1. CALIFORNIA’S INDIVIDUAL SELF-SUFFICIENCY PLANNING (ISSP) PROJECT
SOCIAL SECURITY ADMINISTRATION (SSA) STATE PARTNERSHIP INITIATIVE (SPI)
CALIFORNIA’S
INDIVIDUAL SELF-SUFFICIENCY PLANNING (ISSP) PROJECT
Talking Points:
As _______________, I am privileged to tell the ISSP story – what we wanted to do with this grant, what happened, our outcomes, lessons learned, and systems recommendations. INTROS

2. CALIFORNIA ISSP PROJECT
California awarded $3.5 million, five year research and demonstration project to assist individuals with severe psychiatric disabilities go to work and lessen or eliminate SSA benefits
One of eighteen State Partnership Initiative Grants nationwide
Talking Points:
7 years ago SSA and RSA put out to states RFA to come up with innovative research and demonstration projects that would assist SSA recipients to go to work and get off benefits.
While 9 million on SSI/SSDI – less than ½ of 1% get off benefits because of going to work.
Particularly concerned with those with psychiatric disabilities – fastest growing disability group.
Statewide stakeholder’s group came together in summer of 1998 and put in a proposal that became one of 18 projects awarded nationwide, called the State Partnership Initiative, or SPI.

3. CALIFORNIA ISSP PROJECT
Statewide multi-constituency group provided oversight, developed program design
Kern County On Track Employment Services, San Mateo County Vocational Rehabilitation Services project sites
Allen, Shea and Associates Program Evaluator
Department of Rehabilitation managed grant, provided vocational rehabilitation services through Mental Health Cooperative Programs
Talking Points:
Oversight committee met quarterly throughout the project – EDD, DMH, DHS, DSS, SSA, DOR, key project staff, line and admin
Via RFA VRS and OTES selected – 17 applied
Via RFP John Shea selected as project evaluator
DOR managed grant and made available VR services locally.
2 project sites part of California’s 25 Mental Health Cooperative Programs – DOR and county mental health worked together to assist persons with severe psychiatric receive employment services and mental health supports.

4. “Scariest thing about going to work is the fear of losing my healthcare.”
Talking Points:
One of our earliest steps was to ask the people we were planning to serve what was getting in the way of going to work, and what kind of services they would find helpful.
The most common responses was dealing with the fear of losing their benefits and help in sorting out the complexity of benefit programs, SSA, Medi-Cal, welfare, supportive housing, and what happens when they try to go to work.
ISSP Participant

5. HYPOTHESIS The employment supports of benefits planning
and service coordination before, during and
after existing vocational rehabilitation and
mental health treatment programs will:
Increase employment earnings
Increase employment success rate
Decrease public mental health costs
Decrease SSA benefits
Talking Points:
Responding to consumer’s needs we wanted to add the ongoing employment supports of benefits counseling, planning and management and service coordination to existing available employment services and mental health treatment.
We found that long term employment supports was generally not provided here in California, and we wanted to demonstrate via a rigorous research design that this service would generate increased employment success and earnings, and decreased public mental health and SSA benefit costs.

6. CORE SERVICES Grant Funded Existing Services Available
Benefits counseling, planning and management
Ongoing service coordination and employment support
Existing Services Available
Vocational counseling, training and education
Employment preparation, job development and placement
Mental health treatment
Talking Points:
This slide depicts the essential core services that were made available to our grant participants. For anyone wanting to replicate the results we achieved, this is the blueprint to follow. Funded by the grant they received ongoing benefits planning and service coordination that was provided before, during, and after the vocational counseling, job placement and mental health treatment that was available as part of the existing mental health cooperative program.

7. THE BENEFITS PLANNER/SERVICE COORDINATOR TEAM
Provide benefits and budget education, planning and management assistance
Counsel impact of work on household income
Assist with service and benefits acquisition
Assist with employment and career counseling
Collaborate with community service providers, to include SSA field office
Mitigate overpayment and eligibility problems
Provide consultation/training to colleagues
Talking Points:
For the new, or grant funded services this slide provides a depiction of the job duties of the 2 person benefits planner/service coordinator teams fielded at our project sites in San Mateo and Kern counties.
Any of these services can and are provided by such professionals as VRCs, mental health workers, employment specialists, job developers, job coaches and social workers.
What is new is defining long term employment support in terms of this constellation of job duties, and creating positions to deliver this service.

