By Donald M. Fitch, M.S., Executive Director
Center for Career Freedom
Developing Evidence-Based Practices For Vocational Rehabilitation Programs
An analysis of over five-hundred intake application forms by persons with psychiatric disabilities to the Center for Career Freedom together with their computer skills training records and employment outcomes suggests persons who receive Social Security Disability Income (SSDI) are four times as likely to return to competitive employment as persons who receive Social Security Income (SSI) or Public Assistance (PA).
Implications include a need for more precise definition of research variables, alignment of vocational training program practices with the consumer’s abilities, and government policy reform regarding the economics of recovery.
While our mission is the rehabilitation and recovery of persons with severe and persistent mental illness leading to competitive employment, we’re aware that most jobs, like most disabilities, are not alike.
As consumer/survivors with a long and varied work history ourselves, we knew from experience we had to have sufficient, demonstrable skills to get beyond a high turnover, minimum wage entry-level job to a satisfying economically viable career. The economics of recovery dictated giving up $600-$800/mo. in Government disability, $500-$700/mo. in rent subsidy, $120 in food stamps and $200 for prescription drugs if you were on SSI/Medicaid. The cost to replace these benefits for our students averaged over $1,400/mo. (about $17,000/yr.) We estimated our graduates would have to acquire sufficient skills to gross $12/hr., full time. Twice the minimum wage.
Job market research and labor statistics for Westchester County showed employers would pay this rate for persons proficient in MS Word, Excel, PowerPoint plus 45 wpm in keyboard skills. Proficiency in QuickBooks and medical billing (ICD-9) would pay more.
In order to achieve this goal we chose to become a NYS Dept. of Education Business School and Microsoft Office Applications Specialist Authorized Testing Center as an integral part of our Drop-in Center.
One of the prerequisites to survival in business is information. You’re constantly refining your business as your knowledge of your consumer’s needs, competition, economic trends, compliance, etc. grows. Our applicant/ student/employee outcome tracking system was never anoption and began with our first Drop-in.
Five hundred seventeen intake application forms collected over a four year period were first tabulated by type of government assistance program. The incidence (%) at the Center and government program summaries appear below.
|GOVERNMENT PROGRAM||SUMMARY/ELIGIBILITY/BENEFITS/EARNINGS RETENTION FOR CENTER POPULATION|
|SSI: (30%)||Medically disabled persons who generally have much less than 10 years work histroy. Typical monthly benefits include: Cash income ($639), Food stamps ($120), Medicaid (includes prescription drugs) and Section 8/Shelter Plus rent subsidy (70%). Current government policy allows recipient to keep the first $85/Mo. plus 1/2 of all earnings over $85/mo., up to $1,350/Mo.|
|SSDI: (30%)||Medically disabled persons who generally have more than 10 years of work history. Typical benefits include: Cash income ($778), (ave. @ the Center,), no Food Stamps, Medicare (does not include meds), Section 8/Shelter Plus rent subsidy (70%). Government policy allows recipient to keep up to $800/Mo.|
|SSI & SSDI: (16%)||See above.|
|Public Assistance: (6%)||Needy but not medically disabled e.g. able bodied homeless. Usual benefits include: cash income ($140), food stamps ($120), Medicaid and shelter/housing allowance.|
|None/Applied: (18%)||Not enrolled in any benefit program or application pending.|
Third, employment outcome records; Microsoft certification by program, hours, title, and earnings were examined for all known employed members/graduates. (56)
Finally, all available data for the fifty-six; application forms, training records and employment outcomes were examined. Analysis of the data includes comparisons between the five assistance program groups and across the three populations; “applicants,” “students” and “employees.” Statistically significant differences are noted. Note: For detailed tables go towww.freecenter.org/research.
A chart: “Monthly income of SSI and SSDI, recipients at the Center for Career Freedom” was prepared to provide a pictorial summary of the economic history and recovery patterns of SSDI and SSI recipients before and after joining the Center.
The aggregate lifetime earnings, tax contribution, savings, training expense and return on investment for the fiftysix Center graduates/employees was also calculated.
The summary characteristics of all 517 applicants are presented below. All data are self-reported. The “diagnosis” was verified and refined according to information supplied by the care-giver and prescribed medication.
