Findings from a Study of the SSI/SSDI Outreach, Access, and Recovery (SOAR) Initiative. Strategic Planning Forums

12/15/2009

SOAR states participate in a two-day professionally facilitated strategic planning forum to strategize how SOAR critical components will be implemented locally. Up to 30 stakeholders participate in the forum, which is intended to establish buy-in among stakeholders and lay the groundwork for inter-agency collaboration. The forum is the first opportunity for stakeholders to come together to collectively strategize how SOAR can be implemented in the context of existing local efforts to support homeless individuals. During the forum, stakeholders develop a strategic action plan that specifies the steps participants will take toward implementation. Below we describe the TA contractor's role in the forums, the myriad of forum participants, the emergence of in-state leadership, and the resultant action plans.

1.  The Role of the TA Contractor

In some states, the TA contractor's influence was critical to bringing various partners to the table. The TA contractor assists each state in preparing for its strategic planning forum. In advance of the forum, the contractor convenes a planning call to help state leads identify which stakeholders to invite to the forum so that the appropriate agencies and individuals are represented. Engaging the appropriate stakeholders during the planning process is important to foster early buy-in for the initiative so stakeholders are motivated to serve as change agents in implementing SOAR. Establishing early buy-in among stakeholders also helps to mitigate inter-agency implementation barriers that could threaten the success of the initiative. Without the contractor's influence and recruitment efforts, some state leads were skeptical that they would have been able to assemble all key players, particularly SSA. They believed that they did not have sufficient prior relationships with the key players to draw on and were not yet savvy in marketing the initiative to potential partners.

Forum participants uniformly praised the TA contractor for its facilitation of the in-state forums and the extent to which it engaged participants. The TA contractor serves two key roles at the strategic planning forums. First, the contractor introduces SOAR to stakeholders by describing the program's critical components and how it can help stakeholders achieve systemic changes. Informing stakeholders how their agencies can be instrumental in launching as well as directly benefit from SOAR is crucial to establish broad buy-in and support for the initiative. Second, the TA contractor assists states and communities with developing a strategic action plan to ensure that critical program elements will be in place to maximize the award of SSI/SSDI benefits to individuals who are homeless. Specifically, the contractor helps stakeholders assess their current environment, consider possibilities for change to better support individuals who are homeless and have disabilities, and think concretely about how such change can be implemented. During the forum, the contractor provides structure and facilitation for state-driven decision making. The contractor's initial intention is not to be prescriptive about the roles stakeholders should assume or the specific steps states should take to implement SOAR. As a result, the content strategic action plans varied from state to state and the process did not necessarily result in a strong action plan (see Section A.4 below for more discussion).

2.  Forum Participants

Stakeholders participating in the forums typically include state PATH contacts, local homeless service providers, state mental health agencies, local and/or regional SSA staff, state DDS representatives, and a variety of other service providers that assist individuals who are homeless. In most places, prior relationships between SSA/DDS and other stakeholders did not exist and there was little awareness among other stakeholders of SSA and DDS processes. The strategic planning forum was often the first time SSA and DDS participated in a cross-agency dialogue of how to better support individuals who are homeless and have disabilities.

At least some CBOs that directly serve members of the target group were present at all strategic planning forums in the case study states. While there was considerable variability across states in the extent to which case managers from these organizations had experience providing SSI/SSDI application assistance to clients, all organizations acknowledged at the forums that additional training for case managers was necessary because SSA eligibility requirements and application processes are complex and difficult to understand.

Some potential partners were absent from most strategic planning forums  most notably, large medical providers, such as hospitals, state mental health treatment providers, and representatives from HCH. Formal agency-level relationships typically did not exist between large medical providers and other key stakeholders, in part because most states sent forum invitations to only those agencies they deemed most central to SOAR's objects. Medical providers, however, could be instrumental partners in SOAR because they provide medical documentation and can perform CEs for SOAR claims. These providers also have incentive to support SOAR (financially or otherwise) because it could be a mechanism through which they could recover the costs of providing care to uninsured individuals with disabilities. Organizations that provide legal advocacy were also absent from most strategic planning forums. Such organizations have extensive expertise with SSA eligibility requirements and application processes and routinely interface with SSA and DDS. A legal advocacy organization serves as lead agency in one SOAR locale; such organizations could also be effective partners in other SOAR sites.

