Understanding Work Incentives Benefits Counseling

Research has shown that many individuals with intellectual disabilities have a strong desire to work in competitive integrated employment. At the same time, many of them are also recipients of benefits from disability supports such as Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), state or federal workers compensation, and public healthcare programs such as Medicare and Medicaid. Understanding the impact that paid employment will have on a person’s disability benefits is an important factor in the success of the individual.

Transcript

Welcome  to  CHP  conversations. A podcast  series  produced  by the VCU  College  of  Health  Professions. This  series  includes  conversations with  faculty,  students, and  alumni  who  exemplify our  mission  to  create  influential  leaders  in  healthcare. I'm  Jared  Schultz  and  I  am  in the  Department  of  Rehabilitation  Counseling  here  at the  College  of  Health  Professions at  Virginia  Commonwealth  University. And  I'm  joined  today  by  Dr. Kanako Iwanaga who  is an  Assistant  Professor  in the  rehabilitation  counseling  department. She  received  her  Ph.D.  in rehabilitation  counselor  education  from the  University  of  Wisconsin-Madison,  and  has  worked  at  Northern  Illinois  University, as  an  assistant  professor  prior  to  coming  here  to  VCU. She  is  a  certified  rehabilitation  counselor  and a  licensed  professional  counselor  in  Wisconsin. Dr. Iwanaga  has  five  years  of  professional  experience working  as  a  rehabilitation  counselor for  the  Japanese  government, two  years  as  a  researcher  at the  National  Institute  of  Vocational  Rehabilitation, and  three  years  as  a  lecture  at the  Polytechnic  University  in  Tokyo. She's  published  over  80  peer-reviewed  articles and 7 book  chapters  in  the  last  six  years. Her  research  program  has  a  focus  on evidence-based  rehabilitation  counseling  practices, demand-side  employment, secondary  transition,  validation  of psychological  and  vocational  assessment  instruments for  people  with  disabilities, and  validating  psychosocial  intervention  strategies for  improving psychosocial  and  vocational  outcomes  of  people  with chronic  health  conditions  and  disabilities. Kana,  it's  great  to  have  you  with  me. Thanks  for  joining  me  today. Thank  you.  It's  a  pleasure  to  have  this  opportunity. No.It's- I'm  looking  forward  to  the  conversation. We're  going  to  spend  a  little  bit  of  time  talking  about an  article  that  you  were  the  lead  author  on. It  was  published  in  the  Journal  of Occupational  rehabilitation. And  the  title  is  "Evaluating The Effect of Work Incentives Benefits Counseling on Employment  Outcomes  of  Transition  Age, and  Young  Adult  Supplemental  Security  Income Recipients with  Intellectual  Disability: A  case  control  study." Long  title. Long  title,  but  very  important,  very  important  topic. Incidentally,  for  our  listeners, this  article  won  an  award  from the  American  Rehabilitation Counselor Association  for- it was the  second  place  award for  the  Research  Award  this  last,  this  last  year. So, recognized  by  your  peers  as  being an  important  contribution  to  the  literature. But  once  again,  long  title, but  we're  going  to  pick  some  of  that apart  so  it'll  make  more  sense. But  let's  go  ahead  and  just  get  started. So you're  talking  in  this  study  about the  concept  of  work  incentives benefits  counseling, and,  and  how  that  impacts  the  employment  outcome. And  we'll  get  into  a  little  bit  later  into what  work  incentive  benefits  counseling  is. But  first  of  all,  what  are  some  of the  main  findings  of  the  study? Yeah this  study  provided  empirical  evidence for  the  effectiveness  of  work  incentives benefits  counseling  as  a  means of  positively  influencing  employment  and earnings  outcomes  for  low-income  transition  age  youth with  intellectual  disabilites.  The group which recieved  work  incentives benefits  counseling  had  higher  of  employment  and  higher hourly rates than [the] group which didn't recieve work incentives benefits counseling. Okay, so  those  who  had  that  benefits  counseling, just  to  shorten  that  down a little. Oh yeah, sure. Because that's  a  mouthful. But  that  benefits  counseling  actually  had higher  rates  of  employment  and higher  hourly  wages.  That's  right. That's  fascinating.  It's  a  good  outcome  to  see. Why,  why  did  you  start  on  this  research? Why  focusing  on  the  benefits counseling? Yeah.  So  research  has  shown  that many  individuals  with  intellectual  disability have  a  strong  desire to  work  in  competitive  integrated  employment.  