Findings from a Study of the SSI/SSDI Outreach, Access, and Recovery (SOAR) Initiative. Case Studies

12/15/2009

To gather more qualitative information on how and how well states and localities are implementing SOAR, we conducted in-depth case studies in a subset of six states. The case study approach is useful for explaining the links between real-life interventions and outcomes that are too complex to capture with quantitative measures (Yin 1989). To provide the most complete picture of the initiative as possible, we purposively selected six states for the case studies. Within each, we gathered information from a broad range of agencies and staff directly involved in the SOAR initiative, as well as from other stakeholders. Below we describe our process for selecting the states and briefly describe the six states included in the case studies.

1.  Site Selection

We attempted to select states for the case studies that were diverse on a range of characteristics. First, we selected a mix of Rounds One and Two states, assuming that they would be at different stages of implementation. Second, we attempted to select states that were diverse in terms of geography, income, and race/ethnicity. And third, we attempted to select states that were diverse with respect to implementation of SOAR on the basis of non-subjective data collected by the TA contractor as of April 2008. For example, we considered the number of in-state trainings states reported conducting as of April 2008 (and selected 3 that conducted 5 or more and 3 that conducted less than 5), the number of participants that had been invited to in-state trainings (and selected 3 that had invited 100 or more and 3 that had invited less than 100), whether the lead SOAR agency was a state government or local agency (and selected 3 that were state government agencies and 3 that were local agencies), whether the state had conducted any organized SSI/SSDI advocacy work before SOAR (and selected 3 that had and 3 that had not), the number of initial SOAR pilot sites  that is, a community that attended the state's strategic planning forum and/or was among the first in the state to implement SOAR  (and selected 3 that had implemented SOAR in 10 or more local sites and 3 that had implemented SOAR in less than 10 local sites), and the application approval rate (and selected 3 that had approval rates of 50 percent or higher and 3 that had an approval rate of less than 50 percent or that had not tracked outcome data). Table II.1 presents these key characteristics of the six selected sites based on data collected by the TA contractor.

Table II.1
Key Characteristics of SOAR Site Visit States
State Round Region # In-State Trainingsa # Invited to In-State Trainingsa Lead Contact from State or Local Agency Pre-SOAR Work Initial Pilot Sites Applications Approved/
Decisions Made (Approval Rate) a
UT 1 W 8 260 State No 2 122 / 187 (65 percent)
PA 2 NE 2 65 Local No 1 20 / 20 (100 percent)
OH 1 MW 3 80 Local Yes 6 50 / 110 (45 percent)
MA 2 NE 3 93 Local Yes Statewide 32 / 121 (26 percent)
VA 1 S 5 131 State Yes 6 135 / 163 (83 percent)
NJ 2 NE 7 136 State No Statewide N/A
N/A = not available because outcomes are not tracked
a As of April 2008

Our hope was that the six states selected for the case studies would reflect the range of experiences states have had implementing SOAR. Without detailed information from states that were not selected for the case studies, though, it is not possible to assess the extent to which the selected states are representative of all Rounds One and Two SOAR states and thus the extent to which the findings from the case studies are generalizable.

2.  Data Collection

Within each of the selected case study states, we visited one local community in which SOAR was implemented. We visited pilot communities for three key reasons: (1) presumably, pilot communities had been implementing SOAR the longest and thus have the most experiences to share; (2) most of the data the TA contractor has gathered from states pertains to the pilot communities (providing multiple data sources to compare and contrast in our analysis); and (3) most of the pilot communities participated in the initial planning activities (that is, the strategic planning forum) and thus could provide a more complete perspective on the TA process and how it has evolved at the local level than sites that did not participate in this process. In most cases, we selected the most urban among the pilot communities because the concentration of individuals who are homeless in these areas was the highest. We talked about SOAR rollout with state team leads and trainers during our on-site interviews to gain perspective on the implementation of SOAR in other communities. Table II.2 presents the local communities we visited in each state.

Table II.2
Local Sites Included in the Case Studies
State Local Sites
Utah Salt Lake City
Pennsylvania Philadelphia
Ohio Columbus, Dayton, Troy
Massachusetts Boston
New Jersey Newark
Virginia Richmond, Norfolk, Virginia Beach

We conducted in-depth, in-person two- or three-day visits to each of the six states in the winter and spring of 2009. Using semi-structured guided discussion techniques, we conducted one-hour interviews with each of the following:

  • State team lead
  • Local team lead
  • SSA administrators and staff
  • DDS administrators and staff
  • Key players from all other state and local agencies participating in the state planning forum, including administrators and staff from state mental health agencies and community-based organizations (CBOs), housing and other public assistance agencies, and homeless services providers
  • State trainers

In addition, to gather data on how SOAR is implemented at the ground level, we conducted small group interviews with case managers in each site who had participated in the SSTR training. The interviews addressed questions regarding which of SOAR's critical components case managers do and do not use in practice (as well as why and how), the challenges they have faced in implementing what they learned in training, factors that have facilitated their implementation of SOAR, and outstanding needs they have in supporting homeless SSI/SSDI applicants.

