The Learning & Working RRTC Research & Training Projects

Leadership

• Michelle Mullen, PhD, Principal Investigator
• Mathematica, Consultant

Background

Once they turn 18, many young adults are entering community mental health organizations (CMHOs) to receive services, which are largely reimbursed by Medicaid. To bill Medicaid for these services, the person receiving care must be enrolled in Medicaid. Some states allow “Presumptive Eligibility” (PE), which lets CMHOs temporarily enroll people in Medicaid who seem eligible, so services can start right away and be billed. Another way CMHOs can get paid is to have a young adult apply for Supplemental Security Income (SSI), which gives cash to those with severe disabilities who can’t work. If someone gets SSI, they usually qualify for Medicaid too. But applying for SSI can have long-term downsides for young adults who might be able to work. Young adulthood is a key time for exploring careers and building skills and getting SSI might discourage young people from working or pursuing education, which can hurt their future opportunities. This project, Investigating Primary Mechanisms of Medicaid Eligibility in Presumptive Eligibility States, will explore the mechanisms of Medicaid application for young adults with serious mental health conditions (18+) who are first time service seekers at CMHOs in eligible states.

Research Questions

1. What are the application rates of Presumptive Eligibility (PE or emergency “Medicaid”) and Presumptive Disability (PD) among first-time young adults with serious mental health conditions applicants in eligible states by state, geography (e.g., urban, rural), and type of provider?
   1. For young adults with serious mental health conditions applicants who are accepted, what are the reported demographics/characteristics, state, geography, and provider by application mechanism (PE vs PD).
   2. For young adults with serious mental health conditions applicants who are not accepted, what are their reported characteristics, state, geography, and provider by application

Project Activities

• This project will explore the mechanisms of Medicaid application for young adults (18+) with serious mental health conditions who are new service seekers at CMHOs in eligible states. We will partner with Mathematica, Inc. to conduct a secondary data analysis of the Centers for Medicare & Medicaid Services (CMS) data of all PE/PD applications from 2018-2022 for the states that allow PE to better understand the prevalence of PE vs PD, and for whom. We will use these data inputs to inform a suite of workforce development tools to inform decision-making and practice of CMHO leadership, finance staff, and intake workers.

Leadership

• Michelle Mullen, Principal Investigator
• Louis Harkins, Consultant

Background

Research has shown that Supported Education (SEd), which helps young adults with serious mental health conditions (SMHC) pursue college or vocational training, leads to higher earnings and less reliance on disability benefits over time. Because education and training are so important for improving the futures of young adults with SMHC, a new model to enhance long-term employment outcomes for youth and young adults with SMHC, Helping Youth on the Path to Employment (HYPE), should be tested and evaluated.

Helping Youth on the Path to Employment (HYPE) is a model designed to help young adults with SMHC build successful careers by combining support for both employment and education. HYPE was developed with input from young people, professionals, and experts to make sure it meets real needs. It’s a structured program delivered by trained staff, using a detailed guide (the HYPE Manual) that has been tested and improved based on feedback.

Research Questions

1. 1. Is the implementation of HYPE in a community-based program feasible?
   2. Are the research methods adequate for a future efficacy trial?

Research Activities

To conduct a small feasibility randomized control trial of embedding HYPE, a new career development intervention that integrates supported employment and supported education, into a community mental health organization. This trial will evaluate implementation and research feasibility required for a future, larger randomized controlled trial.

Leadership

• Colleen McKay, MA, CAGS, Principal Investigator
• Marsha Ellison, PhD, Co-Investigator
• Family Run Executive Director Leadership Association(FREDLA), Consultant
• Deanne Unruh, PhD, Consultant
• Evelyn Frankford, Consultant
• Association for Career and Technical Education (ACTE), Consultant

Background

Young adults with serious mental health conditions (SMHC) often face more challenges in finishing school and finding jobs compared to their peers. One promising solution is Career and Technical Education (CTE), which includes programs in high school and college that combine academic learning with hands-on job training. These programs help students earn credentials, gain work experience, and connect to future education or careers.

Research shows that CTE can be especially helpful for youth with disabilities, including those with serious mental health conditions. For example, students who took four or more CTE classes in high school were over four times more likely to get full-time jobs after graduation. However, there are still barriers that make it hard for youth and young adults with SMHC to succeed in CTE programs. These include:

• Strict attendance rules that don’t account for mental health needs
• CTE Instructors who may not understand disabilities or mental health
• Stigma that can lead to fewer opportunities or limited career choices
• Misunderstandings among families and students about the value of CTE

This project will target two of these barriers: 1) enhancing disability and mental health knowledge among CTE Instructors and 2) enhancing the knowledge of youth and young adults with SMHC and their families.

