ODEP SSI Youth Strategies Report

REVISED
Potential Strategies to Improve the

Employment Outcomes of Youth SSI
Recipients
April 18, 2018
Todd Honeycutt
David Wittenburg
Richard Luecking
Kelli Crane
David R. Mann
Submitted to:
U.S. Department of Labor
Office of Disability Employment Policy
200 Constitution Ave. NW
Washington, DC 20210
Project Officer: Kirk Lew
Contract Number: DOLQ129633249/1605DC-17-U-00131
Submitted by:
Mathematica Policy Research
1100 1st Street, NE
12th Floor
Washington, DC 20002-4221
Telephone: (202) 484-9220
Facsimile: (202) 863-1763
Project Director: Todd Honeycutt
Reference Number: 50518.01.311.040.000
This report was prepared for the U.S. Department of Labor (DOL), Office of Disability Employment
Policy by Mathematica Policy Research, under contract number DOLQ129633249. The views
expressed are those of the authors and should not be attributed to DOL, nor does mention of trade
names, commercial products, or organizations imply endorsement of same by the U.S. Government.
This page has been left blank for double-sided copying.
POTENTIAL STRATEGIES FOR YOUTH SSI RECIPIENTS MATHEMATICA POLICY RESEARCH
ABSTRACT
The U.S. Department of Labor’s Office of the Disability Employment Policy and its federal
partners seek to build the evidence base for promising strategies to improve the employment
outcomes for youth ages 14 to 24 who receive Supplemental Security Income (SSI). This report
documents promising strategies to promote sustained, gainful employment for youth SSI
recipients. An important challenge is that there is no single way to identify the most promising of
the reviewed strategies. Testing strategies for youth SSI recipients could range from smaller
interventions to large-scale demonstration projects. Smaller intervention tests could involve
current innovations in evaluation techniques, such as behavioral nudges, rapid-cycle evaluations,
and technical assistance integrated with strategies, that encourage specific practices or outcomes.
Larger demonstration projects might build from existing large Social Security Administration
demonstrations targeted to youth SSI recipients, which would provide evidence on a larger set of
interventions at a much higher cost.
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CONTENTS
ACKNOWLEDGEMENTS ............................................................................................................................ ix
EXECUTIVE SUMMARY ............................................................................................................................. xi
I. INTRODUCTION.............................................................................................................................. 1
A. Project and report background .................................................................................................. 1
B. Methodological approach to identifying promising strategies .................................................... 2
II. TRANSITION CHALLENGES FACING YOUTH SSI RECIPIENTS ................................................ 3
A. SSI eligibility rules can influence youth transition decisions, especially related to
employment ............................................................................................................................... 3
B. Youth SSI recipients have multiple service needs based on their characteristics,
services, and outcomes after age 18 ........................................................................................ 4
C. State differences in SSI participation and resources indicate geographic variation in

service delivery and needs ........................................................................................................ 5
D. Implications for intervention design options .............................................................................. 5
III. FINDINGS THAT INFORM PROMISING STRATEGIES FOR YOUTH SSI RECIPIENTS ............. 7
A. Frameworks to guide strategy development and assessment .................................................. 7
B. Evidence on promising strategies.............................................................................................. 8
1. Evidence from demonstrations targeting youth SSI recipients ........................................... 8

2. Evidence from studies targeting adults and youth with disabilities ..................................... 9
C. Federal and state programs that could influence transition outcomes .................................... 12
IV. CONCLUSION AND NEXT STEPS ............................................................................................... 15
REFERENCES ............................................................................................................................................ 17
APPENDIX A CHARACTERISTICS OF AND GAPS IN TRANSITION SERVICE FRAMEWORKS

FOR YOUTH WITH DISABILITIES ................................................................................ A.1
APPENDIX B EVIDENCE SUPPORTING STRATEGIES INTENDED TO PROMOTE THE

SUCCESSFUL TRANSITION OF YOUTH WITH DISABILITIES .................................. B.1
APPENDIX C FEDERAL AND STATE PROGRAMS ACCESSED BY YOUTH SSI RECIPIENTS .........C.1
v
TABLES
ES.1 Strategies that could promote the employment of youth SSI recipients ........................................ xiii
ES.2 Summary of federal and state programs and systems change efforts for youth SSI
recipients ........................................................................................................................................ xiv
III.1 Strategies that could promote the employment of youth SSI recipients ........................................ 11
III.2 Summary of federal and state programs and systems change efforts for youth SSI
recipients ........................................................................................................................................ 13
A.1 Guideposts for Success policies and practices ............................................................................ A.4
A.2 NTACT effective practices and predictors for postsecondary employment outcomes, as of
January 2018 ................................................................................................................................ A.8
B.1 Strategies with experimental evidence ......................................................................................... B.7
B.2 Strategies with nonexperimental evidence ................................................................................. B.14
B.3 Strategies without evidence ........................................................................................................ B.21
C.1 Strategies offered by federal and state programs .........................................................................C.6
C.2 Systems change strategies for federal and state programs .......................................................C.10
vii
ACKNOWLEDGEMENTS
Mathematica Policy Research prepared this report for the U.S. Department of Labor, Office of
Disability Employment Policy. The authors are grateful for the dedicated research assistance of
Cassandra McClellan and Sarah Palmer, the editorial and production support of Donna Verdier
and Alfreda Holmes, and the technical guidance of Gina Livermore and Yoni Ben-Shalom.
The views and opinions expressed here are those of the authors and do not necessarily reflect the
views, opinions, or policies of the Office of Disability Employment Policy. The authors are
solely responsible for any errors.
ix
EXECUTIVE SUMMARY
The U.S. Department of Labor’s (DOL) Office of the Disability Employment Policy
(ODEP), along with many other stakeholders, is working to improve outcomes for youth ages 14
to 24 who receive Supplemental Security Income (SSI) benefits. Under the SSI Youth Recipient
and Employment Transition Formative Research project, Mathematica will contribute to this
effort by identifying (1) promising programs and policies for youth SSI recipients, including
research questions for further follow-up and (2) testable strategies or strategy models for
assisting young SSI recipients with their transition to sustained, gainful employment. This report,
the first to emerge from this project, seeks to document promising strategies and to serve as a
useful resource for potential programs, demonstration projects, and policy innovations that
promote sustained, gainful employment for youth SSI recipients.
Transition considerations facing youth SSI recipients

To identify promising options to serve youth SSI recipients, it is important to address how
SSI benefits affect their transition to adulthood, especially employment. Three considerations
can affect the participation and outcomes of youth SSI recipients. First, the strict medical,
income, and asset criteria for SSI eligibility have strong roles in influencing youth SSI
recipients’ transition experiences. Second, the demographic, family, health, and housing
characteristics of youth SSI recipients indicate a need for a variety of supports. Third, states have
substantial variation in SSI participation and service availability, which implies that strategies
developed for youth SSI recipients might need to be adjusted in accordance with geography.
Findings that inform promising strategies for youth SSI recipients

Frameworks to guide strategy development and assessment. Best practices for the
employment of youth with disabilities are documented by two transition frameworks that can
inform efforts to promote positive outcomes for youth SSI recipients. Guideposts for Success
was developed by the National Alliance for Secondary Education and Transition (NASET 2005)
and National Collaborative on Workforce and Disability for Youth (NCWD/Y 2009), and the
effective transition practices and predictors matrix is maintained by the National Technical
Assistance Center on Transition (2018). Both frameworks summarize evidence to guide services
offered by practitioners (such as staff from local education agencies, vocational rehabilitation
[VR] agencies, or community rehabilitation providers), as well as the services that youth and
families choose. The two frameworks have many similarities, particularly for strategies around
work, connecting activities and interagency collaboration, and service customization to improve
youth autonomy. However, three important aspects of these frameworks limit their potential for
informing strategies for youth SSI recipients: (1) many of the strategies are supported only by
descriptive or anecdotal evidence; (2) the majority of evidence reflects the experiences of varied
populations of youth with disabilities and, hence, might not represent the specific circumstances
of youth SSI recipients; and (3) benefits counseling and financial education are not well
identified.
Evidence on promising strategies. We draw from two sources to identify strategies to help
youth SSI recipients with employment: (1) two major Social Security Administration
demonstration projects that target the population exclusively and (2) a larger base of studies in
xi
which youth SSI recipients are possibly a subset of a larger population. Table ES.1 provides an
overview of strategies and providers, sorted by level of evidence and target population.
This review of strategies reveals three key findings.
1. The Youth Transition Demonstration (YTD) evaluation provides the most comprehensive
information about promising strategies to improve the employment outcomes of youth SSI
recipients and points to the potential for employment services to influence outcomes for this
population.
2. Random assignment evaluations of federal demonstrations for individuals receiving adult
SSI and Social Security Disability Insurance show the positive impacts of case management,
health plans, supported employment, work incentives, and other supports.
3. Various strategies targeted to youth and young adults with disabilities show consistent
promising evidence on employment outcomes, though much of this evidence is based
primarily on descriptive or non-experimental studies, and a larger number have involved
transition programs that provide participants with employment services coupled with other
services.
Given the lack of evidence for youth SSI recipients, any implemented strategy would do
well to include a pilot period to assess the feasibility of implementation on a small scale.
Federal and state programs that could influence transition outcomes. Modifications of
existing federal and state program rules, either on their own or in conjunction with other
strategies, could be made to promote the employment of youth SSI recipients (Table ES.2).
Youth SSI recipients might also access services from the state VR agency or workforce
development agency or be able to take advantage of systems change efforts seeking to improve
the service environment for youth with disabilities.
Conclusion and next steps

The lack of strong evidence on effective practices for youth with disabilities generally—and
youth SSI recipients specifically—underscores the need for better data and information.
Transition frameworks such as the Guideposts for Success can be used as a starting point to
assess strategies using existing frameworks and evidence from the field, although they might not
be sufficient to promote positive outcomes for youth SSI recipients. There is no single way to
identify the most promising of the reviewed strategies specifically for youth SSI recipients, in
part because tests conducted thus far for this population have been limited. Testing strategies for
youth SSI recipients could range from small pilot tests to large demonstration projects.
xii
Table ES.1. Strategies that could promote the employment of youth SSI
recipients
Strategy (responsible federal organization) Provider
Strategies (targeted to youth SSI recipients) that have or will have experimental evidence
Youth Transition Demonstration random assignment projects (SSA) CRPs, LEAs, postsecondary institutions
Promoting Readiness of Minors in SSI (ED, SSA, DOL, HHS)* State education, LEAs, VR, workforce development
agencies
Strategies (targeted to adults with SSI and/or SSDI benefits) that have or will have experimental evidence
Accelerated Benefits (SSA) SSA
Benefit Offset National Demonstration (SSA) SSA, WIPA
Mental Health Treatment Study (SSA) SSA, community mental health agencies
Promoting Opportunity Demonstration (SSA)* SSA
Supported Employment Demonstration (SSA)* SSA, community mental health agencies
Strategies (targeted to other youth or adults with disabilities) that have or will have experimental evidence
Demonstration to Maintain Independence and Employment (HHS) State departments of health, a health policy authority
and health insurance organization, and a Medicaid
agency
Employment Intervention Demonstration Program (SAMSHA) Academic, public, and private entities provided clinical
and VR services and supports
Job Corps (DOL)a DOL, workforce development agencies
Project SEARCH LEAs, VR, employers
Transition Work-Based Learning Models in Maryland and Vermont VR, CRPs, LEAs (in Maryland)
(Rehabilitation Services Administration, or RSA)*
Strategies (targeted to youth SSI recipients) with nonexperimental evidence
Benefits counseling (SSA) WIPAs, varied organizations
Youth Transition Demonstration nonexperimental projects (SSA) Each project was led by a varying combination of state
agencies
Strategies (targeted to other youth or adults with disabilities) that have or will have nonexperimental evidence
Back on Track to Success Mentoring Program Community organizations
Marriott Foundation Bridges from School to Work Program Nonprofit community organization
Maryland Seamless Transition Collaborative LEAs, VR, state education, state department of
disabilities
Supported employment Nonprofit, multiservice organizations
Think College* Institutions of higher education, along with community
partners such as VR agencies, LEAs, and employers
Transition Work-Based Learning Models in California, Maine, and VR, CRPs
Massachusetts (RSA)*
Utah Pathways to Careers* CRP
Strategies (targeted to other youth or adults with disabilities) without any evidence
Individualized Career Planning model (ED) LEAs
Guided Group Discovery pilots* (Labor) Led by a national collaborative of organizations
focused on disability, workforce, and economic
support, in partnership with local job centers, VR
agencies
Partners for Youth with Disabilities* Private organization
a Job Corps is not targeted to youth with disabilities, but the program does serve this population.
* Currently in the field.
CRP = community rehabilitation providers; DOL= U.S. Department of Labor; ED = U.S. Department of Education;
HHS = U.S. Department of Health and Human Services; LEA = local education agencies; SAMSHA = Substance
Abuse and Mental Health Services Administration; SSA = Social Security Administration; VR = vocational
rehabilitation; WIPA = Work Incentives Planning and Assistance
xiii
Table ES.2. Summary of federal and state programs and systems change
efforts for youth SSI recipients
Federal and state programs accessed by youth SSI recipients

ABLE Act State agencies and financial institutions
Disability Employment Initiative (DOL) DOL, workforce development agencies
Employment First DOL, workforce development agencies
Pre-employment transition services (RSA) VR agencies, LEAs, CRPs
Special education services DOE, state and local education agencies
SSA work supports (SSA) SSA
Ticket to Work program (SSA) SSA
Vocational rehabilitation (RSA) RSA, VR agencies
Workforce development programs (such as YouthBuild, Youth Corps, DOL, workforce development agencies
apprenticeships)
WIPA (SSA) SSA
Systems change efforts
Age 18 redetermination counseling SSA, VR agencies, school districts
Age 18 redetermination changes/work reporting changes SSA
CareerACCESS World Institute on Disability, the National Council on
Independent Living, and PolicyWorks
Partnerships in Employment Systems Change projects Stakeholder consortia involved state and community
agencies and organizations
Tennessee Medicaid 115 waiver program (TennCare Employment and State Medicaid agency and state disabilities
Community First CHOICES) department
CRP = community rehabilitation provider; DOL = U.S. Department of Labor; DOE = Department of Education; LEA =
local education agencies; RSA = Rehabilitation Services Administration; SSA = Social Security Administration; VR =
vocational rehabilitation; WIPA = Work Incentive Planning and Assistance
xiv
I. INTRODUCTION
The U.S. Department of Labor’s (DOL) Office of the Disability Employment Policy
(ODEP), along with many other stakeholders, is working to improve outcomes for youth ages 14
to 24 who receive Supplemental Security Income (SSI) benefits (hereafter called youth SSI
recipients). To successfully continue this work, ODEP seeks a thorough understanding of two
barriers youth with disabilities might face in achieving employment outcomes as adults. The first
is the fragmented support system for youth SSI recipients, which makes it challenging for them
to navigate among supports that could help them secure economic success as adults (Wittenburg
2011). The second barrier is the growth in the number of youth SSI recipients—particularly
children under age 18—which peaked during the Great Recession of 2007–2009.This growth
indicates that many youth may be moving toward a pathway with few prospects for long-term
employment (SSA 2018; Wittenburg et al. 2015b). Because the disabilities and other
characteristics of youth SSI recipients present significant employment barriers, strategies to
address these concerns must be thoughtful and comprehensive. To be convincing to a broad
audience, such strategies must have a rigorous evidence base to support their further
development.
A. Project and report background

