Audit Report - A-13-97-21008

Office of Audit

Disability Applicants’ Responses to Vocational Rehabilitation Issues: A Mail Survey - A-13-97-21008 - 9/24/97

TABLE OF CONTENTS

Respondents Were Uninformed about Vocational Rehabilitation

Health Care Initiatives Were Rated as Important by Most Respondents

Most Respondents Were Uninformed about Work Incentives

Most Respondents Were Not Motivated by Others to Participate in Vocational Rehabilitation

Health Factors Limited Participation in Vocational Rehabilitation

CONCLUSION AND RECOMMENDATIONS

APPENDICES

Appendix A - Survey Response Data

Appendix B - Sample Selection and Nonrespondent Analysis

Appendix D - SSA Activities to Disseminate Information Concerning Vocational Rehabilitation Services

Appendix F - List of Contributors

INTRODUCTION

OBJECTIVE

Our objective was to survey applicants for Social Security and Supplemental Security Income (SSI) disability benefits to determine their knowledge of and participation in the Department of Education's Vocational Rehabilitation program. We also asked about the importance of work incentives as a motivator for the applicants' return to work.

BACKGROUND

The Social Security Administration (SSA) administers two disability programs, Social Security Disability Insurance and SSI, which pay benefits to qualified disabled individuals. To help those with the most severe physical and mental disabilities return to the work force, the Department of Education's Vocational Rehabilitation program provides comprehensive vocational rehabilitation services.

The Social Security Act (Act) permits payment of SSA funds for vocational rehabilitation services to make services more readily available to Social Security beneficiaries and to achieve savings for the SSA trust funds. Also, the Act authorizes the Commissioner of Social Security to enter into agreements or contracts with alternative service providers in cases where a State agency declines to participate in providing vocational rehabilitation services.

On May 13, 1994, the Joint Vocational Rehabilitation Referral Task Force issued its final report which identified obstacles to achieving greater numbers of referral acceptances by the Vocational Rehabilitation Agencies under the existing process. The report found that, "...there is a need for improving the information available to the public to assist them in better understanding and using the rehabilitation and employment features in the disability program." The task force further stated that, "Existing SSA public information does not clearly link work incentives and other disability benefit protections to their potential use for participating in available rehabilitation programs and the attainment of substantial gainful work."

SSA, as part of its disability process reengineering program, is undertaking several initiatives to strengthen the entire disability determination process. To assist in this effort, SSA requested that the Office of the Inspector General conduct this survey to obtain applicants' opinions about the vocational rehabilitation referral process.

SCOPE AND METHODOLOGY

We selected the population for this study from the Disability Determination File (SSA-831), including all adult, nonblind disability and SSI applicants whose initial claims were adjudicated in 1992. From a universe consisting of those individuals identified as potential candidates for vocational rehabilitation services, we selected a random sample of 600 applicants. We excluded 25 applicants from this sample due to death, imprisonment, disabled children incorrectly identified as adults, and incorrect Social Security numbers.

We conducted a mail survey in which we released 575 initial questionnaires, with second and third mailings to nonrespondents. We received 327 usable questionnaires for an overall response rate of 56.9 percent. We surveyed applicants concerning a number of vocational rehabilitation issues. For complete response data, see Appendix A. Percentages listed in the report are based on the number of respondents answering each question. Appendix B contains the confidence interval ranges to be used for each question cited in this report.

We conducted this inspection in accordance with the Quality Standards for Inspections issued by the President's Council on Integrity and Efficiency.

FINDINGS

Respondents Were Uninformed about Vocational Rehabilitation

SSA informs applicants about vocational rehabilitation through interviews, letters, and brochures. Regardless of the methods used, we found that:

Seventy percent stated they were either not told or do not recall being told they might be contacted about vocational rehabilitation services.
Seventy-six percent of those whose claims were approved said they were not told or do not recall being told that their payments might stop if they refused to participate in a vocational rehabilitation program.
Seventy-five percent did not receive or do not recall receiving the leaflet "Working While Disabled--How Social Security Can Help?"
Seventy-four percent indicated that the information they received was either not helpful in understanding vocational rehabilitation or they did not recall receiving the information.

Health Care Initiatives Were Rated as Important

Seventy-five percent rated continued Medicare coverage as very important to encouraging work.
•Seventy-nine percent rated extended Medicaid eligibility as very important to encouraging work.

Most Respondents Were Uninformed about Work Incentives

Fifty-six percent alleged that no one told them about work incentives.
Only 32 percent stated they were told about work incentives by a SSA employee.

Most Respondents Were Not Motivated by Others to Participate

Only 44 percent of respondents reported someone encouraging them to participate in vocational rehabilitation services.