Research Questions

1. What are the professional development needs of CTE Instructors to better ensure the access and success of youth and young adults with SMHC in CTE?
2. Can these identified needs be developed into effective training materials?
3. What information do youth and young adults with SMHC and their families need for access to and success in CTE programming?

Research Activities

The study team will conduct focus two sets of focus groups to explore the needs and strategies that can fuel student success in secondary CTE. These groups are 1) secondary Career & Technical Education (CTE) Instructors, and 2) youth and young adults with SMHC and their families. Findings will inform the development of resources and products for CTE Instructors and for youth and young and their families, that will be later field tested for usability among CTE Instructors and among students.

Leadership

• Michelle Mullen, PhD, Principal Investigator

Background

For college students, graduating is the goal. But for many students with serious mental health conditions (SMHC), finishing college is especially difficult. While people often blame poor grades or mental health symptoms, research shows that these students usually have decent grades (average GPAs between 2.8 and 3.4). The real issue seems to be persistence—staying enrolled and continuing through challenges.

One major reason for this struggle is difficulty with executive functioning skills. These are the mental skills needed to manage time, stay organized, concentrate, and prioritize tasks. In fact, over 70% of students with SMHC say these executive functioning challenges are bigger barriers than their mental health symptoms.

Executive functioning skills are essential for self-management and academic success. Students who have strong executive functioning skills can:

• Plan ahead
• Monitor their progress
• Ask for help when needed
• Use resources like tutoring or counseling effectively

To help with this, researchers developed a program called Focused Skills and Strategies Training (FSST). It teaches practical habits like time management and organization over 12 weeks. In studies, students who completed FSST were:

• Six times more likely to stay in school for another year
• More likely to complete more courses and credits
• Reported fewer mental health symptoms

These findings suggest that improving executive functioning skills can help students with SMHC stay in school and succeed, rather than dropping out due to challenges that could be managed with the right support.

Research Questions

1. Will students who participate in FSST report lower levels of symptoms and stress than those who are assigned to Campus Services as Usual?
2. Can high-fidelity FSST be delivered within a Center for Academic Support (CAS)?
3. Is Implementation Facilitation adequate to support the FSST Supervisor to maintain high fidelity FSST services?

Research Activities

To test FSST in a real-world context, FSST will be evaluated on a college campus. The Center for Academic Support (CAS) on the selected college campus will serve as the location of FSST services. While FSST can be situated in many places on campus, CAS was selected based on the shared principles of academic skills development to improve performance and enhance persistence. We have tested HYPE on Campus within psychological services and disability services; despite their strengths, both may create access and mission barriers for students with serious mental health conditions (SMHC).

This project will address the Intervention Efficacy stage of research. The research will employ a fully powered hybrid type 2 randomized control trial of FSST to evaluate the effectiveness of the intervention in the real world setting of a college Center for Academic Support and explore the adequacy of implementation strategies to maintain high fidelity with campus staff and supervisors. The implementation science framework of an Evidence-Based System for Implementation Support (EBSIS) will be used to structure implementation to enhance adoption and fidelity.

Leadership

• Marsha Ellison, PhD, Co-Principal Investigator
• Vanessa Klodnick, PhD, Co-Principal Investigator
• Council of State Administrators of Vocational Rehabilitation (CSAVR), Consultant
• The Harkin Institute for Public Policy & Citizen Engagement, Consultant

Background

Social Cognitive Career Theory (SCCT) purports that people learn how to think and feel about their career-related opportunities and potential through their social context and career experiences. SCCT proposes a three-factor interaction of 1) self-efficacy (Can I do this?), 2) outcome expectations (What will happen if I do this?), and 3) personal goals (How much do I want to do this?). These combine to influence individual career-related goal planning, motivation, and outcomes. SCCT identifies learning experiences, such as internships, as foundational for self-efficacy, career expectations, and ultimate career performance. Experiential learning is important for learning skills and gaining confidence in entry-level employment for all youth, including those with serious mental health conditions (SMHC). Moreover, many employers are interested in diversifying their workplaces and use internship and apprenticeship programs to build and sustain workforces that include individuals with disabilities. While there are several promising early career supports for youth and young adults with disabilities that are designed to improve skill-development and career and self-career knowledge, they are not employer-sponsored or implemented. The advantage of employer-sponsored/implemented internships is that they are funded and sustained by the employer, and they can function to prepare interns for employment in that setting. Such internships are also de-stigmatized for youth and young adults with serious mental health conditions (SMHC) as they are not developed through the auspices of a mental health agency.