ODEP and its federal partners seek to build the evidence base for promising strategies that
can improve employment and other adult outcomes for youth SSI recipients. Under the SSI
Youth Recipient and Employment Transition Formative Research project, Mathematica will
contribute to this effort by identifying (1) promising programs and policies for youth SSI
recipients, including research questions for further follow-up; and (2) strategies or strategy
models that could be tested for assisting young SSI recipients with the transition to sustained,
gainful employment. Key findings, research questions, policy recommendations, and resources
developed for this project are informed by a Community of Practice (CoP) comprising more than
70 practitioners, policymakers, researchers, employers, and advocates in the fields of
employment, education, health, and financial literacy.
This report, the first to emerge from the project, documents promising strategies to promote
sustained, gainful employment for youth SSI recipients for policymakers to consider in
developing potential programs, demonstration projects, and policy innovations. 1 The report can
also be a resource to the Federal Partners in Transition, a work group of representatives from
several federal agencies who support and coordinate transition services for youth with
disabilities.
ODEP staff and CoP members will provide feedback on promising strategies presented in
this report. That feedback will be incorporated in two subsequent reports that will identify the
most promising target populations and propose evaluation options for select strategies. The first
1
Although other outcomes, such as independence and educational attainment, are also important for youth SSI
recipients, this project focuses on employment as the primary outcome. We interpret sustained, gainful employment
as equivalent to the WIOA (Workforce Innovation and Opportunity Act) definition of competitive, integrated
employment: employment that is at or above minimum wage, the wage is equivalent to the rate employers pay for
similar work performed by individuals without disabilities, the employee has opportunities to interact with other
employees without disabilities, and the employee has opportunities for advancement.
1
will identify target populations of youth SSI recipients (or youth at risk of becoming SSI
recipients) who might benefit from the identified strategies. The second subsequent report will
identify approaches to evaluating strategies that will provide policymakers with compelling
information for assessing the efficacy of promising strategies and the likelihood of their
implementation at a broader scale.
B. Methodological approach to identifying promising strategies

To support ODEP’s overarching objective of identifying promising strategies to improve the
employment of youth SSI recipients, we begin with an overview of the challenges that youth SSI
recipients face in making transitions to adulthood (Chapter II). As part of this overview, we
review SSI program rules and the characteristics of youth under age 18 and young adults (ages
18 to 24) who receive SSI. This summary provides important context for consideration in
identifying strategies that could influence youth outcomes, as well as context for factors that may
have influenced previous demonstrations involving youth SSI recipients.
We then review findings from the literature that could inform future strategy options, which
we divide into three parts (Chapter III). First, we present existing transition frameworks and
literature reviews on effective practices for youth with disabilities. This review identifies
strategies that could be ingredients for future interventions. Second, we summarize findings from
a literature scan, focusing on publications since 2005, to identify demonstrations and strategies
serving youth SSI recipients and other youth with disabilities. As part of this summary, we
highlight the level of evidence supporting each strategy as a tool to assess promising future
strategies. We also present proposed strategy options and system changes that may lack an
evidence base but are nonetheless promising for consideration. Third, we review the federal and
state programs that youth with disabilities access, which might prove relevant in designing future
implementation. For example, some system options might indicate a need for program waivers to
facilitate a future intervention. The summary tables in Chapter III are of particular note because
they provide a quick reference to strategies and previous findings, and identify any not on the
list. In future project reports, we will present updates to this report’s tables as we encounter
additional potential strategies.
This report also includes a supplemental appendix for each of the strategies identified in
Chapter III (Appendices A, B, and C). Appendix A describes the characteristics of existing
transition frameworks for youth with disabilities, Appendix B lists strategies targeted to youth
SSI recipients and youth with disabilities, and Appendix C presents strategies related to federal
and state programs that youth SSI recipients might access.
We conclude with a summary and next steps for consideration (Chapter IV). The ideas in
this chapter build on the strategies presented, their level of supporting evidence, and thoughts for
selecting among options in ways that can promote the knowledge base to improve employment
outcomes for youth SSI recipients.
2
II. TRANSITION CHALLENGES FACING YOUTH SSI RECIPIENTS
An important issue in identifying promising options to serve youth SSI recipients is helping
them overcome existing barriers to their transition to adulthood. The most promising strategies
will address the challenges that impede youth’s long-term adult outcomes, especially
employment. In this chapter, we review issues that could affect the participation and outcomes of
youth SSI recipients: eligibility rules, diversity in recipient characteristics and outcomes, and
regional variation in participation. These issues will be important considerations in narrowing
promising strategies for further implementation.
A. SSI eligibility rules can influence youth transition decisions, especially

related to employment
Eligibility rules for SSI—which can have major effects on a youth’s employment
decisions—are a fundamental consideration in identifying promising strategies to serve youth
SSI recipients. The strict medical, income, and asset criteria for SSI eligibility have strong roles
in influencing youth SSI recipients’ transition experiences. To qualify for SSI, a child under age
18 must have “a medically determinable physical or mental impairment, which results in marked
and severe functional limitations, and which can be expected to result in death or which has
lasted or can be expected to last for a continuous period of not less than 12 months” (42 U.S.C. §
1382c[C][i]). The eligibility and payment calculations account for parental income and assets,
which are “deemed” to the child (that is, treated as the child’s own). These income restrictions
mean that youth SSI recipients most likely face substantial resource constraints in addition to
their disabilities, which could affect long-term adult outcomes.
An especially important feature of the SSI eligibility rules for youth of transition age is the
age-18 redetermination. The Social Security Administration (SSA) reassesses the eligibility of
child SSI recipients under the adult SSI criteria at age 18. This process often creates substantial
uncertainty for families, which is significant, given that the SSI benefit check often makes up
nearly half of the family’s income (Davies et al. 2009). According to Hemmeter and Gilby
(2009), about 42 percent of former child SSI recipients are initially ineligible under the adult SSI
medical eligibility criteria, a percentage that has risen in recent years (SSA 2017). Because SSI
eligibility may be the only way that young adults without children can become eligible for
Medicaid in many states, youth SSI recipients and their parents in these states risk the loss of
health benefits in addition to cash benefits if they fail to become eligible for SSI under the adult
criteria. An additional factor related to the age-18 redetermination process is that some youth
with significant disabilities who were not eligible for SSI before age 18 solely because of
deemed income may become eligible at age 18, when parents’ resources no longer factor into the
youth’s eligibility determination.
Depending on their age, SSI recipients are eligible for certain types of work incentives,
although the U.S. Government Accountability Office (US GAO) concluded that the use of these
incentives is either unknown or low (US GAO 2017). The incentives include features to
encourage earnings (such as the earned income and student earned income exclusions) and
savings (such as the Plan to Achieve Self-Support). SSA also provides access to training through
vocational rehabilitation (VR) agencies and (for adult SSI recipients) Ticket to Work (SSA
2017), for example. We have evidence on effectiveness for three of SSA’s incentives and
3
supports. The Ticket to Work program has resulted in a modest uptake in service use, but not
benefit cessation due to work (Stapleton et al. 2013). The student earned-income exclusion can
be used by students under age 22; less than 2 percent of the eligible SSI population uses this
work support, and evidence about its effectiveness is limited (US GAO 2017). Finally, Work
Incentives Planning and Assistance (WIPA) programs disseminate information on how
employment can affect benefit receipt (Livermore et al. 2011; Schimmel et al. 2011). One large-
scale federally supported research project, Promoting Readiness for Minors in SSI (PROMISE),
has leveraged these programs; descriptive evidence suggests a positive association with
employment for those using WIPA services, but such a link cannot be considered causal. One
challenge to the broader use of these incentives is that SSI families may be concerned that work
and pursuit of a career could jeopardize their children’s current SSI eligibility or future eligibility
after age 18.
B. Youth SSI recipients have multiple service needs based on their

characteristics, services, and outcomes after age 18
A second important factor in identifying promising strategies for youth SSI recipients is
understanding the service needs of youth SSI recipients based on their characteristics, service
connections, and outcomes. The demographic, family, health, and housing characteristics of
youth SSI recipients indicate a need for a variety of supports. According to SSA administrative
data, most child SSI recipients are male, who, in addition to mental impairment such as
developmental disabilities, intellectual disabilities, or autism, have a range of other types of
conditions requiring different types of supports, accommodations, and assistive technologies
(SSA 2017). Many child SSI recipients also receive unearned income, including financial
support from absent parents; for those residing with their parents, fewer than half have parents
with any earned income. In 2000, the last year for which there was a national survey of SSI
children, 71 percent lived in single-parent families, and almost half of all recipient families
included another family member with a disability (Wittenburg 2011).
Aside from the complexities of the SSI rules, youth SSI recipients and their families must
navigate a highly fragmented service delivery system to obtain other supports such as schooling,
health, and accommodations (Currie and Kahn 2012). Multiple service agencies—each with
different eligibility requirements and funding streams—make up this fragmented system.
Families must be sophisticated in managing the complex network of services required for the
care of their child. The U.S. GAO (2017) notes, for instance, that SSA does not have a
systematic way to connect transition-age youth on SSI to state VR agencies that provide training
and employment services.
Many individuals who received SSI as children but not as adults have poor transition
experiences after age 18, particularly relative to their peers without SSI. Wittenburg (2011)
found that 57 percent of former SSI children between the ages of 19 to 23 were not enrolled in
education programs, receiving VR services, or employed. They also had high secondary school
dropout rates (39 percent) and low employment rates (22 percent). Similarly, Deshpande and
Dizon-Ross (2016) studied SSI children and observed that they have low incomes as young
adults, regardless of whether they are determined eligible for SSI at age 18. However, the main
difference between those who are and are not found eligible for adult benefits is that those
removed from SSI at age 18 face substantially greater income volatility as adults than those who
4
remain on SSI. Although many are employed, few earn at or above the SSI benefit amounts that
they received as children, and one-fourth of these beneficiaries eventually apply for adult SSI
benefits.
C. State differences in SSI participation and resources indicate geographic

variation in service delivery and needs
Promising strategies for youth SSI recipients must also address the substantial variation in
SSI participation in different states. This variation implies that strategies developed for youth SSI
recipients may need to be adjusted in accordance with geography. For example, Wittenburg and
colleagues (2015b) showed evidence of clustering of SSI caseloads by state and by county, with
higher rates of participation in northeastern and southern states and lower rates in western states.
Hemmeter and colleagues (2017) also found substantial variation in programmatic outcomes
across state lines, with age-18 cessation rates ranging from 20 to 47 percent and large cross-state
differences in eventual long-term SSI and employment outcomes. These patterns reflect, in part,
geographic variation in income and poverty levels––areas with low income and high poverty
rates also have high rates of youth SSI recipients.
An additional consideration for geographic variation is differences in transition resources

between and within states. Although states broadly provide similar education, labor, and
vocational rehabilitation services to assist with transition, differences can occur based on
resources available at a given time, service quality, and the amount of collaborations and
connections occurring at the state and local levels around transition. For example, state VR
agencies historically vary in when they first began working with high school youth (that is,
before or at high school graduation) and school districts are not consistent in the types of
transition and employment-related supports that they offer (Honeycutt et al. 2015a, 2015b; U.S.
GAO 2017).
D. Implications for intervention design options

Each issue discussed above affects the strategies chosen to serve youth SSI recipients, given
their heterogeneous demographic, impairment, and geographic characteristics. As we describe in
more detail in Chapter III and Appendix B, SSA has developed its major demonstration projects
involving youth SSI recipients in ways that attempt to address these issues, including the Youth
Transition Demonstration (YTD) and the ongoing PROMISE demonstration. For example, YTD
included (1) individualized employment services to meet the needs of individual youths; (2)
individual sites with variations in the target population, service providers, and some services; and
(3) SSI program waivers, including incentives that allowed participants to keep more of their
earnings than under current rules. Hence, ODEP and other policymakers could follow SSA’s
example by implementing strategies in ways that address some of the unique factors of this
population.
5
III. FINDINGS THAT INFORM PROMISING STRATEGIES FOR YOUTH SSI

RECIPIENTS
In this chapter, we summarize findings from the literature on transition frameworks and
intervention strategies to identify promising strategies to overcome the issues identified in
Chapter II. We first identify strategy frameworks proposed to help all transitioning youth with
disabilities, then focus more directly on strategies for youth SSI recipients. We conclude with a
summary of federal and state programs that are accessed by youth SSI recipients, which could
factor into the development of interventions. As noted in Chapter I, each of the subsections
below is supplemented by a corresponding appendix.
A. Frameworks to guide strategy development and assessment

Best practices for the employment of youth with disabilities are documented by two
transition frameworks that can inform efforts to promote positive outcomes of youth SSI
recipients. “Guideposts for Success” was developed by the National Alliance for Secondary
Education and Transition (NASET 2005) and National Collaborative on Workforce and
Disability for Youth (NCWD/Y 2009), and the effective transition practices and predictors
matrix is maintained by the National Technical Assistance Center on Transition (NTACT)
(2018). Both summarize evidence to guide services offered by practitioners (such as staff from
local education agencies [LEAs], VR agencies, or community rehabilitation providers [CRPs]),
as well as the services that youth and families choose.
The two frameworks have many similarities, particularly for strategies around work,
connecting activities and interagency collaboration, and service customization to improve youth
autonomy. Guideposts for Success places strategies into five overarching categories in
accordance with strategy type: (1) school-based preparatory experiences, (2) career preparation
and work-based learning experiences, (3) youth development and leadership, (4) connecting
activities, and (5) family involvement. The NTACT matrix framework organizes its strategies in
three categories: (1) secondary school practices, (2) vocational rehabilitation practices, and (3)
predictors of postsecondary outcomes. The first two categories correspond to the organization
responsible for the strategy, while the latter is a catchall for strategies with largely correlational
evidence about their effectiveness with postsecondary outcomes. These categories for the
frameworks are particularly important in considering strategies for youth SSI recipients, and
Appendix A offers more details about the similarities and differences of the frameworks.
The importance of the strategies in each framework was recently emphasized by a wide-
reaching examination of competitive integrated employment policy and practices undertaken by
the Advisory Committee on Increasing Competitive Integrated Employment for Individuals with
Disabilities and mandated by WIOA (ODEP 2016). The report recommended specific
approaches for youth, including expanded work experiences before leaving high school,
improved coordination across agencies and opportunities for braided funding, and more rigorous
evaluations to document effective models of transition.
However, three important aspects of these frameworks limit their potential for informing
strategies for youth SSI recipients. First, many of the strategies are supported only by descriptive
or anecdotal evidence, which creates challenges for including strategies in any one intervention
7
model. Specifically, few strategies have been rigorously tested independently, although some
have been tested in combination with others. Second, the majority of evidence reflects the
experiences of varied populations of youth with disabilities and, hence, may not represent the
specific circumstances of youth SSI recipients who might have additional challenges (such as
relatively more severe impairments and living in low-income families). Third, benefits
counseling and financial education—which, given the eligibility rules outlined in Chapter II,
could be important supports for youth SSI recipients—are not well identified across the
frameworks.
Despite these limitations, the frameworks offer important guidance that could help identify
promising strategies. For example, one approach is to assess whether each proposed intervention
touches on the categories in the Guideposts and NTACT frameworks. If an intervention is
missing a key category, it will be important to note why this category is missing and how, if at
all, it may influence outcomes. In this way, the frameworks can help pinpoint promising
ingredients for final proposed strategies, particularly if there is a lack of rigorous evidence on the
approach. An important caveat, however, is that these models provide guiding principles, yet
many strategies—particularly those outside of early work-based experiences—have a limited
evidence base.
B. Evidence on promising strategies

