Reprinted with permission from Gaylord, V., Golden, T., O'Mara, S., and Johnson, D. Impact: Feature Issue on Young Adults with Disabilities & Social Security Administration Employment Support Programs Spring 2002, 15(1), published by the Institute on Community Integration (UCEDD), University of Minnesota, Minneapolis. Implications of the Ticket to Work and Self-Sufficiency Program for Young Adults Thomas P. Golden Employment and Disability Institute, School of Industrial and Labor Relations, Cornell University Susan O'Mara Benefits Assistance Resource Center, Virginia Commonwealth University David Brewer Employment and Disability Institute, School of Industrial and Labor Relations, Cornell University Carol Blessing Employment and Disability Institute, School of Industrial and Labor Relations, Cornell University On December 17, 1999, President Clinton signed the Ticket to Work and Work Incentives Improvement Act (P.L. 106-170) into law establishing in section 101(a) the Ticket to Work and Self-Sufficiency Program (Ticket to Work Program) as well as several other provisions to support the movement of beneficiaries with disabilities who receive Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) into employment. The Ticket to Work Program was established to expand the universe of providers available to beneficiaries with disabilities as they are afforded the opportunity to choose from whom they access their needed employment services and supports. The Ticket to Work Program also increased provider incentives to serve these individuals. The Social Security Administration (SSA) administers this new program with the support of Maximus, Inc, the entity contracted with by the SSA to serve as the program manager. The SSA is currently contracting with agencies to serve as Employment Networks (EN). These ENs perform an array of duties under the law, including providing employment services, vocational rehabilitation (VR) services, and other support services to assist individuals with disabilities to obtain and maintain employment. Under this program, the SSA is directed to provide to beneficiaries with disabilities who meet certain eligibility criteria a Ticket they may use to obtain employment services, VR services and/or other support services from an EN of their choice. “A Ticket under the Ticket to Work and Self-Sufficiency Program is a document that provides evidence of SSA’s agreement to pay an EN or a State VR agency for providing employment services, VR services and/or other support services to a Ticket recipient who requests such services.” (SSA 2001, p. 12) The Ticket to Work Program will be phased in nationally over a three-year period beginning in January, 2002, with beneficiaries in 13 states: Arizona, Colorado, Delaware, Florida, Illinois, Iowa, Massachusetts, New York, Oklahoma, Oregon, South Carolina, Vermont and Wisconsin. The remaining states will be included by January, 2004. Who Is Eligible For The Ticket To Work Program? The Ticket to Work Program is a voluntary program for those beneficiaries with disabilities with an interest in going to work. To be eligible for a Ticket a beneficiary must be entitled to cash benefits from either SSI or SSDI and have completed their age 18 redetermination as well as their first continuing disability review if medical improvement was expected by the SSA. Translated into English, this means that most beneficiaries between the ages of 18-65 will get a Ticket. This would include transition-aged youth that meet the above criteria. What Services Are Available Under The Ticket To Work Program? Basically, there are no limitations on services and supports available under the Ticket to Work Program as specified in the Ticket to Work and Work Incentives Improvement Act. However, services and supports may be limited by the capacities and expertise of specific ENs and whether or not the service is employment-related and necessary to support the employment goal. What Are the Types of Employment Awareness? When thinking about the type of employment services that may best suit youth in transition, it is helpful to recognize that they may fall among one of the following three distinct categories of employment awareness. Services will vary greatly depending upon which of the three profiles a person most closely matches, however all of these areas require that service providers are adept at forming and sustaining strong partnerships within and throughout a variety of communities: * A person has limited or no idea of what they are interested in pursuing in relationship to employment. The person who fits into this category benefits from being provided multiple opportunities to acquire first-hand knowledge about a broad variety of employment options. The individual may participate in a range of assessment activities including but not limited to completing interest inventories, touring employment sites, interviewing employees/employers, and experiencing internships both within the school and general community. The intended outcome of the work is to guide a student through different work environments and activities in order enable them to make more specifically informed decisions about the chosen employment path. * A person has an idea about the type of employment they are interested in pursuing, but there is no formal plan guiding the path towards employment. In this scenario, it is important that the student’s employment goal is articulated in the plan for education so that appropriate