Ticket utilization and implementation: Investigating use patterns of the Ticket to Work program from the consumer’s perspective

Abstract

BACKGROUND:

The Ticket to Work Incentives and Improvement Act provides work incentives for Social Security Administration (SSA) beneficiaries with various disabilities. Of the 9,963,114 tickets “rolled” out, approximately 64,000 Tickets were used. The small amount utilized indicated a further need to investigate individual Ticket usage.

OBJECTIVE:

This article takes a policy perspective, exploring and discussing personal experiences of Supplemental Security Income beneficiaries who received a “Ticket to Work” in 2003.

METHODS:

A small pilot survey was administered to five beneficiaries. A close read of the responses in concert with a discursive approach was conducted to determine additional factors that may play a role in the participants’ decisions to use their Tickets.

RESULTS:

Participants were overwhelmed with the amount of information provided in the Ticket packages and perceived disincentives (e.g., loss of existing health care and disability benefits) to act on their Tickets.

CONCLUSIONS:

Considering the ambiguity expressed by the participants, customized employment may be a viable solution to reduce load on agencies and increase participation in Federal programs. From a policy perspective, this study illustrates the value of small pilot studies and first-person accounts to determine participants’ ability to understand complex activities and to decide to act. It also reinforces the importance of consumer-led input into long-term support programs.

Keywords

Ticket to Work disability benefits programs customized employment consumer ambiguity programmatic disincentives

1. Introduction

A significant public policy concern is how best to address the health, economic, and social needs of persons with disabilities. Depending upon how the term disability is defined, it is estimated that approximately 56.7 million Americans, 19% of the population in the United States, currently live with disabilities (Brault, 2012). Disability, for the purposes of this paper, is the Federal definition found in the current version of the Social Security Act (2013). Disability is the “inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) 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” (Pub. L. No. 74–271 §223(d)(1)).

Persons with disabilities who are trying to find and keep work face “multilayered and complex” problems, such as “negative public attitudes, limitations caused by their disability, the lack of skills, and the lack of knowledge of and access to technology in addition to confusing work incentives add another layer of barriers” (O’Day, 1999, p. 41).

In this paper, we first examine the demographics of disability and employment from a policy perspective, identifying barriers from the literature. Next, we present a qualitative analysis of a pilot study on five individuals in the Ticket to Work program to illuminate their issues and concerns about the program. We then offer a transitional perspective on the Ticket to Work program framed within a customized employment context. Finally, we offer recommendations on how rehabilitation professionals may reframe disability to reduce stigma, address re-entry concerns, and help individuals with disabilities navigate ‘tickets’ in their return to work, with a focus on the value of consumer input.

2. The demographics and economic impact of disability

Issues revolving around disability and employment have been recurrent public policy concerns in the United States. Disability poses an economic loss to both the individual and society due to the subsequent withdrawal from the labor market and reliance upon disability benefits programs. Federal spending for disability assistance is more than $350 billion annually, with the state share of joint Federal-state disability programs estimated to be $71 billion (Livermore, Stapleton, & O’Toole, 2011).

Approximately 12.8% of the civilian population living in the United States have a disability (Kraus, Lauer, Coleman, & Houtenville, 2018). The prevalence of of disability in working-age persons (ages 18 to 64) is estimated to be 10.6% (Kraus et al., 2018), but only 30 percent (29.3%) of working-age people with disabilities in the US are employed (Bureau of Labor Statistics, 2018, June 21). Of those individuals with disabilities who are working, approximately 23% were able to find full-time/full-year employment (Erickson, Lee, & von Schrader, 2017) while 32% of individuals were employed part-time (Bureau of Labor Statistics, 2018, June 21). However, approximately 45 percent of individuals with disabilities who are not working are actively looking for work (Social Security Administration, 2018, February 28).

The rate of poverty in working-age people with disabilities in the United States is approximately 20.9 percent (Kraus et al., 2018). Additionally, 19.2 percent of working-age people with disabilities receive Supplemental Security Income SSI) payments (Erickson et al., 2017). The highest health insurance coverage rate (93 percent) was for people who reported a self-care disability (Erickson et al., 2017). Although 34.4% of working-age people with disabilities reported health insurance coverage through an employer (theirs or another family member), 23.9 percent of reported Medicare coverage, and 42.1 percent reported Medicaid coverage (or other government-low-income or disability assistance plan) (Erickson et al., 2017). Figure 1 provides a visual of the increase in the number of men and women between the ages of 18 and 64 who reported a work limitation over the past 30 years.

