Predicting rehabilitation outcome for supplemental security income and social security disability income recipients: implications for consideration with the ticket to work program

Journal of Rehabilitation, July-Sept, 2005 by Jackie B. Rogers, Malachy Bishop, Ralph M. Crystal

The United States government provides income replacement assistance for individuals with disabilities through two programs: Social Security Disability Income (SSDI) and Supplemental Security Income (SSI). To be considered disabled under either of these programs, the individual must have a severe disability that will result in death or will result in an inability to perform substantial gainful activity for at least 12 months.

Although an identical definition of disability is used for the two programs, differences do exist in qualifying for each. To be qualified for SSDI one must have worked and made contributions to Social Security. Conversely, only those individuals who have not made enough work contributions to qualify for SSDI and who meet income and resource limits are eligible for SSI (Wheeler, Kearney & Harrison, 2001/2002).

The number of individuals receiving SSDI and SSI dramatically increased during the 1990s. As a result, the Social Security Administration (SSA) is attempting to understand this trend and to find methods to help individuals with disabilities remain in the labor force or return to work (Wheeler, Kearney, & Harrison, 2001/2002). One method of assistance is through the provision of vocational rehabilitation services. Vocational rehabilitation services have been found to have a positive effect on return to work rates for people receiving disability benefits (Hennessey & Muller, 1995). These services, however, appear to be underutilized.

Shrey and Bangs (1991) found that 44% of beneficiaries participating in a Social Security return-to-work projects reported no contact with state rehabilitation agencies or other vocational rehabilitation providers. A 1987 study by the United States General Accounting Office (GAO) (as cited in Shrey & Bans, 1991) revealed 12% of beneficiaries were evaluated for rehabilitation services and only .3% of the beneficiaries returned to work alter receiving rehabilitation services. Similarly, Hennessey & Muller (1994) found that few vocational rehabilitation (VR) services were being provided to beneficiaries of Social Security disability programs, and that those beneficiaries, who did receive services, portrayed VR as not influencing their decision to work.

Vocational rehabilitation services can be provided by public vocational rehabilitation agencies, or, under the new Ticket to Work program implemented by the Social Security Administration, by private rehabilitation providers. The success of the Ticket to Work program will depend significantly upon establishing methods of identifying those individuals who will benefit from vocational rehabilitation services and identifying the most effective types or combinations of rehabilitation services for these individuals.

Numerous studies have been conducted to identify individuals who would benefit from rehabilitation services by examining the factors that may predict employment of these individuals. The majority of studies appear to focus upon demographic characteristics of the individuals. Berry (2000) found that white males were more successful in employment outcomes than nonwhite and female subjects. Other significant factors impacting employment outcomes included education, family income, activity limitations, hospitalization, and health status. Swett (2000) found educational level, age, type of disability, and type of Social Security benefit were significant in predicting employment. Kearney (1997) conducted a survey to determine the medical and non-medical factors that were most successful in predicting return to work for individuals who were disabled by a back condition. He observed that individuals with higher levels of education, who were seeking less physically demanding and more skilled occupations, were more likely to return to work. The type of medical provider (family doctor, company doctor, or specialist) and the existence of other chronic diseases had minimal to no impact on return to work.

The impact of the type of vocational rehabilitation service provided to SSI and SSDI beneficiaries has not been thoroughly examined. Hennessey and Muller (1995) examined the effectiveness of vocational rehabilitation services, i.e., physical therapy, vocational training, job counseling, general education, and job placement, upon actual work outcomes by using data from the New Beneficiary Follow-up survey conducted by the SSA. The effect of job counseling was not significant. Job placement services were found to have a dramatic effect on the tendency to work. Beneficiaries who were provided with this service were over four times more likely to return to work than beneficiaries who did not receive the service. However, job placement was only offered to approximately two percent of the beneficiaries. Vocational training (offered to 5% of beneficiaries) doubled the rate of return to work. Physical therapy (20% of beneficiaries) and general education (approximately 2.5% of beneficiaries) also had positive significant effects on return to work.