Study Details | Pathways to Work

3166-Working Toward Welln

Study quality: High

High

Reason for the rating: This study received a high study quality rating because it is a low-attrition randomized controlled trial with no known issues that suggest the findings cannot be attributed to the intervention.

Intervention: Working toward Wellness

Population and employment barriers:

Parents, Specific employment barriers (Mental illness)

Services provided:

Case management, Education, Health services (Substance use disorder treatment and mental health services)

Setting: Tested in multiple settings

Study design

Design:

Randomized controlled trial

Study group formation:

Rhode Island Medicaid recipients who were 18 to 64 years old, had children, and were eligible for United Behavioral Health services (19,120 individuals) were sent a letter with an initial depression screening. The program contacted, by telephone, those who returned the screener (4,053 people) and those who were identified as at-risk for depression based on the screener (1,613 people). After a telephone screening, those found to have depressive symptoms and who agreed to participate (507) were randomly assigned to either the Working Toward Wellness intervention condition (253) or a comparison group (254); eight people later dropped out of the intervention condition. Random assignment occurred between November 17, 2004, and October 20, 2006.

Time period of study:

Participants were randomly assigned between November 2004 and October 2006 to receive one year of treatment. This study looks at the impacts 6 months, 18 months, and 36 months after random assignment.

Primary outcome domains examined:

Increase short-term earnings, Increase long-term earnings, Increase short-term employment, Increase long-term employment

Other outcome domains examined:

Physical health, Mental health, Parenting and co-parenting, Child well-being, Financial assets

Study funded by:

ACF and the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services funded this study, with additional funding from the U.S. Department of Labor. The study is part of the Enhanced Services for the Hard-to-Employ Demonstration and Evaluation Project.

Results

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Outcome domain	Measure	Timing	Study quality by finding	Comparison group mean	Intervention group mean	Impact	Units	Sample size
Increase short-term earnings	Monthly income	Month 18	High	1,170.00	1,134.00	-36.00	2007 dollars	428
Increase long-term earnings	Monthly income	Month 36	High	1,215.00	1,250.00	35.00	2008 dollars	429
Increase short-term employment	Currently employed	Month 18	High	51.50	53.20	1.70	percentage points	428
Increase long-term employment	Currently employed	Month 36	High	50.20	47.20	-3.00	percentage points	429

Short-term outcomes are those measured 18 months or fewer after participants are first offered services. Long-term outcomes are those measured between 18 months and 5 years after participants are first offered services. Very long-term outcomes are those measured 5 years or more after participants are first offered services.

Findings quality key:

High
Moderate

Study quality terms?

The findings quality describe our confidence that a given study’s finding is because of the intervention. We do not display findings that rate low.

Findings key:

A moderate-to-large favorable finding that is unlikely to be due to chance
A moderate-to-large favorable finding that might to be due to chance
A small favorable finding that is unlikely to be due to chance
A small favorable finding that might be due to chance
A favorable finding that is unlikely to be due to chance, but we cannot determine the standardized effect size
A favorable finding that might be due to chance, but we cannot determine the standardized effect size
A moderate-to-large unfavorable finding that is unlikely to be due to chance
A moderate-to-large unfavorable finding that might to be due to chance
A small unfavorable finding that is unlikely to be due to chance
A small unfavorable finding that might be due to chance
An unfavorable finding that is unlikely to be due to chance, but we cannot determine the standardized effect size
An unfavorable finding that might be due to chance, but we cannot determine the standardized effect size
A finding that is unlikely to be due to chance, but we cannot determine the standardized effect size or direction
A finding of no effect that might be due to chance

Favorable findings are impacts in a direction that is socially desirable. Statistical significance indicates the likelihood that a study finding is due to the intervention, rather than due to chance. Findings are described as moderate-to-large if the intervention produced a sufficiently large change in the outcome. An impact receives this designation if the standardized effect size is equal to or greater than 0.25 or equal to or less than -0.25.