Fig. 1

Current Population Survey Prevalence Number: The number of men and women who report a work limitation in the United States 1981 to 2011. Generated from http://disabilitystatistics.org/reports/cps.cfm?statistic=prevalence [Current Population Survey, Elements: Men & Women, Age 18 to 64: United States’ All years; Bar chart].

3. Why focus on employment?

After decades of changes in federal law, regulation, and policy designed to promote the growth of publicly funded long-term services and support programs, we see the influence of the independent living and disability rights movements of the 1970s and 1980s in the development of participant-directed long-term services and supports. This support model emphasizes the importance of “individuals determining for themselves the types of services and supports they need to remain independent and reside in their community” (Sciegaj et al., 2016, p. 2). In addition, the research clearly shows that consumer-informed services can have equally as positive outcomes for their clients as traditional services, particularly for practical outcomes such as employment (Doty, Mahoney, & Simon-Rusinowitz, 2007; Doughty & Tse, 2011; Drake, Bond, & Becker, 2012; Jung & Bellini, 2011; R. T. Roessler, Williams, Featherston, & Featherston, 2006; Thomas & Hall, 2014). One of the major priorities for many persons with disabilities is employment (return to work).

Why is there such emphasis on return to work? Employment is one of the highest priorities for many people with disabilities and it is a central aspect of the recovery paradigm (Drake et al., 2012). Understanding the effect that disability has on individuals and society is critical as we examine the importance of employment and the processes that assist individuals with disabilities to return to work.

It is a recognized fact that major life activities include participation in the workforce. Although early estimates concluded that once an individual with a disability experiences a withdrawal from the workforce and becomes unemployed, the return to work is less than 1 percent (Ticket to Work and Work Incentives Improvement Act, 42 USC 1320b-19, Section 2(a)(8), 1999). The economic impact of helping individuals with disabilities to return to work is significant from a policy perspective. If even 2 percent of persons with disabilities returned to work, the lifetime savings to the Disability Insurance Trust and General Revenue Funds would be approximately $3.5 billion (R. Roessler, 2002). Hence, since the mid-1970s, attention has shifted from income support for people with disabilities to policies designed to promote independence, freedom of choice, and employment.

3.1 “Tagging” disability

In policymaking, the definition of disability varies depending on who defines it, for what purpose, and the context. There are explicit and implicit definitions of disability. An explicit definition is in the Social Security Act (2013). To be found disabled for purposes of Social Security disability benefits, individuals must have a severe disability (or combination of disabilities) that has lasted, or is expected to last, at least 12 months or result in death, and which prevents working at a “substantial gainful activity” level. An implicit definition is in the decennial census. The U. S. Census Bureau defines disability as difficulty with specific functions, including aural, visual, cognitive, and ambulatory tasks; self-care; and independent living (Erickson, Lee, & von Schrader, 2012, p. 58).

Although it can be argued that being defined as a person with a disability helps the government determine the number of individuals who may require assistance from Federal or shared Federal-State programs, being defined, or tagged, as a person with a disability may also result in a change in perception of an individual’s capabilities and capacity despite a disability. Hanson (2014, p. 16) suggests the knowledge that is associated within a category is “so culturally shared that the simple mention of a category … produces expectations of what the persons belonging to it are like and how they should behave.” Negative societal and workplace attitudes, functional limitations due to disability, lack of employable skills, and navigating numerous complex and cumbersome systems are everyday challenges that must be addressed, discussed, accommodated, and resolved in an individual’s quest to become employed. This requires changing the mindsets and perceptions of persons involved in employment initiatives.

Individuals with disabilities need to understand the work incentives regarding return to work and understand how these incentives in the Ticket to Work Program can benefit their livelihood and quality of life. However, they must first overcome the frames surrounding disability. The United States Social Security disability system has essentially operated as if all ‘tagged’ individuals are disabled, hence, not able to work. The system has provided few work premiums to induce recipients to return to work. The impact of this missing piece on the recipient’s behavior is that fewer individuals return to work. It is recognized that work disincentives are inherent in any program that is designed to provide earnings-replacement benefits to persons who are unable to find work due to long-term severe mental and physical disabilities (Mashaw & Reno, 1996).

