Disability Benefits and Service Use

本提案的研究目的是促进我们对患有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的残疾福利，服务使用（医疗，心理健康，康复），种族和临床表现之间关系的理解。人们普遍认为，患有精神疾病的人往往经历与他们的精神状况有关的严重的职业损害和相关的经济困难。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年工作激励改进法案的立法改革，导致政策制定者重新考虑当前残疾政策的多个方面。不幸的是，康复工作并没有被证明能显著增加精神残疾者的工作收入。此外，我们对公共残疾福利如何影响工作行为或各种公共系统中可用的其他服务的使用知之甚少。目前，退伍军人服务系统为研究临床症状、相关残疾和服务使用之间的关系提供了一个独特的机会，因为它是一个大型的封闭系统，提供了广泛的医疗、心理健康和社会服务。此外，退伍军人管理局系统所服务的客户（即退伍军人）很有趣，因为他们代表了农村和少数民族成员比例很高的人口。因此，退伍军人制度代表了研究一系列变量的机会，这些变量对政策制定者、倡导者和关心精神病患者福利的关键利益相关者都有普遍的兴趣。在这项研究中，我们将通过检查档案数据，包括行政和医疗记录，更多地了解服务使用与一些相关变量（例如，种族，症状报告，残疾寻求，就业）之间的关系，包括在VA系统内服务的约450名患有严重创伤后应激障碍的创伤受害者。这些数据可能会影响我们对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的理解，包括与相关精神残疾和康复工作的重要接口。这一提议响应了《2010年保健人员》和《衔接科学与服务报告》关于康复和干预措施的建议（建议9）。

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).