At the  same  time  many of  them are also  recepients  of  benefits  from  disability  support, such  as  Social  Security Disability  Insurance,  Supplemental  Security  Income, state  or  federal  workers  compensation, and  public  healthcare  programs such  as  Medicare  or  Medicaid. So  the  fundamental  issue  then  is  when  someone  receives those  benefits  and  then  they start  to  work  in  a  competitive  environment, their  income  could  impact  that. Exactly, yes. Yeah. So  historically,  when  I  first  started  in  the  field, we  would  sometimes  refer  to  that  as disincentives  to  work  because you  don't  want  your  benefits  to  go  down (That's right) that  you're  receiving,  but  you  want to  be  out  there  working  in  the  community. And  so  the  important  piece of  that  is  helping  them  to  understand that  impact  that  the  work is  going  to  have  on  the  benefits (Exactly). Okay. How  much  do  you  think  these,  Disability  Support  Programs, how  much  support  do  they  provide different  households?  And  like  yeah, total  percentages  that-  Yeah,  sure. So  for  low-income  households  with  children  receiving  SSI, such  disability  support,  on  average, provides almost  half  of  total  household  income. Even  more  alarmingly,  44%  of  these  families live  below  the  federal  poverty  threshold even  after  including  disability  [inaudible]  benefits. Therefore,  given  these  economic  stressors, many  individuals  and  families are  understandably  highly  concerned about  potential  disruption  or deduction  of  public  benefits  and  eligibility resulting  from  increased employment  activity  and  earnings. These  concerns  become  as a  significant  barriers  to people  with  disability  gaining  employment, increasing  earnings  and achieving  ongoing  career  development. Well,  the  focus  of  the  study  was on  young  adults  and  transition-age  children. Yes.  So  with  so  much  of  the  support  of  the  household, like (Right.) almost  half  of  the  household  being  provided through  that  child's  benefits (Exactly.), you  could understand  our  parent  would  be  like "Hang  on. You're  not  going  to  go  get  a  job. We  need  that  revenue  and  we  don't  want  it  to  be  impacted." How-  is  social  security, is  the  Social  Security  Administration  aware  of the  problem  and  have  they  been doing  anything  to  try  and  address  it? Of  course  they  did. And  Social  Security  Administration, has  been  easing  some  of  that  restriction to  encourage  beneficiaries  to  work. However,  benefit  to  the  recipient  may  be  unfamiliar  with the  work  incentives  built into  Social  Security  Administration  programs. Also,  they  may  not  understand  fully how  employment  will  change  their  benefit. This  uncertainty  contributes  to  the  widespread  on the  employment  and  the  unemployment of  people  with  disabilities. And  that's  understandable.  I  mean, those  programs  can  be  very  complex. It  can  be  hard  to  understand (Right.) everything  that  goes  into  it. And  so  someone  who  isn't  working  in that  all  the  time  may not  have  the  background  to  understand  how  it  is. That's right. So  what  can  we  do  to  change  the  situation? Are  there  any  strategies? Yeah,  it  is  very  important  to  provide some  services  that  help  them  clear  that  uncertainty. So one  that  was an effective  services  is  work  incentives benefits  counseling,  which  is called  benefit  counseling. Okay. So  it  seems  like  that's  a  very  important  element of  the  employment  process. Can  you  tell  me  a  little  bit  about what  specifically  work  incentive  benefits  counseling  is? Sure.  Work  incentives  benefits  counseling gives  Social  Security disability  program  beneficiaries  the information  they  need  to make [an] informative  decision  about  work. It  helps  them  understand  how  earning money  may  affect  disability  payments, health  care,  and  other  publicly-funded  benefit. This  information  is  essential  to  getting  and keeping  a  job.  A benefit counselor assesses  a  consumer's  [inaudible]  and  goals, identify  available  options  and  manage  benefits, and  then  work  activity  to  help the  consumer  achieve  their  goals. Benefits counseling  allows  those receiving  their    services  and  support  to  make informed  choice  about  their  level  of work activity  and  achieve  economic  self-sufficiency. So  it's  a  very  important  part  of the  employment  process  when you're  working  with  someone  with  a  disability. And  you're  starting  to  look  at  work  opportunities and  what  wages  they'll  be  making  and  the  impact  of  that. Is  there  any  evidence  to  show that,  that  benefits  counseling  has  an  impact  on  outcomes? Yeah, yeah.  