Education, Employment and Disability Among Young Persons with Early Psychosis Participating in OnTrackNY

Introduction Early psychosis intervention programs have expanded rapidly in the United States (Bello et al, 2016). Comprehensive early treatment programs have demonstrated success internationally (Craig et al, 2004, Grawe et al, 2006, Secher et al, 2015). These demonstrated successes led the federal government to establish block grant funding to states: in 2014, $25 million dollars was set aside for evidence-based early psychosis treatment, which was increased by another 5% in 2016 to $50 million annually (Dixon, 2017). New York State (NYS) was an early adopter and has rapidly expanded CSC across the state. This study prospectively evaluated education and employment outcomes over time within NYS’s CSC program, OnTrackNY. Methods Employment and education trajectories were assessed for individuals who had at least one three-month follow-up assessment, from the program’s inception in October, 2013, through September, 2016 (N=325). Rates of Social Security Administration (SSA) disability enrollment were assessed for individuals enrolled from October, 2013 to June, 2017 (n=679). Education and employment status was estimated using longitudinal logistic models utilizing generalized estimating equations with an autoregressive covariance structure to account for within-subject correlations over time. To test how education/employment changed over time, pre-specified contrasts were tested from the longitudinal model for the mean change in sequential follow-up visits. A Kaplan-Meier estimator with discrete time to event and censoring at last observed follow-up month with no event was used to estimate the probability of any education/employment by one year after admission and to estimate the risk of disability by two years after admission. Results Approximately 40% of participants were engaged in school or work at baseline, which increased to 80% by 6 months. The estimated probability of being employed or in school at some time during the year after admission is 87.9% (95% Confidence Interval (CI)=[82.9, 92.0]). Relative to women, men had significantly lower odds of education/employment. Relative to non-Hispanic whites, individuals who were Asian, Hispanic or Black had lower odds of education/ employment. Relative to individuals who had not yet completed high school, individuals whose highest educational attainment was High School (HS) or GED had lower odds of educational/employment. At admission, 2.5% (17/679) clients were receiving SSA disability benefits. The Kaplan-Meier estimates that 18.3% (95% CI=[13.9, 23.9]) of clients followed for two years obtained disability benefits. In bivariate cox regression analyses, individuals with lower (worse) occupational and social functioning scores have significantly greater risk of disability enrollment than individuals with higher scores (in multivariate analysis, only lower occupational functioning remains significant). Age, gender, race, ethnicity, and symptom scores were not significantly associated with disability enrollment. Discussion This study demonstrates that individuals with early psychosis who receive CSC in non-research community settings achieve significant improvements in education and employment. Gender, race/ethnicity, and baseline education predicted education and employment outcomes, while poorer functioning was associated with risk of SSA disability benefits (Humensky et al, 2017). CSC teams should make particular efforts to support the work and school goals of individuals who may be more likely to struggle in achieving engagement in work and school.