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WorkWORLD

Benefit Planning Decision Support System:


Assisting People With Disabilities To Find Earnings And Work Incentive Solutions To Low Income and Health Care Problems While Benefiting Taxpayers And Government Policy Implementers

 

Summer, 2003


Mark L. Hill, David J. Ruth, P. David Banks,
James L. Troxell, Robert M. Carlson,
Michael J. Hine, and Simone W. Jones

 

Employment Support Institute
School of Business
Virginia Commonwealth University


Copyright Ó 2003
Employment Support Institute, Virginia Commonwealth University
Richmond VA, 23284-4000

www.workworld.org
workworld@vcu.edu


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Abstract:

The Employment Support Institute (ESI) at Virginia Commonwealth University’s School of Business developed and continuously improves innovative decision support technology, which simplifies complex disability benefit and employment policy.

The system fosters self-determination, informed choice, higher net income, and efficient use of government resources by helping people with disabilities achieve greater self-sufficiency and self-determination.

Disability benefit, employment, and welfare programs currently interact in complex and/or incompatible ways that often discourage and even frighten beneficiaries from seeking employment and increased earnings.  Policy complexity and "incentive incompatibilities" or "perverse incentives" (Scotch, 1994) serve as barriers, not only to the employment of individuals with disabilities, but also to the efforts of policy makers seeking to improve policies and remove disincentives.

ESI has been working with the Social Security Administration (SSA), State agency personnel, Olmstead leadership teams, advocacy organizations, and individual software users to develop and continuously improve the WorkWORLD decision support software to meet these challenging problems.

ESI is working to gain Federal, State, and advocate partners to cooperatively build a national and local infrastructure that will maximize the benefits of decision support technology for people with disabilities.  ESI customizes the decision support system for agencies, organizations, and individual users to build comprehensive strategies focused on creating the best outcomes for citizens with disabilities and taxpayers.

WorkWORLD Knowledge Based Decision Support, in conjunction with ESI’s consultation, technical assistance and training, provides the following advantages:

(1) Software users discover “earnings-based” opportunity paths to greater independence by gaining individualized knowledge about the rules that govern work incentives and benefits, promoting self-determination;

(2) Standardized interpretation of policies is advanced, reports and plans are easily shared, and greater agreement among stakeholders is achieved, reducing confusion and fear;

(3) Policy makers and disability advocates can examine the effects policies have on diverse recipients, identifying when the policies work, when they are in conflict, and when they produce an unintended outcome; they can compare the value of different State employment policy initiatives from State-to-State;

(4) ESI Policy Analysts, as they are programming specific calculations and text results, often discover policy interactions that result in disincentives to employment.  WorkWORLD can then be used to help leadership understand those gaps and disincentives.  ESI Policy Analysts can also use the pre-WorkWORLD Excel calculation engine to help leadership test their policy ideas by, for example, modeling various proposals to see which of the proposals achieve a more seamless Medicaid Buy-In that rewards substantial gainful activity while insuring safer self-sufficiency;

(5) ESI staff can help people with disabilities and their advocates to use WorkWORLD decision support and other Information Systems applications that help them manage individual budgets/vouchers, consumer driven Medicaid waivers, and other Self-Determination requirements;

(6) WorkWORLD downloadable consumer stories and case files, available at http://www.workworld.org/DownloadMain.html#CaseProfiles, are provided to teach people about the advantages and options associated with SSA’s new Ticket to Work program and other empowering benefits and work incentives;

(7) ESI staff provide training, consultation, technical assistance, and continuous improvement of WorkWORLD software, related Information System tools, and the WorkWORLD Internet site (www.WorkWORLD.org);

(8) ESI provides multiple ways to use the extensive indexed, hyperlinked, and searchable help system that has evolved: a) the help system is integrated into the software so that a user is provided context sensitive direct access to specific topics related to individualized questions, alerts, and recommendations; b) the help system is made operational on the WorkWORLD website (without context sensitivity) and provides one of the most comprehensive disability policy databases available anywhere; c) ESI facilitates electronic linkages with our State partners by identifying within their e-government efforts opportunities to link to specific content within the WorkWORLD help system furthering the concept of a “virtual” help wizard;

(9) ESI provides an important addition to eligibility and resource finding systems that many states are investing in by augmenting those efforts with a system that “encourages earnings based solutions to low income,” and ultimately a reduction in the need for government intervention.

A model for facilitating collaboration has been developed and is presented, along with selected implementation highlights from several states.

To view another article discussing how WorkWORLD can help foster effective Self-Determination, go to http://www.bus.vcu.edu/esi/sd/selfdetermine.html


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Table of Contents

Abstract

Introduction

What is the Problem?

ESI Applies Technology and Business Solutions

ESI Begins Development of WorkWORLD

A WorkWORLD “Network of Collaborators” Emerges

State Partners in the WorkWORLD Collaboration Network: Maximizing Outcomes

Massachusetts

Oklahoma

South Carolina

Virginia

Georgia

Delaware

South Dakota

Iowa

North Carolina

Future Collaboration Innovations

Archetypes and Person Roles: Maximizing Outcomes with the WorkWORLD Decision Support System

Federal, State, and Advocacy Organization Based Decision Support Facilitator (DSF)

ESI and State Based Policy Analyst Interpreter

Decision Support Developer/Analysts (DSDA)

Web Site Builder and Manager

WorkWORLD Benefits Consultant/Trainer

Volunteer Community Facilitator

People with Disabilities

Summary

Footnotes

1.  The Olmstead Decision

2.  “Independence Plus” Medicaid Waiver Templates

World Wide Web Resources for KBDS Systems

References

 


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Introduction

What is the Problem?