services may be obtained and orchestrated in concert with the academic goals for standard achievement. The intended outcome of the work is to integrate the program and services so that a person is moving steadily toward their stated employment goal and that annual evaluations and subsequent educational/program goals are developed in response to this. Linkage to community service providers, employers, and other community entities is essential for providing a seamless transition from school to employment. * A person has clearly articulated employment goals and there is a formal plan in place and it is being implemented. The person who fits this category will benefit from employment services and supports that will enhance the existing programs, services and activities. Fine tuning vocational skills, honing work environments, expanding community membership roles, building a career ladder, etc. are the outcomes toward which to strive. What Are Decisions That Should Be Made In Accessing Ticket To Work? Once a beneficiary has made a decision to pursue work, that person must take into consideration several types of information to aid them in making the best decision in regard to selecting an EN: * Their unique interests, preferences, abilities, and support needs. * The impact of their choices on their financial well-being and independence. * Individual service provider capacities to best meet their unique set of employment needs. * Elements of a comprehensive work plan clearly outlining their preferred employment indicators, goals, and objectives. While the notion of gathering and organizing such information can be a daunting task for any person considering employment, the prospect may be even more overwhelming for a youth in transition who has limited experience in the competitive employment and employment service arenas. It is important to recognize, however, that for many it does not entail starting from scratch. Many transition-aged youth who become eligible to access the Ticket to Work program will already be actively engaged in planning for the transition to life and employment in the community. As defined in federal statute, transition planning should begin at age 14, or earlier if deemed appropriate. The Individuals with Disabilities Education Act mandates several transition benchmarks be adhered to. They include the development of a statement of needed transition instruction, development of an Individual Education Plan, identification of long-term adult outcomes, identification of needed transition services, and, finally, development of a coordinated set of activities for transition to employment, postsecondary education, and community living. Employment-related questions that transition-aged youth, parents, and educators are likely to be already addressing during the transition planning process include: * What are the quality indicators of employment for this student? * Are the student’s preferred outcomes viable and do they have a feasible plan for attainment? * If not, how will we support them in identifying more viable and feasible outcomes? * What supports might this person need to work toward this outcome? * What are current resources and supports that can be built on? * Where can additional resources and supports be secured? * What will be the impact of work on the person’s benefits, health care, and overall financial situation? * What level of earnings/income will the student need to generate to support their overall goals for adult life in the community? For many, the information and insights they will have gained through addressing questions such as these in the transition planning process will serve as a foundation for their efforts to evaluate and choose an Employment Network responsive to their interests and needs. Consideration of Interests, Abilities, Preferences, and Support Needs Prior to selecting a provider to deliver employment services, an individual must consider developing a profile of what their preferred employment outlook is based on their interest, preferences, abilities and support need. To begin developing this profile, an individual should first consider what they are most interested in doing for work – their preferred field of interest (e.g. computer technology, customer service, health and human services, etc.). Next they should look at what types of environments they are most interested in performing this work in. Let’s say for example a person expresses a strong interest in computer technology – specifically data entry and materials development. That type of work can be done in a variety of settings – a college, a factory, a doctor’s office, and an array of other locations. Selecting the setting, in many cases, is dictated by other employment indicators. Does the person want a fast-paced environment, low stress, high occurrence of interaction with co-workers, certain hours/schedule, certain types of benefits, a specific pay range, etc.? These preferences dictate the type of environment that might be most conducive to the individual’s overall level of job satisfaction. Getting an understanding of this up front in the employment planning process is critical and will assist the individual in making a more informed choice as to what provider is best equipped and has the most experience placing individuals in jobs that best match their profile. A second important aspect is the person having an understanding of what their unique and specific needs for support are. For example, if the