SOAR provides states with an opportunity to engage in strategic planning, develop and nurture inter-agency relationships, and receive training and TA to improve the SSI/SSDI application process for individuals who are homeless, particularly those who have mental health conditions. When implemented with adequate staff resources and commitment, SOAR improves the capacity of case managers to navigate the SSI/SSDI application process and has the potential to increase the SSI/SSDI application approval rate while decreasing processing time. The ultimate benefits of the initiative to states and their homeless populations are directly proportional to states' investment of time and resources. This chapter identifies some common elements that facilitated successful implementation of SOAR and provides considerations for the initiative's future.
Factors That Facilitate Successful Implementation of SOAR
States varied widely in the extent to which SOAR was implemented with fidelity to the model and to which their efforts were sustained after the initial in-state planning forums and trainings. Based on the interviews, focus groups, and analysis of data collected in the states selected for the case studies, several factors appeared to contribute to the successful implementation of SOAR across communities. As illustrated in Table VI.1, many of these factors were missing in states that struggled to implement SOAR.
- Strong and Consistent Leadership. Consistent leadership was essential at all phases of the project. At the state level, leadership was needed to coordinate the in-state trainings and empower and facilitate on-going communication among key stakeholders. Effective state leads had a genuine commitment to SOAR and an understanding of SOAR's goals and potential benefits, both to individuals who are homeless and to their own agencies.
- Agency-level Support for SOAR. Support from their agency management and direct supervisors empowered state leaders to dedicate the time and energy needed to coordinate trainings, troubleshoot challenges, and facilitate regular communication among stakeholders to sustain the initiative. Without such buy-in, particularly in the absence of financial support for SOAR, state leads were less able to treat the initiative as a priority. In states where the state level leadership of SOAR changed due to staff turnover, buy-in from the state leader's agency and direct supervisor helped to ensure that the initiative did not flounder during the transition to new leadership. In addition to the state lead having support, developing buy-in at the highest possible levels of other agencies that participated in SOAR, including those agencies in which case managers worked, was essential to ensuring that the initiative was sustained. In several states, support for SOAR came from the same agency that administered PATH funding. There may be potential for states to develop greater synergy between the activities of the PATH and SOAR initiatives.
- Engagement of SSA and DDS. Active participation of SSA and DDS in all phases of the initiative helped to ensure that the development of SOAR-specific application processes and procedures was well-received and fit well within standard local SSA and DDS office practices. The engagement of SSA and DDS allowed communities to better tailor SOAR to overcome the particular challenges to obtaining SSI/SSDI specific to their communities. The more deep-rooted engagement among SSA and DDS was, the more beneficial it was to the initiative. Communities in which SSA and DDS were most engaged had the commitment of regional and local office staff, including front-line staff, their supervisors, and senior management. These staff were often engaged in the planning of activities but also participated in the in-state trainings and provided ongoing feedback on application outcomes to case managers and the state lead.
- Structured Inter-Agency Communication. The success of SOAR is largely dependent on developing and maintaining strong interagency collaborations to develop application procedures, monitor the progress of the initiative, and continuously improve the application process. Consistent communication among SSA, DDS, case managers, and the state and/or local lead was essential to solidify inter-agency collaborations, advance SOAR, and overcome challenges to implementation. While informal frequent communication was often facilitated through existing relationships, several states conducted formal monthly or quarterly meetings among these stakeholders to foster regular structured communication. These meetings provided an opportunity to discuss any challenges to completing application, gather feedback on the quality of applications, and provide ongoing training. Further, they provided stakeholders with motivation to continue the initiative and were a forum to celebrate the successes of SOAR.
- Identification of Qualified Trainers. In-state trainers who had some existing familiarity with the SSA application process and support from their supervisors were well-positioned to train case managers in the SOAR curriculum. Trainers who had no previous experience with the SSA application process required more support to become competent trainers, and in some states, never conducted any trainings.
- Supervisory Support for Case Managers and/or Dedicated Benefit Specialists. Case managers were empowered to use the critical components of the SOAR curriculum when they had support from their supervisors to dedicate the time required to assist individuals who are homeless with applications. To the extreme, some states dedicated staff exclusively to providing SSI/SSDI application assistance to these clients. States that employed this model were best able to submit a volume of high-quality applications.
- Targeted Implementation. States that piloted SOAR in a small number of local sites were able to hone the SOAR approach and troubleshoot challenges, learn from their early experiences, and then spread the initiative to other areas of the state. Those that attempted to implement SOAR in more than three communities directly following the in-state planning forums, and particularly those that attempted to implement SOAR statewide, experienced greater difficulties coordinating activities and engaging in ongoing communication.
- Outcome Data Collection. States that made an effort to systematically track outcomes at the beginning of the initiative were better able to monitor the progress of activities, troubleshoot challenges, and overcome barriers to success. The tracking of outcomes developed a sense of accountability and provided the data necessary to encourage stakeholders to sustain and propel the initiative forward. Without the systematic collection of data, case managers, SSA, and DDS staff were unable to determine whether SOAR was having a positive impact on their clients and were therefore less encouraged to continue to dedicate the time and energy necessary to implement the initiative.