Current disability benefit, employment, and welfare programs interact in complex ways that often discourage beneficiaries from seeking employment and increased earnings.  People with disabilities who wish to work often fear they will be forced to choose between giving up benefits and supports and their efforts to achieve independence through earnings.  They must navigate highly complex policies and procedures with the programs they currently use, and the programs they could potentially use, to determine a plan of action that leads to greater independence.

In addition, Federal and State social programs spawned from divergent special interests often interact in conflicting ways.  This diversity in benefit and work incentive programs creates a confusing and convoluted environment for people to understand and navigate.  People with disabilities, their advocates, and the professional community alike find it difficult to make confident informed choices about benefit options and employment goals when they encounter these complexities.

Further, even with recent reform legislation, including Public Law 106-170, the Ticket to Work and Work Incentive Improvement Act of 1999 (Social Security Administration (SSA), Office of Employment Support Programs, 2000), many "incentive incompatibilities" among the social poverty and benefits programs remain.  For example, people with disabilities must demonstrate that they are unable to work because of their disability in order to be eligible for SSA benefits, but once determined eligible they are encouraged to use work incentives to achieve earnings (Social Security Handbook, 2001).

People with disabilities fear that working might demonstrate work potential that could threaten their continued eligibility.  This belief is especially true for those that are not expert in the details of work incentive use, a very large population of SSA recipients and beneficiaries.  There are nearly eight and one-half million working age (18-64) SSI and SSDI recipients and beneficiaries (Social Security Administration, Office of Policy, 2001).  Fifty percent of SSI recipients receiving wages are labeled persons with mental retardation, but they comprise only about 24% of all SSI recipients aged 18-64.  Only 8.7% of 18-64 year old SSI recipients receive earnings; 55% of those working make under $200 a month and 66% make under $500 a month (SSA, SSI Recipients who work, Quarterly Report, March 2003).

A major source of incentive incompatibility results from the fact that both eligibility and benefit levels for many government benefits are tied to earning levels.  Programs such as Housing rent supplements, Supplemental Security Income (SSI), Disability Insurance (SSDI or Title II), Medicaid, Medicare, Food Stamps, and Temporary Assistance to Needy Families (TANF) are characterized by benefits that either disappear or are reduced when a beneficiary's earnings rise.

In addition, people come from a variety of perspectives and often interpret policies differently.  When policies are interpreted inconsistently, there is increased confusion, fear, and caution; all factors which increase the potential for employment-incompatible responses (Hill, et al, 1998; 2002).  People considered experts within their own agencies often provide contradictory interpretations of policy regulations.  For example, Policy Analysts at the Employment Support Institute (ESI) at the Virginia Commonwealth University School of Business expend significant effort to get “agreement” from internal experts about what a specific policy actually means.

Field people in regular contact with the public are expected to deliver “accurate” policy information.  This is an unrealistic expectation when personnel writing the regulations frequently disagree with each other about what a policy actually means.  Further, there is a lack of training to help field representatives become “expert” at policy interpretation.

Incentive compatibility (that is, compatibility between the actions you want to encourage individuals to take and the incentives that you offer them for doing so) is critical for encouraging productive human behavior (McWhirter, 1993; McCoy, 1992; Scotch, 1994).  However, the lack of coordination across policies, programs, and agencies has resulted in a system of "perverse” or counterproductive incentives for people with disabilities (Scotch, 1994).  Many people who use government program supports have great difficulty navigating the different program eligibility rules, their qualification for various waiver programs, and the possibilities for using work incentives that may be beneficial to their situations.

Harris reports that 72% of non-working people with disabilities want to work (National Organization on Disability, 1998).  The reasonable fears people with disabilities have of losing disability-related benefits as a result of earnings, however, is a real factor in maintaining their high unemployment levels.  Perverse incentives, complexity, policy misinterpretation, confusion, and fear combine to reduce the likelihood of employment outcomes that are beneficial for both people with disabilities and taxpayers.

Almost 75% of people with disabilities remain unemployed in an economy that has seen employment opportunities grow for all other workers in the 1990’s.  Current weakness in the economy is likely to drive the percentage of people with disabilities unemployed even higher.  Of those people with disabilities who do work, hours and employment opportunities are significantly constricted by program eligibility guidelines, income limitations, asset limitations, and other complex human service program interactions.

The evidence that nearly all individuals with disabilities could work, if support and environmental changes were provided, has not led to the increases in employment that should have been achieved in the last decade (Nerney, 1998).  Although government programs encouraging work incentive use have grown, they remain largely underutilized, and unemployment continues at unacceptably high rates.  Even with the currently weak economy, 75% unemployment for people with disabilities is inordinately disproportionate to other minority populations struggling with unemployment.

To meet these challenges, it is critical for adults and young people with disabilities and their parents to be engaged in a person driven process at an early stage in planning transition from school to work or from unemployment to employment (Wehmeyer and Lawrence, 1995; Miner and Bates, 1997).  It is equally important to bring people with severe disabilities into any individualized process so that they can make informed choices about how to take advantage of work incentives and other program opportunities for improved independent living and employment outcomes (Foxx, et al, 1995).

However, the confusing policy environment works against achieving real self-determination for people with disabilities, a principle central to the goal of full inclusion, informed choice and economic and social self-sufficiency of people who have disabilities.  Self-determination addresses the limited freedom of choice and independent action experienced by individuals with disabilities and their attendant poverty in the present human services system.  Nerney (1998) maintains that self-determination is dependent on four basic principles:  freedom to develop a personal life plan, authority to control a targeted sum of resources, support to obtain personal goals, and responsibility for contributing to one's community and using public dollars wisely.  Principles of self-determination establish that people with disabilities are the planners and decision-makers in all daily living activities, such as working and taking financial control of service resources and personal income (Southern Collaborative on Self-Determination, 1997).