A  lot. Work  incentives  benefit  counseling  services  contribute  to achieving  the  full  employment  potential of  public  benefits recipients  and   reducing  dependents  on state  and  federal  benefits and  increasing  financial  well-being. Research  has  suggested  is  that  the beneficiaries  who  receive benefit  counseling  services  achieve significantly  greater  improvement  in  earning, employment,  utilization  of work  incentives  and  transitioning  off benefit  roles  including  SSI  or  SSDI. For example  research  has  shown  us  who  received  work  incentives benefits  counseling  earned  more  than twice  than  those  who  have  not  received the  benefit  counseling  and  engage  in  more  than four  times  over  substantial  gainful  activity. Those  are  some  very  significant outcomes (Exactly). Yeah. As  I  was  reading  your  study, one  of  the  things  that  stuck  out  to  me was  the  idea  of  using  the  benefits  counseling  as, as  an  independent  variable. Essentially,  this  is  one  of- this is the  intervention (Right) and  I've  always  thought  of  it  in all  my  work  is  something  that  we  do. I  guess  I  never  really  thought  of  it  as an  intervention  in  and  of  itself, but  it's  really  some  great  data to  show  that  it  can  be  very effective  in  increasing  the  quality  of  the  outcomes. Yeah.  So, Kana,  why  did  you  research  focus  on  transition-age youth  with  intellectual  disability? Yeah, that is a  good  question  in  the  United  States. Transition-age  youth  with  disabilities  receiving SSI  need  to  be  pre-qualified as adult recipients  of  SSI  when they  turn  to  18  years  old. If  we  did  decide  to  be  pre-qualified, may  never  seek  work. This  not  only  leads  to  high  long-term  cost  to  taxpayer, taxpayer  as  a  result  of  ongoing  benefits. But  also  confines  individuals  to a  high  likelihood  of  sustained  lifelong  poverty. Therefore,  it's  a  period  where  use  benefits  of  SSI terminate  is  a  significant  milestone for  transition  age  youth  with  disabilities in  terms  of  potential  career  development. If  more  transition  age  youth  make  the  choice  not  to  prequalify  for  SSI  due  to work  or  post-secondary  educational  aspirations, there  is  a  potential  for vast  reduction  in  the  number  of  people  dependent  on lifelong  disability  benefits  and increase  in  those  able  to enter  the  middle  class. Among  the  transition  age  youth  with  disabilities. Many  studies  have  shown  that  individuals  with intellectual  disability  continue  to own  subminimum  wages. They may  engaged  in highly  segregated  settings  and live socially  isolated  lives. Therefore,  we  focus  on  transition-age youth  and  young  adults  with intellectual  disability  who receive  Social  Security  income. Well,  so  major  transition  period  in  their  life. Not  only  in  terms  of  work  and  moving  into  adulthood, but  the  services  that  they're  eligible for  and  how  those  transition as well (That's right). Could  you  talk  to  us  a  little bit  about  the  details  of  the  study and  kind  of  get into  what  it  is  that  you  are  trying  to  accomplish. Sure.  We  used  the  United  States  Department  of  Education, Rehabilitation  Services  Administration Case  Service  reported  dataset. It  is  called  RSA-911  dataset. This  data  includes  information regarding  demographics,  disability, service  interventions,  employment  status  at  closure, and  some  work  related  information. Inclusion  criteria  for  this  study  were ages  from  18  to  35. A  primary  diagnosis  of intellectual  disability  at  the  intake.  SSI recipients at  intake and  DC  with  vocational  rehabilitation  services, we  used  propensity  score matching  analysis  for  this  study. This  is  a  mathematical  analysis  method designed  to  minimize  the  effect  of confounding  variables  when  estimating treatment  effect  using  observational  data. There  are  1,046  transition-age  youth, and  young  adults  with intellectual  disability  who  received the  benefit  counseling  in  the  RSA-911  dataset. Propensity  score  matching  was able  to  identify [the] same  number. So  which  means  1,046  transition-age youth, and  young  adults  with  intellectual  disability  who did  not  receive  benefits counseling. That [inaudible]  the  prominent characteristics [inaudible] the  treatment  group [inaudible] the  prominent  characteristics  included  age, gender,  race,  special  education, low-income,  and  different  sources. So. You went  into  the  national  data  set. You  were  able  to  pull  out your  intervention  group  and  your  control  group. There  were  matched  on  those, those  demographics  so  you're  able  to  control  for  those. So  Kana,  what  were  some  of  the  things  that  you've  found? Sure. We  found  is  that  benefit  counseling  group  were more  likely  to  achieve  competitive  integrated  employment. More  detail,  59%  benefit counseling  group  versus  44%  over  control  group. Also  work  incentive  benefits  counseling  group earned  higher  hourly  wages, which  is  average  10.18 dollars. While  control  group  average