Disability Benefits and Service Use

这项建议的研究目的是促进我们对残疾福利，服务使用（医疗，心理健康，康复），种族和严重创伤后应激障碍（PTSD）和其他相关精神疾病的创伤受害者之间的临床表现之间的关联的理解。人们普遍认为，精神病患者往往会遇到严重的职业障碍和与其精神状况有关的经济困难。临床和康复服务的最新进展、公众舆论的变化以及随后对福利和1999年《工作激励改进法》进行的立法改革，促使决策者重新考虑现行残疾人政策的多个方面。遗憾的是，康复工作并未显示出显著增加精神残疾者与工作有关的收入。此外，我们对公共残疾福利如何影响工作行为或使用各种公共系统中的其他服务知之甚少。目前，VA系统提供了一个独特的机会，研究临床症状，相关的残疾和服务使用之间的关系，因为它是一个大型的，封闭的系统，提供了广泛的医疗，心理健康和社会服务。此外，由VA系统服务的客户端（即，退伍军人）的情况令人感兴趣，因为他们所代表的人口中农村和少数民族成员所占比例很高。因此，VA系统提供了一个机会，可以研究一系列变量，这些变量对政策制定者、倡导者和关注精神病患者福利的关键利益相关者具有普遍意义。在这项研究中，我们将更多地了解服务使用和一些相关变量之间的关系（例如，种族，症状报告，残疾寻求，就业），通过检查档案数据，包括行政和医疗记录，对约450名创伤受害者与严重创伤后应激障碍服务的VA系统。这些数据可能对我们理解严重创伤后应激障碍和其他相关精神疾病的创伤受害者的服务提供系统产生影响，包括与相关精神残疾和康复工作的重要接口。该提案是对《2010年健康人》和《连接科学与服务》报告关于康复和干预措施的建议（建议9）的回应。

The research aim of this proposal is to advance our understanding of the association between disability benefits, service use (medical, mental health, rehabilitation), race, and clinical presentation among trauma victims with severe posttraumatic stress disorder (PTSD) and other associated mental illnesses. It is well accepted that persons with mental illnesses often experience severe occupational impairment and related financial hardships associated with their psychiatric condition. Recent advances in clinical and rehabilitative services, and changes in public opinion and subsequent legislative reform toward welfare and the Work Incentives Improvement Act of 1999, have led policy makers to reconsider multiple aspects of the current disability policies. Unfortunately, rehabilitative efforts have not been shown to significantly increase the work-related income of persons with psychiatric disabilities. Furthermore, we know relatively little about how public disability benefits affect work behavior or use of other services available within various public systems. At present the VA system offers a unique opportunity to study the relationship between clinical symptoms, associated disability, and service use because it is a large, closed system which provides a broad range of medical, mental health, and social services. Furthermore, the clients served by the VA system (i.e., veterans) are of interest in that they represent a population that has high percentages of rural and minority members. Thus, the VA system represents the chance to study a range of variables that are of general interest to policy makers, advocates, and key stakeholders concerned with the welfare of mentally ill persons. In this study we will learn more about the relationship between service use and a number of relevant variables (e.g., race, symptom reporting, disability seeking, employment) by examining archival data, including administrative and medical records, on approximately 450 trauma victims with severe PTSD served within the VA system. These data may have implications for our understanding of service delivery systems for trauma victims with severe PTSD and other associated mental illnesses, including the important interface with associated psychiatric disability and rehabilitation efforts. This proposal is responsive to Health People 2010 and the Bridging Science and Service report recommendation regarding rehabilitation and interventions (recommendation #9).