Unfortunately, these principles will be hard to achieve without tools like WorkWORLD Decision Support technology which help people with disabilities establish a plan based on careful analysis of the interacting policies that affect their alternative choices.  WorkWORLD is assistive software technology developed by ESI to organize complex information and present options for users to consider based on their individual circumstances.  The freedom to establish a personal life plan is an essential ingredient in self-determination, as Nerney proposes, but a clear understanding of the implications of each alternative choice in the development of that plan is unlikely without the use of advanced technology such as decision support software.  The complexities in disability related social policy prevent all but the most gifted individuals from being true “experts.”  Understanding all the implications and options for convoluted situations is possible for many people, however, with the use of WorkWORLD Decision Support technology.

Informed choice and self-determination are real possibilities when decision support software technology is broadly available to provide information that is cross-agency integrated and simplifies individual situations.  People can use the software themselves, or with expert mentor/benefit consultant supports when needed, to evaluate their choices.  Volunteers, for example, have been trained in the high technology community of Colorado Springs to be expert third party benefit consultants using WorkWORLD for people who need additional help using decision support software (Hall, Butzin 2001).

To encourage work and to help make self-determination a real possibility, ESI has been building expertise in Policy Analysis and Knowledge Based Decision Support (KBDS) systems (Holsapple and Whinston, 1996).  ESI has been applying these skills for people with disabilities and their advocates for over a decade.  Through the development of expertise in this area, WorkWORLD software has evolved (Hine, et al, 2003).  A web site, www.workworld.org, also supports users of the software.  The design of the WorkWORLD KBDS system is based in knowledge gained from information systems experts who use new developments in computer hardware and software to help executives and employees make better decisions (Bostrom, 1992; Gray, 1992).  ESI's software clarifies the relationships among multiple policies and programs, and depicts the impact of policies on diverse individual situations.

WorkWORLD users create personalized spreadsheets by answering a series of questions about their current situations.  The questions include personal information such as age, marital status and state of residence, information about the benefits currently being received, and financial information such as earned and unearned income received.  If WorkWORLD finds that the benefits are not in line with the circumstances, then the user is given a list of possible reasons and told to contact the benefit agency to discover whether an over- or under-payment situation exists.  The identification of over and under SSA payments has proven to be an enormous benefit to users of WorkWORLD.  Confidentiality features are included so that consumers can control access to their personal information.

WorkWORLD then calculates whether the benefits received are appropriate for the users' situations or whether additional information is required.  Once the current situation is complete and accurate, users can create "new situations" (new columns in the spreadsheet) to see what will happen to their benefits and net income if they go to work, use a work incentive, or change some other pivotal circumstance that will have significant bearing on their current eligibility or benefits status.   For example, a user may wish to model what will happen when a significant life change occurs, such as a change in marital status, becoming an adult at age 18, or a change in living situation. 

Another simple, but real, outcome that many users discover is that immediate increases in wages and or number of hours worked is allowed without causing risk to their current benefits.  North Carolina WorkWORLD Benefit Consultants report that after providing work incentive and benefit advice consumers often are able to immediately increase their net income through wage increases (State Partnership Initiative-North Carolina Quarterly Report, Oct 2000).

“Greg” gets Decision Support using WorkWORLD:

In Figure 1 and 2 below we demonstrate how the software’s architecture provides decision support to one person at a time.  Greg is a 17 year-old student who recently began getting Supplemental Security Income (SSI) benefits that are reduced from $552 to $172 per month because SSA deems $400/month of Greg's parents' income as being available to him. 

WorkWORLD tells Greg (in Figure 1, the “Text Results” section) that if he knows of education, training, transportation, or other expenses that could help him to become more self-supporting, he might be able to increase his benefit amount by saving or paying for those expenses and including them in a Plan for Achieving Self Support (PASS), one of SSA’s most potent, yet underutilized, work incentives (Hill, 2003).  It also tells him that any PASS amount higher than $380/month would not further raise his benefit.  If Greg "clicks" for more information, WorkWORLD explains the PASS work incentive and tells him what kinds of expenses would qualify.

 

Figure 1: WorkWORLD Text Results

 

Figure 2: WorkWORLD Numeric Results

 

Greg decides that he would like to save $380/month for purchasing equipment that he would need to start a small computer document preparation business after he graduates.  So he uses Column Two to create that “What If?” situation.  The first two columns of Figure 2 show the numerical results.  If SSA accepts his PASS, his SSI benefit amount would go from $172 in Column 1 to $552 in Column 2.  Note that his Net Income (bottom line) stays the same, but that he can set aside $380 each month in a bank account as an "Employability Investment."  Figure 3 shows the same information graphically.

Looking back at the Text Results in Figure 1, WorkWORLD recommends that Greg sees what would happen if he got a job.  Recently Greg's Special Education teacher had suggested that Greg could qualify for an $9.88/hr, 20 hr/wk, computer job through the school's "Career Education" program.  With the appropriate supports, she thought Greg might succeed.  Greg was unsure about pursuing the opportunity, however, because he had only recently convinced SSA that he was too disabled to work (so he could get Supplemental Security Income (SSI) and Medicaid).  Medicaid coverage is essential to him, and he does not want to jeopardize it.

The 3rd column in Figure 1 shows that Greg's fears may be justified.  Since he had not yet received his letter of final determination from SSA, if he earns over the Substantial Gainful Activity (SGA) amount, he might be determined not disabled and therefore lose his SSI and Medicaid. By clicking on the "More Information" link, he finds out that SGA in 2003 is $800 per month.

The 2nd Text Result in column 3 of Figure 1 gives Greg another "Alert."  It tells him that he must take advantage of the Student Earned Income Exclusion (SEIE) if he goes to work.  He had answered "No" to the question about SEIE because he didn't know anything about it and he was in too much of a hurry to look at the "More Info" topic on that question.  This time he clicks on "More Information" and finds out that because he is a student, he can earn up to $1,340 per month without having his SSI check decreased.