Significant changes in public policy across the years have positively affected the availability of supported services, particularly in employment supports (Growick, 2001; O’Brien, Revell, & West, 2003; Weaver, 1991). These include the Individuals with Disabilities Education Act (IDEA, Pub. L. 108–446, 2004), the Rehabilitation Act Amendments of 1992 (Pub. L. 102–569), the Cash and Counseling Demonstration Project (Doty et al., 2007), the Ticket to Work and Work Incentive Improvement Act (1999, Pub. L. 106–170), and the Workforce Innovation and Opportunity Act (2014, Pub. L. 113–028).

4. The Ticket to Work Incentives and Improvement Act of 1999

Until the recent enactment of the Workforce Innovation and Opportunity Act of 2014 (WIOA), the Ticket to Work Incentives and Improvement Act of 1999 (TTW-IIA) was the largest piece of federal disability legislation since the passage of the Americans with Disabilities Act (Growick, 2001, p. 91). The purpose of the TTW program is “to expand the universe of service providers available to beneficiaries with disabilities who are seeking employment services, VR services, and other support services to assist them in obtaining, regaining, and maintaining self-supporting employment” (Federal Register: July 7, 2003 p. 40119–40125). To do so, the TTW utilizes a number of strategies, including work incentives.

4.1 Importance of work incentives

The TTW-IIA provides work incentives for persons with disabilities who receive benefits from the Social Security Disability Insurance program (SSDI) or the Supplemental Security Income Program (SSI) administered by the Social Security Administration (SSA). The program is described as being “about work, improving quality of life and economic independence, informed choice, and protected health care and the perception of understanding the Ticket program needs to be elevated for Ticket holders and Employment Networks” (Wehman & Revell, 2003, January). TTW incentives included (a) Expanded availability of health care services, (b) Expedited reinstatement of benefits, (c) Deferral of medical disability reviews, (d) Work incentives advisory panel, and (e) Work incentives outreach program.

However, two things have hampered previous ‘return to work’ programs for people with disabilities: programmatic barriers to employment and work disincentives. Work incentive research has historically focused upon “the complications inherent in the work incentives and the resulting complexities and difficulty in understanding these incentives” (MacDonald-Wilson, Rogers, Ellison, & Lyass, 2003, p. 302). Many people receiving SSDI and SSI are unaware of work incentives (Golden, O’Mara, Ferrell, & Sheldon Jr, 2000).

Because the intent of the TTW is to remove as many barriers to employment and work disincentives as possible, it is important to explore and evaluate the TTW program and its work incentives for people with disabilities. This target population needs to have a comprehensible and barrier-free means for returning to work and sustaining gainful employment. Hence, research on the utilization of the TTW program will help us to understand the impact on individuals with disabilities who are able to return to gainful employment.

5. A look at a pilot study on the Ticket to Work

In 2003, 9,963,114 tickets were “rolled” out of the Social Security Administration. Of those, 5,784 tickets were taken to public/ private employer networks and 59,097 tickets were taken to state VR agencies (Social Security Administration, 2015). Since we were curious as to the reasons why so few tickets were used nationally, we conducted a small pilot study to explore the personal experiences of five SSI/SSDI beneficiaries who received a “Ticket to Work” in 2003. We wanted to know three things: 1) what were the experiences of individuals seeking information regarding the TTW-IIA, 2) had the individuals developed a plan to return to work, and 3) had their attempts been successful in their attainment of gainful employment.

We developed and administered a ten-item open and closed-ended survey to five SSI and/or SSDI beneficiaries residing in Alachua County, Florida. The project received IRB approval. Of the five participants, two were male and three were female. Both males identified as Caucasian. One female identified as being of Hispanic origin and the remaining two females identified as Caucasian. Participants ranged from 26 years of age to 52 years of age. Types of disabilities (not in order of frequency) reported by these individuals included: 1) Schizoid Affective Disorder; 2) Bi-Polar, Other; 3) Pre-Lingual Hearing Impairment; 4) HIV-Positive; and 5) AIDS. Participation occurred on a voluntary basis and participants did not receive monetary compensation. One participant had a graduate degree and two of the other participants had a 4-year degree. The remaining two participants stated that they had completed high school and one of the two had pursued some post-secondary education.

The administration of the survey took place at various public, not-for-profit agencies (NFPs) in the area. Individuals self-selected for the study. The survey questions were designed to elicit information that would help us understand how persons with disabilities perceived the TTW and how they utilized their Tickets, specifically Ticket Action, Ticket Comprehension, and Vocational Activity.