individual doesn’t understand the functional implications of their disability for work, they might want to consider a provider who can assist them in learning more about themselves as an important first step in developing their work plan. If the provider does not have specific expertise in assessment or evaluation, the individual might want to consider another provider that does. In the case of someone who understands their capacities and ongoing needs for very specific, specialized support, they might want to consider a provider or group of providers that can not only provide vocational rehabilitation counseling, job development and placement services, but also specialized therapies needed such as speech language pathology, occupational therapy, cognitive therapy, etc. For someone who just needs modifications to a vehicle for transportation to and from work to achieve their specific work goal, they might want to consider locating a provider with resources to cover those associated costs or a provider who is knowledgeable about the SSA’s work incentive provisions and can assist them in writing a Plan for Achieving Self Support. Impact on Financial Well-Being and Independence Most individuals considering pursuit of employment are doing so to increase their financial well-being and independence. It is a critical step in the informed decision making process to make sure that beneficiaries understand how their benefits will be impacted by earnings and employment. These benefits not only include SSI and SSDI, but also housing subsidies, Temporary Assistance for Needy Families, state Medicaid, Unemployment Insurance, Worker’s Compensation and other state benefits. Benefits Planning, Assistance and Outreach Projects (BPA&O) around the country can provide major assistance in helping beneficiaries to understand this impact, as well as provide information on available work incentives to support the work effort. BPA&O Projects are specifically charged with the responsibility of targeting and providing benefits planning and assistance services to transition-aged youth in the geographic area served by their program. A Benefits Specialist within a BPA&O Project can help the young person and their family understand the specific dollar amount of earnings needed to off-set the loss of benefits across an array of programs as well as other benefits the person might need to have such as health care. This dollar amount, coupled with other employment benefits needed, provides an important benchmark or profile for the potential service provider and beneficiary to work with as they consider annual earnings a job must generate to ensure the person’s financial well-being and increased independence. Assessment and Selection of an Employment Network Once an individual has a basic understanding of what their unique interests, preferences, skill set, and need for employment supports are, the process of selecting a provider begins. A comprehensive and careful review and comparison of potential employment networks should occur during this assessment process. Potential providers should be evaluated on a number of levels including staff qualifications, service delivery characteristics, and their effectiveness in assisting other individuals with disabilities to realize their employment, benefits, and financial goals. In addition to formal interviews with potential employment networks and a review of their outcome data and records, effort should also be made to gain insight and feedback regarding the satisfaction of the network’s current or former customers. Remember, it is the customer that has the choice of who they select as a service provider and/or deposit their “Ticket” with. As with shopping for a new car, it is important to shop around for the best deal with the most features. Comprehensive Plan for Employment Evaluating the services and supports being provided starts with ensuring that the beneficiary’s individualized work or service plan incorporates all the important elements of services to be provided as well as the preferred employment outcome. This service-planning document serves as a contract between the beneficiary and the service provider. If it has not been agreed to by both the service provider and the beneficiary and incorporated into the plan, then it becomes difficult to evaluate. For example, if the individual and the service provider have identified that a full-time job in the field of computer technology is the preferred outcome, it should be built into the individual’s work plan. That will help guide the service provider as they are doing job development and provide them a benchmark against which to measure jobs they are developing. If the salary must be at a certain level to off-set loss of benefits, then that should be built in as well. Let’s say an individual is going to lose their subsidized housing within a year of becoming employed at a certain level; that individual’s plan should also identify strategies for supporting that individual in locating alternative housing or at a minimum a referral to a community resource to assist with this. A final important consideration is that of quality assurance. As mentioned earlier, under the Ticket to Work Program a beneficiary does have a right to terminate services with the original EN and solicit services from another EN. However, prior to making this decision, the individual should work with the provider to resolve any differences and make sure they understand how they are