Figure 3: WorkWORLD Graphic Results

 

The 4th columns in Figures 2 and 3, show what happens when he does receive the letter of final determination, attempts the “Career Education” job, and counts his earnings as an SEIE.  His SSI benefit remains $552, his Net Income rises from $172 to $1,022, and he's still putting away $380 per month toward his future small business venture.  Perhaps even more important, he does not lose his Medicaid, at least not until his business becomes a real success and he can afford private insurance.

The above example shows how WorkWORLD can help people be better informed and equipped with choices that offer pathways to improve personal net income, health care coverage, and a higher quality of life.  People who are using benefit and work incentive programs can move forward with practical, viable plans for employment.

Research supports the value of decision support and standardized interpretation of policies.  Improving clarity and predictability can result in increased confidence and empowerment for people with disabilities (Smull and Danehey, 1994).  Some users are reporting that as WorkWORLD begins to be used by more people, an improvement in the standardized interpretation of policies begins to take place (State Partnership Initiative-North Carolina Quarterly Report, Oct 2000).

Understanding a person's perspective and situation, providing assistance in making informed choices, and facilitating the growth of "natural supports" (Nisbet, 1992) are valued disability practices.  Further, disability researchers (Nisbet, 1992; Hill, et al, 1998; Nerney, 1998; Moseley, 1999) recommend shifting more locus of control for managing the financial supports of the system from the professional bureaucracy to the person and/or to the person's trusted advisors.  ESI's WorkWORLD Knowledge-Based Decision Support system is specifically designed to help all users gain clear information about the consequences of alternative paths and solutions.  WorkWORLD stimulates motivation to act upon selected paths and helps agencies receiving the self-determined plans to better accept and understand what people with disabilities are proposing (State Partnership Initiative-North Carolina Quarterly Report, Oct 2000).

Unfortunately, without expert information about complex social policy none of the decision makers will be able to build or assess alternative solutions with accuracy.  ESI's WorkWORLD is designed to help the user gain clear and accurate information about the consequences of alternative paths and solutions.


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ESI Applies Technology and Business Solutions to the Development and Enhancement of WorkWORLD

The Employment Support Institute (ESI) was established within the Virginia Commonwealth University School of Business to research, explore, and apply business and technology solutions to social policy problems.

One of the most frustrating and unfair social problems that exist worldwide relates to the inappropriate dependencies created by disability and poverty policies.  The intent of most disability and poverty legislation begins with an honorable purpose: providing supportive environments for people with difficult or disadvantaged circumstances.

Most employment related policy has a “transitional” component.  That is, support is often meant to be temporary while people get their difficulties worked out, gain a job skill, get assistive technology, and/or receive other rehabilitation services.  Long-term permanent supports are usually targeted for people that are defined as having the most “severe” disabilities or situations.  Unfortunately, too often the results of legislation are unmanageable and confusing interagency rules and regulations.  These non-integrated policies can create barriers and stumbling blocks and sometimes-even worse: the reverse of the original intent might be inadvertently rewarded; i.e., un- and under-employment.

One business-spawned innovation to solving complex problems comes from the fields of Business Management and Information Systems.  Specifically, Decision Support Technology (DST) designed to model alternative strategies and their likely results has been found to be quite useful by business leadership and technologists alike (Holsapple, C. W., and Whinston, A.B., 1996; Senge, 1990; Senge et. al. 1994; Bostrom, R.P., Watson, R.T. and Kinney, S.T. (Eds.) 1992).

ESI staff, having previously built Lotus and Excel spreadsheets (Ruth, Hill, and Wood, 1990) and CareerCALC software to help people do the calculations associated with Social Security Administration Supplemental Security Income Work Incentives, began to explore more sophisticated Decision Support Technology (DST).  ESI asked, “Could greater investment in this new technology be used to help manage and improve disability and poverty social programs, especially those related to employment, health care, and self-determination outcomes?”


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ESI Begins Development of WorkWORLD

Once committed to the effort, and with funding from the Social Security Administration (SSA) and others, ESI staff created innovative software design features to help people not only model alternative solutions and their likely numerical results, but to also allow them access to a “context sensitive” hyper-linked Help and Information system and other “text” results which provide individualized alerts, notes, and recommendations.

The ESI team focused on the architecture and design challenge of reducing and simplifying the amount of information each user would have to consider.  The team decided that the software should first ask questions to discover the user’s current situation, and then provide Help and “What If” options related to that individual situation only.  Results are then generated to describe the alternative outcomes selected, in graphs, numerical tables, and in text results.  The inputs and results can be used to build reports and/or short and long term plans.  Files and case scenarios can be saved and exported to communicate with all who are involved with a case via email or networks.  Privacy and confidentiality features are included in the software.

One unique innovation is the prompting of users to “Try alternative work incentive and earnings based solutions.”  Users are provided in-depth Help/Information and results that relate to the person’s current or proposed “What If” situation.  The user discovers opportunity paths to higher net income, health care maintenance, and independence via earnings and work incentives.  Text results include Alerts, Notes, and Recommendations, with “More Information” tabs that take a person to topics in the Help/Information system which relate specifically to the issue at hand.  More detailed information can be obtained by using hypertext links to additional elaboration, when needed.  In some cases the best information is available outside of WorkWORLD, so the Help/Information system will direct people to phone numbers, contact agencies or websites, and if the user is online at the time, open a browser and link to the recommended website.  Navigation buttons allow the user to return to previous screens.

A key advantage of the WorkWORLD design is that information that does not relate to the individual user is avoided or minimized.  Policy provisions and minutiae that do not effect his or her situation do not bombard the user.  Such extraneous unrelated information contributes to confusion, fear, and misinterpretation of policies.  With WorkWORLD, users are able to make decisions based on observed results related to a variety of chosen individualized options.  The effects on net income, health care availability, work incentive options, earnings changes, and other individualized information is provided.