However, from a grounded theory approach (Glaser & Strauss, 1967), we became curious about the ambiguity participants reported experiencing when reviewing their options with the TTW. Factors that affect their ability to act, to decide, include personal views, feelings, and thoughts; previous experience; educational levels; and resiliency. These factors are seldom captured or discussed in policy analyses; policy analyses attempt to define a problem, explore the options, and suggest the best option based on the analysis. However, policy analyses often are grounded in ambiguity, especially when defining terms such as “public good” or initiating actions such as “return to work.” Policy analysis seldom frames the intended action using the concerns or “understanding” by the intended participants. Different groups (e.g., policymakers and consumers) look at and categorize the same phenomena differently and each use different ways of expressing themselves. Hence, the ambiguity expressed by Ticket holders may not be apparent to policymakers or analysts due to the different frames or perspectives held by each group. To gain a better feel for how participants express their concerns, we also chose two participants, “Bob” and “John” (pseudonyms), to explore more closely as they tried to make sense of the TTW, potential decisions, and consequences from those decisions.

5.1 Ticket action

Participants were asked questions about actions that they had taken since receiving their “Ticket” in the mail. One participant stated, “I put it in the trash”. Another participant stated that he had “researched online to find out what it was about and contacted the Benefits Assistant (BPAO)”. Two participants contacted their local Vocational Rehabilitation Agency and set up an appointment with a counselor to discuss their “Ticket”. The final participant reported that it was “in my folder” and stated that he put it aside and intended to find out more information about his Ticket.

5.2 Ticket comprehension

Participants were asked if they understood why they received the Ticket in the mail. Three of the participants reported that they did not understand why they were sent the Ticket. One participant indicated that s/he understood why it was sent to him/her and another participant stated that s/he did not take the time to read the information. The participant who did not take the time to review the information stated, “you know, frankly, after I read the part about the BPAO [Benefits Planning, Assistance, and Outreach] and skimmed through the rest, I didn’t pay much attention to it, because I just don’t trust the bureaucracy”.

Three of the participants in this study discussed their Ticket with Vocational Rehabilitation Counselors. Two participants reported that the providers understood the purpose of the Ticket and knew how to utilize their ticket. One participant indicated that when he contacted VR “they actually didn’t know anything about the Ticket to Work program”.

Participants were asked if they thought that there were any reasons that would prevent them from using their Ticket. One participant stated, “the best reason is that I just don’t trust it”. Another participant stated, “I think it may … if I get laid off or get canned for any reason I have to apply again … . I’d get turned down”. The three remaining participants stated that they could not think of any reasons that would prevent them from using their Ticket.

5.3 Vocational activity

All five of the participants stated that they would like to work or return to work. Two of the five participants indicated that they had made previous attempts to return to work. One of the two participants replied, “I need a job. I am waiting for a job. I want a job”. The other three participants stated that they had not attempted to achieve gainful employment.

We see, with this summary of participant responses, that the recipients of a Ticket had ideas of how the Ticket would affect their lives. This in itself is just a snapshot. However, a more granular view of the responses provides a glimpse into how two respondents dealt with ambiguity and confusion created by their receipt of the Ticket.

5.4 “I really was puzzled with it all”

If we take a closer look at two of the respondents, Bob and John (pseudonyms), we find the both participants are primarily concerned about the future of the program, of real employment, and changes to their existing benefits. Both men are confused about the purpose of the Tickets they received, the decisions they must make, and the consequences of those decisions. Ambiguity reigns; the ‘not knowing’ of what will happen, of choosing to act or not act. Bob describes his confusion. “ … I needed more understanding of what I was having here. I needed more understanding of what that was about.” He was able to figure out that “It had something to do with benefits and jobs. I didn’t have a job, and this was going to be a benefit.” His reiteration that he needs more understanding reinforces his ambiguity regarding the TTW. Note the use of ‘what’ in Bob’s description of trying to make a choice: what do I have here? What was this about? We see caution in his analysis of the TTW as in the use of ‘something’ with benefits and jobs. The relationship between the two does not appear to be laid out explicitly for Bob. John also was cautiously optimistic but was pessimistic about the longevity of the program and its possible impact on him. “I’m hoping the ticket would help me get a job if the government, or the whoever’s in charge don’t fold back on it, and say, you know, “oh, this is not doing too well, and we’ll just, you know, just take it back” cause I can’t afford health care.” John also was cautious that an unidentified someone, not John, may make a decision that has consequences for him.

