Improving post-school living, learning and earning outcomes of youth with disabilities who receive Supplemental Security Income (SSI): Findings and recommendations from six national PROMISE demonstration sites

Lamar is a 15-year-old youth with Autism who lives at home with his parents and three siblings under the age of 17, one of whom who also has a disability. Together they live in a rent-subsidized apartment complex in an urban setting and utilize a myriad of other needs-based programs that assist them in paying for utilities, food, and healthcare. Neither of Lamar’s parents attended college, and one dropped out of high school. One of Lamar’s parents works outside the home; they live from paycheck to paycheck and many of their monthly bills are currently past due. Both parents report that they are sometimes overwhelmed with managing their household, their finances, and their children’s educational programs and needed supports. Like most parents, they want to see their kids do better than they did and have a better life. However, they are cautiously optimistic and have limited expectations regarding the employment outlook for either of their children who have disabilities. Lamar’s dad states that they are one crisis away from their monthly budget being decimated and their house of cards collapsing in on them.

The experiences described by Lamar and his family are not atypical, but rather represent the lived experience of a growing number of families living in poverty. A 2017 GAO report found a 44 percent increase between 2000 and 2016 in the number of youth with disabilities determined eligible for Supplemental Security Income (SSI), a federal means-tested income program (GAO, 2017). This population of youth with disabilities experiences disparate employment, educational and economic outcomes; fewer than one percent of youth between the ages of 14 and 18 receiving SSI had an open case with a state Vocational Rehabilitation (VR) program in 2015, while only 13 percent of young adults aged 19–23 receiving SSI were receiving public VR services (Rangarajan et. al, 2009). Evidence-based practices and predictors aligned with successful post-school outcomes for youth with disabilities have been identified through previous research. Specifically, paid employment and/or work experiences, parental expectations, inclusion in general education, self-determination skills, social skills, parental involvement, and interagency collaboration were noted as positive predictors of successful employment and educational outcomes (Test, Mazzotti, Mustian, Fowler, Kortering & Kohler, 2009; Wehman, Sima, Ketchum, West, Chan & Lueking, 2015).

Prior to the release of the GAO data, the U.S. Departments of Education, Labor, and Health and Human Services were already monitoring the trend, and collaborated to fund a large, experimental study designed to better understand how implementation of specific evidence-based interventions may change employment outcomes for youth receiving SSI benefits. The Social Security Administration (SSA) also joined this initiative, supporting the national evaluation of the research demonstration project. As noted in the project press release, the overarching goals were to “help child recipients achieve better outcomes, including graduating from high school ready for college and a career, completing postsecondary education and job training, and obtaining competitive employment in an integrated setting resulting in long-term reductions in reliance on SSI” (https://www.ed.gov/news/press-releases/department-awards-211-million-promoting-readiness-minors-supplemental-security-i).

The Promoting Readiness of Minors in Supplemental Security Income (PROMISE) project collectively recruited and enrolled over 13,000 youth between the ages of 14-16 years old receiving SSI benefits across six research sites: Arkansas, California, Maryland, New York, Wisconsin, and ASPIRE, (a collaboration between Utah, Montana, Colorado, Arizona, North Dakota, and South Dakota). Recruitment took place across a 24-month period beginning Spring 2014 and each site was required to enroll and serve a minimum of 2,000 participants. Upon enrollment, participants were randomly assigned to treatment and control groups via an algorithm designed and managed by Mathematica Policy Research, the national evaluator for the project. A package of evidence-based services were available to treatment group participants and their families in all six sites, including paid work experiences and jobs, self-advocacy and social skills training opportunities, work incentives benefits counseling and financial empowerment, career exploration and family coaching and supports.

The articles in this special issue tell an important story of how these six demonstration projects formed a Center of Practice focused on designing, implementing and evaluating successful interventions that improved the employment, educational and economic outlook for young people like Lamar and his family. This special issue features a compendium of information and perspectives from authors and researchers representing each of the six PROMISE research demonstration sites and the National Technical Assistance Center at the Association of University Centers on Disabilities (AUCD). The first section of the issue highlights strategies, interventions, and employment outcomes. Next, multiple articles contribute insight and experience around fidelity to specific implementation models and participant engagement. Finally, the issue concludes with two articles offering key lessons learned as well as recommendations for sustaining specific elements of the PROMISE model beyond the demonstration funding period.

Over the six years of the national research demonstration, the research demonstration projects amassed a significant body of data supporting the impact of evidence-based practices on the employment outcomes of youth who receive SSI. The six projects worked individually and collectively to implement and scale up a complex series of interventions to address the poor postschool outcomes for youth who receive SSI. To accomplish this, the sites articulated a well-defined problem and identified critical stakeholders needed to contribute not only to consensus building, but also to developing solutions and strategies to address the problem and achieve the desired outcomes. They established and implemented fidelity measures to gauge processes and implementation of the intervention, as well as agile continuous quality improvement approaches to elevate stakeholder voices and allow innovations to emerge across the implementation.

From an outcomes perspective, demonstration sites actively engaged in outreach and recruitment strategies, case management services, and other employment and education intervention services. Outreach, recruitment and continued engagement of the target population posed a distinct challenge not only at the beginning, but over the entire course of the demonstration. SSI youth and their families are often a transient population with limited connectivity—lack of transportation places limits on face-to-face communication, while financial pressures restrict access to communication technology. In addition, the complexity of poverty further exacerbated these conditions; family energies are focused on basic immediate needs such as food, housing and security, rather than future-oriented development needs. Demonstration projects engaged in nimble management strategies to constantly improve upon their outreach and engagement practices and provide new and improved engagement incentives to offset participation costs, which had a positive impact on both fronts. Allocating dedicated staff and resources specifically to re-engaging youth and their families who were at risk of dropping out of PROMISE forestalled and even increased the proportion of youth and their families who were continuously engaged with program services.

The projects learned that once youth and families were engaged, interest-based job placement, case management supports and job readiness training were significant predictors of success for youth in work experience programs. The personalized attention provided by a designated case manager was essential in introducing youth and their families to local services and supports and played a critical role in supporting successful work outcomes. Additional findings also underscored the impact of youth and parent expectations on youth engagement in work after completing high school. Finally, collaboration amongst stakeholders was an important contributor to regional cohesion and partner satisfaction, and the most effective methods were identified as development of shared objectives and clearly defined roles, sharing of information and resources, and frequent communication.

Lastly, the final section of this journal highlights an overview of lessons learned and recommendations for replication and sustainability of key service and policy elements from the project sites. It can be challenging for public programs to sustain all components of initiatives such as these without additional funding. However, the authors identify critical elements to be considered as they offer low cost, and potentially cost neutral, options for consideration. The lessons learned through PROMISE regarding implementation of evidence-based service interventions, engagement strategies, and the critical importance of collaboration between the educational, vocational rehabilitation, and Medicaid systems emphasize the need to proactively invest in the youth SSI population. The early introduction of employment-focused services and supports, offered and provided in a manner that acknowledges and addresses the challenges that families living in poverty frequently face, offers a distinct opportunity to positively impact the career trajectory and financial future of many individuals with disabilities.