Marion McCoy, Ph.D. Mustafa Karakus, Ph.D. William Frey, PhD

1. Improving Access to Disability Benefits Among the Chronically Homeless Population: SSA-HOPE evaluation outcomes Marion McCoy, Ph.D. Mustafa Karakus, Ph.D. William Frey, PhD

2. President’s Initiative: End Chronic Homelessness in 10 years (2013) • To support this goal, the Social Security Administration (SSA) funds HOPE projects that provide outreach services and disability application assistance to individuals who meet the HUD definition of chronically homeless.

3. Previous relevant research: • Income support is a significant factor that differentiates people with mental illness who are domiciled from those who are homeless (Rossi, 1989). • Successful housing outcomes for veterans who were homeless and had mental illness are associated with receipt of public support payments (Rosenheck, et al., 1995). • Inter-agency efforts to integrate services enhance access to disability benefits among people who are homeless and have mental illness (Rosenheck, et al., 1999).

4. SSA- Homeless Outreach Projects and Evaluation (HOPE) Awards • In 2004, 41 HOPE cooperative agreements to public or private organizations in every region of the country were awarded. • Programs received 4 years of funding. • Current HOPE programs end in September, 2008.

5. Project HOPE Goals • Outreach and engage people who are chronically homeless and have a disability • Assist enrollees with disability benefit applications  • Improve quality and timeliness of medical evidence • Enable quick determinations and benefit payments • Reduce processing time for SSA and Disability Determination Services (DDS) • Provide enrollees with housing and support services  • Improve housing status and quality of life

6. Components of the SSA-HOPE “intervention” for HOPE grantees: • A training manual about the SSA disability processing system; • Assigned liaisons in Disability Determination Services (DDS) & SSA offices; • Technical assistance from liaisons & staff at SSA HQ; • Annual grantee training conferences

7. Study objective: • Assess differences in client outcomes for HOPE grantees compared to comparison groups • Focal outcomes: Time to determination decisions (i.e., to allow or deny disability entitlements)

8. HUD definition of a person who is chronically homeless • Unaccompanied individual; • Has a disabling condition; • Has been continuously homeless for a year or more OR 4 episodes of homelessness in last 3 years; • Has been sleeping in a place not meant for human habitation or living in a homeless shelter

9. A “disabling condition” in HUD definition for chronic homelessness: • Limits an individual’s ability to work or perform 1 or more activities of daily living; • Is diagnosable (e.g., substance abuse disorder, serious mental illness, developmental disability); • Includes the co-occurrence of 2 or more of these conditions

10. Primary Evaluation Data Sources • HOPE program quarterly reports • HOPE Web site records • Focus groups (with program staff, SSA FO, & DDS) • HOPE site visits and interviews with staff & enrollees • SSA “831” data (info that DDS used to make a decision about disability benefits) • For HOPE enrollees • For Comparison Agency participants

11. Comparison agency groups • Comparison agencies do similar work with the same population but do not receive HOPE funding • Comparison agencies • Randomly assigned, 17 agencies received HOPE training manual (C1); 14 agencies did not (C2) • 31 comparison agencies were recruited in the HOPE grantees’ locales; 19 had 831 data available for the evaluation

12. HOPE Analysis: Procedures • Mixed methods: both quantitative and qualitative analysis procedures were used • Content analysis was used to analyze qualitative data from focus groups, quarterly reports, and site visits • Descriptive and statistical procedures were used to analyze HOPE web site and 831 data

13. HOPE Final sample composition • 831 data for HOPE enrollees on timing and final decisions for benefit allowances. • N=3,055 • 831 data for comparison agency clients on timing and final decisions for benefit allowances. • N=198 • Final sample size: N = 3,253

14. HOPE Final Sample Demographics(Total N= 3,253: HOPE programs n=3,055 Comp. Agencies n=198) Note: All numbers in percentages except average and median age. *Gender distribution is significantly different (Chi2 p=0.016).

15. HOPE Final Sample Demographics(cont. 2) Note: All numbers in percentages. *Education is significantly different (Chi2 p=0.007)

16. HOPE Final Sample Demographics(cont. 3) Note: All numbers in percentages.

17. Cox Proportional Hazard Model Note: Proportionality assumption cannot be rejected at 0.01 percent. (chi2=204.57)

18. “Time to determination” calculations • TtoD: the time between the date a disability application is filed and the date that DDS reaches a decision (to allow or deny benefits to the claimant). • HOPE enrollees received determinations almost a month earlier than claimants in either of the comparison agency groups who received the HOPE manual (C1) or agencies that received no support (C2). Note: We apply Average effect of Treatment on the Treated (ATT) estimation with the Radius Matching method (bootstrapped standard errors) in our propensity score estimation.

19. Summary: • Outcome analyses show that the SSA-HOPE “intervention” effectively reduced processing time for initial disability claims compared to local comparison agencies that did not receive SSA help.

20. Other findings • Approximately 41% of initial or reconsidered claims were allowed benefits in the final sample • No significant differences found for • allowance rates for HOPE program vs. comparison agency (C1, C2) clients; • allowance rates for comparison agencies that received the HOPE training manual (C1) vs. those that didn’t (C2) • HOPE enrollees’ living status at 1 year was significantly improved over status at intake (HOPE website data) • HOPE programs with successful outcomes report increased inter-agency coordination and cooperation

21. Thank you!