The process of using the Ticket was also problematic. Both Bob and John encountered similar problems. Bob reports, “I really wasn’t sure of what it was all about. You know, I knew that they wanted to discuss something with me, and then they gave it to me. But, no, I really didn’t understand.” Ambiguity plays a role in the decision-making processes of both Bob and John. Who should be contacted was not immediately apparent to them, increasing the ambiguity in which they operated. Bob contacted his case manager at the local Social Security Office, who investigated and told him to contact his VR counselor. John was even more lost. No one contacted him about the TTW, no one referred him to an employment network, and he received no information about Benefits Planning Assistance Outreach. If it had not been for a specific contact at a local non-profit who referred John to the local Social Security Office, who then directed him on how to utilize the TTW, John would not have been able to use the Ticket. These are examples of how the lack of organizational knowledge affects individual decisions to act and reinforces the ambiguity and confusion faced by the respondents.

The language used by Bob and John mirrored each other. They were fearful, afraid of what this change may mean. This fear was exacerbated by the TTW mail-outs. The information in the TTW package was confusing; it was too much information about too many complex topics and procedures. More importantly, for them, it lacked clear, concise information on the precise steps they needed to take for each different, discrete task and who they were to contact for what piece of information. As Bob explained, he wanted to know “if they’d help me with this, with that process of getting this thing done.” For Bob and John, the ambiguity was almost overwhelming and delayed their ability to take full advantage of TTW.

These same concerns are echoed in the literature that persons with disabilities face significant obstacles concerning changes in status, engaging in new employment initiatives, and navigating yet another system and processes with changes in rules for inclusion and exclusion.

The conclusions derived from this pilot study did have several limitations. First, the small number of participants involved in this study limited adequate representation of gender, race/ethnicity, and disability experienced among the SSI and/or SSDI beneficiary population. Secondly, the survey/interviews were conducted in separate venues and by different interviewers, which could have potential impacts upon reliability and validity. Third, Florida was one of the first thirteen states to begin the “receipt” of Tickets from the SSA.

Even with its limitations, the study does indicate that there are problems with the comprehension and utilization of the Ticket to Work program and provides preliminary data and a foundation to validate a further need to address these issues. The problems we found have been echoed in a number of other studies (Berkowitz, 2003; Cook et al., 2006; Livermore, Goodman, & Wright, 2007; Livermore & Roche, 2011; Thornton et al., 2007, May). The 2012 TTW report found that the post-regulation cohorts were more likely to report satisfaction with TTW; however, they were also less likely to report service needs and were less likely to be employed (Livermore, Hoffman, & Bardos, 2012, September 24). Although participation in TTW was limited, those individuals who did participate had better outcomes and increased employment (Thomas & Hall, 2014). However, the significant challenge that continues to remain is how to increase participation and successful, sustained employment of individuals with disabilities in Federal and shared Federal-state incentive programs.

6. Organizational and program process as barriers to employment

In 1999, the U.S. General Accounting Office (GAO) suggested that supported employment programs for persons with disabilities were hampered by a number of organizational and processual factors (Sim, 1999). The first factor the GAO identified was the goals of the Social Security program and local VR agencies did not always converge. Additional factors included the lack of availability of VR services and the timing of VR referral, which often occurs much later after the onset of the disability. The final factor was simply that there was little incentive for return to work built into the payment structure (Sim, 1999). Due to low participation rates, Ticket program regulations were revised in 2008, with the intent to clarify and address issues concerning service delivery, assessment, and procedures, particularly with employment networks (Bertoni, 2011, September 23). A later Federal report reported a lack of program oversight that has affected the intent of the program (2011, June 6).

However, the question remains, why is there such low participation among Social Security beneficiaries? One consistent response to the question is the confusion on how work affects Social Security beneficiaries. Possible effects include loss of existing benefits, lack of awareness of available incentive programs, lack of appropriate support and information within employment networks and vocational settings, and limited self-determination on the part of individuals with disabilities (Hernandez et al., 2007; Moulta-Ali, 2012, January 6). The fact that the same concerns are echoed in this study, and the literature shows that the marketing of TTW is not addressing recipients’ concerns. From a policy perspective, the program is failing to adequately inform recipients as well as failing to create a process in which employment professionals and recipients are able to engage with each other in constructive dialogue to effect employment.

