Transcript Failure to Comply - Community Voices Heard

Failure to Comply:
The Disconnect Between
Design and Implementation
in HRA’s WeCARE Program
A Research Project
By Community Voices Heard
Presentation Format

WeCARE Program Overview

Research Design

Research Findings

WeCARE Client Testimonies

Recommendations
WeCARE
Program
Overview
PATHWAYS FOR A PUBLIC
ASSISTANCE RECIPIENT
BEGIN
Specializes in basic skills
and literacy instruction
for individuals with low basic skills
and limited English proficiency
HRA
JOB CENTER
When an individual
applies for
public assistance
at a job center
(formerly referred to
as a welfare center),
he or she is referred
to one of three
HRA programs,
depending on
his or her
physical, mental
health
or substance abuse
barriers or
skill or educational
level
WECARE
Organizations contracted
by HRA provide a continuum
of services to public assistance
Recipients with potential physical
& mental health limitations
to employment
HRA BACK TO WORK
Employment and training organizations
contracted by HRA
provide job readiness
training, placement services and vocational training
to public assistance recipients
What is WeCARE?
Wellness, Comprehensive Assessment,
Rehabilitation and Employment

HRA program to help PA recipients
with potential barriers to employment
to attain their highest levels
of health and self-sufficiency.

Two primary contracting organizations:
FEGS and Arbor E & T
What Is WeCARE Supposed to Do?

Individualized and Inclusive
Approach

Comprehensive Assessment

Specialized Services
What WeCARE Is Supposed To Do:
The Comprehensive Assessment
HRA Customized Assistance Services - WeCARE Assessment Outcomes
Psychosocial
assessment
Comprehensive
medical exam
Biopsychosocial
Assessment
Lab tests, x-rays,
etc.
Specialty medical
exam
Functional
Outcome
Comprehensive
Service Plan
Client is
employable
may require minimal
accommodations
Vocational
Rehabilitation
Client is employable
with limitations
Wellness
Rehabilitation
Client needs
medical treatment to
stabilize condition
Federal Disability
Client is
unemployable
Why Pay Attention to WeCARE

High Cost: $201,465,000 allocation
over 3 years

Large Population: 55.7% of the
caseload is partially or completely
unable to work

Hard to Reach: Many with multiple
and complex barriers to employment
Research
Design
Data Source Categories

HRA Documents and Meetings
• Policy Directives, Contracts, Vendor Guidelines, Testimony

Client Conversations
• Outreach workers held 7-10 minute conversations with 727
clients at 10 WeCARE sites

Focus Groups
• Seven 2.5 hour sessions, 40 participants

Client Interviews
• 7 in-depth interviews conducted
Research
Findings
Overall Finding
Good Program Design
=
Good Practice
Design and Implementation Divide
• Assessments
• Escalating Outreach
• Federal Disability Benefits
• Job Search/ Job Placement
• Program Monitoring and
Evaluation
Finding: Assessments
Design
Vs
Practice

Comprehensive

Poor Quality

Individualized

Low Completion
Rate
Incomplete Assessments
WeCARE Assessment Completion Rate as of
October 2, 2006
19 percent of
those referred
for a WeCARE
Assessment did
not complete it
140,000
119,885
120,000
100,000
80,000
60,000
22,778
(19%)
40,000
20,000
0
Individuals Referred by HRA
for WeCARE Assessment
Individuals That Did Not
Complete the Assessment
Poor Assessment Quality
Long waits
Short visits with Doctors
Recommendations and
Documents from Personal
Doctors are Ignored
WeCARE Participant
Testimony
Judith Schraemli
Finding: Escalating Outreach
Program Design



Help clients meet
requirements
Vs
Practice

No outreach

Limited
Communication

Lots of sanctions
and case closures
Letters, phone calls, contact
with family, home visits
No sanctions until all
outreach has failed
No Escalating Outreach
WeCARE Cases Closed or Sanctioned from November 2004August 2005
20,000
17,800
18,000
16,000
14,000
12,000
10,000
10,000
8,000
4,700
6,000
4,000
2,000
1,250
1,850
Cases
Sanctioned
That Remain
in Sanction
Cases
Sanctioned
That Are Now
Fully Active
0
Total Number Cases Closed
Cases Closed That Remain
or Sanctioned
Closed
Cases That
Were Closed
And Are Now
Re-Opened
Finding:
Federal Disability Benefits
Program Design


Vs
Vendors get $$ to help
clients obtain federal
benefits (SSI/ SSDI)
Focus on trying to shift cost
from NY City and State to Feds
Practice

Clients unaware of
assistance

Low success rates

Many eligible
clients
not applying
WeCARE Client Testimony
Terrance McSween
Finding: Job Search/ Job
Placement Services
Program Design


Vs
Specialized Work Experience
Program sites
Individual Plan for Employment
based on work experience and
career goals
Practice

One-size fits all

WEP not
specialized
 Low
employment
placement rate
Job Search/ Job Preparation
Job Placement
WeCARE Employment Rate as of October 13, 2006
Only 5.4% of
those who are
employable with
limitations
obtained
employment
50,000
45,543
45,000
40,000
35,000
30,000
25,000
20,000
2,500
(5.4%)
15,000
10,000
5,000
0
Individuals Found To Be
Employable with Limits
Individuals That Have Obtained
Employment While In WeCARE
Finding: Program Monitoring
Program Design
Vs
Practice

Outside organization to conduct
quarterly evaluation

Only 1 evaluation
to date

Organization should be
independent of HRA

Only medical
facilities evaluated

Ensure quality, effectiveness
and integrity of Services

No measures of
effectiveness
Recommendations
Assessments
HRA Should:

Create hotline for questions
about assessment process

Allow clients to see personal
doctors for assessment
Escalating Outreach
HRA Should:
 create
a mandatory 1 month wait
period before a case is sanctioned
or closed.
 Create
WeCARE liaison at Job
Centers to oversee outreach
Federal Disability Benefits
HRA and WeCARE Vendors Should:
 Subcontract
the provision of
federal disability services to an
organization with expertise
 Align
WeCARE assessment with
eligibility criteria for Federal
Disability Benefits
Job Preparation


End unpaid Work Experience
Program (WEP)
Replace WEP with paid
supportive work programs linked
to individual’s interest and
experience
Monitoring and Transparency
HRA Should:

Establish a WeCARE participant
advisory board

Hire independent organization to
conduct evaluation of ALL WeCARE
services and program components

Post quarterly monitoring reports
and all Vendor statistics on HRA
website