Sample characteristics

Most participants (90 percent) were female; the average age of participants was between 35 and 36 years old; and 44 percent of participants were employed at the time of random assignment. Participants had, on average, between one and two children ages 18 or younger. The majority (54 percent) held a high school diploma or GED but no other education; 22 percent had a technical or four-year college degree, and 24 percent lacked a high school diploma or GED. The sample was 45 percent White, 33 percent Hispanic, 12 percent Black, and 6 percent of another racial or ethnic group. Finally, 35 percent had severe depression, and 12 percent had very severe depression.

Age

Mean age

35 years

Sex

Female	90%
Male	10%

Participant race and ethnicity

Black or African American	12%
White, not Hispanic	45%
Another race	6%
Unknown or not reported	3%
Hispanic or Latino of any race	33%

The race and ethnicity categories may sum to more than 100 percent if the authors reported race and ethnicity separately; in these cases, we report the category White, rather than White, not Hispanic.

Family status

Parents

100%

Participant employment and public benefit status

Were employed

44%

Participant education

Had some postsecondary education	22%
Had a high school diploma or GED	76%
Did not have a high school diploma or GED	24%

Specific employment barriers

Had a mental illness

100%

Intervention implementation

Implementing organization:

United Behavioral Health

Program history:

The Working Toward Wellness program was developed by Group Health Cooperative and delivered by United Behavioral Health for the evaluation.

Intervention services:

Individuals in the Working Toward Wellness group received intensive outreach from case managers (to enter and remain in treatment). Master's-level care managers placed telephone calls to Working Toward Wellness participants to encourage them to seek treatment for their depression. The care managers also helped coordinate health appointments, encouraged and monitored follow-through on appointments and treatment plans, and provided supplemental information and counseling. Ninety-four percent of participants received a call from a care manager, and the average participant received nearly monthly contact. During the calls, care managers also asked participants about their employment status, goals, and barriers to employment, such as child care. Participants who resisted seeking professional treatment were offered a structured psychoeducational program that the care manager administered over the phone. The goal of the phone program was to establish a positive relationship between care managers and participants and maintain participant engagement.

Mandatory services:

None.

Comparison services:

Participants in the comparison group received referrals to mental health care providers but received no intervention beyond this standard practice.

Service receipt duration:

Care managers placed telephone calls to participants periodically over the course of a year. The average participant received nine calls from his or her care manager.

Intervention funding:

ACF, U.S. Department of Health and Human Services; Office of the Assistant Secretary for Planning and Evaluation; U.S. Department of Labor.

Cost information:

The average cost of providing the intervention was $7,686 per participant. The average cost of providing comparison group services was $6,734 per person. The net intervention cost, or difference between the two, was $952 per person. This represents how much more it cost to provide intervention services compared to comparison services.

These figures are based on cost information reported by study authors. The Pathways Clearinghouse converted that information to a single amount expressed in 2018 dollars; for details, see the FAQ. This information is not an official price tag or guarantee.

Study publications

Kim, Sue, Allen LeBlanc, and Charles Michalopoulos (2009). Working Toward Wellness: Early results from a telephone care management program for Medicaid recipients with depression, Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Available at https://www.acf.hhs.gov/sites/default/files/opre/working_wellness.pdf.

Kim, Sue, Allen LeBlanc, Pamela Morris, Greg Simon, and Johanna Walter (2010). Working Toward Wellness: Telephone care management for Medicaid recipients with depression, eighteen months after random assignment, Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Available at https://www.acf.hhs.gov/sites/default/files/opre/telephone_care.pdf.

Kim, Sue, Allen LeBlanc, Pamela Morris, Greg Simon, and Johanna Walter (2011). Working Toward Wellness: Telephone care management for Medicaid recipients with depression, thirty-six months after random assignment, OPRE Report #2011-21, Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Available at https://poseidon01.ssrn.com/delivery.php?ID=976118072096020070099124017073103096059080095032024041078114019074022108098094075125031006120043049043112118119068004114123091044000063069006096027010004065030073066052063084000127097095095126084093126106064025095098119073100090122079120094115066117&EXT=pdf.

View the glossary for more information about these and other terms used on this page.

The Pathways Clearinghouse refers to interventions by the names used in study reports or manuscripts. Some intervention names may use language that is not consistent with our style guide, preferences, or the terminology we use to describe populations.

Study of Working toward Wellness