Demographics; age ( 41 yrs. mean), gender (52% female), ethnicity (76% Caucasian, 15% African American, 4% Hispanic), education (61% some college or more), cash income ($564/mo. avg.) and food stamps (26%), currently working pt (22%).
- Depressive/Anxiety Disorder(40%)
- Bi-Polar Disorder (25%)
- Schizophrenia (22%)
- Schizoaffective Disorder (21%)
- Borderline Personality Disorder(12%)
- Co-occurring disorders; MICA, MRDD, TBI, etc. (10%)
- All others (12%)
- Psychiatric hospitalization (50% ever, 29% past 2 years) and history of alcohol/substance abuse (32%).
- Employment history (78% have not worked in past 2 years or more) last job title; clerical (25%), retail (17%), maintenance (10%), food service (8%)
- Driver’s license (53%), computer at home (39%), registered to vote (56%).
|SSDI||SSI||Difference vs. SSDI|
|Avg. Monthly Cash Income||$778||$565||($213)|
|Some College or More||66%||47%||(19)|
|Registered to Vote||61%||48%||(13)|
|Clerical Positions (Last)||33%||21%||(12)|
|Retail Positions (Last)||10%||21%||11|
*+/- Points; 95% Level
PUBLIC ASSISTANCE VS. TOTAL SAMPLE
Compared to all applicants, statistically significant characteristics of persons on public assistance at the Center include:
|Total||PublicAssistance||Difference vs. Total|
|Avg. Monthly Cash Income||$564||$138||($426)|
|History of Alcohol/Substance Abuse||32%||66%||34|
|Some College or More||61%||48%||(13)|
|Registered to Vote||56%||43%||(13)|
|Borderline Personality Disorder||12%||--||(12)|
|Not Worked in Past 2 Years||78%||90%||(12)|
*Not All Eligible
GRADUATES/EMPLOYED VS. TOTAL SAMPLE
Fifty-six students successfully completed the Microsoft Certification Program and returned to competitive employement. Compared to the total sample, this group was found to have a significantly different proportion of people on seven of the study variable:
|Total||MS Certified/Employed||Differencevs. Total|
|Public Assistance Recipients||6||-||(6)|
|Some College or More||61||78||17|
|Computer at Home||39||56*||17|
*this is an inflated incidence due to a performance incentive offered by the Center; a refurbished Pentium computer for Microsoft certified students who retain employment for 6 months.
Compared to SSI recipients who are Microsoft certified employees, SSDI recipient Microsoft certified employees tended to:
- Have a work history of higher earning rates and more senior job titles.
- Were more self-reliant and proactive in their job search
- Sought positions in small business with less structure and more responsibility
- Required less job coaching and fewer job supports
SSDI graduates were significantly different from SSI graduates on two important dimensions:
- They earned twice as much as our SSI graduates (18,000 vs. 9,080).
- They completed the MS certifications in half the time (1 yr. vs. 2 yrs.).
The chart summarizes a sample of our students/graduates monthly income for SSDI and SSI recipients at various stages in their lives:
- A rise in income before the onset of their illness.
- For SSDI recipients only, a decline in income following the onset.
- Stabilization following initiation of SSI and/or SSDI benefits.
- 1-2 years training at the Center.
- And a rise in actual and projected income for those graduating and entering competitive employment.
Plotting our population’s economic behavior over time, then, overlaying key events in their lives to explain them, unlocked the dynamics of our disability in a new way. Our level of emotional functioning could be viewed as related to our level of earnings. Age and income are more objective standards, easily recalled and verifiable. The dynamics are typical of the Center’s population and represent the majority of recipients.
A dramatic difference between the two groups is the significantly greater income across all life stages and events of the SSDI recipients. While the SSDI recipient’s income rose quickly in their 20’s, it rapidly declined in their 30’s following the onset of illness. The initiation of their SSDI benefits halted the free fall and clearly provided a safety net and economic stabilization. (We also knew from our intake assessment Satisfaction Survey that most of these recipients reported satisfaction with their psychiatrist, medications, therapist and housing.)