The WorkWORLD KBDS system "computer augments" policy related decision-making.  In other words, the software assists individuals (e.g., policy-makers/implementers, people with disabilities, advocates, and others) to organize and understand information so that productive opportunity paths can be identified and evaluated.  The user’s fear of trying earnings and work incentives is reduced in the process.  [Go to “What is WorkWORLD?” at http://www.workworld.org/WhatIsWW.html for a detailed description of the software features, including accessibility features for people with visual impairments.]

ESI takes a two "path" approach.    Path 1 focuses on empowering individuals and their advocates to navigate current policies, to find opportunities, to achieve employment outcomes, and ultimately, a better quality of life.  Path 2 is directed at system improvement for a better future.  ESI is committed to continuous improvement of decision supports (both technology tools and staff skills) for people who are making and implementing policies and for individuals affected by those policies.


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A WorkWORLD “Network of Collaborators” Emerges

The participation of Federal, State, and advocacy organizations that promote, design, or implement disability and poverty policy is coalescing around an effort to maximize the outcomes possible with the WorkWORLD KBDS system.  ESI is working to help organizations promote or establish new infrastructure designs to take better advantage of decision support technologies.  New Internet, decision support, communication, and collaboration technologies all create the opportunity to help individuals and organizations effectively use the WorkWORLD KBDS system.  Installing new technology within business, government, or the community at large requires special considerations and supports to successfully integrate “technological and behavioral change” into the user community (Orlikowski, 2000; Tichy, 1983; Tillquist, 2000).

ESI’s position is that State, Federal, and advocacy organizations need customized “change” supports since organizations vary on so many levels, including political, strategic, technical, legislative, and leadership within a given community.  States, for example, may vary on the number of State implemented programs, their emphasis on “self-determination” and “informed choice”, their methods of funding providers of employment services, the availability of knowledgeable “benefits consultants”, and the design of the State’s current e-government and information system structure.  Since variety in policy implementation is the nature of a democratic society, ESI recognizes the need to customize personnel and technology support tools to achieve improvement most efficiently.

ESI encourages organizational partnerships where teamwork and facilitated collaboration can point to the best way to use decision support tools, technical assistance, training and consultation in each policy eco-system.  Each collaborating organization benefits the other participants; a win-win network is gaining partners and momentum.  Each collaborator works to simplify, compare and improve overlapping policies, and the benefits of this synergy are becoming increasingly apparent.

The speed, depth, and quality of initiatives on the two important paths described above (i.e., the policy improvement path and the individual benefits analysis and planning path) are, in part, dependent on the emergence of these partnerships.  SSA and ESI are cooperating to build some State differences into WorkWORLD software.  However, more direct state participation will allow ESI to gain information from people intimately involved with specific practices and obstacles, and thus from people who are closer to finding solutions to the problems (Deming, 1986).

Several State organizations have become “collaborators” in the network to improve the comprehensiveness and value of their WorkWORLD system.  We will describe progress in Massachusetts, Oklahoma, South Carolina, Virginia, Georgia, Delaware, South Dakota, Iowa, and North Carolina to illustrate a variety of ways States are integrating and expanding their WorkWORLD capabilities.


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State Partners in the WorkWORLD Collaboration Network: Maximizing Outcomes

ESI actively works with organizations to integrate and use decision support technology to achieve employment outcomes for their citizens and beneficiaries. 

ESI has developed a State Customizing Template describing sample goals, objectives and staff roles.  The sample template is available by request. 

Modifying the software for a particular state, however, is not required and can be considered later in the implementation process.  For example, North Carolina efforts (although they are interested in eventual State-specific information in WorkWORLD) demonstrate that customizing the software is not necessary to reap significant benefits for a State’s citizens.

The sections below present some examples of how WorkWORLD and expert support from the Employment Support Institute is currently being used in selected States.


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Massachusetts

Key personnel of the Massachusetts Rehabilitation Commission (MRC) recognized the value of integrating WorkWORLD into their concept of a virtual decision support system.  William Noone and Claire Ghiloni at MRC have been advocating for WorkWORLD to become an integral part of the broader Massachusetts e-government efforts.  Massachusetts has an award winning strategy to improve services to citizens using the Internet, with MassCares (http://www.masscares.org/) as the cornerstone of their social service comprehensive plan.

MassCARES includes the following technological initiatives:

1.      A Central Information Storehouse (based on the Executive Office of Health and Human Services' effort to construct a single database providing an unduplicated count of all consumers across all 15 of its agencies)

2.      An On-Line Analytical Processing (OLAP) tool providing an ability to access and analyze client and service data in a user-friendly way to improve planning and evaluation

3.      A variety of web-based service tools that will redefine how citizens relate to government and access services.

One such service tool is the Resource Locator providing online search capability for community-level resources for citizens and third party intermediaries.  Another tool is an Eligibility Wizard that will analyze a consumer's demographic data to provide information on the services or programs for which a consumer may be eligible.  In addition, prototypes are being developed on client referral, case monitoring, and risk factor reporting tools.

Strategic conference calls between MRC, ESI, ICI (Institute for Community Inclusion), and MassCARES personnel determined that WorkWORLD goes beyond the eligibility and resource locator type of decision support under construction in many states and completes the important leg of decision support focused on the individual’s fears and motivations to work.  The addition of WorkWORLD in their comprehensive plan provides a tool that illuminates for the consumer a “safe” path to “achieving self-sufficiency through use of individual work incentives.”  WorkWORLD effectively moves people beyond “eligibility” and “resource locator” efforts and toward greater motivation to work, reducing fears, encouraging independence and self-determination.  Helping people become less eligible for services by helping them become more independent completes MRC and MassCARES comprehensive plan for people with disabilities and the agencies that serve them.  Integrating the WorkWORLD decision support system within MassCARES will likely help legislators and leadership to better rationalize expenditures for e-government.  The WorkWORLD effort will show their comprehensive plan includes a tool that focuses on the ultimate goal “to assist people to achieve independence and self-determination” while reducing their need for State match resources.  MRC, ESI, ICI, and MassCARES personnel recognize the value of encouraging people to use their own individual work incentives.  Creating a system that activates individual use of their personal work incentives reduces the need for a State Medicaid match resource.