We can draw from two sources to identify strategies for new initiatives to help youth SSI
recipients with employment. 2 The first source includes two major SSA demonstration projects
that target this population exclusively. The second source includes a larger base of studies in
which youth SSI recipients are possibly a subset of a larger population. These studies include
demonstrations targeted to adults (including young adults) with SSI and/or Social Security
Disability Insurance (SSDI), as well as those targeted to youth and young adults with disabilities
(with or without SSI).
Below and in Table III.1, we provide a brief overview of findings from previous research,
sorted by level of evidence and target population. Within these categories, we list the names of
the strategies and providers. Appendix B provides a more in-depth review of these strategies,
including the providers, target population, evaluation approach, and findings. This additional
information might be useful to readers who want to know details such as the size of impact
estimates.
1. Evidence from demonstrations targeting youth SSI recipients

The YTD evaluation provides the most comprehensive information about promising
strategies to improve the employment outcomes of youth SSI recipients, based on six projects
implemented at different sites across the country. The YTD projects sought to help youth SSI
recipients and at-risk youth with disabilities maximize their economic self-sufficiency as they
transitioned to adulthood, using the Guideposts for Success framework to develop intervention
2
As noted in Appendix B, this evidence is partly based on two sources: (1) larger reviews from a report of the
Clearinghouse for Labor Evaluation and Research (CLEAR 2015) about employment programs and demonstration
projects involving SSI or SSDI beneficiaries and (2) our own literature review about the challenges of implementing
employment programs for people with disabilities (Wittenburg et al. 2013).
8
services. Programs offered services for case management, employment, and benefits counseling,
among others, and program participants also had access to SSA waivers of certain program rules
to enhance work incentives (such as extending the age at which the student earned income
exclusion was applicable). Specifically, all YTD projects included work-based experiences (such
as job training and volunteer experiences), empowerment activities (such as self-advocacy
training), family involvement, and system linkages (connecting youth to other providers)
(Luecking and Wittenburg 2009). However, the target population and the service delivery
emphases varied substantially.
An important lesson from YTD is the potential for employment services to improve
outcomes: three of the six projects increased paid employment by about 7 percentage points
during the third year after the youth enrolled in the evaluation (Fraker et al. 2015). The
experiences of an early set of YTD projects (some of which were later involved in the random
assignment evaluation) point to important qualitative information on implementation issues for
projects targeting youth SSI recipients, particularly on the need for tracking services and
outcomes and the difficulties of pursuing systems change.
The design of YTD does not allow us to assess how specific service components within
Guideposts affected the outcomes. Each YTD project implemented a model that followed
Guideposts, but it did not set up the design to enable rigorous evaluation of each component.
However, there does appear to be a correlation between employment impacts and

employment services, underscoring the findings from the frameworks described above. First,
projects that delivered more hours of employment-focused services to higher proportions of
treatment group youth had the largest impacts. Second, youth SSI recipients who had early work
experiences had a higher probability of paid employment two years later (Mamun et al. 2017).
We also found some evidence outside of YTD for benefits counseling as a stand-alone support.
Further evidence about serving youth SSI recipients will emerge from the evaluation of
PROMISE. As with YTD, PROMISE includes a sharp focus on providing youth SSI recipients
with paid work experiences, and its evaluation includes a rigorous random-assignment evaluation
design. However, PROMISE differs from YTD in three ways: (1) PROMISE programs have a
stronger focus on coordination with state social service agencies, whereas YTD projects were
offered by universities and private, nonprofit service providers; (2) PROMISE programs deliver
services to both youth and families; and (3) PROMISE emphasizes collaboration among state
and local agencies and organizations serving youth with disabilities. Results from the evaluation
are not yet available, but implementation evaluations of the programs are producing preliminary
information about successes and challenges in providing services to youth SSI recipients.
2. Evidence from studies targeting adults and youth with disabilities

Evidence from several types of studies involving adults and youth with disabilities could
provide insights into promising strategies for youth SSI recipients (see Table III.1 and Appendix
B). These include federal experimental demonstration projects targeting adults with SSA benefits
and a range of studies (with varying levels of evidence, as discussed below) involving youth with
disabilities.
9
Random assignment evaluations of federal demonstrations for individuals receiving adult

SSI and SSDI offer some important insights. These demonstrations show the positive impacts of
case management, health plans, supported employment, work incentives, and other supports. In
particular, they indicate that supports that were more customized to the individual’s needs had
stronger employment effects than strategies with less customization (Wittenburg et al. 2013), and
supported employment strategies based on the Individual Placement and Support (IPS) model
consistently led to improved employment for adults with psychiatric impairments (Bond et al.
2008; Drake et al. 2009). This latter finding is particularly notable, given that the supported
employment model has not been tested rigorously among youth.
Aside from federal demonstration projects, various strategies targeted to youth and young
adults with disabilities show consistent promising evidence on employment outcomes. Much of
this evidence is based primarily on descriptive or nonexperimental studies, and a larger number
of studies have involved transition programs that, like YTD, provide participants with
employment services coupled with other services. For example, promising programs that appear
to improve employment rates for youth with disabilities include the Maryland Seamless
Transition Collaborative Program, Utah Pathways to Careers, and Marriott Foundation Bridges,
all of which targeted specific groups of youth and young adults and provided them with long-
term, comprehensive transition supports. However, we cannot say whether the transition
programs alone influenced the positive outcomes because they have not been rigorously
evaluated against a credible comparison group to assess the efficacy of the strategies. Other
strategies with potentially positive outcomes are supported employment and Think College.
Supported employment, a systematic approach for employment, health, and case management
supports, advances competitive employment for individuals with severe mental illness. It can be
offered by VR agencies as a specific service, with vendors adhering to various requirements,
training, and standards, although agencies might differ in its implementation (Wehman et al.
2014). Think College promotes postsecondary education opportunities for students with
intellectual and developmental disabilities and autism (Grigal et al. 2017a, 2017b).
Among these studies are evaluations of the Job Corps and Project Search projects for youth
with disabilities. Hock and associates (2017) found promising impacts on employment for youth
with medical conditions who used Job Corps services in the 1990s. This is the only study to
show a decline in reliance on SSI. Similarly, Project Search includes several descriptive projects
along with a small study that highlights promising employment outcomes (Wehman et al.
2014b). Both projects have limitations in terms of applying the lessons to youth with disabilities
because of the cohorts they studied and sizes of the target populations. Nonetheless, the
compelling evidence from both suggests that they may offer worthwhile strategies, particularly
given the prominence of Job Corps and Project Search in delivering employment supports to
many subgroups of youth across states.
Our literature scan also identified three strategies (individualized career planning, guided
group discovery, and partners for youth with disabilities) that lacked supporting evidence for
their effectiveness. We anticipate identifying other strategies that are not yet supported by
evidence through input from the CoP.
In summary, examples of strategies for informing future options to promote the employment
of youth SSI recipients are numerous, with the caveat that rigorous evidence specific to these
10
youth is limited to that from YTD. Given the lack of evidence for youth SSI recipients, any
implemented strategy would do well to include a pilot period to assess the feasibility of
implementation on a small scale. As outlined in Wittenburg and colleagues (2014), pilot tests can
be especially valuable for assessing strategies before they reach full scale by identifying
implementation challenges (for example, can providers deliver services?), data needs, and other
evaluation issues (such as meeting sample targets).
Table III.1. Strategies that could promote the employment of youth SSI
recipients
Strategies (targeted to youth SSI recipients) that have or will have experimental evidence
Youth Transition Demonstration random assignment projects (SSA) CRPs, LEAs, postsecondary institutions
Promoting Readiness of Minors in SSI (ED, SSA, DOL, HHS)* State education, LEAs, VR, workforce development
agencies
Strategies (targeted to adults with SSI and/or SSDI benefits) that have or will have experimental evidence
Accelerated Benefits (SSA) SSA
Benefit Offset National Demonstration (SSA) SSA, WIPA
Mental Health Treatment Study (SSA) SSA, community mental health agencies
Promoting Opportunity Demonstration (SSA)* SSA
Supported Employment Demonstration (SSA)* SSA, community mental health agencies
Strategies (targeted to other youth or adults with disabilities) that have or will have experimental evidence
Demonstration to Maintain Independence and Employment (HHS) State departments of health, a health policy authority
and health insurance organization, and a Medicaid
agency
Employment Intervention Demonstration Program (SAMSHA) Academic, public, and private entities provided clinical
and VR services and supports
Job Corps (DOL)a DOL, workforce development agencies
Transition Work-Based Learning Models in Maryland and Vermont VR, CRPs, LEAs (in Maryland)
(Rehabilitation Services Administration, or RSA)*
Strategies (targeted to youth SSI recipients) with nonexperimental evidence
Benefits counseling (SSA) WIPAs, varied organizations
YTD nonexperimental projects (SSA) Each project was led by a varying combination of state
agencies
Strategies (targeted to other youth or adults with disabilities) that have or will have nonexperimental evidence
Back on Track to Success Mentoring Program Community organizations
Marriott Foundation Bridges from School to Work Program Nonprofit community organization
Maryland Seamless Transition Collaborative LEAs, VR, state education, state department of
disabilities
Supported employment Nonprofit, multiservice organizations
Think College* Institutions of higher education, along with community
partners such as VR agencies, LEAs, and employers.
Transition Work-Based Learning Models in California, Maine, and VR, CRPs
Massachusetts (RSA)*
Utah Pathways to Careers* CRP
Strategies (targeted to other youth or adults with disabilities) without any evidence
Individualized Career Planning model (ED) LEAs
Guided Group Discovery pilots* (Labor) Led by a national collaborative of organizations
focused on disability, workforce, and economic
support, in partnership with local job centers, VR
agencies
Partners for Youth with Disabilities* Private organization
a Job Corps is not targeted to youth with disabilities, but the program does serve this population.
* Currently in the field.
ED = U.S. Department of Education; HHS = U.S. Department of Health and Human Services; SAMSHA = Substance
Abuse and Mental Health Services Administration.
11
C. Federal and state programs that could influence transition outcomes

In addition to the specific strategies described in the previous section, modifications of
existing federal and state program rules, either on their own or in conjunction with other
strategies, could be made to promote the employment of youth SSI recipients (Table III.2 and
Appendix C). Youth SSI recipients might also access services from the state VR agency or
workforce development agency or be able to take advantage of systems change efforts seeking to
improve the service environment for youth with disabilities.
As outlined in Chapter II, SSA offers work incentives, supports, and programs for youth SSI
recipients, although most current recipients do not use these offerings. Other than descriptive
information about use, we have evaluation findings on just three (Ticket to Work, student earned
income exclusions, and WIPA), with mixed evidence on their effectiveness. The limited use of
work incentives reflects the complicated design of SSI and those incentives, along with lack of
information on the part of youth and families and fears that cash benefits will be lost. Strategies
that promote knowledge and simplify the rules could result in greater earnings and thus a lower
need for benefits among youth SSI recipients. However, no SSA demonstration study to date has
resulted in program exits from SSI or SSDI in part because any earnings gains were not
sufficient to disqualify participants for SSA disability benefits. Another factor in this finding is
that the supports provided by some demonstration studies were not intended to result in program
exits because that was not a goal of the demonstration.
Outside of SSA incentives, a new incentive called the ABLE account could be an important
way to support employment in future demonstrations (ABLE National Resource Center 2018).
An ABLE account allows youth to apply tax-free savings to education and employment supports,
among other types of support. These savings are notable because the amounts are excluded from
the calculation of benefits, including SSI, the Supplemental Nutrition Assistance Program
(SNAP), and Medicaid. This may give youth SSI recipients and their families a new opportunity
to save money without the fear of losing benefits because their resources exceed the asset limits.
In terms of obtaining services, state VR agencies represent a major source of support given
that about one-third of their clients are transition-age youth, and about one in five youth eligible
for VR services receive SSI or SSDI (Honeycutt et al. 2016). This latter number represents about
4 percent of all transition-age youth who are SSI recipients or SSDI beneficiaries. Thus, state VR
agencies can be critical partners for interventions serving this population.
The need to develop a more rigorous evidence base for VR services can be an important
design consideration. For example, despite a sizable body of evidence on service provision and
outcomes for youth involved with VR (for example, on the positive employment outcomes of
youth receiving specific work-related services through VR), this evidence typically has been
descriptive, and few studies have applied more rigorous analytical approaches to identifying the
effects of VR services for youth relative to other—or no—services. Among exceptions that have
documented an association between VR and positive employment outcomes are supported
employment services (Wehman et al. 2014a) and VR services provided in tandem with other
services through the Maryland Seamless Transition Collaborative (Luecking et al. 2017).
Moreover, although many VR agencies offer a range of programs for youth, few studies
document the details of program operation or the outcomes of the youth involved. Given changes
12
resulting from the Workforce Innovation and Opportunity Act, the number of youth a VR agency
serves might increase and the types of transition services delivered might change as agencies
provide more pre-employment transition services and customized employment services. As a
result, VR agencies may wish to know both whether these changes lead to better outcomes and
which services are most effective.
Workforce development agencies provide an additional set of programs that youth with
disabilities can access, such as the summer youth employment and apprenticeship programs.
Though the programs are not targeted exclusively to youth with disabilities, that population
represents one of the groups eligible for services, should they meet age and other requirements.
As noted earlier, we identify the positive effects of Job Corps for youth with health conditions,
which underscores the possibility that youth with disabilities or youth SSI recipients could use
that program. Initial results from DOL’s Disability Employment Initiative, still being fielded,
point to qualitative successes but also to challenges in improving employment services and
outcomes for individuals receiving SSI or SSDI.
Finally, systems change efforts are an alternative, top-down strategy to improving and
expanding transition supports. Such efforts include greater collaboration and connections
between agencies serving youth SSI recipients, such as LEAs, VR agencies, workforce
development agencies, and Medicaid programs. Some of these changes are already occurring
through WIOA (for example, with VR agencies working more with LEAs to provide pre-
employment transition services [NCD 2017]) or through specific Medicaid waiver programs.
Other systems change efforts have been proposed, but not tested, to assist youth SSI recipients.
CareerACCESS, for example, has a theoretical framework through which to modify SSA work
incentives and provide counseling, employment, and other services.
Table III.2. Summary of federal and state programs and systems change
efforts for youth SSI recipients
Federal and state programs accessed by youth SSI recipients
ABLE Act State agencies and financial institutions
Disability Employment Initiative (DOL) DOL, workforce development agencies
Employment First DOL, workforce development agencies
Pre-employment transition services (RSA) VR agencies, LEAs, CRPs
Special education services DOE, state and local education agencies
SSA work supports (SSA) SSA
Ticket to Work program (SSA) SSA
Vocational rehabilitation (RSA) RSA, VR agencies
Workforce development programs (such as YouthBuild, Youth Corps, DOL, workforce development agencies
apprenticeships)
WIPA (SSA) SSA
Systems change efforts
Age 18 redetermination counseling SSA, VR agencies, school districts
Age 18 redetermination changes/work reporting changes SSA
CareerACCESS World Institute on Disability, the National Council on
Independent Living, and PolicyWorks
Partnerships in Employment Systems Change projects Stakeholder consortia involved state and community
agencies and organizations
Tennessee Medicaid 115 waiver program (TennCare Employment and State Medicaid agency and state disabilities
Community First CHOICES) department
CRP = community rehabilitation provider; DOL = U.S. Department of Labor; DOE = Department of Education; LEA =
local education agencies; RSA = Rehabilitation Services Administration; SSA = Social Security
Administration; VR = vocational rehabilitation; WIPA = Work Incentive Planning and Assistance
13
IV. CONCLUSION AND NEXT STEPS
This chapter presents conclusions from the information presented in Chapters II and III and
the appendices regarding strategies to improve the employment outcomes of youth SSI
recipients. It also suggests next steps for policymakers interested in promoting interventions for
this population.
The lack of strong evidence on effective practices for youth with disabilities generally—and
youth SSI recipients specifically—underscores the need for better data and information. The
services that workforce development agencies, state VR agencies, LEAs, and other community
providers offer need better documentation of service delivery and outcome tracking to allow
appropriate comparisons among groups of youth. Such information will lead to a better
understanding of effective practices. WIOA data reporting requirements will further these types
of efforts for youth with disabilities, but policymakers can require even more information to add
to the evidence base for youth SSI recipients. An additional but related data issue is that LEAs
and other providers at the state and local levels need consistent data from SSA to identify youth
SSI recipients and to assist with evaluation activities. Importantly, few studies identified in this
review have included SSA benefit receipt as an outcome, which is a relevant consideration for
the population of interest.
Transition frameworks such as the Guideposts for Success can be used as a starting point to
assess strategies using existing frameworks and evidence from the field, although they may not
be sufficient to promote positive outcomes for youth SSI recipients. A major challenge in
applying these frameworks is that the population of youth SSI recipients has potentially
heterogeneous service needs (see Chapter II). This finding suggests that strategies will most
likely need to be customized to the youth and the environments in which they live, especially
because of the large geographic variation in SSI participation. Chapter III identified the multiple
options that exist for serving youth SSI recipients. The most promising strategies—the ones with
the strongest and most consistent evidence—involve early work-based strategies and
comprehensive transition programs that provide an array of services (such as YTD and MSTC);
other strategies have yet to be fully tested.
There is no single way to identify the most promising of the reviewed strategies specifically
for youth SSI recipients, in part because tests conducted thus far for this population have been
limited. This constitutes an important challenge for those who want to improve the employment
outcomes of youth SSI recipients. A corollary to this challenge is that ODEP and others
interested in the successful transition of youth SSI recipients have ample opportunities to fill the
knowledge gap. That is, any strategy applied to this population, if it is rigorously tested, can add
to the knowledge base on the effectiveness of a strategy.
Testing strategies for youth SSI recipients could range from small pilot tests to large
demonstration projects. Funding pilot tests could be a cost-effective and timely investment for
evaluating many strategies, if those strategies can be applied with intensity and at a small scale.
Such tests could integrate current innovations in evaluation techniques, such as behavioral
nudges, rapid cycle evaluations, and technical assistance, with strategies to encourage specific
practices or outcomes. Larger demonstration projects might be necessary for examining
strategies with higher resource costs and multiple organizational players.
15
In summary, this report identified several strategies from the field that provide a starting
point for consideration in improving the employment outcomes of youth SSI recipients, and they
can serve as a foundation for the project’s future reports. Multiple options can be used to narrow
the list, which in part depends on the subset of youth SSI recipients to be targeted (such as child
SSI recipients or new young adult SSI recipients) and on evaluation options that will be covered
in future reports. For example, while some strategies in this text may be promising because they
reflect aspects of the transition frameworks on best practices (such as the Guideposts for
Success), the ultimate value of a strategy may depend on its ability to scale to a broader
population. One especially promising avenue for gathering information on strategies will be the
CoP, which might provide information on the strategy’s potential for implementation, evaluation,
and, ultimately, scalability.
16
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24
APPENDIX A
CHARACTERISTICS OF AND GAPS IN TRANSITION SERVICE FRAMEWORKS