The State Employment Leadership Network (2010, January, p. 7) reminds us that “Work is a fundamental part of adult life... It gives us a sense of purpose, shaping who we are and how we fit into our community.” Individuals with even the most significant disabilities have the capacity to work. This has been proven repeatedly through state systems change initiatives and government funded demonstration projects. However, the literature shows that many service providers, even those who have the best intentions, are unable to keep up with the continuous changes in administration, policies, and procedures. These changes result in providers wearing multiple hats and in high staff turnover. Hence, individuals with disabilities must go through a continually ‘revolving’ door of providers.

Many advocates believe that real change and improvement will not occur until the service delivery structure is changed from one that is “service directed” to one that is “self as advocate” or “consumer-directed (Callahan, 2000; Simon-Rusinowitz et al., 2002). The literature seems to indicate that consumer-direction is not simply a matter of shifting federal responsibilities to the state as a way to bring programs “closer to the people” (Buehler, Bernet, & Ogden, 2012; Buehler & Holtgrave, 2007; Ottman & Laragy, 2010; Ottmann, Allen, & Feldman, 2013; Tilly & Wiener, 2001). For some, consumer-direction goes one step further, placing resources directly in the hands of consumers (Doty et al., 2007; Doughty & Tse, 2011; James, 2000; O’Brien et al., 2003; Simon-Rusinowitz et al., 2002). It is the responsibility of employment networks (ENs) to provide appropriate access and services to program participants, especially in the TTW program (Bertoni, 2011, September 23; U. S. Government Accountability Office, 2011, June 6). However, in order to provide employment services and supports to designated beneficiaries, the ENs must meet certain qualification requirements (Blanck, Clay, Schmeling, Morris, & Ritchie, 2002). The overarching question is how to help ENs provide those services and supports and still meet qualification requirements. This is where a continuum of innovative strategies can come into play. And of these strategies, customized employment, a person-centered, strengths-based, team approach, is the most viable option.

7. Customized employment

In addition to the TTW legislation, Federal legislation and judicial rulings have attempted to create an employment service environment conducive for individuals with disabilities. From the Americans with Disabilities Act (Pub. L. 101–336) to Olmstead v. LC to the Workforce Investment Act of 1998 (WIA, Pub. L. 105–220) and most recently to the Workforce Innovation and Opportunity Act of 2014 (WIOA, Pub. L. 113–128), government agencies must not only make reasonable modifications to service systems but must also ensure self-determination and full inclusion for persons with disabilities. In short, state vocational rehabilitation agencies and their partners will provide services that reflect the informed choice of the service consumers (Nicholas, Luecking, & Luecking, 2006). Customized employment is one strategy rehabilitation professionals can use to help service consumers achieve their objectives of gainful and meaningful employment (Wehman, Targett, & West, 2014).

In 2001, the U. S. Department of Labor Office of Disability Employment Policy (ODEP) started a Customized Employment (CE) initiative. The CE process is described as “a flexible blend of strategies, services, and supports designed to increase employment options for job seekers with complex needs through voluntary negotiation of the employment relationship with the employer” (Office of Disability Employment Policy, [2015]). The jobseeker drives the process and is the primary source of information. The Customized Employment process begins with an exploration phase termed Discovery. This phase lays the foundation for employment planning through the development of a vocational profile that provides a narrative snapshot of the person including interests, talents, and conditions for employment. The planning process then results in a blueprint for the job search. The job search results in a negotiated employment relationship that meets the needs of both the job seeker and the employer (Griffin, Hammis, Geary, & Sullivan, 2008). Figure 2 provides a visual representation of the CE process with the job seeker being at the center of the process.

Fig. 2

The Customized Employment Process.

In the state of Florida, Discovery has been available as a billable service through the VR system for several years. Community-based providers are trained in the Discovery process and practice skills with a real job seeker with a high level of technical assistance from experts in CE strategies. Once certified, these providers receive referrals from VR to complete the Discovery process and produce a quality Vocational Profile that will be utilized to amend the Individualized Plan for Employment (IPE) to better align with the job seeker’s interests, talents, and conditions for employment.