Small group interviews generally lasted approximately 90 minutes. During our initial calls with the state or local SOAR team lead to arrange the site visit, we requested a list of individuals who participated in the initial training in the locality. We used this list to recruit five to ten case managers. One member of the site visit team facilitated the group interview (using a semi-structured discussion guide) while the other took detailed notes. Mathematica provided lunch for case managers as incentive to participate.

3.  Description of States

Although each state included in the case studies was trained in SOAR using a single model, each implemented the program slightly differently. In addition, the initiative operated in very different environments in each site, both structurally and politically. This section provides a brief description of each site, focusing on the evolution of SOAR and the key stakeholders as context for the remaining chapters of the report.

Utah.  The director of Utah's Homeless Task Force believed that SOAR could help the state advance its ten year-plan to end homelessness. His leadership of SOAR and persistent outreach and follow-up efforts were essential to the formation and continuation of SOAR in the state. Initially, in-state trainings reached case managers at a range of state agencies and CBOs. One year into SOAR, however, the leadership of the Department of Workforce Services (DWS), the state agency that provides employment and support services to improve customers' economic opportunities, created a team of SOAR-trained specialists charged with helping General Assistance clients in the most populous regions of the state apply for SSI and Medicaid. DWS is in the process of extending that assistance to clients statewide. While current SOAR trainings and support focus on DWS staff, some case managers from other organizations continue to draw on prior SOAR trainings to help clients access SSI. All individuals who have received SOAR training are invited to quarterly SOAR summits that provide a forum for case managers to ask technical questions; SSA and DDS attend these meetings as well as in-state trainings.

Pennsylvania.  Pennsylvania had an unusual introduction to SOAR. The state submitted an application for Round One TA and was unsuccessful, but was later invited by the federal agencies supporting SOAR to participate in Round Two, with the specific condition that SOAR be implemented in Philadelphia. This city had recently lost other sources of federal funding in the area of homelessness and the implementation of SOAR there was perceived as a way to mitigate the ramifications of that loss. Thus, all SOAR activity in Pennsylvania is focused in Philadelphia. Two state agencies (the Department of Community and Economic Development and the Department of Public Welfare) have a degree of responsibility for clients who are disabled and homeless, but aside from some involvement during the strategic planning phase, they have had minimal involvement in SOAR. In Philadelphia, all SOAR activities are managed by the Homeless Advocacy Project (HAP), a non-profit organization that offers free legal services to such clients. Their SOAR-related activities are funded under a contract from the city Office of Supportive Housing (OSH). In response to concerns that SOAR would become an unfunded mandate, OSH identified a source of funding for SOAR through a pre-existing contract it had with HAP in a different issue area. The first year of funding supported HAP in conducting SSTR training for 40 local agency case managers, hosting two local SOAR strategic planning forums, coordinating and overseeing the submission of 40 SSI/SSDI applications and related documents by those who received training, and collecting outcome data. The second year of funding supported HAP in continuing to roll out SOAR and oversee the submission of an additional 29 applications. HAP had experience conducting SSI advocacy and appeals before SOAR, and existing personal relationships between staff at HAP and other agencies involved in SOAR facilitated ongoing and open communication about how the initiative would be implemented. Funding from OSH for SOAR will expire in June 2009, and a key challenge in the continuation of the initiative in its current form and to expanding the initiative to other parts of the state will be identifying alternative sources of funding.

Ohio.  In Ohio, SOAR was rolled out to six communities that the state identified through a request for proposal process. Leadership for SOAR originated in the state Interagency Council on Homelessness. Bidding communities (10 areas submitted proposals to participate in SOAR through their continuums of care) were required to discuss in their applications how they would provide the staff and resources required to execute the initiative given no financial or human resources were available, aside from SOAR training, to assist staff. Although some staff had a strong leadership role in the state at the outset, lack of financial and human resources combined with staff turnover left the initiative without clear direction, leadership, or enthusiastic support from any upper-level staff in the state. At the local level, a combination of staff turnover and what the state perceived as the wrong audience at the in-state trainings (supervisors rather than case managers) meant that a great deal of information on the application process and key SOAR practices was lost before the initiative was implemented in the field. Despite challenges in leadership, motivated case managers and their supervisors have kept the initiative moving forward in several communities and continue to use the skills acquired through SOAR.