Once ESI began providing the WorkWORLD Help/Info system on the web, many new State options became apparent.  In Massachusetts we are cooperatively linking and customizing the way web visitors can access knowledge about the Massachusetts system.  In addition to creating links at the MassCARES site, specific sections of the WorkWORLD help system can become integral to other Massachusetts websites.  For example, at the MRC's prototype Transportation Resources website (http://mouseantics.com/transportation/index.htm) there is a link under the category Consumers and Advocates named “Massachusetts Benefits Information System”.  Clicking there leads directly to the Massachusetts’ component of the WorkWORLD Help/Info system, seamlessly connecting a specific State’s customized Benefit Information System to specific content within the overall WorkWORLD Help/Info system.

MRC and MassCARES talks are proceeding and other innovative strategies are emerging on ways to enhance the collaborative e-government effort.

The Massachusetts WorkWORLD Help/Info System contains basic information about State-administered special housing programs, State SSI Supplements, Workers’ Compensation, Transitional Aid to Families with Dependent Children and Emergency Aid to the Elderly, Disabled and Children, among other programs and policies.  It also contains comprehensive information about MassHealth Standard, MassHealth CommonHealth, MassHealth Family Assistance, and other Massachusetts Medicaid programs.

NOTE: This information is available in the current version of WorkWORLD software and is also available at: http://www.workworld.org/wwwebhelp.html.  Use the Table of Contents to go to: Benefits Information, State Specifics, and Massachusetts.  Or use the index and type in "MA.").

MRC also commissioned ESI to integrate calculations and results for the various MassHealth programs into WorkWORLD.  The current version of WorkWORLD will calculate eligibility and, when applicable, the costs of deductibles and premiums for these State health programs.

The Massachusetts experience illustrates one of the important side benefits of creating and testing the calculations to be integrated into WorkWORLD.  ESI Policy Analysts, as they are testing the calculations, often discover policy interactions that may have unintended consequences.  While testing the eligibility calculations for MassHealth Standard and CommonHealth, for example, ESI Policy Analysts discovered a significant disincentive for some SSI recipients who are students living at home.  If such a student is in a family that has income just within the income limits for MassHealth Standard, and if the student goes to work and earns enough to raise that family's income above those income limits, then the student would be eligible for Medicaid through the CommonHealth program.   The rest of the family, however, could lose MassHealth eligibility completely after a transitional time limit has expired.  All of this is true despite the fact that the student may have been advised that the SSI Student Earned Income Exclusion (SEIE) work incentive would keep his or her earnings from lowering the SSI cash benefit.

One cooperative effort, now in its beginning stages, is to create "WorkWORLD Profiles" designed specifically for Massachusetts – stories that will show readers paths to greater independence as well as possible pitfalls such as the one described above.  The stories will demonstrate that some fears about employment are unfounded and some are real; but that in most cases there are ways that work incentives can be used to help individuals avoid the pitfalls while furthering their financial independence through increased earnings. 

The Massachusetts partnership has been characterized by a close and active relationship among ESI Policy Analysts, the in-kind liaison provided by MRC, Bill Noone, and other Massachusetts expert personnel.  MRC determined the priorities, provided much of the information, and quickly researched questions raised by ESI Policy Analysts.  The partnership in Massachusetts has had a special focus on exploring better ways to collaborate with in-kind in-State policy experts.  Emerging software that facilitates collaboration on code and content projects such as WorkWORLD will be assessed with technical and policy expert in-kind personnel in Massachusetts.

In connection with the customization of WorkWORLD software in Massachusetts, the Project Impact Benefits Planning, Assistance, and Outreach Project has established an electronic case management system as the cornerstone of its services.  WorkWORLD is used for benefits analysis and individual plan development, while the Project Impact data collection repository is used to ensure accurate case tracking from intake through phases or follow-along.

Project Impact benefits counselors regularly go to various program offices in their territory to encourage referrals and to begin a preliminary intake process to establish an individualized plan with benefits recipients.  WorkWORLD is used to establish each person’s current situation and to begin modeling alternatives that may be useful to manage benefits most effectively and to use work incentives to improve self-sufficiency.  This plan is continuously monitored with regular follow-along.  If a work incentive is actually approved (such as an SSA-approved Plan for Achieving Self Support [PASS]), then follow-along for it is maintained as well. 

Using the assessments and guidance provided by WorkWORLD, nineteen (19) PASSes have been written by Project Impact staff.  In addition, eleven (11) PASSes have been written by counselors at MRC, for a total of thirty (30).  In the 2002 program year, SSA reported 39 of 50 states with a number of open PASSes fewer than the 30 established in Massachusetts by the Project Impact/MRC partnership alone.

In 2003, ESI is continuing to collaborate with MRC to add State policy and program information to WorkWORLD.  Information about Olmstead Planning Grant activities and a new transportation initiative for people with disabilities in Massachusetts will be featured in the software.  State leadership will work to make decision support technology integral to benefits planning and employment counseling efforts by forming inter-agency partnerships and re-designing incentives and supports to encourage use.


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Oklahoma

WorkWORLD is currently being integrated into the network of statewide employment supports in Oklahoma.  Using WorkWORLD software was a key component in Oklahoma’s SSA State Partnership Initiative.  In collaboration with the Oklahoma Department of Rehabilitation Services (ODRS), the Tulsa Mental Health Association and the National Alliance for the Mentally Ill, the Oklahoma Work Incentive Project is examining the mechanisms of the new Ticket to Work voucher program.