8. “Being able to come back time after time to hear the same information about work incentives helped me a lot to take some of the fear out of working.”
Talking Points:
Not only were participants involved in helping design the project’s service delivery, their input was solicited throughout the project.
Work incentives from SSA, Medi-Cal, welfare and supportive housing are very complex, especially when they interact with each other. A common response from our participants was that consistent redundancy was very helpful in understanding the rules, feeling safe enough to make employment efforts, and making fiscal decisions where they could plan on a reliable outcome.
ISSP Participant

9. SSA WAIVERS SSA approved California in May 2001 to pilot 4
SSI waivers for project participants.
These included:
$4 earnings to $1 cash benefit reduction, instead of 2 to 1
Ability to save up to $8k in an Individual Development Account per year, instead of $2k
Count unearned income as earned income for the 4 to 1 reduction
Suspension of Continuing Disability Reviews during waiver participation
Talking Points:
About mid-way through the project SSA approved four states to pilot 4 SSI waivers as an additional encouragement for project participants to work.
Instead of losing a dollar of benefits for every two dollars earned, they could earn four dollars before they lost a dollar of cash benefits.
They could save $8k in an IDA per year instead of $2k.
Their unearned income would count as earned income
CDRs would be suspended during waiver participation.

10. THE INDIVIDUAL SELF-SUFFICIENCY PLAN
Participants:
Commit to obtaining and maintaining employment
Choose services and benefits needed
Develop employment support system
Talking Points:
Each grant participant volunteered to enroll by developing and signing an individualized plan to achieve self-sufficiency, and
Committing to pursue employment,
Choosing the services and benefits they needed to work,
And developing the employment support system they needed to stay employed.

11. PARTICIPANT PROFILE All have a severe psychiatric disability
40% Psychosis
56% Mood Disorder
4% Other
All receive Social Security benefits
40% SSI
32% SSDI
28% Both
Talking Points:
To be eligible for participation in the project an individual must have been determined to have a serious mental illness as defined by Kern and San Mateo county mental health, and to be currently receiving SSI, SSDI, or both.
In looking at the demographics of the participants we found that 56% had a mood disorder, 40% had a thought disorder, and that 40% received SSI, 32% received SSDI, and 28% received both.
In terms of age, sex, ethnicity, and education the participant profile was similar to a matched comparison group that we constructed for studying outcomes in the grant.

12. PARTICIPANTS SERVED Maintained active caseload of 150 participants
50 per two person team
Served from 1999 through 2004
286 served during project
Talking Points:
At On Track Employment Services in Kern county we placed one two person team of a benefits planner and service coordinator that served a caseload of 50 people.
At Vocational Rehabilitation Services in San Mateo we placed two 2 person teams that each served an active caseload of 50 persons for the five years of the project study.
From 1999 through 2004 the project served a total of 284 participants, with a total active caseload of 150 at any given time.

13. INCREASED EMPLOYMENT EARNINGS
Average Covered UI Earnings Per Person Per Quarter
$1,046
$895
$634
Talking Points:
This is the first of four outcome slides that depict the results of the project.
The first is the average quarterly earnings per person as reported by EDD in their covered unemployment insurance earnings. The blue line shows ISSP participants with an average of $496 per quarter at intake. After one year their earnings jumped to $895 and then continue to increase to $1,046 after two years. The red line is a closely matched comparison group who received VR and mental health services without the ongoing employment support of the grant. They started at $339 at DOR case opening, rising to $634 after one year, and dropping off to $585 after two years.
$496
$585
$339
1 yr Post Intake
2 yrs. Post Intake
At Intake

14. Rate of DOR Successfully Employed Case Closures
INCREASED EMPLOYMENT SUCCESS RATE
Rate of DOR Successfully Employed Case Closures
72%
39%
Talking Points:
Our second outcome slide matches ISSP participants with a comparison group who received DOR plan services, and whose cases were closed as successfully employed (status 26) or unsuccessfully employed (status 28). The ISSP participants demonstrated a 72% success rate as opposed to the matched comparison group who demonstrated a 39% success rate.
Success rate is the percentage of DOR cases where plan services were provided that resulted in successful employment.

