Findings from a Study of the SSI/SSDI Outreach, Access, and Recovery (SOAR) Initiative. Considerations for the Future

12/15/2009

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.

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