FOR YOUTH WITH DISABILITIES
As a starting point for identifying strategies to improve employment of youth SSI recipients,
we present information from two commonly used frameworks for the transition of youth with
disabilities. For each, we identify strengths and weaknesses in consideration of this study’s target
population.
Stakeholders can use frameworks to synthesize existing literature findings and expert
knowledge in ways that help them identify and use practices that promote outcomes of interest.
Two such frameworks exist for transition services: (1) Guideposts for Success, developed by the
National Alliance for Secondary Education and Transition (NASET 2005) and the National
Collaborative on Workforce and Disability for Youth (NCWD/Y 2009), and (2) the effective
transition practices and predictors matrix maintained by the National Technical Assistance
Center on Transition. Each is intended to guide policymakers, administrators, service providers,
and youth and families on choices regarding transition services. SSA incorporated Guideposts
for Success in the completed Youth Transition Demonstration.
Before describing these two frameworks in detail, we first identify commonalities, themes,
limitations, and gaps that emerge across them regarding transition services.
• The two frameworks have important commonalities and differences. Common strategies
include early work-based experiences, teaming among practitioners working with a youth,
interagency collaboration, and youth autonomy. Benefits counseling and financial education,
an important support for youth SSI recipients, are not well identified across the frameworks.
Although it is mentioned in Guideposts for Success, this service is listed in NTACT as a VR
practice rather than a broader practice outside VR agencies.
• Evidence is often descriptive and relies on information beyond youth SSI recipients.
The strategies identified in each framework often are supported on the basis of descriptive
evidence, in part because it is challenging to identify each strategy separately. Additionally,
the evidence supporting the strategies is based primarily on studies of youth with
disabilities, youth with specific conditions (such as intellectual or developmental
disabilities), or youth with relatively severe conditions, as opposed to youth SSI recipients
who may have other needs. Hence, an important role for a future project might be to provide
rigorous evidence on one or more strategies from these frameworks, specifically for youth
SSI recipients.
• Benefits counseling and financial education, youth development, self-advocacy and self-
determination, mentoring, and mobility supports (such as assistive technology and
travel training) require more evidence. A comparison of Guidepost practices with
NTACT’s practices and predictors matrix suggests that several strategies listed in
Guideposts for Success do not yet have a high level of evidence to support their stated
relationships to employment outcomes. Most noteworthy among these gaps are benefits
counseling, youth development, self-advocacy and self-determination, mentoring, and
mobility supports (such as assistive technology and travel training). Strategies around
employment services and around interagency collaboration have the most evidence. Perhaps
not surprisingly, the largest number of strategies for transition-age youth with strong
evidence has focused on developing human capital, particularly in promoting employment.
A. Guideposts for Success

Guideposts for Success is a collection of high quality, effective transition practices compiled
by experts through a consensus-building process (NCWD/Y 2009). Its recommendations stem
from an extensive review of practice and research evidence on the factors that help youth
succeed. The level of evidence supporting the Guideposts ranges from rigorous evaluations and
correlational research to anecdotal evidence and expert opinion.
Guideposts for Success practices are organized around five key themes for the development
of programs and activities to improve the postsecondary education and employment outcomes
for students (Appendix Table A.1). It includes practices that all youth need for their transition to
adulthood and employment, with additional practices identified for youth with disabilities.
Several public and private entities have implemented strategies based on those included in
the Guideposts for Success framework, providing insights on how to best serve different
populations of youth with disabilities. For example: SSA used the model to inform its YTD
projects (Rangarajan et al. 2009); Guideposts factored into the development of the Federal
Partners in Transition outcome goals (Federal Partners in Transition Workgroup 2015); and U.S.
DOL relies on the model for interventions such as the Disability Employment Initiative (US
DOL 2018) and Pathways to Careers: Community Colleges for Youth and Young Adults with
Disabilities Demonstration Project.
Appendix Table A.1. Guideposts for Success policies and practices

Guidepost Policies and practices
School-based To perform at optimal levels in all education settings, all youth need to participate in educational
preparatory programs grounded in standards, clear performance expectations, and graduation exit options based
experiences, including on meaningful, accurate, and relevant indicators of student learning and skills. These should include
access to high-quality, the following:
standards-based • Academic programs that are based on clear state standards
education for all
• Career and technical education programs that are based on professional and industry standards
students
• Curricular and program options based on universal design of school, work, and community-based
learning experiences
• Learning environments that are small and safe, including extra supports such as tutoring, as
necessary
• Supports from and by highly qualified staff
• Access to an assessment system that includes multiple measures
• Graduation standards that include options
In addition, youth with disabilities need to do the following:

• Use their individual transition plans to drive their personal instruction, and use strategies to
continue the transition process post-schooling
• Have access to specific and individual learning accommodations while they are in school
• Develop knowledge of reasonable accommodations that they can request and control in
educational settings, including assessment accommodations
• Be supported by highly qualified transitional support staff who may or may not be school staff

Career preparation and Career preparation and work-based learning experiences are essential in order for youth to form and
work-based learning develop aspirations and to make informed choices about careers. These experiences can be
experiences, including provided during the school day or through after-school programs, and will require collaborations with
classroom and other organizations. All youth need information on career options, including the following:
community-based • Career assessments to help identify students’ school and post-school preferences and interests
experiences as well as
• Structured exposure to postsecondary education and other lifelong learning opportunities
information about career
options • Exposure to career opportunities that ultimately lead to a living wage, including information about
educational requirements, entry requirements, income and benefits potential, and asset
accumulation
• Training designed to improve job-seeking skills and workplace basic skills (sometimes called “soft
skills”)
To identify and attain career goals, youth need to be exposed to a range of experiences, including
the following:
• Opportunities to engage in a range of work-based exploration activities, such as site visits and
job shadowing
• Multiple on-the-job training experiences (paid or unpaid), including community service, that are
specifically linked to the content of a program of study and school credit
• Opportunities to learn and practice their work skills (so-called “soft skills”)
• Opportunities to learn firsthand about specific occupational skills related to a career pathway
In addition, youth with disabilities may need to do one or more of the following:
• Understand the relationships between benefits planning and career choices
• Learn to communicate their disability-related work support and accommodation needs
• Learn to find, formally request, and secure appropriate supports and reasonable
accommodations in education, training, and employment settings
Youth development Youth development is a process that prepares young people to meet the challenges of adolescence
and leadership through and adulthood through a coordinated, progressive series of activities and experiences that help them
mentoring and other gain skills and competencies. Youth leadership is part of that process. To control and direct their own
engagement lives based on informed decisions, all youth need the following:
opportunities • Mentoring activities designed to establish strong relationships with adults through formal and
informal settings
• Peer-to-peer mentoring opportunities
• Exposure to role models in a variety of contexts
• Training in skills such as self-advocacy and conflict resolution
• Exposure to personal leadership and youth development activities, including community service
• Opportunities that allow youth to exercise leadership and build self-esteem
Youth with disabilities also need the following:

• Mentors and role models, including persons with and without disabilities
• An understanding of disability history, culture, and disability public policy issues as well as their
rights and responsibilities

Connecting activities Young people need to be connected to programs, services, activities, and supports that help them
to both informal and gain access to chosen post-school options. All youth may need one or more of the following:
formal service systems • Mental and physical health services
• Transportation
• Housing
• Tutoring
• Financial planning and management
• Post-program supports through structured arrangements in postsecondary institutions and adult
service agencies
• Connection to other services and opportunities (e.g., recreation)
Youth with disabilities may need one or more of the following:

• Acquisition of appropriate assistive technologies
• Community orientation and mobility/travel training (e.g., accessible transportation, bus routes,
housing, health clinics)
• Exposure to post-program supports such as independent living centers and other consumer-
driven, community-based support service agencies
• Personal assistance services, including attendants, readers, interpreters, or other such services
• Benefits-planning counseling, including information regarding the myriad of benefits available and
their interrelationships so that youth may maximize those benefits in transitioning from public
assistance to self-sufficiency
Encouraging family Participation and involvement of parents, family members, and/or other caring adults promotes the
involvement and social, emotional, physical, academic and occupational growth of youth, leading to better post-school
supports outcomes. All youth need parents, families, and other caring adults who do the following:
• Have high expectations that build upon the young person’s strengths, interests, and needs and
that foster each youth’s ability to achieve independence and self-sufficiency
• Remain involved in their lives and assist them toward adulthood
• Have access to information about employment, further education, and community resources
• Take an active role in transition planning with schools and community partners
• Have access to medical, professional, and peer support networks
In addition, youth with disabilities need parents, families, and other caring adults who have the
following:
• An understanding of the youth’s disability and how it may affect his or her education,
employment, and daily living options
• Knowledge of rights and responsibilities under various disability-related legislation
• Knowledge of and access to programs, services, supports, and accommodations available for
young people with disabilities
• An understanding of how individualized planning tools can assist youth in achieving transition
goals and objectives
Source: NCWD/Y (2009) as presented in Honeycutt et al. (forthcoming).
B. NTACT’s effective transition practices and predictors matrix

NTACT systematically evaluates transition practices according to their effectiveness. Its
work, funded by the U.S. Department of Education, extends the process used by Guideposts for
Success to actively track strategies that emerge in the literature; unlike that framework, however,
it does so without a theoretical foundation. That is, it presents strategies and their level of
evidence without further consideration other than by the outcome and the strategy type (NTACT
2018). The included strategies and their evidence level are continually updated as new findings
emerge in the literature, with results presented to the field (for example, Haber et al. 2016;
Mazzotti et al. 2012). NTACT also provides technical assistance to state stakeholders using the
strategies identified in this review process, thereby promoting the use of practices deemed to be
effective.
NTACT maintains web-based lists of effective practices and predictors related to three
postsecondary outcomes: education, employment, and independent living. These lists are
updated as research evidence emerges. For each practice or predictor, NTACT describes its
characteristics, cites relevant sources for more information, and assesses its level of evidence.
The practices and predictors are organized around three areas: (1) secondary school practices
(student-focused planning practices, student development, and school completion); (2) VR
practices (such as collaboration, employment, and service delivery); and (3) predictors of
postsecondary outcomes based on correlational studies.
In Appendix Table A.2, we list the strategies related to postsecondary employment

outcomes that are listed under each type of practice, sorted by the level of evidence (as of
January 2018).
Appendix Table A.2. NTACT effective practices and predictors for

postsecondary employment outcomes, as of January 2018
Level of evidence Practice
Employment outcomes
Evidence-based practices Secondary school student-focused planning practices

and predictors - Published curricula to teach student involvement in the individualized education program
(IEP)
Secondary school student development practices
- Self-determined learning model of instruction to teach goal attainment
Research-based practices Secondary school student-focused planning practices

and predictors - Self-advocacy strategy to teach student involvement in the IEP meeting
- Self-directed IEP to teach student involvement in the IEP meeting
- Response prompting to teach employment skills
- Self-management instruction to teach specific job skills
- Simulation to teach social skills
- Whose Future Is It? to teach self-determination skills
Vocational rehabilitation collaborative practices
- Counseling and a working alliance between the counselor and the consumer
- Interagency collaboration
Vocational rehabilitation employment practices
- Supported employment
Vocational rehabilitation professional training practices
- Impact of counselor education and consumer outcomes
Vocational rehabilitation service delivery practices
- Services to a target group
Predictors of postsecondary outcomes
- Inclusion in general education
- Occupational courses
- Paid employment/work experience
- Vocation education
- Work study
Level of evidence Practice