Considerations for the Future
In the final section of this report, we offer considerations for future SOAR efforts. We first discuss ways in which federal agencies can continue to support SOAR and ensure that states have the resources and support necessary to implement and sustain the initiative in a manner that is most likely to facilitate positive impacts on the lives on homeless individuals. We then discuss strategies that can enhance the future TA that states receive. A major strength of the SOAR model is that it can be tailored to each community while implementing a common strategy of strengthening interagency relationships and teaching a standard curriculum that provides case managers with skills to navigate the SSI/SSDI application process. Thus, options for future TA efforts might be considered in the context of each state and community. The broad considerations described below will need to be developed further as part of the strategic planning within each state and community.
1. Considerations for Federal Agencies Supporting SOAR
- Resources to Support State Leadership. In the absence of financial support to conduct SOAR activities, state leads found it difficult amid their many other responsibilities to dedicate the time necessary to develop SOAR to its potential. Many states are currently struggling with budget deficits and are searching for ways to reduce expenditures on health and human services, which may jeopardize the ability of states to allocate resources for SOAR. Federal agencies supporting SOAR might consider providing states with resources to fund (either fully with federal dollars or through a federal-state match) a full-time position for a SOAR project coordinator. Alternatively, federal agencies might consider encouraging or providing incentives to states to dedicate a portion of their PATH, Mental Health Transformation, or Continuum of Care funds to support SOAR leadership. This financial support would enable the state lead to fully commit a portion of his or her time to the initiative. The ideal agency in which the state lead resides and the mechanisms of financially supporting that individual may differ by state depending on the existing service structure and interagency relationships.
- Ensure the Commitment of Participating State Agencies and Organizations. Implementing and sustaining SOAR requires that each stakeholder commit time and resources to achieve the maximum benefits for individuals who are homeless. In addition to the commitment of a state lead, SOAR requires the institutionalization of the initiative within the state lead's agency. While many state and community organizations have fully committed to SOAR, federal agencies might consider developing a formal mechanism to solidify their commitments. For example, a memorandum of understanding (MOU) between the head of the state team lead's agency, the TA contractor and, to the extent feasible, federal agency representatives may help to encourage states to continue to support the initiative throughout the time that they receiving TA and to build momentum to sustain SOAR after federal support for the initiative has ended. An MOU might outline the responsibilities of each party, stipulate the channels of communication, and specify clear milestones, target dates, and consequences for inaction. State agencies might use the same template to develop MOUs with partner agencies in the state.
- Work with SSA at the Federal and Regional Levels. SSA functions in a manner that allows, within some boundaries, local offices to tailor policies and procedures to meet the needs of the community and service system. While having some local autonomy allows SSA to better meet the needs of applicants, some SSA staff reported the need to gain support from their managers and/or regional director before proceeding with SOAR. Gaining that support was often difficult and time consuming for local SSA staff. Federal agencies supporting SOAR might consider developing a strategy for SOAR at the national and/or regional levels while balancing the need for local SSA offices to maintain their autonomy. Staff from the federal agencies that support SOAR, in partnership with the TA contractor, may wish to reach out to SSA national and regional directors and other senior management within SSA to provide them with preliminary evidence of the initiative's success at reducing backlogs and improving the lives of applicants, as well as tested methods of altering local SSA office procedures to support the initiative. Gaining such support could be useful in getting the message down to local SSA offices and creating efficiencies in decision making related to SOAR within SSA.
- Remove Limits on the Time States are allowed to Receive TA. All states involved in SOAR can likely benefit from additional TA, but their needs vary according to their stage of implementation. Launching a new initiative (or resurrecting a failing one) can take a long time and sustaining an existing initiative can require unique expertise as new challenges arise. Federal agencies supporting SOAR might consider removing any limits on the amount of time states are able to receive federally funded SOAR TA to ensure that states receive a level of support proportionate to their level of need and consistent with the realities of the timeline for implementation. This would allow states that experience setbacks an opportunity to follow through with implementation. The key would be not to create additional lag time between the TTT session and the initial in-state training, but to provide more assistance to states upfront in establishing relationships and processes as well as during and after the in-state trainings to facilitate the use of SOAR in practice. The TA contractor could conduct an interim scan of states' needs to determine which states may require TA beyond 18 months and develop state-specific plans accordingly. Alternatively, states could request TA beyond 18 months but be required to document their challenges and develop a brief plan that both describes which activities require TA in order to meet their goals and proposes a timeline for the activities. The TA would then be tailored to the specified goals and activities and conducted within the proposed timeline.
- Support the Reporting of Performance Indicators. Currently, states have little accountability for their efforts related to SOAR. States are not required to report any data to the TA contractor or federal agencies. The lack of accountability may contribute to less interest toward implementing the model with fidelity and sustaining the initiative over time. Federal agencies supporting SOAR might consider requiring states to report performance indicators and/or collect outcome data as a condition of receiving TA or other resources associated with SOAR. However, data collection and reporting may be difficult with tight budget constraints. States are likely to need resources and TA to establish or use existing data tracking and reporting systems. Performance indicators may include number of in-state trainings, number of SOAR applications completed, application approval rates, time from application submission or protective filing date to approval or denial, and reasons for denials.
