Interagency Committee on Disability Research

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• Interagency Committee on Disability Research
• Interagency Subcommittee on Employment
• State of the Science Conference
• June 23, 2008
• Dennis Moore, Ed.D.
• Professor, Department of Community Health
• Boonshoft School of Medicine
• Wright State University
• Framing the Need for a Coordinated Federal
  Research Agenda Theme 2 Disability Workforce
  Experiences and Needs

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Psychosocial disabilities

• Psychosocial disabilities appear to be
  differentially increasing in disability programs
• Involves wide cross section of working Americans
  also
• Persons with psychosocial disabilities frequently
  have additional conditions
• Substance use disorders (SUD) correlated with
  mental illness

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Medical conditions and psychosocial disabilities

• Almost one-fourth of all stays in U.S.
  community hospitals for patients age 18 and
  older7.6 million of nearly 32 million
  staysinvolved depressive, bipolar, schizophrenic
  and other mental health disorders or substance
  use related disorders in 2004 (9.9 billion
  nationally)
• Agency for Healthcare Research and Quality
• (AHRQ/HHS, April 2007)

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• Currently, over 1/3 of all Vocational
  Rehabilitation (VR) consumers are diagnosed with
  either mental illness, substance use disorder, or
  both as primary or secondary disabilities
• (RSA Case Services Data, 2006)

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Substance Use Disorder and VR
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SUD prevalence within VR

• Substance abuse screener (SAVR-S) was validated
  using DSM IV with 1,000 VR consumers OH IL
• Active SUD diagnosis (DSM IV r Criteria) in 22.1
  of sample at time of application to VR
• Finding is consistent with previous research (33
  - 23) (DiNitto Schwab, 1993 Moore Li, 1998)
• Heinemann, et al, 2008

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If a reliable and valid, low-cost, short
screening instrument for substance abuse were
available specifically for the VR setting, would
you use it? N 214 counselors in 2 states
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RRTC R1Promoting Substance Use Assessment by
Vocational Rehabilitation Agencies study
ongoing

• 6 VR state agencies using SAVR-S screener
• Over 7,000 screenings to date
• 42 68 of VR staff participating
• 30.6 average screen positive for SUD
• 14.2 average rate consumer refusals

RRTC intermediate findings
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Supported Employment Individualized Placement
and Support
Developed by Deborah Becker Robert Drake
Dartmouth University
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Some philosophical underpinnings of
Individualized Placement and Support

• People can opt for work even if treatment is
  ongoing and recovery is in early stages
• Consumer directly works on finding employment
• Team interacts with employer
• Employment provides stability and recovery
  support
• Relapse may be integral to early process
• Jobs increasingly stabilize and lead to career
  ladder

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RRTC R2 Efficacy of the Individual Placement
and Support (IPS) Model for Consumers with
Disability and Substance Use Disorders - study
ongoing

• Goal To investigate the efficacy of IPS among
  persons with traumatic brain injury or other
  severe disabilities with coexisting substance use
  disorders (SUD).

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Individualized Placement and Support

• Very challenging approach for persons with TBI or
  other co-existing disabilities, as evidenced by
  low baseline employment levels
• Randomized trial of 200 persons at OSU and WSU
  clinics serving persons with SUD full cohort
  now recruited and completing follow-up interviews

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• Supply Side question about IPS
• Does IPS demonstrate equivalent longitudinal
  employment gains for persons with SUD and
  co-occurring disabilities as shown for persons
  with SMI?

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• Supply Side question about IPS
• What level of fidelity can VR maintain to the IPS
  model as they implement this approach?

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• Demand Side question about IPS
• What measurable impact does IPS have on
  subsequent VR utilization by an employer?

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Employer challenges where solutions could also
benefit persons with psychosocial disabilities,
including SUD
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Substance Abuse
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Illicit Drug Use by Industry

• The highest rates of past month illicit drug use
  among full-time workers aged 18 to 64 were found
  in accommodations and food services
  (16.9 percent) and construction (13.7 percent)
  industries

SAMHSA, The NSDUH Report Worker Substance Use,
by Industry Category, August, 2007
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Heavy Alcohol Use by Industry

• The highest rates of past month heavy alcohol use
  among full-time workers aged 18 to 64 were found
  in construction (15.9 percent) arts,
  entertainment, and recreation (13.6 percent) and
  mining (13.3 percent)

SAMHSA, The NSDUH Report Worker Substance Use,
by Industry Category, August, 2007
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Rediscovering an old idea the Recovery Work
enclave

• Broad Description
• An employer based work site supervised by
  facility employees. Alternate shift or
  sequestered work area. Some on-site recovery
  accommodations (e.g., drug free recreation/
  socialization, peer oriented recovery meetings)
• Expected Outcomes
• Coworker support for recovery
• Reduced employment-generated relapse risk
• Increased productivity
• Higher job retention rates

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Employee retention, especially related to

• Stress
• Depression mental health
• Substance abuse
• Obesity
• Injury
• Chronic health conditions

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SC VR Business Partnership Network

• Membership in the VRBPN can help employers
• Improve customer service and expand their
  customer base to include more
  people with disabilities, their families and
  friends.
• Identify people with disabilities ready for
  employment.
• Return injured workers to the workplace.
• Access information on low-tech and low-cost job
  accommodations.
• Understand ADA compliance i.e., interviewing
  techniques.
• Share information and network with other
  employers.
• Brenda Williams, SCVRD liaison for the
  Business Partnership Network
• Larry C. Bryant Commissioner

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Clear federal guidelines and incentives for
business to hire persons with disabilities
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• National HP 2010 Disability Chapter 6 includes
  only one alcohol/drug health indicator
• Reduce alcohol use by pregnant women with
  disabilities (CDC)
• Treatment Episode Data Set and National Survey on
  Drug Use and Health do not measure disability
  (SAMHSA)
• Dozens of overlapping federal definitions of
  disability
• (ICDR, 2003)

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Employee transportation availability and costs a
growing problem for American business
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Transportation Alternative Partnership
TAP is the TransOptions Transportation
Alternatives Partnership program delivering the
benefits of mobility services and customized
alternative transportation programs directly to
your company
  Did you know employer-subsidized commuting
benefits can be excluded from your state and
federal tax returns?