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Evidence echoes previous literature reviews on the challenges of generating substantive impacts, though customized supports to well-targeted populations show some potential.

The most effective interventions provided intensive, customized supports and services focused on job training, placement, and retention to narrowly defined target populations.

Interventions that provided support services or incentives to help beneficiaries keep more of their benefits when working had small or no impacts on employment, even if spending on services was high.

There is no evidence of SSI or SSDI caseload reductions, even among interventions that improved employment and/or earnings.

Little is known about interventions for improving earnings of people with TBI and PTSD.

Recruiting beneficiaries to participate in demonstrations was difficult, which limited the generalizability of study findings.

Fidelity to the demonstration model is important.

Work incentives and supports can be difficult to implement in the context of SSA’s existing work incentives, creating potential confusion for beneficiaries and program staff.

A strong technical assistance component, with incentives for service providers to accept the assistance, is important to successful implementation.

Demonstrations should be pilot tested before being implemented on a national scale.