Findings from a Study of the SSI/SSDI Outreach, Access, and Recovery (SOAR) Initiative. Implementation of SOAR's Critical Components

12/15/2009

After training, some case managers were able to integrate SOAR into their regular practice and prepare high-quality SSI/SSDI applications. Generally, these case managers had time and organizational support to prepare SOAR applications, were enthusiastic about the initiative, or both. They found some SOAR critical components more or less useful than others. Case managers almost universally became clients' authorized representatives and found this practice extremely useful. One of the most contended components was the medical summary report. Case managers expressed confusion about the purpose of the medical summaries and anxiety and misunderstanding about how to write them. In light of this, and in response to time constraints and/or feedback they received from DDS, many case managers did not complete them. In one state, DDS encouraged case managers who lacked the time or ability to write full medical summary reports to call the assigned DDS contact to give an oral report, to fill out a short functional observation form that DDS developed, or both. The two-page focuses on activities of daily living (ADLs) that are relevant for homeless applicants; the standard thirteen-page form that DDS often uses for the general pool of SSI/SSDI applicants was too long and not entirely applicable.

More often, case managers found in-state trainings informational, but not transformational; many never or rarely implemented SOAR in practice. Simply obtaining information about the SSI/SSDI application process has value in and of itself, but the intent of SOAR is to alter case managers' behavior. Many case managers felt that they did not have time to prepare SOAR applications. Case management staffs were often overburdened with other responsibilities and faced budget cuts that affected client to staff ratios. In some sites, time spent on paperwork (including benefit applications) that did not entail face-to-face time between case managers and clients was not billable. Moreover, if case managers did not implement SOAR soon and frequently after training, the skills they learned diminished over time.

Despite the wealth of information it contained, many case managers did not use the SSTR manual as a reference and felt the need for refresher training. One trainer did offer follow-up sessions regarding submitting online applications, which she described as an opportunity to give participants a booster shot regarding SOAR critical components; other trainers encouraged participants to attend multiple training sessions designed for case managers who are new to SOAR.

Given time and resource constraints, assisting homeless individual with filing SSI/SSDI applications using the SOAR model had the most potential when CBOs dedicated one or more SOAR specialists to provide application assistance and enabled other case managers to maintain their current responsibilities. Five states were able to dedicate benefit assistance specialists either by shifting responsibilities around within agencies' current organizational framework and resources or by obtaining funding for newly created staff positions. Three states used PATH monies to fund full- or part-time benefits acquisitions specialists, because state leaders saw SOAR as congruent with PATH's goals and because SAMSHA supported using PATH funds for this purpose. One state welfare agency created new positions focused exclusively on benefit assistance, hoping that these positions would ultimately allow the state to recoup General Assistance expenditures. In the fifth state, a city agency redirected funds, awarding a contract to implement SOAR to a CBO with which they had partnered on a previous anti-homeless initiative. Having specialized staff, however, did not guarantee the collaboration and commitment necessary to yield positive application outcomes. In two states, during periods of staff turnover SOAR specialists received little supervisory support and had weak relationships with other stakeholders; the frequency and quality of their SOAR applications diminished during this time.

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