Improving Access to Disability Benefits Among the Chronically Homeless Population: SSA-HOPE evaluation outcomes

Marion McCoy, Ph.D.

Mustafa Karakus, Ph.D.

William Frey, PhD

President’s Initiative: End Chronic Homelessness in 10 years (2013)

•To support this goal, the Social Security Administration (SSA) funds HOPE projects that provide outreach services and disability application assistance to individuals who meet the HUD definition of chronically homeless.

Previous relevant research:

• Income support is a significant factor that differentiates people with mental illness who are domiciled from those who are homeless (Rossi, 1989).

•Successful housing outcomes for veterans who were homeless and had mental illness are associated with receipt of public support payments (Rosenheck, et al., 1995).

• Inter-agency efforts to integrate services enhance access to disability benefits among people who are homeless and have mental illness (Rosenheck, et al., 1999).

SSA- Homeless Outreach Projects and Evaluation (HOPE) Awards

•In 2004, 41 HOPE cooperative agreements to public or private organizations in every region of the country were awarded.

•Programs received 4 years of funding.

•Current HOPE programs end in September, 2008.

Project HOPE Goals

•Outreach and engage people who are chronically homeless and have a disability

•Assist enrollees with disability benefit applications Improve quality and timeliness of medical evidence Enable quick determinations and benefit payments Reduce processing time for SSA and Disability Determination

Services (DDS)

•Provide enrollees with housing and support services Improve housing status and quality of life

Components of the SSA-HOPE “intervention” for HOPE grantees:

•A training manual about the SSA disability processing system;

•Assigned liaisons in Disability Determination Services (DDS) & SSA offices;

•Technical assistance from liaisons & staff at SSA HQ;

•Annual grantee training conferences

Study objective:

•Assess differences in client outcomes for HOPE grantees compared to comparison groups

Focal outcomes: Time to determination decisions (i.e., to allow or deny disability entitlements)

HUD definition of a person who is chronically homeless

•Unaccompanied individual;

•Has a disabling condition;

•Has been continuously homeless for a year or more OR 4 episodes of homelessness in last 3 years;

•Has been sleeping in a place not meant for human habitation or living in a homeless shelter

A “disabling condition” in HUD definition for chronic homelessness:

•Limits an individual’s ability to work or perform 1 or more activities of daily living;

•Is diagnosable (e.g., substance abuse disorder, serious mental illness, developmental disability);

•Includes the co-occurrence of 2 or more of these conditions

Primary Evaluation Data Sources

•HOPE program quarterly reports

•HOPE Web site records

•Focus groups (with program staff, SSA FO, & DDS)

•HOPE site visits and interviews with staff & enrollees

•SSA “831” data (info that DDS used to make a decision about disability benefits)

For HOPE enrollees For Comparison Agency participants

Comparison agency groups

•Comparison agencies do similar work with the same population but do not receive HOPE funding

•Comparison agencies

Randomly assigned, 17 agencies received HOPE training manual (C1); 14 agencies did not (C2)

•31 comparison agencies were recruited in the HOPE grantees’ locales; 19 had 831 data available for the evaluation

HOPE Analysis: Procedures

•Mixed methods: both quantitative and qualitative analysis procedures were used

Content analysis was used to analyze qualitative data from focus groups, quarterly reports, and site visits

Descriptive and statistical procedures were used to analyze HOPE web site and 831 data

HOPE Final sample composition

•831 data for HOPE enrollees on timing and final decisions for benefit allowances.

N=3,055

•831 data for comparison agency clients on timing and final decisions for benefit allowances.

N=198

•Final sample size: N = 3,253

HOPE Final Sample Demographics(Total N= 3,253: HOPE programs n=3,055 Comp. Agencies n=198)

Age HOPE Comp.

Under 30 14.1 10.1

30-39 18.2 18.7

40-49 34.9 33.3

50 + 32.6 37.9

Average 42.8 years 45.0 years

Median 45 years 47 years

Gender*

Male 54.7 45.5

Female 23.0 24.2

No 831 data 22.3 30.3Note: All numbers in percentages except average and median age. *Gender distribution is significantly different (Chi2 p=0.016).

HOPE Final Sample Demographics (cont. 2)

Race HOPE Comp.

White 22.8 20.2

Black 14.0 10.6

Other 6.8 8.1

No 831 data 56.4 61.1

Note: All numbers in percentages. *Education is significantly different (Chi2 p=0.007)

Education* HOPE Comp.

Less than high school

25.7 36.9

High school 40.9 36.4

More than high school

26.0 20.7

No 831 data 7.4 6.0

HOPE Final Sample Demographics (cont. 3)

Note: All numbers in percentages.

Disability HOPE Comp.

Psychiatric/emotional 52.6 56.1

Musculoskeletal 14.3 11.6

Other disabilities 33.1 32.3

Cox Proportional Hazard Model

Variables Hazard Ratio

Robust std. err.

Prob.

HOPE Program 1.24 0.11 0.013

Age LT30 1.01 0.08 0.929

Age 30-39 1.13 0.04 0.001

Age 40-49 1.00 0.03 0.909

Male 1.07 0.06 0.214

Gender - N/A 1.00 0.07 0.962

Psychiatric/emotional

1.06 0.06 0.345

Musculoskeletal 0.93 0.03 0.029

White 1.09 0.10 0.355

Race - N/A 0.75 0.08 0.006

Less than high school

1.06 0.04 0.111

High school 1.03 0.04 0.522

Note: Proportionality assumption cannot be rejected at 0.01 percent. (chi2=204.57)

“Time to determination” calculations

• TtoD: the time between the date a disability application is filed and the date that DDS reaches a decision (to allow or deny benefits to the claimant).

•HOPE enrollees received determinations almost a month earlier than claimants in either of the comparison agency groups who received the HOPE manual (C1) or agencies that received no support (C2).

Propensity Sore Matching

N

Treatment

NControl

Avg. Treatment

EffectStd. Error T-stat

2,252 196 -0.8 month 0.30 -2.65

Note: We apply Average effect of Treatment on the Treated (ATT) estimation with the Radius Matching method (bootstrapped standard errors) in our propensity score estimation.

Summary:

•Outcome analyses show that the SSA-HOPE “intervention” effectively reduced processing time for initial disability claims compared to local comparison agencies that did not receive SSA help.

Other findings

•Approximately 41% of initial or reconsidered claims were allowed benefits in the final sample

No significant differences found for• allowance rates for HOPE program vs. comparison agency (C1,

C2) clients; • allowance rates for comparison agencies that received the

HOPE training manual (C1) vs. those that didn’t (C2)

•HOPE enrollees’ living status at 1 year was significantly improved over status at intake (HOPE website data)

•HOPE programs with successful outcomes report increased inter-agency coordination and cooperation

Thank you!