Promising practices and Secondary school student-focused planning practices
predictors - Check and connect to promote student participation in the IEP meeting
- Computer-assisted instruction to teach participation in the IEP process
- Whose Future Is It? to teach student knowledge of transition planning
- Community-based instruction to teach employment skills
- Computer-assisted instruction to teach specific job skills
- Constant time delay to teach specific job skills
- Extended career planning services to teach finance skills
- Mnemonics to teach completing a job application
- System of least-to-most prompts to teach communication skills
- System of least-to-most prompts to teach job-specific skills
Vocational rehabilitation organizational practices
- Data driven
- Employer relations
- Excellent Service, Every Consumer, Every Time (E-3)
- Incubator units
- Organizational skills enhancement
- Rapid response and internal service specialized coordinators, counselors, and caseloads
- Share point
- Strong business model
Vocational rehabilitation service delivery practices
- Acquired brain injury program
- Career exploration services
- Choose to Work
- Community Rehabilitation Program certification
- DARSforce
- Embedded training programs
- Essential elements of service delivery
- Individual placement and support
- Maryland Seamless Transition Collaborative
- Soft skills training
- Utah Defendant Offender Workforce Development Taskforce
- Valforce
- Work incentive planning and benefits counseling
Vocational rehabilitation environmental and cultural factors
- Organizational culture
- Increasing visibility and communication/constituent relations
- Agency leadership
- Partnerships
- Rehabilitation counselor and unit autonomy
- Resources
- Return on investment
- Service integration and business model
- Staff training and development
- Support for innovative and promising practices
- Working alliance and client-centered services
Other vocational rehabilitation promising practices
- Empowerment and customer self-concept
Predictors of postsecondary outcomes
- Career awareness
- Community experiences
- Exit exam requirements/high school diploma status
- Interagency collaboration
- Parent expectations
- Parental involvement
- Program of study
- Self-advocacy/self-determination
- Self-care/independent living
- Social skills
- Student support
- Transition programs
- Travel skills
- Youth autonomy/decision making
Source: NTACT (2018) as presented in Honeycutt et al. (forthcoming).

Note: Evidence-based practices are the highest level of evidence for NTACT. The assessment is based on research that used
a rigorous research design, demonstrated a strong record of success for improving outcomes, underwent a systematic
review process, and adhered to quality indicators related to a specific research design.
Research-based practices are derived from research that used a rigorous research design, demonstrated a sufficient
record of success for improving outcomes, may or may not have undergone a systematic review process, and may or
may not adhere to quality indicators related to a specific research design.
Promising practices are based on research that demonstrates limited success for improving outcomes, may or may not
have undergone a systematic review process, and may or may not adhere to quality indicators related to a specific
research design.
APPENDIX B
EVIDENCE SUPPORTING STRATEGIES INTENDED TO PROMOTE THE

SUCCESSFUL TRANSITION OF YOUTH WITH DISABILITIES
This appendix presents specific evidence on strategies that have been applied, at least in
part, to youth SSI recipients. We start with recent summaries of evaluations of employment
programs, with an emphasis on those targeted to SSA disability benefit recipients. We next
identify strategies that have—or will have—experimental evidence, which is the highest level of
evidence in determining whether a strategy has an impact on employment outcomes. We then
turn to those strategies that have some descriptive or quasi-experimental evidence to support
them, and we conclude with strategies that have been proposed for youth SSI recipients but not
yet tested. A caveat to the discussion below is that we do not present information on the
relationship of strategy costs to strategy benefits. This aspect is often omitted from existing
studies because the studies either are not positioned to provide a true measure of benefits to costs
or (in the case of SSA demonstration programs) they did not observe any reduction in SSA cash
benefits. In other cases, the benefits that accrue to a youth likely do not outweigh the cost of
delivering services, at least monetarily. Selection of strategies might involve a benefit-cost
calculation, especially when the cost of delivering a strategy is particularly large.
A. Summaries of employment programs for people with disabilities

Two recent summary papers provide overviews of findings relevant for youth SSI recipients.
The first paper is a report from the Clearinghouse for Labor Evaluation and Research, or
CLEAR, on employment programs and demonstration projects that involved individuals
receiving SSI or SSDI benefits (CLEAR 2015). The second paper describes the challenges of
implementing employment programs for people with disabilities (Wittenburg et al. 2013). Both
papers reviewed a comprehensive set of studies that took place within a specified period.
Although drawn from many studies since 1985 that include working-age adults as well as youth,
the themes that these papers identify continue to be relevant in considering strategies for youth
SSI recipients.
The findings from demonstrations for individuals receiving SSA benefits underscore the
difficulties in providing supports that lead to long-term independence, improved earnings, and
decreased benefit levels for our population of interest. Themes relevant to strategies for youth
SSI recipients include the following:
• The most effective strategies provided intensive, individualized supports and services
around job training, placement, and retention to narrowly defined target populations.
Because of their intensity and required customization, the most effective programs had high
per-person costs relative to other programs. Conversely, strategies that provided uniform
incentives to broad beneficiary populations with a range of disabilities were unsuccessful in
improving employment and benefit receipt outcomes.
• There is no evidence of SSI or SSDI caseload reductions across SSA demonstrations, even
when strategies improved employment or earnings. A few programs were successful in that
participants experienced a modest increase in earnings. However, the higher earnings were
insufficient to allow participants to be financially independent or to disqualify them for SSI
or SSDI benefits. (There is promising evidence from a subgroup of Job Corps participants
with medical limitations that the program reduced reliance on SSI participation [Hock et al.
2017], but the findings for the subgroup are from a cohort in the 1990s.)
B.3
• Work incentives and supports can be difficult to implement in the context of SSA’s work
incentives, creating possible confusion for beneficiaries and program staff. The new work
strategies tested were placed largely within SSI and SSDI work supports, which are complex
and deeply embedded in SSA’s administrative processes. As a result, some demonstrations
had difficulty implementing needed changes in a way that created well-informed
participants, knowledgeable staff and counselors, and efficient modified administrative
processes.
• The fragmentation of the disability support system impedes the ability to implement and
evaluate employment strategies. Because of this fragmentation, many tested strategies
required modification of program rules within only a single program or agency. Thus, when
tested, strategies were not as strong as they might have been had other program rules been
modified. More recent demonstrations rely on interagency cooperation to test strategies that
need to overcome program fragmentation and require modification of rules across programs.
B. Strategies supported by experimental evidence

As noted in the reviews of Guideposts for Success and the NTACT matrix, few studies have
used experimental evidence to identify the impacts of transition services targeted to youth with
disabilities, much less youth SSI recipients. Appendix Table B.1 lists six studies that used
randomized control trials (RCT) targeted to youth with disabilities or health conditions that
emerged in our literature search. Because they used an RCT for their evaluations, these studies
are among those with the highest level of evidence. These studies have typically involved
intensive, customized, integrated services and supports to youth. Only one completed study,
SSA’s Youth Transition Demonstration, targeted youth SSI recipients, although another
demonstration serving that population (PROMISE) is currently in the field.
1. Completed evaluations involving youth SSI recipients

The six YTD experimental projects had a strong focus on employment and vocational
supports for youth. The projects that participated in the random-assignment evaluation developed
service strategies, combined with SSA waivers of certain program rules to enhance work
incentives, which were intended to help youth with disabilities maximize their economic self-
sufficiency as they transitioned to adulthood. At the time, YTD was the largest effort to test
strategies that had adopted aspects of the Guideposts to Success framework. Although YTD is
based on that framework, the evaluation does not provide an evidence basis for all of the
framework’s strategies, as each YTD project developed services unique to its environment.
The impacts of the YTD were positive though inconsistent across projects. Three of the six
YTD projects had positive impacts of approximately 7 percentage points on paid employment
during the third year after the youth enrolled in the evaluation (Fraker et al. 2015). The largest
impacts were concentrated in the projects that delivered more hours of employment-focused
services to higher proportions of treatment group youth, underscoring both the importance of
work-focused services and the need for greater intensity of such services. Also, the
demonstration’s SSA waivers resulted in higher SSI retention for those in the treatment group.
B.4
2. Other evaluations involving adults and youth with disabilities

Other evaluations offer experimental evidence that is relevant to developing activities for
this project, given their focus on younger adults or SSI recipients. These evaluations include
random-assignment demonstrations sponsored by SSA or other federal agencies and two studies
involving youth and young adults.
The Accelerated Benefits Demonstration, the Benefits Offset National Demonstration, and
the Mental Health Treatment Study are examples of SSA demonstrations for adults that included
SSI recipients (along with SSDI beneficiaries). Each demonstration provides evidence of more
service usage and stronger positive effects among younger adults (generally under age 39).
Targeted supports, health plans, and work incentives in these demonstrations are possible
ingredients of interventions for youth SSI recipients. However, any of the strategies from these
demonstrations would most likely have to be modified substantially to produce substantive
impacts on employment, as they (1) were tailored for adult populations and (2) generally had
limited effects, at least in comparison with YTD.
The Demonstration to Maintain Independence and Employment and the Employment

Intervention Demonstration Program (EIDP) are non-SSA-funded demonstrations that targeted
narrower populations of adults with specific impairments with a specified set of services that
included employment. Only one, EIDP (which provided supported employment supports for
individuals with psychiatric conditions), had positive impacts on employment outcomes.
The experimental findings from two other projects suggest additional strategies to improve
the employment of youth. The first, Project Search, emphasizes work-based experiences for
youth and young adults. The evaluation relied on a small sample of youth (N = 40) with autism
spectrum disorder, but indicated a positive employment impact. Its findings complement other
descriptive evidence on the value of Project Search, described later, and Mamun et al. (2017)
present options for a more comprehensive evaluation. The second, Job Corps, is a DOL-funded
career preparation program for youth and young adults. Secondary analyses of findings from an
earlier RCT point to employment impacts for youth with health conditions that are greater than
those for youth without health conditions. These findings suggest the potential for a large
evaluation to test the impacts of Job Corps for youth with disabilities more broadly.
3. Current evaluations
Three sets of demonstration projects currently in the field will enhance our knowledge of
service impacts for youth with disabilities. Two sets involve youth and the third set targets adults
with disabilities.
PROMISE, a demonstration project involving the U.S. Department of Education, SSA,

DOL, and the U.S. Department of Health and Human Services, funds six sites in 11 states.
Similar to YTD, PROMISE includes a sharp focus on providing youth with paid work
experiences and a rigorous random assignment evaluation design. However, PROMISE and
YTD differ regarding service providers, the focus of services, and scale of activities. As Fraker
and colleagues (2014) note, PROMISE programs focus strongly on coordination with state social
service agencies, whereas YTD projects resided in universities and private, nonprofit service
providers. Additionally, the PROMISE programs deliver services to both youth and families,
B.5
whereas YTD served only youth. Finally, PROMISE is a larger intervention that delivers
services to over 6,000 youth; the YTD projects served a total of approximately 2,600 youth.
PROMISE program and evaluation data could be useful for understanding the characteristics of
youth SSI recipients that are associated with service receipt and outcomes, as well as document
types and intensity of service provision (particularly around work-based learning experiences
[WBLE]).
The Rehabilitation Services Administration (RSA) is sponsoring WBLE demonstration

projects at five state VR agencies, two of which (in Maryland and Vermont) will involve RCT
evaluations. Each of the projects targets high school students with disabilities, with the
evaluations focused on implementation issues around WBLE service delivery, along with
eventual postsecondary education and employment outcomes. These RSA-sponsored
demonstrations could be leveraged, depending on sample sizes, to identify outcomes of youth
SSI recipients as a subset of the larger population or, with SSA cooperation, to identify the
impact of these programs on federal disability benefit outcomes for youth with and without
benefits.
Two SSA demonstrations (Promoting Opportunity Demonstration and Supported

Employment Demonstration) currently fielded might provide additional opportunities to
understand service provision for SSI recipients. The Promoting Opportunity Demonstration
offers simplified benefits strategies; the other demonstration delivers comprehensive supported
employment supports to adults with psychiatric conditions. Evaluation findings from both could
point to levers in improving employment outcomes that could apply to youth SSI recipients.
B.6
Appendix Table B.1. Strategies with experimental evidence

Primary organizations Study purpose and analysis
Strategy Target population Strategy description involved Employment impacts method Key findings Source
Strategies targeted to youth SSI recipients

Youth Transition Youth ages 14 through Provided youth with (1) SSA; private institutions By Year 3, employment Study purposes: to determine Youth with disabilities Fraker et al. 2014,
Demonstration random 25 at enrollment who employment-related services and public organizations. rate increased at three effective service strategies for are more likely to 2016;
assignment projects were receiving or at risk (based on the Guideposts for programs, and earnings assisting youth with disabilities receive employment- Hemmeter 2014;
of receiving SSI, with Success framework) that increased at two improve their economic self- promoting services
Mamun et al. 2017
six programs in five varied by site and (2) waivers programs. Total income sufficiency in their transition to participating in YTD
states (Colorado, of certain SSI and SSDI (that is, earnings plus adulthood, and to determine the projects. Increases in
Florida, Maryland, New program rules. benefits) increased at five impact of early work experience provided service hours
York, and West programs. YTD impact on employment outcomes of youth correlated with stronger
Virginia). Additional reports reviewed by with disabilities. employment outcomes.
target population CLEAR were given the The research aimed to determine
characteristics varied highest evidence rating. whether the YTD projects
by site. All but one of provided youth with services that
the evaluated sites would promote employment, and
(Maryland) enrolled SSI whether the YTD projects
recipients exclusively. improved employment and other
Implemented from 2006 transition outcomes for those
to 2012. youth as compared to their
outcomes without YTD project
participation.
RCT across six sites (treatment =

2,756; control = 2,347).
Promoting Readiness SSI recipients ages 14 Core strategies: formal ED, SSA, DOL, and HHS; Currently in the field. Study purpose: to document None (demonstration is Fraker et al. 2014;
of Minors in SSI to 16 in six programs agency-level partnerships; state agencies (disability, program implementation, still in the field, no Honeycutt et al.
across 11 states case management; benefits education, mental health, differences in service receipt and impacts reported yet) forthcoming
(Arkansas, California, counseling and financial or VR). changes in educational
Maryland, New York, literacy training; career and attainment, employment
Wisconsin, and a work-based learning credentials and outcomes, SSI
consortium of six states experiences; and parent payments, public benefits, and
[Arizona, Colorado, training and information. total household income.
Montana, North
Dakota, South Dakota, RCT; from about 2,000 to 3,330
and Utah]). enrollees per site (half in the
Implemented from 2013 treatment group and half in the
to 2018. control group).
B.7