Health Factors Limited Participation

Over two-thirds of respondents listed health problems as the primary reason for not participating in vocational rehabilitation.
Seventy percent stated they were either not told or do not recall being told they might be contacted about vocational rehabilitation services.
Seventy-six percent of those whose claims were approved said they were not told or do not recall being told that their payments might stop if they refused to participate in a vocational rehabilitation program.
Seventy-five percent did not receive or do not recall receiving the leaflet "Working While Disabled--How Social Security Can Help?"
Seventy-four percent indicated that the information they received was either not helpful in understanding vocational rehabilitation or they did not recall receiving the information.

Health Care Initiatives Were Rated as Important

Seventy-five percent rated continued Medicare coverage as very important to encouraging work.
Seventy-nine percent rated extended Medicaid eligibility as very important to encouraging work.

Most Respondents Were Uninformed about Work Incentives

Fifty-six percent alleged that no one told them about work incentives.
Only 32 percent stated they were told about work incentives by a SSA employee.

Most Respondents Were Not Motivated by Others to Participate

Only 44 percent of respondents reported someone encouraging them to participate in vocational rehabilitation services.

Health Factors Limited Participation

Over two-thirds of respondents listed health problems as the primary reason for not participating in vocational rehabilitation.

CONCLUSION AND RECOMMENDATIONS

The survey showed that, despite SSA's efforts, applicants remain uninformed about vocational rehabilitation services and work incentives. The applicants' medical conditions often limited their participation in the program. In addition, applicants' uncertainties concerning loss of medical coverage was frequently mentioned as an important factor in their reluctance to seek these services.

The low percentage of participation in vocational rehabilitation services, as well as applicants' lack of awareness of these services, reemphasizes the need for SSA to take steps to strengthen the dissemination of information regarding the availability of vocational rehabilitation services and to promote recipients' rehabilitation. In support of the May 13, 1994 Joint Vocational Rehabilitation Referral Task Force report, we recommend expanding public access to information, focusing on the positive aspects of rehabilitation, employment, and work incentives. We recommend that SSA consider the following options:

pilot test revisions to public information materials through focus group meetings;
include periodic "stuffers" or "reminder notices" in mailings such as annual cost-of-living notices, annual earnings notices, continuing disability review notices, etc., emphasizing the availability of vocational rehabilitation services, participation in those services, and work reporting requirements;
develop and administer exit surveys of individuals completing applications to ensure that explanations of vocational rehabilitation and work incentives are understandable; and
seek front-line employee insights and recommendations concerning vocational rehabilitation referrals.

SSA COMMENTS

SSA agreed with the recommendation and indicated that some of the options had merit. The Agency has already taken action in some of the areas. The full text of SSA comments, except for technical comments, is in Appendix C of this report. SSA also identified a number of activities undertaken since the issuance of our draft report to strengthen the dissemination of information regarding the availability of vocational rehabilitation services to promote recipients' rehabilitation. Those activities are identified in Appendix D of this report.

APPENDIX A

SURVEY TABLES

Sex (327 responses)

Responses	OASDI	SSI	In Pay	Total	% of Respondents
Female	59	87	102	146	44.65
Male	82	99	143	181	55.35
TOTAL	141	186	245	327	100.00
% of Respondents	43.12	56.88	74.92

Age (at established onset date) when disabled (281 responses)

Responses	F	M	OASDI	SSI	In Pay	Total	% of Respondents
1-10	11	10	10	11	16	21	7.47
11-20	12	8	4	16	14	20	7.12
21-30	22	23	20	25	37	45	16.01
31-40	18	48	26	40	49	66	23.49
41-50	37	40	36	41	56	77	27.40
51-60	22	25	35	12	39	47	16.73
61-64	3	2	2	3	5	5	1.78
TOTAL	125	156	133	148	216	281	100.00
% of Respondents	44.48	55.52	47.33	52.67	76.87
No Response	21	25	8	38	29	46	N/A

Number of years of education prior to any education acquired as part of a rehabilitation program: (320 responses)

Responses	F	M	OASDI	SSI	In Pay	Total	% of Respondents
1-6	8	17	9	16	20	25	7.81
7-9	29	52	34	47	60	81	25.31
10-12	36	37	25	48	54	73	22.81
High School Graduate	45	45	43	47	71	90	28.13
Some College	20	20	22	18	27	40	12.50
College Graduate	5	4	5	4	6	9	2.81
Post Graduate College Study	1	1	1	1	2	2	.63
TOTAL	144	176	139	181	240	320	100.00
% of Respondents	45.00	55.00	43.44	56.56	74.38
No Response	2	5	2	5	5	7	N/A

At the present time, how many others do you financially help to support in the household? (322 responses)