For most SSI recipients, their income actually improved with the initiation of SSI benefits. According to this data, initiation of benefits occurred almost ten years before SSDI recipients—perhaps due to the earlier onset of illness with greater functional impairments.
At about fifty years of age, students graduate and enter competitive employment. The economics of recovery for SSDI recipients allow for a transition or work hardening phase of part-time employment. Their earnings can approach up to $800/mo. and they can still receive their disability checks. At the Center, the average of 778 would yield a total maximum income of about $1560/mo.; $12/hr for about 30 hrs. of work/week. A few dollars over the $1,400/mo. selfsufficiency goal.
On the other hand, the certified SSI recipients are faced with a daunting, if not impossible hurdle. The sharp reductions in benefits; even with the Medicaid buy-in, results in a net zero gain point of $400/mo. Put another way, an SSI recipient grossing $400/mo. takes home nothing. All their incremental income are eaten up by earnings penalties stipulated by each of the four government programs.
The SSI recipient profile generated by the data and powerfully illustrated by the chart paints a grim picture. The earlier illness onset and more severe impairment appears to result in less years of education, less years competitive employment and less lifetime earnings.
What is not plotted on this chart are the overwhelming majority who have chosen not to pursue MS certification and/or competitive employment, at this time. (They would have been represented by a flat line).
Prior to our SSI/SSDI research, we learned through experience, conferences and analysis of intake assessment and staff notes that we were challenged by three student tracks: 1) over 2 years to obtain certification 2) 1-2 years 3) under 1 year. Key characteristics of each group are:
- Fragile SPMI
- Hospitalized <1 year (ECT)
- Methadone (MICA)
- Sober (MICA) < 1 year
- Mild MR/DD
- Moderate cognitive dysfunction
- Moderate learning disabilities
- Poor/No work History
- Moderately stabilized, may need housing, medications adjusted
- Moderate work history
- Poor ego strength
- High School/ some college
- Mild learning disabilities
- Stabilized: Meds, $, Housing, Transportation, etc.
- 10+ years work history; types, computer at home
- Some college or graduated
We have found Group 1 requires intensive one on one instruction, Group 2; a mix of both teaching methods and Group 3; small classes.
RETURN ON INVESTMENT
Simply put, ROI asks the question “What am I getting for my money?” Increasingly, the current administration is asking this question about the social services it funds. In some instances more information about the quantity and quality of services delivered is sought e.g. PROS Medicaid Outpatient Program. In other cases its already been decided it would be more efficient to outsource the service e.g. Maximus; Ticket to Work, One Stop, etc.
With the Federal tax cut, NYS budget shortfall, zero increment in Federal funds (President’s Commission Report) and an estimated one-third reduction in government personnel due to retirement in the next five years, increases in the efficient delivery of Social Services e.g. agency consolidation, computerized outcome tracking, per capita cost data, etc. will become the norm.
The average per capita cost for training a student through several Microsoft Certifications and job placement at the Center is about $9,000. This compares favorably to the 12-15K/person/job spent by local federally funded vocational/ employment programs.
Our average MS graduate’s gross annual first year/earnings is about $17,000. That’s a return on investment of over 200% the first yr.
The numbers get very big, very fast when we calculate the contribution of all 56 graduates/employees:
|Annual Gross Income:||972,144|
|Total contribution; year 1:||1,639,948|
|Less total Expense:||504,000|
|Net Annual Gain||1,135,948|
Over an average work-life of 24 years, the total earnings of these 56 people without any raises, cola, etc, is about 23,000,000! The SSDI and SSI savings together add another 10,000,000 for a total contribution of 33,000,000! If we were forced to shut our doors tomorrow, we would feel we have fulfilled our mission.
The study goal was to identify and profile those characteristics associated with the various populations contained within the Center’s recovery spectrum. We felt if we could identify the significant variables, we would then be in a better position to create and test program refinements in order to improve the Center’s success rate.
At first glance, our four year tracking study of five hundred persons with a fifty variable multivariate analysis revealed the somewhat obvious conclusion that past performance and future success were correlated. The data revealed the SSI, SSDI & Public Assistance “handles” were the tip of the iceberg; a number of other variables were correlated with these three government assistance programs codes.