Strategies targeted to young adults with SSI and/or SSDI benefits

Accelerated Benefits New SSDI beneficiaries Provided health benefits SSA; 53 metropolitan No impacts on Study purpose: to determine the Participants used Michalopoulos et
Demonstration without insurance ages before Medicare eligibility to areas were included in the employment. effectiveness of health care health benefits and had al. 2011
18 to 54. Implemented otherwise uninsured study. benefits provided through the reduced unmet health
from 2007 to 2011. beneficiaries. A subset of demonstration for SSDI care needs.
participants received beneficiaries without insurance.
telephone-based employment
and benefits services.
RCT; about 2,000 new SSDI
beneficiaries (assigned to one of
two treatment groups or to a
control group).
Mental Health SSDI beneficiaries with Participants in 23 study sites SSA; services delivered Employment at 24 Study purpose: to determine Supported employment Frey et al. 2011
Treatment Study a primary impairment of received access to health and primarily by community months was significantly whether SSDI beneficiaries with can be implemented
schizophrenia or an supported employment mental health agencies. different for the treatment schizophrenia or an affective with fidelity to this
affective disorder. services for a 24-month and control groups (61 disorder would be supported in population of SSDI
Implemented from 2006 period. The study included percent and 40 percent, returning to work via supported beneficiaries.
to 2010. SSA benefits waivers respectively). Earnings, employment and systematic
(continuing disability review wages, hours worked, medication management services.
Fourteen percent of
suspension for three years). and months employed those eligible enrolled
were also different for the
RCT; 2,238 SSDI beneficiaries. in the study.
two groups.
Benefit Offset National SSDI beneficiaries. Participants offered a $1 for SSA; incentives No long-term impacts on Study purpose: to highlight The intervention led to Wittenburg et al.
Demonstration Implementation $2 benefit offset for earnings, counseling services earnings. estimated impacts of the an increase in benefit 2015a
occurred from 2011 with some provided provided by WIPA demonstration on benefits paid to amounts.
through 2012. enhanced work incentives projects. SSDI beneficiaries.
counseling. Implemented in Enhanced work
10 sites.
RCT; 968,713 and 12,744 incentives counseling
beneficiaries across the two-stage had no detectable
design. incremental effect
above traditional work
incentives counseling.
Promoting Opportunity SSDI beneficiaries. Demonstration will test SSA. Currently in the field. Study purpose: to test a simplified None (demonstration is None
Demonstration Implementation to simplified benefits offsets and work incentives and a benefit still in the field, no
occur from 2018 work incentives and will offer offset for SSDI beneficiaries to impacts reported yet)
through 2021. benefits counseling; projects determine its effect on earnings,
planned for eight sites. employment, and benefit
payments.
RCT; 15,000 individuals assigned

to one of two treatment groups or
to a control group.
B.8

Supported Employment Individuals ages 18 to The demonstration will test SSA; services provided by Currently in the field. Study purpose: to assess whether None (demonstration is None
Demonstration 50 who have applied the provision of integrated community mental health offering evidence-based still in the field, no
for SSDI or SSI and are vocational, medical, and agencies. interventions of integrated impacts reported yet).
interested in working. behavioral health services vocational, medical, and
Implementation to using an IPS model to behavioral health services to
occur from 2017 enrollees for 36 months; to be individuals with behavioral health
through 2022 implemented in 30 sites. conditions can increase
employment outcomes and reduce
the demand for disability benefits.
RCT; 3,000 individuals assigned

to one of two treatment groups or
to a control group.
Strategies targeted to other youth or adults with disabilities

Demonstration to Workers with potentially Four sites (Hawaii, Kansas, The programs were led by None of the programs Study purpose: to determine the Positive effects in some Whalen et al. 2014
Maintain Independence disabling health Minnesota, and Texas) two state departments of had earnings impacts impact of the demonstration on programs on functional
and Employment conditions. offered wrap-around health health, a health policy participant employment outcomes, limitations and SSA
Implemented from 2006 services, employment authority and health use of federal disability benefits, benefit receipt.
through 2009. supports, and case insurance organization, health status, and earnings.
management. and a Medicaid agency.
RCT; programs ranged from 190
to 1,793 enrollees.
Employment Individuals ages 18 and Supported employment SAMSHA; academic, Participants ages 25 to Study purpose: to determine the Younger individuals Burke-Miller et al.
Intervention older with psychiatric program with clinical and VR public, and private entities. 30, but not those ages 18 impact of supported employment with mental health 2012
Demonstration disabilities in seven services and supports that to 24, had better on employment outcomes for issues had an
Program states. Implemented varied across the programs. employment outcomes youth and youth adults compared advantage in seeking
from 1996 to 2001. than those over the age to older adults. employment over those
of 30. who were older.
RCT. N = 1,272 participants; 47 Duration of supported
percent of those age 18–24 (n = employment programs
81) were SSI recipients and 50 was correlated with
percent of those age 25–30 (n = positive work
168) were SSI recipients. outcomes.
B.9

Job Corps Job Corps participants Provides youth and young DOL; workforce Youth with medical Study purpose: to determine the Job Corps could help Hock et al. 2017
with medical limitations. adults with employment and development agencies. limitations in Job Corps impact of the program on meet policy goals for
Study data were taken educational services, training, worked an average of 21 employment outcomes and improving work
from the original and support in a residential more weeks and 998 reliance on disability benefits for outcomes for youth with
National Job Corps setting. more hours than those youth with limitations from medical disabilities and
Study undertaken in the not in the program. Job conditions. reducing their
1990s. Analysis for Corps participation for dependence on
those with medical these youth also disability benefits. The
RCT; N = 472 youths with medical
limitations was increased earnings by limitations (271 in the treatment participating youth with
conducted in 2017. $9,708 over a four-year medical limitations
group and 201 in the control
period, a 29 percent group). SSI receipt not identified observed a collective
increase relative to those 52 percent reduction of
at baseline.
not in the program. total SSI received.
Project SEARCH Youth with autism ages Project SEARCH is a high LEAs, VR agencies, 21 individuals with autism Study purpose: to determine the Participants were Wehman et al.
18 to 21. school work-to-transition workforce development were hired into impact of the program with significantly more likely 2014b
The study was program for youth with agencies, and employers. competitive employment supports for autism spectrum to be employed than
conducted over a three- disabilities; it integrates jobs, compared with one disorder on employment outcomes those not in the
year period. employers and businesses individual in the control and work support requirements for program.
with other educational and group. youth with autism.
community rehabilitation
service providers to engage
RCT. N = 40 (24 in the treatment
youth with disabilities in paid group and 16 in the control group).
work experiences.
Transition Work-Based High school students Incorporates four empirically University, VR agency, Currently in the field. Study purpose: to document None (demonstration is None
Learning Model with an IEP or 504 supported strategies and LEAs. program implementation and still in the field, no
(Maryland: Way2Work Plan. Implemented associated with post-school assess differences between the impacts reported yet).
Maryland) from 2017 to 2022. success for students and treatment and control group
youth with disabilities. students in service receipt,
employment outcomes, and
postsecondary education
enrollment.
RCT. Enrollment goal is 400

students equally divided between
treatment and control groups.
B.10

Transition Work-Based High school students Provides work-based learning VR agency and Currently in the field. Study purpose: to document None (demonstration is None
Learning Model who are VR clients. experiences in integrated community college program implementation and still in the field, no
(Vermont: Linking Implemented from 2017 settings under the VR system. assess differences between the impacts reported yet).
Learning to Careers) to 2022. program to improve students’ treatment and control group
post-school outcomes. students in service receipt,
employment outcomes, and post-
secondary education enrollment.
RCT. Enrollment goal is 800

students equally divided between
treatment and control groups.
B.11
C. Strategies supported by nonexperimental evidence

We identified studies related to 12 strategies with nonexperimental evidence on outcomes
for youth with disabilities (Appendix Table B.2). The largely consistent positive evidence on
employment is tempered by the lack of methods involving random assignment; therefore, these
are strategies for which investments in a demonstration project with strong evaluation designs
could provide insight as to their effectiveness. These studies include quasi-experimental
evaluations that take advantage of natural experiments or a matched comparison group, along
with descriptive studies that present pre-intervention and post-intervention statistics, with or
without a valid comparison group, and often with a small number of participants. Most of these
studies have samples of youth with disabilities rather than of youth SSI recipients. When SSI has
been included as a control variable, the results typically indicate that youth SSI recipients have
poorer outcomes than do youth without benefits, suggesting that such youth face additional
barriers.
Only two of the strategies involve individuals receiving SSA benefits, the nonexperimental
YTD studies and benefits counseling. The nonexperimental YTD studies provide important
qualitative information on implementation issues for programs targeting youth SSI recipients.
These programs chose not to participate in the random assignment evaluation, but they did
provide services to many young SSI recipients. The implementation of these programs
demonstrated the difficulty of pursuing large systems change efforts, the primacy of employment
services to be offered alongside other supports, and the need to clearly define—and measure—
both the service model and the outcomes of interest. We identified only one study featuring
benefits counseling, which showed a positive association between benefits counseling receipt
and modest employment outcomes (Delin et al. 2012). (We present additional information for
benefits counseling under SSA’s WIPA program in Appendix C.1, below.)
The supported employment studies in our review that have included youth and young adults
have been small in scale and used a pre-post methodology to document their positive
employment outcomes. Though these studies have been descriptive, without the use of valid
comparison groups, they should be considered in the context of a much richer and rigorous set of
studies documenting the effectiveness of the IPS supported employment model (such as Bond et
al. 2008 and Drake et al. 2009), along with the results from EIDP.
Other targeted employment programs identified in the literature scan involved transition
programs. These programs, which provide a package of services that emphasize employment, are
the Maryland Seamless Transition Collaborative, Project Search, Utah Pathways to Careers, and
Marriott Foundation Bridges. These studies used a range of methodologies for their evaluations;
they have tended to show consistent and positive employment outcomes for the youth with
disabilities who received services in these programs.
Think College is the only strategy included in the literature scan that promotes the
involvement of youth in postsecondary educational opportunities. It is pursuing two projects, one
to promote the participation of youth with intellectual disabilities or autism in inclusive
postsecondary programs and the other to explore a model of transition services connecting
students to secondary education, postsecondary education, and transition services that lead to
paid employment (Grigal et al. 2017b).
B.12
Three other RSA transition WBLE demonstrations not using a random assignment
evaluation design are currently in the field. Evidence from these studies (in California, Maine,
and Massachusetts) could provide additional evidence on WBLE models and best practices,
implementation challenges, and positive outcomes for those receiving WBLE.
B.13
Appendix Table B.2. Strategies with nonexperimental evidence

Primary
organizations Study purpose and
Strategy Target population Strategy description involved Employment impacts analysis method Key findings Source

Benefits Individuals receiving Social SSA-funded return-to-work SSA; jointly led by Across the two projects, Study purpose: to Service intensity was highly Delin et al. 2012
counseling Security disability benefits. projects: Wisconsin state Department of benefits counseling led determine the impact of correlated to strong employment
Pathways to Independence Independence and participants to earnings a program’s benefits outcomes.
and Wisconsin SSDI Employment along gains of $34 and income counseling on SSDI
Employment Pilot. The with the state increases of $37 in each beneficiaries’
projects focused on Department of quarter of a two-year employment outcomes.
developing employment Health Services period. The employment
support service programs to rate increased 1.1 Descriptive analysis with
create job opportunities for percent each quarter.
a comparison group.
individuals with disabilities, Analysis sample of 911
improve community
people across the two
resources, and decrease studies. One hundred
reliance on SSDI and SSI.
twenty-three individuals
received SSI and 788
received SSDI.
YTD Youth ages 14 through 25 at Provided youth with (1) SSA; each project The evaluation did not Study purpose: to Strong partnerships between Martinez et al.
nonexperimental enrollment who were receiving or employment-related and was led by a varying include results on highlight the design and vocational and educational 2010
projects at risk of receiving SSI. Additional other services such as combination of state employment. implementation lessons service providers are important for
target population characteristics benefits counseling (based agencies such as learned from the seven youth transition programs. Bold
varied by program. Two of the on Guideposts for Success) VR and education, original YTD projects initiatives to address systems
seven programs operated for the that varied by site and (2) local agencies such supporting employment- change are difficult to implement.
full five-year period from 2003 to waivers of certain SSI and as education boards focused interventions for Small programs can be scaled to
2009, two projects ended services SSDI program rules. and school districts, youth with disabilities. operate in multiple sites and with
early, and three participated in the and private a larger population. Intervention
random assignment evaluation. organizations. Mixed-method process strategies should be clearly
evaluation. defined and linked to outcomes,
and both should be measured.
Delivering support services (such
as case management and
benefits counseling) without
employment services is not likely
to result in positive employment
outcomes.
B.14
Primary
Strategies targeted to other youth with disabilities
Back on Track to Young adults ages 16 to 26 years Mentees were matched with Community Of the 79 participants, 29 Study purpose: to For individuals with traumatic Kolakowsky-
Success with a recently acquired disability a community-based mentor agencies returned to school and determine the impact of brain injuries, spinal cord injuries Hayner et al. 2012
Mentoring (such as traumatic brain injury, who facilitated check-ins 13 worked. the mentoring program and other neurological disorders,
Program spinal cord injury, and other and follow up assessments on the number of youth mentoring can yield positive
neurological disorders) in 17 to track progress on goals. and young adults with results for achieving educational
California counties. The study disabilities accessing and vocational goals, as well as
focused on program data from educational or community integration and
2005 to 2010. employment independence.
opportunities and to
highlight increases in
community integration
between program
enrollment and exit.
Pre-post, no comparison
group of N = 131 young
adults.
Maine Transition Transition-age youth within two Expanding a Progressive RSA, VR agency, Currently in the field. Study purpose: not yet None (demonstration is still in the None
Work-Based years of high school graduation. Employment model and local rehabilitation identified. field, no impacts reported yet).
Learning Model Implemented from 2017 to 2022. extending programs and providers, LEAs,
Demonstration services provided by Jobs and employers. Matched comparison
for Maine’s Graduates to evaluation design.
five new schools.
B.15
Primary
Marriott Youth with disabilities participating The program enhances Nonprofit community Approximately 75 Study purpose: to Bridges participation was Hemmeter et al.
Foundation in the Bridges programs. employment opportunities organization percent of Bridges determine if participation correlated with increased earnings 2015; Fabian
Bridges from for youth with disabilities by participants had earnings in the program led to capacity for participants. 2007; Gold et al.
School to Work developing permanent, by the age of 30. Fifty positive short- and long- 2013; Dong et al.
Program competitive placements and percent of youth term outcomes for 2016
incorporating individual receiving SSI on employment, earnings,
career development plans enrollment had earnings and receipt of SSI and
with the potential for by age 30, and less than SSDI benefits for youth
quantifiable vocational half still received SSI participants under 30,
advancement. (compared with 34 and to determine the
percent of the characteristics that may
comparison group). predict whether a
Bridges participant would
gain competitive
employment and the
extent to which certain
characteristics can
predict Bridges job
placement rates.
Descriptive studies, one

