kathleen thomas, phd alan r. ellis, msw mona kilany, mph joseph morrissey, phd
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Kathleen Thomas, PhD Alan R. Ellis, MSW Mona Kilany, MPH Joseph Morrissey, PhD 2009 Annual meeting of the American Public Health Association November, 2009 Supported by a contract from the North Carolina Department of Health and Human Services - PowerPoint PPT PresentationTRANSCRIPT
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Intensive and irregular service use as possible barriers to employment for people with psychiatric and other disabilities
Kathleen Thomas, PhDAlan R. Ellis, MSWMona Kilany, MPHJoseph Morrissey, PhD
2009 Annual meeting of the American Public Health AssociationNovember, 2009
Supported by a contract from the North Carolina Department of Health and Human Services Division of Vocational Rehabilitation Services
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Service use as a barrier to employment:Presenter Disclosure
Kathleen Thomas
The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose
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Service use as a barrier to employment:Background
Employment among people with disabilities is lowo 37%o Compared to 80% among those without a
disability
Among people with disabilities who are not working
o Most (63%) want to work
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Service use as a barrier to employment:Background
Employment among people with disabilities has been associated with individual characteristics
o Personal: male gender, absence of co-morbidity, and disability type
o Service: high educational level, receipt of vocational services
=> These don’t serve well as policy levers
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Service use as a barrier to employment:Background
People with disabilities cite two important barriers to work
o Fear of loss of benefits (income support and health insurance)
o Health
=> We don’t really know what ‘health’ means in this context
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Service use as a barrier to employment:Study goals
o Exploratory examination of the association between intensive or irregular patterns of service use and work
o Enhance our understanding of enrollment in North Carolina’s new Medicaid buy-in and how to target resources to remove barriers to work
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Service use as a barrier to employment:Data
North Carolina Medicaid claimso Fiscal years 2002-2007o Adults with disabilitieso Eligible for Medicaid through receipt of
Supplemental Security Income or section 1619b
o n=127,431
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Service use as a barrier to employment:NC Medicaid SSI/1619b recipients
Characteristics Median
Mean
Std Dev
Percent
Age 44.0 42.1 14.6
Male 43.3
White 43.7
Psychiatric Disability
58.0
Cognitive Disability 16.6
Significant work 15.0
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Service use as a barrier to employment:NC Medicaid SSI/1619b recipients
Service use Median
Mean
Std Dev
Days 23.0 42.5 61.4
Consistency 0.30 0.39 0.34
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Service use as a barrier to employment:NC Medicaid SSI/1619b recipients
Days
Consistency
Low Medium
High
High --- 1.48 1.08
Medium 1.48
1.00 0.74
Low 1.39
0.73 0.47
Logit of work as a function of service use, controlling for personal characteristics
Odds Ratios
Overall model and construct fit significant, p<0.0001
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Service use as a barrier to employment:NC Medicaid SSI/1619b recipients
Personal Characteristics
Odds Ratios
95% CI
Age 1.00 0.99-1.00 *
Male 1.36 1.32-1.40 *
White 1.17 1.14-1.21 *
Psychiatric Disability 0.84 0.81-0.87 *
Cognitive Disability 0.67 0.64-0.70 *
Logit of work as a function of service use, controlling for personal characteristics
Overall model fit significant, p<0.0001
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Service use as a barrier to employment:Summary
Among people with disabilities enrolled in Medicaid
o Low number of service use days and high consistency in patterns of use are associated with employment
o Both days and consistency are important, neither outweighs the other
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Service use as a barrier to employment:Limitations
o Service use data do not capture sick days spent at home
o People may need more services than they receive
o Claims data provide limited contextual information
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Service use as a barrier to employment:Implications
o People who are struggling with illness do not have the resources to work
o Sometimes, poor access to and continuity of care may limit people’s ability to work
o Findings call for attention to scheduling health care use to accommodate work commitments
o Investment in advocacy skills that address negotiating scheduling appointments may help to support work