Further examination showed because SSDI recipients have been engaged in competitive employment for at least ten years; they have the experience, proven work skills, interpersonal skills, a full resume with references and a driver’s license. They knew how to dress, how to interview and what’s appropriate office behavior. For the majority ofSSDI recipients their track record of achievement began before employment; with their attendance or graduation from college. They come to the Center to update their keyboard skills and Microsoft certification; Word, PowerPoint, Excel, etc., for career counseling and job placement assistance. They’re on a fast track and our role is their vocational “stepping stone”.
The tougher challenge we quantified was how to refine the training program, career counseling, job placement and supported employment for SSI recipients.
SUMMARY OF FINDINGS
- Microsoft Certified SSDI recipients are four times as likely to return to self-sustaining competitive employment, as SSI Microsoft Certified recipients.
- Study variables which may explain this are significant differences in the years of education and competitive employment, severity of functional impairment/ diagnosis and barriers of government policy regarding economic recovery.
- Analysis of the economics of recovery for SSDI recipients demonstrated the feasibility of transitioning off disability to self-sustaining taxpayer status following the acquisition of sufficient marketable skills to earn at least $12 hr. and the endurance to work at least 29 hr./ wk.
- SSI recipients, in addition to being challenged to overcome their fewer years of schooling and work experience and, their severity of symptoms, are faced with a net zero gain of gross earnings a the $400/mo. level, even with the Medicaid buy-in elimination of the spend down.
- The overall contribution to the economy and return on investment of the Center’s Microsoft Office Specialist and employment program is exceptional.
- Charting income over time and overlaying key life events to explain the variations offers new insights into the dynamics of our disability and recovery.
- Insure all intake, client tracking, supported employment, academic research, etc. include data on the various government benefit programs; SSI, SSDI, Section 8/Shelter Plus, Food Stamps/ Medicaid/Medicare, etc. and earnings/work history. (Re) run these data using analysis of variance, multiple regressions and mapping where possible. (Mining Social Security’s lifetime earnings tracking system data base presents an excellent research opportunity).
- Be aware that combining the SSI and SSDI populations, whether in research or recovery, averages out their dynamics. The increased clarity in understanding their uniqueness has enabled us to tailor our training, techniques, staff assignments, expectations and timetables to optimize our limited funds.
- Legislation to remove significant economic disincentives for SSI recipients is still critical. The Medicaid buy in, Pass Plan, 1619b, Ticket to Work, etc. do not address the enormity of this issue.
- Include some of the business persons who create $6-12/ hr. jobs on the committees that plan and administer vocational programs to provide real world criteria and training needs.
- Encourage the university based research centers that are funded to research our population to expand the scope of their studies to include perspectives and professors from their adjoining Economics and MBA departments. Multi-disciplined studies could include social program economics, bridging caregiver and employer value systems, the effectiveness of various performance incentives commonly used in business e.g. cash bonuses, etc.
- Create a Federal task force comprised of the policy people from the major benefits legislative programs; SSA, HUD, DSS, Medicaid, etc. With the goal of producing an integrated, consumer based viable economic plan for persons on SSI who hope to transition to competitive employment.
- Develop, test and distribute a simple spreadsheet which summarizes the impact on benefits for various earnings scenarios for the majority of SSI and SSDI recipients, to aid in their (caregivers) understanding of the economic opportunities and challenges associated with their recovery.
Donald Fitch, M.S., is the Founder & Executive Director of The Center for Career Freedom, White Plains, New York. Fitch, 64, earned a B.A. in Psychology from NYU’s College of Arts and Science and a Masters in Counseling from L.I.U. His internship was with St. Vincent’s Hospital. A survivor of mental illness, Fitch founded the Center in 1998 after fifteen years in administration, fundraising, consultation and direct care in the non-profit sector. Populations served included persons with mental and physical disabilities, substance abusers, children in foster care, the elderly, persons with HIV/AIDS and others. He also spent fifteen years in business as a marketing consultant, head of his own importing company, a marketing manager at the Pepsi Cola Company in Purchase, New York and as their marketing consultant. He is a Vietnam era Veteran, a father of three sons and a grandfather of four granddaughters.