15. DECREASED PUBLIC MENTAL HEALTH COSTS
% Decrease of Medi-Cal Costs Per Person Per Year
21%
16%
13%
13%
12% 2%
This slide shows 2 studies that demonstrate that the provision of employment services, whether resulting in successful employment or not, decrease public mental health costs. DMH’s service unit cost database was merged with DOR’s outcome database to track Medi-Cal billed MH services (minus medications) 1 year before services started and then tracked costs at least 1 year afterwards.
The right bar graph shows consumers of employment services in our MHCOOP programs without ISSP services –it shows an overall 13% drop in costs from 1 yr after services to 1 yr before. However inpatient services showed only a 2% drop 1 yr after case closure. We then studied ISSP participants, who maintained a 13% decrease in cost over 3 yrs after services started, and showed a 21% drop in in-patient services.
Comparison Group (N=591) (1yr. Before vs 1 yr after DOR Closure)
ISSP Participants (N=209) (1 yr Before vs 3.7 yrs after)

16. DECREASED SSA BENEFITS
As of June 2004:
92 participants working (43 at start of project)
17 off cash benefits; 9 more if no waiver
64 reduced cash benefits
11 increased SSDI amount by more than 20%
58 participants not working
Benefit amount increased 12% due to COLAs during project period
Adding the SSI waiver benefits enabled our ISSP participants to keep more of their cash benefits longer. With 4 for 1 rather than 2 for 1 participants could earn over $30,000 and still be eligible for SSI. Anecdotally we observed a significant number commit to full-time, higher paying jobs because of the waiver. We also observed a number of working individuals whose total benefit amount went up because they were replacing lower earnings quarters with higher earnings quarters for SSDI benefit calculation.
Its important to note that at the time we stopped the outcome studies 1/3 of the participants were not working, although of the 286 served only a handful did not show earnings at any time in the 5 yr period. In spite of participants’ efforts and this excellent service, not everyone could work.

17. “Having the support and assistance of the ISSP team has been very important in getting and keeping a job.”
Talking Points:
At the end of the study period our project evaluators, John Shea and Steve Ekstrom, received consumer feedback via personal interviews and structured phone and mail-in surveys in order to supplement our data analysis and feedback from participating grant staff.
It is probably an understatement to say that our participants were pleased with the project.
ISSP Participant

18. LESSONS LEARNED -1 On going benefits counseling/service
coordination is a powerful service
Providing employment services and supports to individuals with severe psychiatric disabilities significantly increase earnings and savings in public benefits
Long term employment support facilitates permanent results
Talking Points:
We certainly proved what we set out to do – that is, ongoing employment supports makes a powerful, permanent difference in people’s lives, and it saves taxpayer dollars. Thus it is one of those things in life where everybody benefits.

19. LESSONS LEARNED – 2 The complexity of SSA rules significantly
impact SSA costs
Resolving benefit payment crises and proactive planning builds trust that SSA supports work
Close, positive relationship with SSA field offices result in overpayment reduction and saves substantial SSA administrative cost
We also learned why benefits counseling and planning is so important, and that is that the complexity of the rules and regulations create a barrier to employment in of itself. Experts are needed not only to translate and make sense of the rules, but to ensure that the system behaves correctly.
Along the way we discovered that our staff’s working relationships with the local SSA field offices resulted in a dramatic reduction in overpayment issues. We would encourage SSA to pursue further research and demonstration study to quantify this savings in administrative cost. They could then determine the cost effectiveness of financing this service as part of their benefits.

20. RECOMMENDATION - 1 Fund Benefits Planning/Service
Coordination as an employment
support before, during and after
transitional employment
services.
Talking Points:
The key word to this slide is the word “Fund”. We have made the case that this service benefits consumers, the vocational rehabilitation system, the public mental health system, and the Social Security Administration. Funding in today’s climate is a challenge. We encourage decision-makers to consider transforming existing service delivery, and also to dedicate new funding, such as the Mental Health Services Act.

21. RECOMMENDATION - 2 Department of Rehabilitation and
County Mental Health work
together to provide
employment services and mental
health supports.
Talking Points:
This project has also provided hard data evidence that our Mental Health Cooperative Programs provide a blueprint for successful employment services, and that persons with severe psychiatric disabilities are more successful when receiving vocational rehabilitation and mental health treatment in a team approach.

22. “The ISSP program gave all of us that were involved one of the biggest reasons to get better. The biggest reason was believing in myself again. It gave me a dream for the future. The program was the best thing Social Security ever had to offer people on SSI.”
Talking Points:
This is an eloquent testimonial from one of our project participants. However, it is also representative of one of many positive responses we received. For staff who have had the privilege of contributing to this project, and have seen a number of individuals literally transform their lives, this kind of service truly represents the best we have to offer.
ISSP Participant

23. CALIFORNIA ISSP PROJECT
Points of Contact:
1. Grant Manager: Warren Hayes (916)
2. Project Site Managers:
Kern County Dennis Farrell (661)
San Mateo County Robert Manchia (650)
3. Project Evaluator: John Shea (707)
These individuals would be happy to provide additional information on the project, from its administration, to its service delivery, to its evaluation.
Questions?