Massachusetts.  The SOAR initiative in Massachusetts originated with the Department of Transitional Assistance (DTA), which funds homeless shelters and homeless services statewide and also provides individuals and families with food assistance, job assistance, cash assistance and emergency shelter.[3] While the DTA initially agreed to serve as the state agency home for SOAR, its involvement in SOAR has been minimal since the initiative's inception. Prior to SOAR, the Department of Mental Health (DMH), Healthcare for the Homeless (HCH), and the state DDS were involved in their own efforts to provide SSI/SSDI benefit assistance though these were not necessarily coordinated in any formal way. Realizing that a coordinated effort to provide SSI/SSDI benefit assistance to homeless populations was a critical factor to ending chronic homelessness and addressing unmet medical needs, DMH and its PATH contractor, Eliot Community Services, attempted to implement SOAR statewide. Three training sessions were planned  one in Boston, one in central MA, and one in western MA  though the training in western MA never materialized due to competing priorities among the trainers. Although the state and partnering organizations believed in the intent of the SOAR initiative, efforts to sustain the SOAR model as designed diffused for several reasons. First, local agency staff were not committed to submitting applications; staff were already overworked and unable to dedicate time to SOAR and there was no buy-in or incentive among agency directors or supervisors to implement SOAR. Second, state agencies were reluctant to dedicate staff time to SOAR in the absence of funding and did not have a cohesive plan for moving the initiative forward. Trying a different tactic, in 2008, DMH awarded excess PATH funds to Eliot to hire six dedicated benefit specialists. The funding is for federal fiscal year 2009 only; the state is actively trying to identify other sources of funding to sustain the PATH benefit specialist positions beyond 2009. Each benefit specialist is deployed to one of six regions across the state to assist individuals who are homeless apply for SSI/SSDI benefits. They regularly visit homeless shelters and receive referrals from shelter case managers and tenant preservation programs. While the specialists did not go through SOAR's SSTR training, they did receive the training manuals and they use strategies consistent with the SOAR model.

New Jersey.  The SOAR initiative in NJ was implemented along two distinct tracks. First, the state Department of Mental Health (DMH) applied for and received PATH funds to support one full-time equivalent staff member, whose responsibility would be to take a leadership role in navigating the SSA system, linking individuals who are homeless to SSA resources, and training state PATH agencies to do the same. This position was created within Project Live, the PATH provider for the city of Newark. Since January 2007, Project Live staff have been providing training to other PATH program staff statewide as well as to other interested community agencies upon request. Second, the state Veteran's Administration (VA) sent two of its staff members to a SOAR TTT session with the intention of providing training to VA social workers and case managers. Three of four planned trainings were held for VA staff; the fourth training was canceled due to lack of VA staff interest and the VA has no plans to continue with SOAR. The initiative in NJ began to flounder when both the PATH Coordinator at DMH and the Homeless Services Coordinator at the VA left their respective positions; their departures left these two key state agencies with no one to claim ownership of SOAR. Though Project Live continues to conduct at least four trainings per year, as it is required to do by contract, there are no other SOAR-related activities occurring in the state and no coordinated effort to track SOAR activities and application outcomes. While current leadership within both DHM and the VA want their own case managers to receive SOAR training, neither feels that they have time to serve as the SOAR state lead or that doing so is within their purview.

Virginia.  Virginia PATH leaders applied for SOAR because they saw the program as a natural extension of existing efforts to assist individuals who are homeless obtain benefits. Prior to its involvement in SOAR, the state PATH director had collaborated with the SOAR TA contractor on a benefits acquisition training program. The PATH director was designated as the SOAR state lead and planned to use SOAR to strengthen communities with existing initiatives and implement the training in two new sites. However, the SOAR sites varied considerably in their ability to use the training. In some localities, SOAR leaders were unable to convince stakeholders to dedicate time or other resources to SOAR, and as a result collaboration between stakeholders stagnated. In other sites, SSA and DDS staff work closely with case managers, and agency leaders reported that the number and quality of SOAR applications has increased. A large number of case managers were trained across the state, but many of these case managers do not prepare SOAR applications. Currently, PATH funds support several SOAR specialists (one full-time and several part-time) who prepare SOAR applications regularly in their localities. Staff turnover within these positions, however, has been problematic. In addition, the state PATH director's position was vacant for several months, leaving Virginia without state leadership or coordination for SOAR. The state has recently hired a new PATH director who is making considerable efforts to engage SOAR stakeholders and re-invigorate the initiative with the assistance of local leadership.

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