Leiter, V., & Wood, M.L. (1997). Case management at work for SSA disability beneficiaries: process results of the Project NetWork. Social Security Bulletin, 60 (1), 29–57.
- This article summarized the results of a process evaluation of Project NetWork, a demonstration launched by the Social Security Administration (SSA) to test various strategies for providing vocational rehabilitation (VR) services to its disability insurance beneficiaries as well as blind and disabled applicants for and recipients of Supplemental Security Income benefits.
- The study, which was part of an evaluation that also included impact and cost analyses, assessed the feasibility of providing VR services to SSA beneficiaries with severe disabilities. It drew on interviews with program staff, management information system data, and a variety of program documents to examine the roll-out and implementation of four models of service delivery, each implemented at two sites.
- The authors determined that it was feasible to recruit people with severe disabilities for a rehabilitation program and provide the range of required services. Models with varying institutional arrangements were equally successful in attracting the interest of this population and arranging for the services they needed to meet their vocational goals.
Features of the Intervention
The SSA launched Project NetWork in 1991 to gauge the viability of providing the range of needed vocational rehabilitation services to its beneficiaries with acute disabilities. Specifically, it tested four models for recruitment and service provision that varied in intensity and by hosting institution. The four models, each implemented in two sites over a 24-month period, included the following:
- The SSA Case Manager Model, in which existing SSA staff without a VR background conducted case management (with support from field consultants with VR experience)
- The SSA Referral Manager Model, in which existing SSA staff without prior VR experience were again asked to take the lead, but only in referring beneficiaries to external providers of case management services (preferably those who could offer no-cost or subsidized services)
- The Private Contractor Model, in which private sector providers with VR expertise conducted case management
- The VR Outstationing Model, in which staff from state VR agencies were out-stationed to local SSA offices to act as case managers
The eight study sites were located mostly in urban areas in eight states.
Features of the Study
This study examined the implementation of Project NetWork’s four models of service delivery. Specifically, it assessed the efficacy of the variety of outreach strategies used; whether it was possible to provide all the services to a beneficiary pool with widely varying disabilities and goals needed; and how progress on outreach and service provision varied across the four strategies. It also highlighted implementation successes and challenges throughout different phases of the program. To gather these data, the evaluators interviewed program staff at all eight sites at four points during the program period—conducting about 200 in-person interviews with case managers, referral managers, project leads, and relevant administrative staff. In addition, the evaluators drew on program data and documents, which included procedures manuals, forms used by staff to guide program processes, notes from calls between headquarters and local staff, and 160 beneficiary case folders (20 from each site).
Overall, the study found that all the models achieved similar results in terms of meeting recruitment and intake goals and serving a variety of beneficiaries. As intended, the SSA Referral Manager Model provided services at lower intensity. It relied largely on existing assessment information, developed individual referral plans rather than the more comprehensive individual employment plans, and purchased fewer services.
The study also highlighted a number of successes and challenges with various aspects of the program:
- Recruitment. The demonstration met its recruitment targets—5 percent of all eligible beneficiaries volunteered to participate in Project NetWork. Of the variety of recruitment strategies used, quarterly invitation letters to SSA beneficiaries were most successful, bringing in the majority (60 percent) of all volunteers, who numbered 8,248 in total. However, considerable backlogs developed in response to these mailings, which resulted in delays in starting screening procedures and service provision. The authors suggested sending smaller batches of invitation letters more frequently to prevent such backlogs.
- Intake. After beneficiaries expressed interest in the program, they were invited to take part in an informational interview and randomly assigned to the treatment or control group. During intensive periods of beneficiary intake, those already enrolled in the program did not always receive the attention and support they needed from program staff. Study participants suggested different staff members perform the beneficiary intake and service provision functions in the future to ensure that program participants received the support they required at all times.
- Conducting initial assessments. Managers gathered medical, psychological, and vocational assessment information on the beneficiaries to gain a comprehensive understanding of their goals, needs, and work-related limitations. Most medical and psychological assessments were obtained from the beneficiaries’ existing providers at no cost, which enabled managers to reduce spending, but resulted in delays that had a detrimental effect on beneficiaries’ interest in the project. There were also delays in obtaining vocational assessments, which some managers addressed by conducting the assessments themselves.
- Preparing plans. Staff in three of the four models developed individual employment plans, which specified the beneficiaries’ work-related goals and intermediate objectives, services to be provided to the beneficiary, and core activities to be completed by the case manager and beneficiary. The SSA Referral Manager Model sites prepared individual referral plans, which only described goals and listed referrals to external providers, and took less time to develop than the more comprehensive employment plans. Program managers across all the sites expressed the need for more training on preparing these plans.
- Service delivery. After completing a plan, program managers brokered a variety of rehabilitation services for beneficiaries, of which job placement support was most common (it was provided to 30 percent of all beneficiaries). Other services included training, transportation support, specialized services, and medical and psychological services. Beneficiaries were also provided assistive devices, financial support to cover employment-related costs (such as uniforms and tools), and assistance with emergency costs. In the SSA Case Manager and SSA Referral Manager models, managers found the compilation of lists of service providers particularly challenging given their lack of experience in the field.
Considerations for Interpreting the Findings
This was a focused study that set out well-defined research questions and structured its analysis to provide targeted information on the feasibility of the program. Quantitative management information system data supported the findings, providing an overview of levels of participation and beneficiaries’ progress through various program stages, and qualitative interview data collected at strategic junctures throughout the program, which offered insight into the feasibility of key activities, from program launch to intake to service provision. The article did not provide enough information on data collection and analysis to be able to assess the reliability and objectivity of the data and the methods used to elicit findings. However, there were no indications of bias in the article—the authors were neutral in describing key findings and highlighted both successes and challenges in implementation