Vocational rehabilitation helps lift people with disabilities out of poverty

Findings from the Substantial Gainful Activity Project reported in this special issue of the Journal of Vocational Rehabilitation

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IMAGE: IMPACTS OF THE SGA PROJECT INNOVATIONS. CREDIT: JOURNAL OF VOCATIONAL REHABILITATION view more 

CREDIT: CSAVR, ROCKVILLE, MD, USA

Amsterdam, NL, November 10, 2020 - Social Security Disability Insurance (SSDI) benefits do not always keep individuals with disabilities out of poverty. To support these individuals' efforts to lift themselves out of poverty, the Substantial Gainful Activity (SGA) Project was piloted in Kentucky and Minnesota. It showed that individuals who engaged in a vocational rehabilitation services intervention were able to earn increased income above SGA-level earnings. The authors recommend expanding the project to other US state agencies.

In a special issue of the Journal of Vocational Rehabilitation Guest Editors Susan Foley, PhD, Institute for Community Inclusion (ICI), University of Massachusetts Boston, Boston, MA, USA, and Purvi Sevak, PhD, Mathematica, Princeton, NJ, USA, have assembled seven insightful reports on the SGA Project from early design through completion of randomized controlled trials in two states. Stephen Wooderson and John Connelly of the Council of State Administrators of Vocational Rehabilitation (CSAVR) were invited to author a paper about how vocational rehabilitation agency leaders view and value participation in research. Two additional papers report on recent related research.

The relationship between earnings and SSDI benefits receipt has been a major issue in the United States since the program began in 1956. One metric used to determine if a person is unable to engage in work is termed "substantial gainful activity," a monthly dollar amount calculated by the Social Security Administration. State vocational rehabilitation agencies provide employment services to people with disabilities including those receiving SSDI.

"We are in another economic downturn. It is not easy to predict what will happen and how this will affect people with disabilities, but if past is prologue, the next few years may see more applicants to poverty and disability insurance programs," explained Dr. Foley and Dr. Sevak. "During the coronavirus pandemic, vocational rehabilitation agencies are again innovating to consider more remote and virtual ways of connecting, expanding dual customer approaches to serve businesses and workers as clients, and looking for more tools to put in a practitioner's toolbox. Finding solutions to help people return to work and find work that can provide economic stability will be an important role for state vocational rehabilitation agencies."

The Rehabilitation Services Administration funded the SGA Project to identify vocational rehabilitation agency practices that lead to improved earnings for SSDI clients upon completion of vocational rehabilitation. It awarded a cooperative agreement to the Institute for Community Inclusion at the University of Massachusetts Boston and Mathematica Policy Research.

Working with more than 100 practitioners representing over 20 vocational rehabilitation agencies, the design phase of the SGA Project identified high performing agencies and key practices that might contribute to that performance with the ultimate goal of designing an effective intervention.

The testing phase of the project tested an intervention designed to improve earnings outcomes of SSDI beneficiaries who were clients of Kentucky and Minnesota state vocational rehabilitation agencies. Mathematica Policy Research assessed service, employment, and earnings outcomes, while ICI interviewed and followed SSDI clients who participated to understand why people seek work, what influences their choices about earnings levels, and how vocational rehabilitation services played a role in their decisions.

Frank Martin, PhD, and Purvi Sevak, PhD, both from Mathematica, Princeton, NJ, USA, review the implementation and impacts of the SGA Project demonstration in Kentucky, They describe the SGA Project model components, the implementation experience in Kentucky, and the impact of the innovations on vocational rehabilitation service and employment outcomes. Although results from the present study showed that participants did not consistently receive all components of the innovations, the innovations led to a 17 percentage point increase in clients with a signed individualized plan for employment (IPE) within 30 days of application, an 8 percentage point increase in closures with competitive employment, and a nearly 6 percentage point increase in the number of clients with earnings at or above the SGA level. The SGA earnings threshold for non-blind SSDI beneficiaries was $1,090 at the start of the testing phase in 2015 and $1,170 at the end of the testing phase in 2017.

A noteworthy aspect of the project was that it emphasized financial counseling, which required the hiring of work incentive coordinators, who were trained and certified to provide a much richer set of early and ongoing financial counseling. "Kentucky's successful implementation of an office-level random assignment design permitted a rigorous test of the SGA Project innovations," noted the authors. "Early, positive impacts on key outcomes suggest other agencies might use this approach to rigorously assess the effectiveness of new services and programs and for a broader set of vocational rehabilitation clients."

Key findings from the SGA Project include:

• Delivering services at a faster pace is feasible. The number of days to signed individual plan for employment (IPE) was reduced; the number of clients with a signed IPE within 30 days of their application increased by 17 percentage points. Quicker access to and progress through services allow people to maintain momentum in their search for work.

• SGA Project innovations can increase competitive employment. A combination of rapid client engagement, a faster pace of vocational rehabilitation services, financial and benefits planning, job placement services, and a coordinated team approach led to an 8 percentage point increase in employment and a 5.7 percentage point increase in the rate of SGA-level earnings for SSDI beneficiaries, potentially helping them on their path to higher income and financial independence.

• People with disabilities are able to return to work after receiving SSDI benefits. Researchers found that having a team of trusted individuals to provide accurate information, counsel clients, and help identify the types of jobs clients would like to do in their local labor market was a successful strategy.

• Partnerships between state vocational rehabilitation agencies and researchers in universities and private organizations are increasing knowledge about what will work to help people with disabilities advance economic opportunities.

• Randomized controlled trials of public vocational rehabilitation services, the gold standard to find out what works, while admittedly challenging to implement, are possible.

• Research that vocational rehabilitation agencies value and can use have a likelihood of improving outcomes for clients.

Writing about the Council of State Administrators of Vocational Rehabilitation (CSAVR), John Connelly, JD, and Stephen Wooderson, MS, both from CSAVR, Rockville, MD, USA, present the case for why researcher-vocational rehabilitation partnerships are an important strategy for innovation and provide suggestions for strengthening those partnerships.

CSAVR launched its Vision 2020 goals with an express interest in innovation. The CSAVR is a membership organization of the chief administrators of the 78 public vocational rehabilitation agencies. The Council's members and their agency staff assist some 1.2 million persons with disabilities to become or remain productive members of the workforce, as well as provide support to their business customers with such issues as recruitment and the provision of reasonable accommodations.

The authors describe CSAVR's investment in research and provide data from a survey of state vocational rehabilitation agencies on research participation. "Researchers can increase state vocational rehabilitation agency participation in their projects by involving the agency in study design, minimizing the time and resource burden on the agency, and demonstrating that the proposed research will yield products that benefit customers and improve staff competency," they commented. "Vocational rehabilitation agencies are motivated to engage in research that will clearly add value and improve operations with minimal burden. It is hoped that greater agency participation in research will yield better data to guide agencies in the future."

The Guest Editors point to some of the challenges encountered during the project. Access to work incentives counseling, finding high paying jobs through job placement services, and team communication across large geographic areas can create barriers to services for people receiving SSDI. Another challenge noted was that vocational rehabilitation staff may be skeptical in adopting the SGA model. "Because the pacing innovation was a major shift from their usual, more deliberate approach, some counselors initially resisted adopting the faster approach," they commented.

Dr. Foley and Dr. Sevak suggest that the rapid engagement coordinated team approach studied by the SGA Project is another tool in the toolbox to attain goals. "We are finding more and more practices that are showing promise. Team approaches, rapid response, and dual customer strategies that match talent to opportunity are evolving. Every worker gets a job, every job gets a worker," they concluded.

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