with a comparison group.
Fifteen to 18 percent of
participants were SSI
recipients.
B.16
Primary
Maryland High school students eligible for The model delivered State VR agency, Of 124 students Study purpose: to Model participants experienced a Luecking et al.
Seamless VR services and receiving special transition services during state education included, 26 percent describe the shorter time from eligibility to 2015, 2017
Transition education or 504 services. the final three years of a agency, department achieved individualized, implementation of the development of the
Collaborative Services began in the 10th grade. student’s secondary of disabilities, and paid inclusive model and how youth Individual Plan for Employment,
Each site was able to tailor its education. A VR counselor 11 school districts. employment, 23 percent ultimately transitioned but longer open cases; received
target population. was actively involved were enrolled in from public education to more job-related services and less
Implemented from 2007 to 2012 in throughout services. The postsecondary post-secondary assessment and diagnostic
11 Maryland school districts. intervention included education, and 14 education or services; and cost less to serve.
aspects of the Guideposts percent were employed. employment.
for Success framework
(NCWD/Y 2009). Program intervention promotes
Follow-up quasi- Descriptive study and the early involvement of VR,
experimental study found quasi-experimental which may allow for more rapid
that 42 percent of 377 study. Quasi- information sharing between
students exited from VR experimental study students and families. The
with employment, included 377 youth (24 information sharing may allow for
compared with 23 percent of whom better coordination of resources
percent of a matched received SSI); the between schools and community
comparison group. Youth matched comparison partners, resulting in cost savings
in the program worked group had 6,111 youth of VR funds.
slightly fewer hours and (24 percent who had SSI
earned less per week at after weighting).
closure than those in the
comparison group.
Project SEARCH High school students and young Project SEARCH is a high LEAs, VR agencies, Six out of 10 participants Study purpose: to Participation in Project SEARCH Müller et al. 2014;
adults with intellectual and school work-to-transition workforce were offered permanent determine the impact of may contribute to improving Mamun et al.
developmental disabilities. program for youth with development jobs within three months the program on rates of participants’ job readiness and 2016; Project
disabilities; it integrates agencies, of program conclusion. job readiness and employment prospects. SEARCH website
employers and businesses employers. employment for 10 (www.ProjectSEA
with other educational and young adults with RCH.us/)
Participants’ scores in
community rehabilitation their entry-level job skills disabilities.
service providers to engage
and workplace behavior
youth with disabilities in paid increased. Descriptive study with
work experiences.
quantitative and
Project SEARCH qualitative data. Sample
program data for the included ten young
2013–2014 school year adults with disabilities
indicates that 67 percent ages 17 to 24.
of participants engaged
in paid employment after Evaluability assessment
completing the program. outlines impact
evaluation design
options.
B.17
Primary
Supported Individuals ages 17 to 24 with Supported employment Nonprofit, Participants involved in Study purpose: to While variations in policies and Ellison et al. 2014;
employment serious mental health conditions; program adapted for young multiservice the model were more determine the vocational programs can create obstacles to Ferguson et al.
individuals with autism spectrum adults with specific organizations; likely to work (relative to and educational impacts service, the model can be 2012; Wehman et
disorder; youth with intellectual conditions; supported specialized a comparison group) of an adapted supported adapted for people with certain al. 2012, 2014a
and developmental disabilities employment delivered by residential treatment during the study period. employment model for conditions.
ages 16 to 25 who received public VR agencies. programs; state VR participants with
VR services. agencies. psychiatric conditions.
For the VR study, Supported employment can be
supported employment used to support VR outcomes of
was associated with a Descriptive analyses, youth.
12.5 percent higher with the samples for
employment rate, with some studies not
more positive effects exceeding 36 people
observed for youth (some of whom received
receiving Social Security SSI). Case-control study
benefits. of VR youth (N =
23,298), of whom 43
percent received SSI or
SSDI.
Transition VR-eligible high school students Students participate in RSA, VR agency, Currently in the field. Study purpose: not yet None (demonstration is still in the ExploreVR 2018
Pathways with disabilities living in customized work-based job centers, and identified. field, no impacts reported yet).
Services Work- Massachusetts. Implemented from learning activities that educational
Based Learning 2017 to 2022. encourage employment or programs. Service description; 651
Model postsecondary education students will be served
Demonstration after high school. Services over the five-year
(Massachusetts) include mentoring, job project.
placement, assistive
technology, benefits
counseling, and related
supports.
Transition Work- Serving approximately 800 Volunteer and paid work- RSA, VR agency, Currently in the field. Study purpose: not yet None (demonstration is still in the California
Based Learning California students with based learning experiences university, LEAs, identified. field, no impacts reported yet). Department of
Model disabilities. Implemented from to prepare students for community Rehabilitation
(California) 2017 to 2022. successful employment and organizations, and 2016
Matched comparison
postsecondary education. local employers. evaluation design.
B.18
Primary
Think College Individuals with intellectual The Transition and Institutions of higher For TPSID, in Year 5 Study purpose: to Employment is positively related Grigal et al. 2017a,
disabilities and autism. Postsecondary Education education, along (2015), 888 students describe the program in to longer length of time in the 2017b
Implemented beginning in 2010. Program for Students with with community participated in 52 terms of institutions that program and enrollment in more
Intellectual Disabilities partners such as VR programs. Of the 324 received grants, academically inclusive programs.
(TPSID) model agencies, LEAs, and students who exited the participant Eighty percent of program exiters
demonstration programs employers. program in Year 5, 110 characteristics, earned one or more credentials.
provide coordination, worked in a paid job and employment and
training, and evaluation an additional 121 educational outcomes,
services to promote high- participated in unpaid and program
quality, inclusive career development sustainability and
postsecondary education activities. evaluation.
options for individuals with
intellectual disabilities.
TCT is still in the data Descriptive studies with
collection phase. quantitative and
Think College also supports qualitative data.
the Think College Transition
(TCT) project, a model for
developing inclusive
college-based transition
services for students with
intellectual disabilities ages
18 to 22.
Utah Pathways to Individuals ages 18 and older with Program helps youth and Community In the first four years of Study purpose: to The employment and earnings Mathematica
Careers intellectual and developmental adults secure employment organization. implementation, 130 describe the approach, results reduced disability benefits Policy Research
disabilities living in Davis County, opportunities in their internships were services, costs, and collected by Pathways 2017
Utah. Implemented beginning in communities. Services completed by 67 impacts of the program. participants by $162 and $178, on
2012. include assessments, paid participants. Forty-six of average, at post-intake follow-ups
internships lasting 8 to 12 the internships resulted at the one-year and two-year
Descriptive analysis of
weeks, employment and in job offers, and 32 participants enrolled marks, respectively.
Expanded to three other sites
post-employment supports, participants accepted
(Maryland, Michigan, and Virginia) through 2016 (N = 91).
in 2015. and a payroll tax adjustment offers. Participation in
for employers. the Pathways program is
associated with
increased employment
rates and earnings.
B.19
D. Strategies without evidence

Three strategies identified in the literature scan that have been implemented have no
documented evidence on their effectiveness (Appendix Table B.3). 3 Each represents a different
model of service provision—a systematic employment and transition service model
(Individualized Career Planning), mentoring supports through groups (Guided Group
Discovery), and a student job readiness program—and presents additional strategies that could
be tested to promote the employment outcomes of youth SSI recipients.
3
We anticipate identifying additional strategies through the CoP.
DRAFT B.20
Appendix Table B.3. Strategies without evidence

Primary organizations
Strategy Target population Description involved Study purpose and key findings Source
Individualized Career Students ages 14 (or younger, The model incorporates the Discovery process and a Vocational The model was Study purpose: to provide an Condon and Callahan
Planning model if appropriate) through age 21 Profile to be used as a resource for guiding the employment conceptualized, overview of the model and its 2008
or high school graduation. process; a Customized Employment Planning Meeting in which the implemented, and field- components, and detail how the
Implemented from 2001 to at student, family, school staff, VR staff, and employers meet to tested in nine Montana model supported students with
least 2008. develop a tailored employment plan; and a final Representational schools. The work was vocational goals and in making use
Portfolio that presents all of the information gathered in the supported by two U.S. of Social Security work incentives
preceding phases into a marketing tool. Department of Education over the course of program
grants. Services varied implementation in Montana schools.
slightly between schools.
The authors claim the strategies are
effective and well received by
individuals with disabilities, their
families, adult services, and
schools, but note that incorporating
the tools into existing practices
requires a larger commitment from
school staff than expected.
Guided Group Individuals with disabilities Job seekers are supported in developing job search plans and DOL, workforce None (demonstration is still in the LEAD Center 2015,
Discovery pilots (Kansas, Maryland, and securing employment that matches their skills and business needs. development agencies, field, no impacts reported yet). 2017a, 2017b
(Kanas, Maryland, Oregon) and veterans with Facilitators are trained to lead Guided Group Discovery sessions VR agencies, and (in
Tennessee, and disabilities (Tennessee). with job seekers and support their aims to gain employment and Tennessee) military
Oregon,) Implemented beginning June other forms of support such as VR and housing. Guided Group occupational specialists
2015 (Kansas and Maryland), Discovery workshops assist individuals with disabilities seeking and disabled veterans
September 2017 (Oregon), employment and those facilitating their employment through the programs.
and December 2017 process of understanding and preparing for customized
(Tennessee). employment and competitive integrated employment.
Partners for Youth with Eighty-five students with A weekly program aimed at improving job readiness by providing Private organization. No evaluation conducted to date. Partners for Youth with
Disabilities (PYD)– disabilities ages 13 to 19 are academic instruction, practical educational experiences, and Disabilities 2017
Youth Enrichment served annually in YEP in mentoring services. PYD has served over 800 youth
Program (YEP) Boston. Implemented and claims the YEP yields
beginning in 2001. improvements in the career
development and independence
skills of participants through
evidence from pre- and post-survey
results, but no specific evidence is
available.
21
APPENDIX C
FEDERAL AND STATE PROGRAMS ACCESSED BY YOUTH SSI RECIPIENTS

Youth SSI recipients access federal and state programs that are important for transition and
could be leveraged or modified to improve their employment outcomes. The OSERS Transition
Guide (OSERS 2017) and GAO studies (US GAO 2012, 2017) describe the programmatic
supports and programs around transition (VR, LEAs, workforce development agencies), and they
point to the need for improved collaboration and describe the challenges that youth face with the
existing transition environment, especially after leaving secondary school. In this appendix, we
first present information about SSA work supports and programs, then turn to other programs
(such as VR and systems change efforts) that many youth SSI recipients encounter. We conclude
with a discussion of proposed but untested systems change efforts that could benefit the
employment outcomes of youth SSI recipients.
A. Evidence regarding SSA work supports and the Ticket to Work program
SSA offers a range of work incentives and supports for youth SSI recipients (SSA 2018)
(Appendix Table C.1). These incentives were developed to encourage the employment and
earnings of SSI recipients or SSDI beneficiaries. The evidence is largely descriptive regarding
prevalence, with no evidence as to their effectiveness in long-term employment or benefit
outcomes. Moreover, statistics to date suggest that these incentives are not widely used by
transition-age youth SSI recipients (US GAO 2017), suggesting barriers to their use.
Of the SSA incentives and programs, we found evidence on just three, with mixed results as
to their effectiveness on benefit receipt or earnings.
• The Ticket to Work program gives adults receiving SSI or SSDI increased access to
employment services through VR agencies and community providers. Its evaluation showed
that provision of access to additional vocational supports resulted in a higher likelihood of
benefit suspension for SSDI beneficiaries (the study did not assess impacts for SSI
recipients) relative to the traditional VR system (Stapleton et al. 2013; Livermore et al.
2013). Other evidence from the evaluation identified provider characteristics and
experiences, characteristics of individuals receiving SSI and SSDI most interested in
returning to work, and longitudinal earnings and benefit outcomes of those receiving SSI
and SSDI.
• The Student Earned Income Exclusion (SEIE) is an SSI program provision that allows
students under age 22 to exclude earned income below a certain threshold from being
included in their SSI payment calculation. Despite the threshold being relatively high
($1,790 per month in 2017), studies have identified both a low take-up rate and limited
evidence of an impact on individual’s total income, particularly among those with lower
levels of earnings. For example, the GAO (US GAO 2017) found that fewer than 2 percent
of transition-age youth SSI recipients access SEIE, although many might be eligible for this
incentive.
• SSA funds WIPAs to provide information about benefit and earnings among those receiving
SSI or SSDI and interested in employment. Although descriptive evidence suggests positive
employment outcomes and the use of work supports for those accessing the program, the
level of supports was relatively low, and it is unclear whether those with earnings would
have had similar levels of earnings without WIPA supports (Livermore et al. 2011;
Schimmel et al. 2011).
C.3
B. Related services from other programs with promising strategies

Evidence on VR’s effectiveness for youth SSI recipients is descriptive, and details about
provided services are limited, despite one-third of VR applicants being transition-age youth. For
example, Wehman et al. (2014a) examined the experiences of youth receiving supported
employment services from VR agencies using a matched comparison design and identified
positive employment effects, particularly for youth receiving either SSI or SSDI. A limitation
cited in the study is that agencies might have delivered supported employment services
differently. Studies such as these, although insightful, are limited in their interpretation because
of selection issues (that is, youth who receive specific VR services might differ from those who
do not in ways that are not measured in the data). Additionally, few studies focus on youth SSI
recipients; those that do often indicate that such youth have poorer outcomes than do youth
without SSA benefits (with the findings from Wehman and colleagues [2014a] being an
exception). There is also some evidence that positive earnings and reduced SSA benefit
outcomes result from the receipt of VR services. Pre-employment transition services represent an
important expansion of VR services to students with disabilities, many of whom will receive SSI.
Youth with disabilities are one of the specific at-risk populations of youth that qualify for
services under the DOL’s workforce development agencies. The Disability Employment
Initiative is a recent effort by the department to encourage states to develop programs that
improve service delivery and employment outcomes for youth and adults receiving SSI or SSDI.
Early impact results were inconclusive on outcomes, but early implementation findings
document the successes and challenges around serving the target population. Employment First,
another systems change effort implemented by DOL, helps states develop policies and programs
that encourage competitive, integrated employment for youth and adults with significant
disabilities.
A new option for individuals with disabilities is the Achieving a Better Life Experience
(ABLE) Act. For individuals who qualify, this benefit allows them to save money without their
SSA benefits being affected. This strategy is relatively new, so there is no evidence yet as to its
frequency of use or its effectiveness in encouraging earnings. However, a program targeting
youth SSI recipients could incorporate this strategy into its service model, as some PROMISE
programs do.
C. Systems change strategies

Broader systems change efforts point to alternative, top-down strategies to improving and
expanding transition supports; such efforts can be complicated to implement, however
(Appendix Table C.2). Partnerships in Employment, an eight-state systems change initiative,
resulted in expansions of Employment First legislation and positive efforts to improve
collaboration across agencies. Two of its state-level evaluations showed modest improvements in
employment outcomes. An alternative strategy involves Medicaid waiver programs, such as one
in Tennessee that assists individuals with intellectual and developmental disabilities with
improved access to employment services.
Also included in Appendix Table C.2 are three systems change strategies that have been
proposed but have not yet been tested. Two of the strategies focus on the age-18 redetermination
process, the point at which SSA assesses child SSI recipients under adult SSI criteria. One
C.4
strategy would provide targeted benefits counseling to prepare child SSI recipients for the age-18
redetermination process, whereas the other would modify the school or work requirements to
provide more incentives for youth to work. A third strategy, CareerACCESS, proposes a series
of vocational and benefits supports to facilitate the long-term transition of youth SSI recipients
ages 18 to 30 into adulthood. Such supports would include extended access to cash benefits and
the ability to save in ways not currently allowed by SSA.
C.5
Appendix Table C.1. Strategies offered by federal and state programs