Responses	F	M	OASDI	SSI	In Pay	Total	% of Respondents
0	79	76	57	98	123	155	48.14
1	31	43	39	35	57	74	22.98
2	15	19	18	16	21	34	10.56
3	8	21	14	15	23	29	9.01
4	10	11	8	13	11	21	6.52
5	2	2	1	3	3	4	1.24
6	0	3	0	3	2	3	.93
7	0	1	0	1	1	1	.31
8	0	1	1	0	1	1	.31
TOTAL	145	177	138	184	242	322	100.00
% of Respondents	45.03	54.97	42.86	57.14	70.81
No Response	1	4	3	2	3	5	N/A

At the present time, how many of those you help to support in the household are children under age 18? (310 responses)

Responses	F	M	OASDI	SSI	In Pay	Total	% of Respondents
0	97	111	88	120	161	208	67.10
1	24	20	18	26	31	44	14.19
2	10	23	19	14	21	33	10.64
3	8	9	3	14	11	17	5.48
4	2	1	1	2	3	3	.97
5	0	2	0	2	2	2	.65
6	0	2	0	2	1	2	.65
7	0	1	1	0	1	1	.32
TOTAL	141	169	130	180	231	310	100.00
% of Respondents	45.48	54.52	41.94	58.06	74.52
No Response	5	12	11	6	14	17	N/A

Were you working at the time you became disabled? (319 responses)

Responses	F	M	OASDI	SSI	In Pay	Total	% of Respondents
Yes	82	115	110	87	147	197	61.76
No	62	60	29	93	93	122	38.24
TOTAL	144	175	139	180	240	319	100.00
% of Respondents	45.14	54.86	43.57	56.43	75.24
No Response	2	6	2	6	5	8	N/A

About how many people worked where you last worked? (Check Ö only one box.) (279 responses)

Responses	F	M	OASDI	SSI	In Pay	Total	% of Respondents
10 or less	36	70	42	64	84	106	37.99
11-24	9	19	12	16	24	28	10.04
25-49	15	21	18	18	30	36	12.90
50-74	5	7	6	6	8	12	4.30
75-99	4	6	5	5	9	10	3.59
100 or more	25	24	32	17	39	49	17.56
I don't know	24	14	15	23	27	38	13.62
TOTAL	118	161	130	149	211	279	100.00
% of Respondents	42.29	57.71	46.59	53.41	75.63
No Response	28	20	11	37	34	48	N/A

Was your disability caused by the work you were doing? (307 responses)

Responses	F	M	OASDI	SSI	In Pay	Total	% of Respondents
Yes	17	44	30	31	46	61	19.87
No	90	84	76	98	127	174	56.68
Don't Know	31	41	29	43	58	72	23.45
TOTAL	138	169	135	172	231	307	100.00
% of Respondents	44.95	55.05	43.97	56.03	75.24
No Response	8	12	6	14	14	20	N/A

Did your employer try to make changes on the job to make it easier for you to work in spite of your disability? (275 responses)

Responses	F	M	OASDI	SSI	In Pay	Total	% of Respondents
Yes	21	15	24	12	29	36	13.09
No	81	115	88	108	142	196	71.27
Don't Remember	17	26	15	28	31	43	15.64
TOTAL	119	156	127	148	202	275	100.00
% of Respondents	43.27	56.73	46.18	53.82	73.45
No Response	27	25	14	38	43	52	N/A

When you filed an application with Social Security for disability benefits, were you informed that you might be contacted about vocational rehabilitation services and how these services might help you go to work? (322 responses)

Responses	F	M	OASDI	SSI	In Pay	Total	% of Respondents
Yes	41	57	51	47	80	98	30.43
No	59	61	54	66	76	120	37.27
Don't Remember	44	60	36	68	87	104	32.30
TOTAL	144	178	141	181	243	322	100.00
% of Respondents	44.72	55.28	43.79	56.21	73.29
No Response	2	3	0	5	2	5	N/A

If your disability claim was approved by Social Security, were you informed that your disability payments may be stopped if you refused to participate in a vocational rehabilitation program and you did not have a good cause for refusing? (307 responses)

Response	F	M	OASDI	SSI	In Pay	Total	% of Respondents
Yes	28	46	38	36	64	74	24.10
No	67	70	58	79	96	137	44.63
Don't Remember	41	55	37	59	81	96	31.27
TOTAL	136	171	133	174	241	307	100.00
% of Respondents	44.30	55.70	43.32	56.68	78.50

No Response	10	10	8	12	4	20	N/A

Did any of the following people encourage you to take part in vocational rehabilitation services? (Check Ö all boxes that apply.) (143 responses)

Responses¹	F	M	OASDI	SSI	In Pay	Total
Family	29	38	30	37	54	67
Doctor(s)	15	27	25	17	32	42
Friends	18	18	15	21	30	36