- Fund a Rigorous Evaluation to Examine the Impact of SOAR. This evaluation was able to document the extent to which selected states have implemented SOAR activities and developed the policies, procedures, and infrastructure necessary to achieve the short-term outcomes. Because SOAR states have not been required to collect or report systematic data, it is not possible at this time to make any definitive statements about the short- or long-term impacts of SOAR in terms of application outcomes or the housing stability, income, and health of individuals who are homeless. There is limited evidence to suggest that SOAR may have helped some communities recoup General Assistance or other costs, but it is not possible to attribute cost savings to SOAR at this time. A rigorous evaluation of the short- and long-term outcomes of SOAR involving the collection of high-quality quantitative and qualitative data from states could gather the evidence necessary to determine the impacts of SOAR and assess the benefits of SOAR relative to the investment in the initiative. Ideally, such an evaluation would examine whether SOAR has an impact on the number of applications submitted, application approval rates, time to benefit determination, and cost savings. While an ideal evaluation would also assess the impact of SOAR on quality of life among applicants who are homeless (for instance, by measuring outcomes such as income, housing, health, and health care), doing so would likely require careful longitudinal data collection and thus a substantial investment of resources.
2. Considerations for Future TA Efforts
- Systematic Outreach to the Supervisors of Case Managers. Case managers who had full support from their direct supervisor and management of their organization were empowered to take the time to participate in SOAR training and complete applications for individuals who are homeless. While some supervisors attend the in-state trainings, there may be a need to reach out to supervisory staff and senior management at CBOs to educate them on the benefits of SOAR for their clients, staff, and agencies as well as the level of effort that will be required of their staff to implement SOAR. Supervisors may benefit from a brief introduction to SOAR and be given an overview of the training that their staff will receive.
- Expand Strategic Planning. The in-state planning forum is an essential first step in developing collaborative relationships and gaining stakeholder buy-in, but these relationships take time to develop. Some states sent staff to a TTT session before there was sufficient stakeholder buy-in and sometimes even before the planning forum itself. States currently develop a strategic action plan as a result of the forums but may require additional forums facilitated by the TA contractor or other structured opportunities to refine the plan and begin the process of nurturing relationships before any training occurs.
- Make More Explicit the Role of Ongoing TA. Ongoing, customized TA is available to help states implement SOAR and overcome any challenges, but states have underutilized this resource. States and the TA contractor may wish to incorporate into the strategic action plans that results from the planning forum (or any new documents developed, such as MOUs) a mechanism for consistent ongoing and structured communication among the TA contractor and the state lead, SSA, DDS, and other partners to troubleshoot any challenges and maintain momentum for the initiative. States may benefit from more regularly scheduled followup from the TA contractor.
- Provide More Guidance on Expectations of Participating Entities. To foster buy-in among state and local agencies, tailor the initiative to the community context, and ensure the initiative could be sustained in the absence of federally funded TA, SOAR TA was designed to support state-driven decision making. Given the struggles that many states have had propelling the initiative forward, however, more prescriptive TA with respect to the expectations of participating organizations may be useful. For instance, applications for TA (or other mechanisms) might require states to demonstrate that the designated lead has a certain minimum percentage of time available to dedicate to SOAR. They also might require that in-state trainers possess certain minimum qualifications and that states designate back-up trainers who will be available in the event of turnover. Applications for the first three rounds of TA required that states identify one or more pilot sites, but afforded states the flexibility to define a site. Future applications might specify that a site entails a city, county, or specific jurisdiction and require that the states identify only one in which SOAR implementation will begin and others targeted for early rollout.
- Identify Sources of Sustainable Funding for Communities. Implementation of SOAR's critical components had the most potential when agencies dedicated one or more employees exclusively to providing benefit assistance through SOAR. Communities identified various sources of funding extemporaneously to support dedicated staff positions, but generally funding was temporary. Communities should begin developing strategies for sustaining the initiative and obtaining funding at the outset of SOAR, perhaps as part of the strategic planning forum. Some communities may not necessarily need new funding to sustain the initiative, but may be able to shift responsibilities to dedicate staff to SOAR. The TA contractor could work closely with state agencies and CBOs to determine how best to do this given their current staff structures.
- Market Data Tracking Systems. Many states and communities have not attempted to track SOAR outcomes while others have tracked outcomes on an ad hoc basis. The TA contractor has developed software that states and communities can use to track outcomes. Communities will likely need assistance to learn to use the software and will require continuous encouragement and quality reviews to sustain any data collection efforts they undertake. However, extensive marketing and TA specific to the implementation of this system may prompt more standardized and comprehensive collection of data necessary to facilitate a quantitative analysis of outcomes and assess the ultimate impact of SOAR.