Both consumers and service providers in the project are using WorkWORLD software.  It is used as a training tool, as a benefit-planning tool, and as a case management tool.  The network of ODRS expert WorkWORLD benefits planning consultants develop and monitor plans with individuals statewide.  WorkWORLD provides users with a clear view of their current situations, and guides them as they make decisions about their benefits and employment.  Randomly selected beneficiaries who have been newly-approved by SSA, and individuals who have recently been re-approved by SSA, participate in the program.  WorkWORLD provides them with an orientation to work incentives and makes it possible to look at a variety of practical recommendations for managing their benefits wisely while earning better net income. 

ODRS has decided to provide a base fee to vendors for an “expert” WorkWORLD Benefit Plan for SSA eligible consumers.  An additional milestone payment will be provided to the plan provider as people successfully execute the earnings component of their plans.  This “institutionalizing” of decision support technology is a major step toward encouraging more people to take advantage of individualized Federal and State work incentives.

ODRS staff and approved providers have received WorkWORLD training.  ESI has provided WorkWORLD training that includes a “train the trainers” program to show benefits consultants and employment support providers how to teach about using WorkWORLD for effective benefits analysis and employment planning.

The WorkWORLD initiative in Oklahoma is focused on shifting the locus of control (and cost) from the State-funded system to the SSA eligible person choosing to use their individual Federal work incentives.  Taxpayers benefit because the illuminated paths for using work incentives to achieve better net earnings generates taxes paid and reductions in long-term government dependence subsidies. 

The Employment Support Institute will continue to support use of WorkWORLD decision support technology in Oklahoma through the following efforts in 2003:

·        Provide expert policy and computer technical support in the inclusion of state and local data and programming for the WorkWORLD software program;

·        With multiple agency contacts, collaboratively develop software change plans and make identified changes to software;

·        Modify software to include new state and local data;

·        Provide training on the use of the WorkWORLD software to National Center for Disability Education and Training (NCDET) staff, Department of Rehabilitation staff, community rehabilitation programs and other entities designated by the Department of Rehabilitation Services;

·        Research policies in Oklahoma-customized WorkWORLD and identify income or benefit cliffs and propose possible policy improvements as appropriate.


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South Carolina

The South Carolina Department of Disabilities and Special Needs (SCDDSN) is leading efforts in South Carolina to bring the benefits of decision support technology to citizens with disabilities and their advocates.

SCDDSN is encouraging its statewide network of County Disabilities and Special Needs (DSN) Boards and other employment providers to use WorkWORLD for sound benefits management and employment planning.  Personnel from the DSN Boards have attended WorkWORLD training and have offered ideas about how the software may be used to greatest advantage throughout the state.  Additional WorkWORLD training programs may be scheduled in the future for a broader network of agency providers, parents, transition specialists, and students.

Future considerations for integrating WorkWORLD into planning and service delivery efforts in South Carolina include:

·        Including WorkWORLD as part of intake for new referrals by DSN Boards.

·        Developing a process and incentive system to support the development of WorkWORLD expert plans by supported employment providers to identify ways consumers can use work incentives before State funds are designated for direct services.

·        Establishing payments for benefits analysis and payments for reaching measurable outcomes defined in the WorkWORLD expert plans.

·        Ensuring that significant others are included in the development and assessment of WorkWORLD plans so that they may see where changes in SSI/DI cash benefits can be offset by gains in net income, both in the short and long term.

·        Encouraging more planning between adult service providers and transition planners in secondary schools, using WorkWORLD to identify opportunities for students to use deemed income from parents to purchase employment supports in SSA-approved Plans to Achieve Self Support and/or to use the Student Earned Income Exclusion.

·        Providing WorkWORLD as a disability support service in the Human Resources departments of industries with enclaves and mobile work crews.

·        Addressing transportation difficulties by using WorkWORLD to identify candidates who may cover their employment-related transportation expenses through SSA-approved Impairment Related Work Expenses.

·        Strengthening relationships with Social Security staff throughout the state by using WorkWORLD to clarify programs, policies, and procedures and to expedite approval of work incentive plans.

The first version of the South Carolina Benefits Information System (SCBIS) has been integrated into WorkWORLD version 5.02.  State-specific programs represented in the SCBIS include, among others:

·        Medicaid Working Disabled Program

·        Home and Community Based Waivers

·        Vocational Rehabilitation services for people with mental retardation, autism, and head and spinal cord injuries

·        Protection and Advocacy services

·        Education, i.e. Transition from School to Work programs

·        Employment Security Commission and Workforce Investment programs

·        Family Independence Program

·        Department of Disabilities and Special Needs Individual and Family Support Services, Day Services, and Residential Services

·        Advocates for Better Child Care Special Needs Voucher program

·        Unemployment Insurance

·        Veterans’ Benefits

·        Supported Employment Provider information


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Virginia

As a part of Virginia’s coordinated response to the U.S. Supreme Court decision in the case of Olmstead v. L.C., the Virginia Department of Rehabilitative Services (DRS) obtained competitive funding through a US Department of Labor Workforce Coordinating Grant to work with ESI to support the State’s efforts to expand and better coordinate Olmstead planning and implementation activities, and to ensure an emphasis on employment-related outcomes for citizens with disabilities.

This grant-funded effort has taken a two-fold approach: improving policies and building a comprehensive system for managing current Virginia policies.  On the one hand, ESI is adding Virginia-specific information and calculations to WorkWORLD to help simplify benefit planning and to encourage greater independence; and on the other hand, ESI is using its Excel-based software-specification tool to model Medicaid Buy-In options so that legislators and agency leadership can make better knowledge based decisions.