Research Questions

1. What modifications of internship models for young adults with SMHC are needed?
2. What is the feasibility of the resulting modified internship model?

Research Activities

This study is comprised of three phases 1) a scan of existing internship opportunities for youth and young adults with SMHC and interviews with key informants (e.g., vocational rehabilitation counselors, business leaders, families) to 2) develop an internship model for youth and young adults with SMHC that will then 3) be implemented and evaluated at two employer sites.

Leadership

• Michelle Mullen, PhD, Principal Investigator
• McSilver Institute for Poverty Policy and Research at NYU Silver School of Social Work, Consultant

Background

The Diverting SSI training project will translate and advance knowledge related to the Investigating Primary Mechanisms of Medicaid Eligibility in Presumptive Eligibility States (Medicaid Eligibility) research project. The two projects will mutually inform the other, as they both aim to reduce the use of SSI application (application via Presumptive Disability [PD] versus Presumptive Eligibility [PE]) as the main mechanism of Medicaid eligibility for youth and young adults with SMHC. This training project will build on the Medicaid Eligibility study’s data inputs and conduct focus groups and key informant interviews to inform the creation of a suite of workforce development tools to enhance the decision-making and practices of community mental health organizations' leadership, finance staff, and intake workers.

Activities

1. The project team will hold focus groups with community mental health organization staff/leadership to inform workforce development tools
2. In partnership with the McSilver Institute, workforce development tools and a free online course to train mental health leadership and service providers are built
3. Field test with providers to prepare for future research and technical assistance projects

Leadership

Michelle Mullen, PhD

Background

The Gig Economy training project will build resources for supported employment (SE) service providers to address their lack of training and resources on supporting informed decision-making about working in the gig economy. Resource development will draw on consultation and key informant interviews with 1) experts on the gig economy across sectors (e.g., technology, transportation and delivery) who can inform content, 2) mental health experts and key informants including youth and young adults with SMHC who have successfully navigated gig economy opportunities, and 3) business and legal experts who can guide and shape toolkit content on tax, disability benefit and related considerations.

Activities

The project team will conduct key informant interviews of young adults with SMHC and experts in gig economy, mental health, business, and law. Then they will develop resources for supported employment service providers to address the lack of training and resources on supporting informed decision-making about working in the gig economy. This toolkit will include a training  

Leadership

• Marsha Ellison, PhD, Principal Investigator
• CreateAbility, Inc., Consultant
• Elizabeth Thomas, PhD, Consultant
• Derek Lewis, Consultant

Background

The Level Up training project will increase the skills needed among youth and young adults with SMHC to obtain early work experience. This training project will use gaming to inform youth and young adults with SMHC, especially high school-age youth, about soft skills needed for success in employment.

Our overall strategy for developing an effective game for youth and young adults with SMHC is “gamification,” using elements of gameplay (competition, scoring points, and following rules), and “edutainment,” an approach to health communication that uses entertainment and education to promote enjoyable and accessible learning. We will employ design-implement-test cycles to ensure that game development is aligned with its purpose and with user experience. Further, because the engagement of players is essential, and to further make this game effective, we will develop it using Artificial Intelligence (AI).

The game will be produced using universal design and accessibility features, e.g., high contrast colors, keyboard accessibility or shortcuts, adjustable settings for font size, and compliance with relevant accessibility standards, such as the Web Content Accessibility Guidelines (WCAG) for web-based content.

Activities

1. Conduct focus groups with youth and young adults to obtain input on the critical features and functions of the game to promote engagement
2. Prioritize and select the key features/functions
3. Design the game flow and goals, and model with static panels
4. Conduct focus groups with youth and young adults on the game model
5. Refine design based on feedback
6. Develop a  game prototype
7. Conduct a usability test with youth and young adults
8. Finalize the game based on the usability test
9. Upload the game to Google Play and Apple App Store
10. Develop dissemination materials for state vocational rehabilitation agencies, secondary schools, community mental health organizations, etc.