3.  Emergence of In-State Leadership

In most states, the agencies that applied for SOAR did not emerge as the operational lead for SOAR activities. States applied for SOAR TA on behalf of their homeless policy academy teams. In only one of the six case study states, the policy academy team lead who applied to participate in SOAR later became the SOAR state lead and was instrumental in bringing stakeholders together to implement the initiative. In other states, member agencies of the homeless policy academy team applied for SOAR and named themselves as the lead agency either as a formality (never intending to assume the responsibilities required of the state lead) or without a firm grasp of what SOAR leadership would entail.

Organizations that emerged as the operational lead for SOAR did so because its activities were a natural extension to their ongoing work assisting clients who are homeless access SSI/SSDI benefits. These organizations were experienced in providing outreach and benefits acquisition assistance to homeless populations and had existing service models that could be adapted to accommodate SOAR activities. However, not all organizations that had this experience had the time or wherewithal to take on SOAR, and in some states, an operational lead never emerged.

Agencies were further motivated to continue acting as the operational lead for SOAR when they recognized that their organization or state could benefit financially from SOAR  either through direct funding to implement SOAR components or through cost recovery mechanisms. In half of the case study states, lead organizations were PATH providers and received PATH funds to carry out SOAR activities. In two of these organizations, funds were directed to hiring staff to complete SSI/SSDI applications and collect data on SOAR outcomes. The third organization received funds to conduct four SOAR trainings per year targeted to PATH staff throughout the state. In one other state, SOAR was viewed as an effective cost recovery mechanism, enabling the state to recoup the cost of providing General Assistance benefits to adults with mental or physical impairments. To assist in this effort, the lead state agency hired staff to complete SOAR applications for individuals receiving state benefits, such as General Assistance, TANF, or refugee benefits. The operational lead in another state received municipal funds to conduct SOAR trainings, complete SOAR applications, collect data on outcomes, and convene stakeholders in an annual SOAR forum.

4.  Resultant Strategic Action Plans

The most tangible result of the strategic planning forum is an action plan for propelling SOAR forward. This plan is intended to establish who and how many staff will contribute to SOAR; how the initiative will be implemented, funded, and sustained; and the nature of cross-agency relationships that will be developed or strengthened to facilitate the success of the initiative. Across the six states, strategic action plans focused on establishing collaborative relationships with organizations that are involved with SSI/SSDI applications. Many stakeholders sought to identify a clear contact at SSA or DDS for homeless providers to use as a resource. States with experience and existing service models for providing benefit assistance strategized how to develop stronger relationships with stakeholders not represented at the forum or in existing efforts. For many, this meant enlisting support from the medical community. Some aimed to establish relationships with medical records departments to improve procedures for obtaining medical evidence, train medical doctors on the importance of providing high-quality medical evidence, or to enlist nurse practitioners, medical residents, and medical doctors to perform medical evaluations. One state also sought to identify a contact at Medicare and the Veterans Administration.

The more specific stakeholders were in identifying timelines, activities, and staff roles, the more they were able to leave the forum with a concrete, actionable plan. Some plans described how and where the trainings would be implemented, identified trainers and CBO's that would be invited to receive SSTR training (and who would recruit them), and approaches for fostering buy-in among local agencies for their staff to implement SOAR. Stakeholders also identified potential solutions to implementation barriers, many of which hindered existing efforts to provide SSI/SSDI application assistance to homeless populations. For example, some states strategized how to assist people who are homeless obtain identification, birth certificates, and a stable mailing address. In states with a scarcity of representative payees, stakeholders strategized ways to increase the availability of payees to better serve the members of the target group.

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