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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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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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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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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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
· |
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