Implementation of the complex intervention in routine mental health treatment settings was feasible, and the intervention was effective in assisting individuals disabled by schizophrenia or depression to return to work and improve their mental health and quality of life.

Security Disability Insurance (SSDI) beneficiaries with primary psychiatric impairments comprise the largest, fastest growing, and most costly population in the SSDI program. The Mental Health Treatment Study provides a comprehensive test of the hypothesis that access to evidence-based employment services and behavioral health treatments, along with insurance coverage, can enable SSDI beneficiaries with psychiatric impairments to return to competitive employment. It will also examine which beneficiaries choose to enter an employment study under such conditions. Currently in the field in 22 cities across the U.S., the MHTS aims to recruit 3,000 SSDI beneficiaries with psychiatric impairments into a randomized controlled trial. This paper describes the MHTS, its background, and its process and outcome assessments.

The Social Security Administration's Mental Health Treatment Study (MHTS) produced positive mental health, employment, and quality of life outcomes for people on Social Security Disability Insurance (SSDI). The investigators discuss major policy implications. First, because integrated, evidence-based mental health and vocational services produced clinical and societal benefits, the authors recommend further service implementation for this population. Second, because provision of these services did not reduce SSDI rolls, the authors recommend future research on prevention (helping people avoid needing SSDI) rather than rehabilitation (helping beneficiaries leave SSDI). Third, because integrating mental health, vocational, and general medical services was extremely difficult, the authors recommend a multifaceted approach that includes streamlined funding and infrastructure for training and service integration. Fourth, because insurance coverage for people with disabilities during the MHTS (pre-Affordable Care Act) was chaotic, the authors recommend that financing strategies emphasize functional-not just traditional clinical-outcomes.

Adequate financing is essential to implementing services for individuals experiencing a first episode of a psychotic illness. Recovery After an Initial Schizophrenia Episode (RAISE), a project sponsored by the National Institute of Mental Health, is providing a practical test of the implementation and effectiveness of first-episode services in real-world settings. This column describes approaches to financing early intervention services that are being used at five of 18 U.S. sites participating in a clinical trial of a team-based, multielement RAISE intervention. The authors also describe new options for financing that will become available as the Affordable Care Act (ACA) is implemented more fully. The ACA will rationalize coverage of first-episode services, but the all-important Medicaid provisions will also require individual state action to implement services optimally.

This paper describes an outcome-based assessment protocol that is used with older individuals who are blind. The assessment process demonstrates how the ICIDH theoretical model can be adapted to address small gains in rehabilitation outcome. The model also illustrates refinements in the ICIDH scaling to create effectiveness measures. A two-dimensional Functional Assessment Scale for measuring personal performance capacities has been found to be quite useful in determining individual needs, in quantifying small gains in rehabilitation intervention, and in evaluating programme effectiveness.