Primary
organizations Employment impacts Study purpose and analysis
Strategy Target population Description involved (level of evidence) method Key findings Source
Ticket to For quasi-experimental The TTW program SSA in Participants are more likely Study purpose: to highlight Service enrollment increased, Livermore et al. 2013;
Work and design (QED), SSDI- supports SSI partnership with than nonparticipants to findings from the seven studies but there was no consistent Schimmel et al. 2013
Work only beneficiaries recipients and SSDI state VR experience nonpayment of completed under the TTW and evidence for increases in
Improvement (excluding SSI) ages beneficiaries with agencies and cash benefits due to Self-Sufficiency Program from suspension of benefits or
Incentives 18 to 39. TTW is employment services other suspension or termination 2011 to 2013, and to detail termination due to work.
Act of 1999 available to all SSI and through providers of rehabilitation from work (5.1 percent employment and benefit
(Ticket Act)– SSDI beneficiaries. The employment service compared with 2.7 percent). outcomes for TTW participants
Ticket to program has been placement services providers. as compared to
Work (TTW) active since 1999. and supports. nonparticipants.
program
QED and several descriptive
studies.
Student SEIE has been SEIE seeks to SSA. SEIE did not have a strong Study purpose: to highlight SEIE recipients do not often Kemp 2010; US GAO
Earned available for all SSI improve the impact on total income for SEIE and information about meet or exceed the annual 2017
Income recipients age 22 and employment and SSI recipients with a small recipient characteristics, as well SEIE limit: one-third of SEIE
Exclusion under since April 1, self-support amount of earned income. as with metrics and variations recipients used less than 10
2005. Before that, SEIE prospects of SSI SSI recipients with high of SEIE use. percent of the potential
was available only for recipients attending levels of earned income may amount and half used less
child SSI recipients. school or receiving have had larger effects. Descriptive analysis with no than 20 percent. Only 4–5
The analysis focused other formal training. comparison group. About percent of SEIE recipients
on SSI recipients who SEIE excludes 26,000 recipients included in reached the limit. Ten percent
received SEIE in any earnings up to the analysis. of SEIE recipients received it
month during 2004 or $1,790 per month (in throughout the calendar year,
2005. 2017) from being whereas 70 percent received it
counted against the for six or fewer months.
SSI payment
amount.
C.6
Primary
WIPA Individuals receiving SSA funds WIPA SSA; local Positive employment Study purpose: to highlight WIPA can support those Livermore et al. 2011;
SSA disability projects to provide providers. outcomes and use of work findings regarding services receiving SSDI and SSI, but Schimmel et al. 2011;
payments information to SSDI supports associated with received, use of SSA work the level of support received SSA 2018
beneficiaries and SSI WIPA services, although this supports, employment, by those who use the projects
recipients about relationship is not causal. earnings, and benefit is modest, and the timing is
benefits and work reductions from an analysis of relatively brief.
supports to facilitate WIPA beneficiaries, in addition
employment to highlighting findings from Those who use more WIPA
outcomes. organizations that received services are more likely to
WIPA grants. access SSA work supports
and have higher earnings; they
Descriptive analysis. are also more likely to have
benefits suspended or
terminated due to work than
those who use WIPA services
less.
Other SSA SSI recipients Impairment-related SSA. None reported. No evaluation conducted to Statistics on use in SSA SSA 2018
work work expenses, date. annual reports.
incentives subsidies, and
not identified special conditions; Descriptive.
above unincurred business
expenses;
unsuccessful work
attempts; continued
payments under a
vocational
rehabilitation
program; expedited
reinstatement; blind
work expenses;
earned income
exclusion; plan to
achieving self-
support; property
essential to self
support; special SSI
payments for people
who work; reinstating
eligibility without a
new application;
1619(b) continued
Medicaid eligibility.
C.7
Primary
Strategies targeted to other youth with disabilities
ABLE Individuals with Tax-free savings State agencies None reported. Study purpose: to provide an No evaluation conducted to ABLE National Resource
accounts disabilities. Enacted in account for and financial overview of the ABLE National date. Center
2014. individuals with institutions. Resource Center, including (http://ablenrc.org/)
disabilities, which do state- by- state resources.
not count toward the
assets cap for SSI, Policy overview.
SNAP, and Medicaid
eligibility. ABLE
accounts allow
individuals with
disabilities to save
money with a lower
risk of losing SSI
eligibility or payment
amounts. ABLE
accounts can be
used toward medical
expenses, education,
transportation,
housing, and
employment
expenses.
Disability Youth and adults who DEI grants support DOL, workforce For adults, positive Study purpose: to document Identified challenges and Department of Labor,
Employment receive Social Security projects nationwide development employment and earnings implementation practices and successes related to TTW and Employment and Training
Initiative disability benefits and that are geared agencies. effects were not statistically challenges, system change benefits counseling and Administration
are unemployed or toward education, different from those in the efforts, service utilization and variation in implementing (https://www.dol.gov/ode
underemployed. The training, and control group. For youth, an exits, employment and earnings service strategies. Programs p/topics/DEI.htm);
Initiative has been employment for imbalance in the outcomes, and educational increased the number of adults Bleimann et al. 2016
active since 2010. DOL youth and adults with characteristics of those in the gains. receiving services.
awarded $123 million to disabilities, with a treatment and control groups
49 projects in 28 states focus on improving resulted in unreliable impact Implementation, descriptive,
as of September 2016. collaboration. estimates. and RCT evaluations.
Employment Youth and adults with Systems change DOL, workforce No key findings to date. Study purpose: to provide an Identifies specific policy and Lead Center 2015
First significant disabilities. effort to promote development overview of pilots launched practice changes conducted
policy, practice, and and other state across four states and highlight within states.
funding opportunities agencies key findings and results.
for community-
based, integrated Implementation and descriptive
employment studies.
C.8
Primary
Pre- High school and WIOA requires state RSA, state VR No key findings to date. Study purposes: to provide an No key findings or lessons to NCD 2017; Sevak and
employment postsecondary students VR agencies to agencies, LEAs, overview of the impact of new date. Miller forthcoming
transition with disabilities. spend at least 15 and community requirements concerning pre-
services percent of their rehabilitation employment transition services
(pre-ETS) federal allocations on providers implemented under WIOA,
providing pre-ETS to including the scope of pre-ETS
students. Required recipients and services and
pre-ETS include job implementation challenges and
exploration successes.
counseling, work-
based learning
experiences,
counseling on
transition or
postsecondary
education
opportunities,
workplace readiness
training, and
instruction in self-
advocacy.
Vocational Transition age youth Vocational State VR Employment associated with Study purpose: to highlight Positive competitive Honeycutt et al. 2015a,
rehabilitation (typically ages 16 to 24) rehabilitation agencies receipt of on-the-job support differences in service practices employment outcomes 2015b, 2016; Alsaman
services who applied for VR services and services (4.3 times higher and transition outcomes across correlated with higher levels of and Lee 2017; Kaya et al.
services and supports. likelihood), job placement state VR agencies serving education, the number of VR 2016; Oswald 2010;
subsequently exited the (3.15 times higher likelihood), youth with disabilities, in services received, and not Wehman et al. 2014a
program. All combined and occupational and addition to determining collecting Social Security
and general state VR vocational training (1.67 correlations between VR disability benefits. Receipt of
agencies (excluding times higher likelihood). recipient characteristics and VR job search and job placement
U.S. territories). One outcomes. services was associated with
study focused on Ohio successful outcomes for youth
VR customers only. Descriptive studies. Percentage with disabilities.
who were SSI recipients or
SSDI beneficiaries varied State VR agencies had
(when measured) from 21 to 33 substantial variation in
percent. employment outcomes for
youth.
C.9
Appendix Table C.2. Systems change strategies for federal and state programs
CareerACCESS Young adults ages 18 to 30 CareerACCESS initiative will support World Institute on Study purpose: to provide an overview of the World Institute on Disability,
with disabilities who are participants through career coaching, benefits Disability, National program and services for young adults with Disability Policy Works, and
current or future SSI and asset building counseling, and Council on Independent disabilities. National Council on
recipients. The program was employment support services. Participants will Living, and Policy Works Independent Living
proposed in 2013. be able to receive SSI federal cash benefits, The project has not yet been implemented. (http://www.ourcareeraccess.or
health care, and the ability to build and keep g/)
their assets.
Age-18 redetermination Families of SSI children ages Provide families with information and SSA, VR agencies, Policy proposal no evaluation conducted to Deshpande and Dizon-Ross
counseling 13 to 17 with a high likelihood counseling on the age-18 redetermination school districts date. 2016
of not receiving SSI as adults. process, including the likelihood of the child’s
removal from SSI and resources to help before
the redetermination.
Age-18 redetermination Child recipients of SSI. Conduct early redeterminations to provide SSA Policy proposal; no evaluation conducted to Wittenburg 2015
changes/work reporting youth more time to adjust to the decision. date.
changes Eliminate work reporting for child SSI
recipients to promote work.
Tennessee Medicaid Individuals with intellectual or The program assists individuals in preparing State Medicaid agency Study purpose: to provide an overview of the TennCare—Employment and
115 waiver program developmental disabilities. for, seeking out, and sustaining employment. and state disabilities program and services. Community First CHOICES
(TennCare Employment The program has been active Services include individual and small group department overview
and Community First since July 2016. employment supports, prevocational training, (https://www.tn.gov/tenncare/lo
None (demonstration is still in the field, no
CHOICES) independent community living supports, family impacts reported yet). ng-term-services-
caregiving supports, and self-advocacy supports/employment-and-
supports. community-first-choices.html)
C.10
Partnerships in Youth and young adults with Five-year grants were awarded to eight states Stakeholder consortia Study purpose: to evaluate the eight programs Tucker et al. 2017
Employment Systems intellectual and developmental to improve competitive integrated employment involved state and and the outcomes observed for youth and
Change projects disabilities transitioning from outcomes through objectives such as community agencies and young adults with intellectual and
school to postsecondary changing policies, removing barriers, and organizations such as developmental disabilities and determine their
education and employment. improving cross-system and interagency state developmental effectiveness and best practices.
Implemented from 2011 collaboration. Six of the eight states disability, VR, and
through 2017 in eight states implemented 50 model demonstration education agencies. In all states, relationships improved between
(Alaska, California, Iowa, projects; the remaining two states developed individuals with intellectual and developmental
Mississippi, Missouri, New other programs targeting individuals with disabilities and their families, service
York, Tennessee, and disabilities. providers, and employers.
Wisconsin).
Alaska, California, and Mississippi consortia
worked to pass Employment First legislation in
their states.
In Mississippi, New York, and Tennessee,

Employment First Executive Orders were
signed.
In Mississippi, 70 students were trained in

employment skills, and 55 students found
employment from 25 employers.
In Wisconsin, the number of students in the

program with paid jobs after one year more
than tripled (from 5 to 18 students). The
number of employers hiring program students
doubled.
C.11
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REVISED

Potential Strategies to Improve the

EXECUTIVE SUMMARY ............................................................................................................................. xi

A. Project and report background .................................................................................................. 1

B. Methodological approach to identifying promising strategies .................................................... 2

II. TRANSITION CHALLENGES FACING YOUTH SSI RECIPIENTS ................................................ 3

C. State differences in SSI participation and resources indicate geographic variation in

D. Implications for intervention design options .............................................................................. 5

A. Frameworks to guide strategy development and assessment .................................................. 7

B. Evidence on promising strategies.............................................................................................. 8

1. Evidence from demonstrations targeting youth SSI recipients ........................................... 8

IV. CONCLUSION AND NEXT STEPS ............................................................................................... 15

APPENDIX A CHARACTERISTICS OF AND GAPS IN TRANSITION SERVICE FRAMEWORKS

APPENDIX B EVIDENCE SUPPORTING STRATEGIES INTENDED TO PROMOTE THE

A.1 Guideposts for Success policies and practices ............................................................................ A.4

B.1 Strategies with experimental evidence ......................................................................................... B.7

B.2 Strategies with nonexperimental evidence ................................................................................. B.14

B.3 Strategies without evidence ........................................................................................................ B.21

C.1 Strategies offered by federal and state programs .........................................................................C.6

Transition considerations facing youth SSI recipients

Findings that inform promising strategies for youth SSI recipients

This review of strategies reveals three key findings.

Conclusion and next steps

Federal and state programs accessed by youth SSI recipients

A. Project and report background

B. Methodological approach to identifying promising strategies

II. TRANSITION CHALLENGES FACING YOUTH SSI RECIPIENTS

A. SSI eligibility rules can influence youth transition decisions, especially

B. Youth SSI recipients have multiple service needs based on their

C. State differences in SSI participation and resources indicate geographic

An additional consideration for geographic variation is differences in transition resources

D. Implications for intervention design options

III. FINDINGS THAT INFORM PROMISING STRATEGIES FOR YOUTH SSI

A. Frameworks to guide strategy development and assessment

B. Evidence on promising strategies

1. Evidence from demonstrations targeting youth SSI recipients

However, there does appear to be a correlation between employment impacts and

2. Evidence from studies targeting adults and youth with disabilities

Random assignment evaluations of federal demonstrations for individuals receiving adult

C. Federal and state programs that could influence transition outcomes

IV. CONCLUSION AND NEXT STEPS

ABLE National Resource Center. “ABLE National Resource Center.” Available at

Alsaman, M. A., and C. L. Lee. “Employment Outcomes of Youth with Disabilities in

Explore VR. “Transition Pathway Services Project.” Available at

Fraker, T. M., R. G. Luecking, A. A. Mamun, J. M. Martinez, D. S. Reed, and D. C. Wittenburg.

Hemmeter, Jeffrey. “Earnings and Disability Program Participation of Youth Transition

———. “Youth with Disabilities at the Crossroads: The Intersection of Vocational

Livermore, G., S. Prenovitz, and J. Schimmel, J. “Employment-Related Outcomes of a Recent

Luecking, R. G., E. S. Fabian, K. Contreary, T. C. Honeycutt, and D. M. Luecking. “Vocational

Mathematica Policy Research. (2017). “Evaluation of the SourceAmerica® Pathways to

NCD (National Council on Disability). “Pre-employment Transition Services Implementation by

NTACT (National Technical Assistance Center on Transition). “Effective Practices and

OSERS (Office of Special Education and Rehabilitative Services, U.S. Department of

Oswald, Gina. “Predictors of Successful Outcomes of Transition-Aged Youth in Vocational

Partners for Youth with Disabilities. “Job Readiness.” 2017. Available at

Rangarajan, A., T. Fraker, T. Honeycutt, A. Mamun, J. Martinez, B. O’Day, and D. Wittenburg.

US DOL (U.S. Department of Labor). “Disability Employment Initiative (DEI).” Available at

Wehman, P., F. Chan, N. Ditchman, and H. J. Kang. “Effect of Supported Employment on

CHARACTERISTICS OF AND GAPS IN TRANSITION SERVICE FRAMEWORKS