hour-  average  hourly  wages  was  9.50 dollars. On  the  other  hand,  the  are  benefits counseling  group  worked  shorter  average  hours  per  week. And  the  control  group. One  impossible  reasons  over  this result is that that  cash  cliff  threshold for  substantial  gainful  activity  was $1,180  per  month  in  2018  when  this  data  was  gathered. When  earnings  exceed  this  amount  by  even  one  dollar, the  entire  SSDI  cash  benefit  maybe suspended  and  it's  beneficiary can  be  terminated  from the program. Therefore,  younger  adults  with intellectual  disability  who  receive  SSI  or  SSDI [are] mindful  over  the  cash  cliff  and a  potential  loss  of  their  financial  and  health  benefit. Because  of  this, the  benefit  concert  in  group  may work less hours  not  to  exceed  this  cash  cliff. So  someone  not  familiar  with  the  program (Okay), might  look  at  the,  the,  the, the  drop  in  average  hours  worked to  the  people  who  receive  benefit  counseling  and  wonder, 'well,  why  would  they  work  less?' And  the  reality  of  it  is, is  that  maybe  helping  them  to  maintain  their  benefits (Exactly.) because  there's  this  cash  cliff where  if  you  earn, you know,  just  a  little  bit  more, your,  your  monetary  benefits  are reduced  or  in  the  case  of  SSDI  discontinued  altogether. So,  yeah,  so  that's  an  interesting  finding that  it's  kinda  seems counterintuitive (Yeah.)  because  you  would  think, why  would  you  want  to  work  less? But  it  actually  is  a  good  thing in  keeping  the  benefits. That's right. What  are  some  of  the applied  implications  of  the  research? And  how  does  this  help  us  move  the  field  forward? As  I  talked,  this  study provided  empirical  evidence  for  the  effectiveness  of benefit  counseling  as  a  means of  positively  influencing  employment  and earnings  outcomes  for  low-income  transition  age, youth  with  intellectual  disability. Benefits,  counseling  should  be fundamental  component  for evidence-based   implement  service. However,  descriptive  analysis  over  the  data  used  in this  study  showed  that just why  in  turn participants  received  benefits  counseling  as  a  service. This  strikingly  low  late  rate of participation  in  a  benefit  counseling  is  very concerning  and  it  shouldn't  be  addressed  more comprehensively  in  policy  and  practice. With  the  passage  over  the  Workforce Innovation  and  Opportunity  Act  of 2014  and  the  Rehabilitation  Act  of  1973  as  amended, vocational  rehabilitation  agencies are required  to  strengthen  their  capacity  to emphasize  transition services  for transition-age  youth  with disability  that  can  lead to meaningful career  and  economic  security to  facilitate entry to  the  middle-class. Benefit  counseling  should  be  provided directory to the individuals and  families  during  the  transition planning and  programming as a  core  part  of  development  of  employment  goals. Addressing  potential  concern  of  individuals  and families  about  the  impact  of  employment  earnings early by  providing  benefit  counseling  may  contribute to  improved  outcomes  by  changing implemented  transition  goals  and increasing  consolidation  of transition  experiencing leading  to  competitive  integrated  employment. In  addition,  given  the  potential  impact  of misinformation  to    limit  or dismiss  potential  employment  opportunities. As a stakeholder  such  as  case  manager, employment  specialist,  social  workers,  or  teachers should  be  informed  about a  basic  but correct  facts  regarding the  impact  of  employment  on  state,  federal  benefits. This  information  about  the  fundamental  or  the  impact of  competitive  integrated  employment  benefits should be  embedded  in  coursework and  professional  development  for all  professionals  who  work  in  areas related  to  their  employment  of  people  with  disabilities. So it's  really  interesting to me  how  this  is  such  a  critical  thing. And  you  talked  and as  you're  responding  to  my  question about  applications  and how  this  can  be  applied is,  you  know,  this- it  seems  like  such  a  fundamental  need. And  yet  there  is  a  lot  of  misinformation, there  is  a  lot  of  misunderstanding and  ignorance  about  the  programs (Right.) which  can  get  in  the  way  of  the,  the, the  individuals  with  disabilities reaching  their  full  potential  in  the  workplace. Exactly. So, Kana, thank  you  so  much. Very  enlightening  and  very  important  element of  the  service  provision  process. I  appreciate  the  work  that  you're  doing  in  this  area. Do you  have  any  other  final  thoughts about  the  importance  of  benefits  counseling? Not  really. We've  we've  covered  it  in  the  research. Yeah,  I  covered  in  my  research. Okay. Thank  you  again,  and  I  appreciate  your  time. Thank  you  so  much.