Ideally, Discovery is utilized at the onset of the VR process as a method of evaluation. Table 1 shows a comparison between Discovery and traditional vocational evaluation strategies. More on the Discovery process and Florida’s implementation of this CE strategy can be found in Smith, Dillahunt-Aspillaga, and Kenney (2015). Due to the large number of job seekers with complex disabilities who are VR eligible but have not been successful in obtaining competitive employment through traditional strategies, Florida VR chose to begin by offering Discovery to those job seekers who have been on caseloads for an extended period of time prior to considering it at the evaluation phase of the VR process. Florida is currently evaluating the effectiveness of Discovery in improving outcomes for job seekers as implemented. Preliminary data shows a much higher rate of competitive, integrated employment outcomes for job seekers who use the strategy. However, it is known that Discovery, in itself, does not equal employment. The other elements of the CE process are critical for successful employment outcomes. Therefore, Florida VR is currently in the process of integrating the full CE process into its menu of services. Other states are following suit as required by WIOA. More information on the elements of the CE process and VR integration considerations and strategies can be found in Smith et al. (2015).

Table 1

Differences in Traditional Evaluation and the Discovery Process

Traditional Evaluation	Discovery Process
Structured setting	Natural setting
Comparative	Individualized
Performance-based	Data from observation
Focus on deficits	Focus on attributes
Prescribed	Comprehensive

7.1 Implications for Ticket to Work success

The person-centered, team-based approach that is utilized during Discovery and other elements of the CE process facilitates a more seamless approach to the provision of services by including all relevant stakeholders in the process. This teamwork model provides an optimal opportunity to educate stakeholders, including the job seeker, family members, services and supports professionals, and employers, about TTW, work incentives, assistive technology, job accommodations and other important topics that may reduce the fear and stigma often associated with employment for persons with disabilities. The collaborative aspect of the person-centered team creates more connections with potential employers and a team approach to navigating the complex service system to ensure that all available resources are utilized and that there are no gaps in services. It is essential that all members of the person-centered team share the philosophy that all people have talents that can be translated into competitive employment. High expectations facilitate successful outcomes.

8. Conclusion

In their study on the impact of a rehabilitation and counseling program on newly entitled SSDI beneficiaries, Weathers and Bailey (2014) found that participants in the program had an almost 50 percent increase in employment and an increase in annual earnings two years after assignment to the program. The literature suggests that disability reform proposals, particularly those that focus on increasing work capacity and tailored employment, can increase the employment rate of persons with disabilities (Doty et al., 2007; Drake et al., 2012; Jung & Bellini, 2011; Thomas & Hall, 2014). Other studies offer different approaches to understanding the success or failure of programs, such as behavioral economics (Drebing, Hebert, Mueller, Van Ormer, & Herz, 2006), or longitudinal studies on transition to work that account for environmental and geographical differences (O’Leary, Livermore, & Stapleton, 2011). What we do know from the growing body of literature on disability and employment is that persons with disabilities want to work. To do so, they need tailored, unambiguous interventions to help them find work that is uniquely suited for them, and employment they can sustain.

The larger policy question, for us, is how can we remove the barriers hindering the realization of the legislative intent of Federal and state laws? Bob and John wanted to work. They were willing to work. However, there were significant barriers, grounded in ambiguity. To successfully engage consumers in long-term supported employment programs, marketing strategies must recognize and address the employment-related fears, interests and support needs of Ticket recipients (Wehman et al., 2014). Lack of clearly explained services, poorly constructed information packets, service silos, limited mechanisms that ensure seamless transition, limited service capacity of disability employment agencies, and variable access all hinder the ability of persons with significant disabilities who seek employment. These same issues also hinder the ability of personnel in employment networks, agencies, and centers to perform their jobs effectively to assist persons with disabilities to gain employment. When information is not clearly laid out, when discrete steps in a complex process are assumed to be ‘common knowledge’, when effective outreach is not conducted, persons who want to work and the people who want to help persons become employed are both hamstrung.

We know that these hindrances can be overcome, as shown by the success of Discovery and the customized employment process, which are successful examples of an effective state policy. This type of personalized service can help participants clarify their questions and uncertainty, to ‘disambiguate’ language. It can also help VR and other rehabilitation professionals to be aware of how program information needs to be designed and to become more mindful of clients’ often unspoken but felt concerns We hope to see more of these types of innovative projects successfully implemented nationally, with the goal of not only achieving the legislative intent of customized employment but also improving the quality of life of persons with disabilities through inclusion in the workforce.

Conflict of interest

None to report.

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