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Principal Investigator: HOWARD H GOLDMAN
Organization: UNIVERSITY OF MARYLAND BALTIMORE
Fiscal Year: 2024
Award: $766,659
Funding agency: National Institute of Mental Health
A major NIMH goal for early psychosis treatment is to “prevent deterioration and disability among
individuals suffering from psychotic illness”. However, rates of Social Security Administration disability (SSI/DI)
enrollment remain high for young people in early psychosis treatment. Existing studies on SSI/DI have limited
information on the FEP population. Enrollment in SSI/DI may provide benefits (including cash assistance,
access to Medicaid/Medicare, and other social entitlements), but also detrimentally impact identity, vocational
aspirations, career development and employment; individuals rarely leave SSAD benefits for full-time work.
Racial disparities have also been identified, but remain poorly understood, with respect to the intersections
between race, structural racism and the poorer outcomes long-documented among ethnoracialized minorities,
particularly Black Americans. It is crucial to generate knowledge with the potential to inform decision-making
about the benefits and trade-offs inherent in SSI/DI participation and help optimize outcomes within the context
of SSI/DI participation among this population of young people (e.g. generally aged 16-30).
The primary goal of this project is to investigate factors influencing decisions to apply for SSI/DI, the
impact of these decisions, and the longitudinal relationships between SSI/DI and career development. This
information will then be used to develop systematic strategies for improving services, supporting client decision
making and optimizing outcomes.
The NIMH-funded Early Psychosis Intervention Network (EPINET), spanning 105 coordinated specialty
care (CSC) programs across 16 states, affords an exceptional opportunity to better understand these issues.
Leveraging the EPINET initiative, this multi-phase, mixed methods study will provide important new knowledge
regarding predictors of application and the relationship between SSI/DI and vocational functioning, will facilitate
development and evaluation of a multi-level menu of actionable targets and associated implementation
strategies, for example, specific ways of improving programmatic supports and policy changes designed to
strengthen SSAD-related outcomes (translation of research to practice). The project is guided by the multi-level
Disability Creation Process (DCP2) framework, and implementation activities by the Consolidated Framework
for Implementation Research (CFIR). The proposed project will utilize quantitative data from the EPINET
common dataset (n=5000+), supplemented with primary quantitative (n = 330) and qualitative (n = 110) data
collection in four distinct states. The study aims are to: determine the extent and predictors of SSI/DI
application, SSAD enrollment and work/school functioning among clients enrolled in CSC programs,
systematically investigate the client experience of SSI/DI decision making (through quantitative and qualitative
data) and using implementation mapping to develop strategies to optimize CSC services as they impact
SSI/DI. Racial differences and potential disparities will be examined across all three Aims.
Terms: <Affect><Age><Attention><Award><Black American><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Characteristics><Circulatory Collapse><Client><Clinical><Communities><Complex><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Coordinated Specialty Care><Data><Data Collection><Data Set><Decision Making><Deterioration><Development><Disability outcome><Disability related outcomes><Disparities><Disparity><Economics><Education><Educational aspects><Employment><Enrollment><Evaluation><Evidence based practice><Feedback><Funding><Generations><Goals><Impairment><Impoverished><Independent Living><Individual><Interruption><Intervention><Intervention Strategies><Interview><Investigators><Ions><Knowledge><Learning><Link><Maps><Maryland><Medicaid><Medicare/Medicaid><Mental Health Services><Mental Hygiene Services><Methods><Modeling><Motivation><NIMH><National Institute of Mental Health><New York><Outcome><Outcomes for persons with disabilities><Outcomes in disabilities><Partnership Practice><Pennsylvania><Persons><Phase><Play><Policies><Population><Poverty><Process><Psychoses><Psychotic Disorders><Race><Races><Recovery><Research><Research Personnel><Researchers><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Schizophrenia><Schizophrenic Disorders><Schools><Security><Service delivery model><Service model><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Shock><Site><Social Insurance><Social Security><Social Security Administration><Structural Racism><Survey Instrument><Surveys><Texas><Time><Translational Research><Translational Science><United States><United States Social Security Administration><Vocation><Work><Youth><Youth 10-21><adolescent minority><adult youth><aged><ages><aspirate><care delivery model><care receiver><care recipients><care services><care systems><career development><circulatory shock><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><dementia praecox><design><designing><developmental><differences due to race><differences in race><differs by race><differs in race><disability><discrimination based on race><discrimination due to race><disparities in race><disparity due to race><early psychosis><economic><enroll><ethnoracial minority><evidence base><experience><first episode psychosis><health care delivery model><healthcare delivery model><implementation strategy><improved><improved outcome><individual heterogeneity><individual variability><individual variation><inequality due to race><inequity due to race><innovate><innovation><innovative><interventional strategy><mental health care><mental healthcare><minority children><minority youth><pediatric minority><prevent><preventing><programs><psychotic illness><race based differences><race based disparity><race based inequality><race based inequity><race differences><race discrimination><race disparity><race related differences><race related disparity><race related inequality><race related inequity><race-based discrimination><race-related discrimination><racial><racial background><racial difference><racial discrimination><racial disparity><racial identity><racial inequality><racial inequity><racial origin><racially different><racially unequal><research into practice><research to practice><schizophrenic><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><shocks><social><social determinants><social role><socio-demographics><sociodemographics><sociodeterminant><strategies for implementation><translation research><translational investigation><young adult><young adulthood><young minority>