any race	14%
Asian	3%
Unknown, not reported, or other	18%

The race and ethnicity categories may sum to more than 100 percent if the authors reported race and ethnicity separately; in these cases, we report the category White, rather than White, not Hispanic.

Family status

Married

24%

Participant employment and public benefit status

Were employed

100%

Participant education

Had some postsecondary education	49%
Had a high school diploma or GED	85%
Did not have a high school diploma or GED	15%
Postsecondary credential	19%

Specific employment barriers

Had a disability	100%
Had a mental illness	100%

Intervention implementation

Implementing organization:

Minnesota Department of Human Services; Texas Health and Human Services Commission Working Well Program

Intervention services:

Adults ages 18 to 62 who were working at least part time and had a behavioral health condition were eligible to participate in the Demonstration to Maintain Independence and Employment (DMIE) in Texas and Minnesota. DMIE participants in these states could receive a suite of services including intensive case management, health benefits supplementing their existing coverage, employment supports, and financial assistance. Intensive case management involved developing an individual plan and goals and addressing barriers to services. Health benefits included enhanced medical services such as chemical dependence treatment, expanded dental coverage, medical transportation, improved access to mental health services, and a subsidized health club membership. Employment supports included career counseling, access to a 24-hour employee assistance program, a peer support group, workplace visits, accommodation assessments, and résumé and interview skill building. Financial assistance included health care premium subsidies, lower health insurance co-payments, and low or no deductibles for health care.

Mandatory services:

None

Comparison services:

The comparison condition applied to adults ages 18 to 62 who were working at least part time and had a behavioral health condition, but did not receive enhanced health services, employment supports, or financial assistance related to health insurance. Comparison group members remained eligible to receive standard health services in their community.

Study publications

Bohman, Thomas M., Lynn Wallisch, Kristin Christensen, Dena Stoner, Allen Pittman, Brian Reed, and Britta Ostermeyer (2011). Working Well–The Texas demonstration to maintain independence and employment: 18-month outcomes, Journal of Vocational Rehabilitation 34(2): 97-106. Available at https://content.iospress.com/download/journal-of-vocational-rehabilitation/jvr538?id=journal-of-vocational-rehabilitation%2Fjvr538.

Gimm, Gilbert, Denise Hoffman, and Henry Ireys (2014). Early interventions to prevent disability for workers with mental health conditions: Impacts from the DMIE, Disability and Health Journal 7(1): 56-63. Available at https://www.sciencedirect.com/science/article/pii/S1936657413001179.

Gimm, Gilbert, Henry Ireys, Boyd Gilman, and Sarah Croake (2011). Impact of early intervention programs for working adults with potentially disabling conditions: Evidence from the national DMIE evaluation, Journal of Vocational Rehabilitation 34(2): 71-81. Available at https://content.iospress.com/download/journal-of-vocational-rehabilitation/jvr536?id=journal-of-vocational-rehabilitation%2Fjvr536.

Ireys, Henry, Gilbert Gimm, Boyd Gilman, Noelle Denny-Brown, and Sarah Croake (2010). Draft report to Congress on the National Evaluation of the Demonstration to Maintain Independence and Employment (DMIE), Washington, DC: Mathematica Policy Research.

Linkins, Karen, Jennifer Brya, Allison Oelschlaeger, Brian Simonson, Soumita Lahiri, Joshua McFeeters, Maik Schutze, Jennifer Jonas, and Mary Alice Mowry (2011). Influencing the disability trajectory for workers with serious mental illness: lessons from Minnesota's demonstration to maintain independence and employment, Journal of Vocational Rehabilitation 34(2): 107-118. Available at https://content.iospress.com/download/journal-of-vocational-rehabilitation/jvr539?id=journal-of-vocational-rehabilitation%2Fjvr539.

Whalen, Denise, Gilbert Gimm, Henry Ireys, Boyd Gilman, and Sarah Croake (2012). Demonstration to Maintain Independence and Employment (DMIE). Final report submitted to the Centers for Medicare & Medicaid Services, Washington, DC: Mathematica Policy Research. Available at https://www.mathematica.org/publications/demonstration-to-maintain-independence-and-employment-dmie.

Gimm, Gilbert, Noelle Denny-Brown, Boyd Gilman, Henry Ireys, and Tara Anderson (2009). Interim report on the Demonstration to Maintain Independence and Employment, Washington, DC: Mathematica Policy Research. Available at https://www.mathematica.org/publications/interim-report-on-the-demonstration-to-maintain-independence-and-employment.

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Study of Demonstration to Maintain Independence and Employment (DMIE)