Virginia-Specific Customization:

DRS provides a liaison (called a Systems Integrator) who helps identify key information and calculations to include, and who coordinates the gathering of needed information.  The Systems Integrator (SI) also arranges for and helps conduct focus groups of consumers, benefits counselors, parents, and state leadership to provide feedback on the planned customization.  ESI provides drafts of the Benefits Information System and the calculation results for evaluation by members of the focus groups.

Medicaid Buy-In Modeling:

The Systems Integrator (SI) collaborates with ESI and others to establish the Buy-In specification options.  ESI then integrates into its WorkWORLD Specification Notebook the calculations that show how the various options interact with the other programs already contained in the notebook's specifications (SSI, SSDI, Section 8 housing, and Food Stamps, as well as SSI related Medicaid and SSDI related Medicare).  The innovative decision support model is designed to discover gaps, disincentives, untapped opportunities, and other potentially good or bad policy interactions with the Buy-In plans under consideration.

As the Virginia WorkWORLD Decision Support system expands, DRS evolves interagency strategic implementation plans to maximize the value of the State WorkWORLD customization.


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Georgia

CobbWorks!, the local Workforce Investment Board, along with Vocational Rehabilitation, supported employment providers, Division of Developmental Disabilities, The Tommy Nobis Center, Cobb and Douglas Community Services Board (a Project EMPLOY Partner), the Cobb County Micro-Enterprise Project, and the Employment Support Institute are collaborating on  a grant from the U.S. Department of Labor under the Customized Employment Program.  The focus of the grant is removing barriers that many Cobb County residents with disabilities encounter as they try to enter or re-enter the workforce, attain new skills, start a business or go directly into the career of their choice.  Partners are working to build the capacity of the local One-Stop system and to demonstrate an innovative, person-driven information system support model replicable for the national Workforce Investment system.

The Employment Support Institute is customizing WorkWORLD with Georgia-specific program and policy information.  State-customized WorkWORLD software will help One Stop staff assess each individual’s preferences, make better use their resources, improve their decisions about benefits and employment, and identify system reporting responsibilities for all who are supporting the individual’s plan.  The list of things a person might need to manage in this endeavor could include: multiple agency reporting requirements, individual daily, monthly, and annual budgets, use of SSA’s Ticket to Work, consumer directed Medicaid waiver services, Vocational Rehabilitation options, Work Incentives, Benefits, Section 8 Housing and Food Stamps rules, tax reporting, communications, hiring support staff, and possibly running a small business.  This list of potential information management requirements demonstrates the many opportunities for a customized Information System to help all stakeholders deal with these complex tasks. 

WorkWORLD will be used initially to help the person’s team evaluate options, create sample situations, refine plans, avoid risky situations, reduce fears of gainful activity, create reports and graphics, and achieve better communication with all stakeholders.

Although WorkWORLD’s current value is significant, it will be further developed to consider additional tasks needed to assist people to access and manage their support options.  WorkWORLD and other information system applications will be designed to support micro enterprise/self employment and an individualized day/month/year budget tool.  In the first two years of the grant ESI will enhance the power of WorkWORLD’s decision support capabilities with an interactive Excel-based budgeting system, and expand the Help system with information related to micro enterprise and self-employment.

Developments in future years of the 5-year project will incorporate additional Information System supports as they become needed to assist individuals.  Possible enhancements are listed in Table I below.


Table I

Enhancing Self-Determination Planning with Management Information Systems and Decision Support Technology

Where do resources come from?

Key Self-Determination Resources

Support Choices and Possible Outcomes From These Resources

Sample Planning, Tracking and Management Tools

 

The Individual

(Self Supports and Resources)

·        SSI/DI PASS

·        IRWE

·        1619 a,b

·        TWP

·        EPE

·        SEIE

·        Earnings

·        Unearned Income

·        Business Income

·        Rent Subsidy

·        Food Stamps

·        Consumer Driven Waiver Services

·        Other individually managed resources: e.g. grant demonstrations, DOL, RSA, NIDRR Projects

·        Knowledge

·        Decision Supports

·        Savings/Set Asides to increase self-support/net income

·        Allow equity appreciation

·        Increased savings for education or personal needs/interests

·        Promotions and more working hours without fear

·        Accessing assistive technology

·        Obtaining jobs and increased earnings

·        Starting Micro Enterprises and/or Self Employment initiatives

·        More choice and control over types and staff related to services (e.g., Personal Care Assistants, work supporters, part-time assistants, residence-mates, co-worker supporters)

·        More independence, more choice in residence, meals, roommates and increased personal, social, and transportation options

·        More freedom in personal relationships, romance, culture, entertainment…

·        WorkWORLD (improved SSA benefit/self support planning)

·        Comprehensive IS and DS organized around an individual’s specific situation

·        OSC-Outlook (calendar, tasks, journal, contacts, proactive and prevention date tickler system/reminders)

·        Excel (Individual budget, tracking hours, reporting to agencies)

·        Quicken (invoices or billing for your supporters)

·        Customizing Help system (WorkWORLD’s system for indexing federal state and local information)

·        Turbo Tax (income and small business tax management)

·        Email and web service (communication of team of supporters, online banking, listserves)

·        Other

Paid Provider and Community Supports

 

 

·        Medicaid Waiver or State Plan option services

·        Vocational Rehabilitation

·        State and Local community Services

·        SSA’s Ticket to Work and related provider resources

·        Request consumer driven options

·        Request exact amount of funding allocated to your plan

·        Request as much control of individualized support budget as possible

·        Request listing of all providers

·        Request choice of providers, locations, roommates, work supporters or mates, etc.

·        If dissatisfied request that you can create your program day or support with available funding

·        Assist funding agencies and formal service to use and monitor your plan with tools listed to the right

·        Use Info systems to help consumer and paid supporters to better communicate and manage multiple resource requirements to achieve consumer's choices

·        WorkWORLD (improved SSA benefit/self support planning)

·        OSC-Outlook, Excel, Word, email and web services, list serves for learning and communicating

·