attempting to support the customer’s movement toward employment. How Might the Ticket Work for a Transition-Aged Youth? Benz, Lindstrom and Yovanoff (2000) studied the relationship between transition practices and postschool outcomes. They summarized four areas of recommended policies and practices: * "Focus secondary and transition services concurrently on the two goals of school completion and postschool preparation. * Promote curricular relevance and student self-determination through student-centered planning and individualized services. * Expand the use of collaborative service delivery programs as a mechanism for delivering transition services. * Extend secondary school reform efforts to include career development, applied learning in the community, and transition planning as a central part of the regular education curriculum for all students.” (p. 527) The Ticket to Work program supports these practices through payment for 18-21 year old students who receive SSI or SSDI benefits and obtain and sustain employment. The very process of using a Ticket insures that students engage in an individualized and collaborative planning, training and placement process, culminating in a paid employment outcome for each individual. The most likely scenario for achieving an employment outcome involves school districts and agencies collaborating to form an Employment Network. The school and agency develop a memorandum of understanding, which details the way in which Ticket money will be divided to compensate each for rendered services. In this example, as the student turns 18, he or she would continue to engage in a person-centered transition planning process, to establish and refine hopes and dreams, and establish a circle of supportive adults and peers. As a part of the planning process, the student would re-establish eligibility for Social Security benefits and be presented with a Ticket and a list of available Employment Networks and activities to learn about each potential choice. If a student chooses the school/agency collaboration as their Employment Network, the school would build on a student’s career pathway, developed as part of the secondary education program, and engage the student within community-based work settings combined with technological and applied academic education, while a student is 18 and 19 years old. As a student turns 20 and 21 years old, a collaborating agency assists the student in securing a paid position with job coaching and follow-up services beyond age 21 as needed. Because all of these activities lead to paid employment, this collaborative Employment Network would be eligible for payment through the Ticket to Work program. Final Considerations The Ticket to Work and Work Incentives Improvement Act of 1999 is widely recognized as the most significant piece of legislation for people with disabilities since the passage of the Americans with Disabilities Act of 1990. Both through the Ticket to Work and BPA&O Programs outlined above, as well as through additional health care and work incentive enhancements, the Act enhances the ability of youth with disabilities to make choices and exercise greater control over the path they will purse from school to work, as well as the supports that will be in place to make success possible. The following are suggestions to ensure that access to these programs and provisions is maximized on an individual level: * Prior to age 18, plan and prepare for the SSI age-18 redetermination. Upon reaching age 18, a redetermination will be conducted to determine the individual’s ability to continue receiving SSI cash benefits under the adult disability criteria. A determination that the individual is no longer eligible for cash benefits under SSI, will likewise compromise their eligibility for the Ticket to Work program. * Begin early to gather and organize information on the Employment Networks providing service in your locality to ensure sound decisions and a smooth and timely transition to services. * Identify and request benefits planning and assistance services from the BPA&O project in your area. A listing of projects across the country is available online at www.ssa.gov/work. * Become familiar with the health care provisions in your State. The Act creates many opportunities and options for States to develop Medicaid Buy-in programs and make other targeted improvements to their Medicaid program. States are, however, not mandated to implement these provisions. As a result, there is significant variation between States in availability and access to these programs. Learn where your State is in this regard and link with appropriate State and local agencies for access. References: Benz, M., Lindstrom, L., Yovanoff, P. (2000). Improving graduation and employment outcomes of students with disabilities: predictive factors and student perspectives. Exceptional Children, (66) 4, 509-529. Social Security Administration (2001); Employment network (EN) for the Ticket to Work and self-sufficiency program. Washington DC. [Available from http://www.yourtickettowork.com]. Thomas P. Golden is on the faculty with the Program on Employment and Disability, Cornell University, Ithaca, New York; he may be reached at 607/255-7727 (voice), 607/255-2891 (TTY), or at tpg3@cornell.edu. Susan O’Mara is Project Coordinator and Trainer for the Virginia Commonwealth University (VCU) Benefits Assistance Resource Center, and Consultant for the VCU National Project Office for the SSA/RSA State Partnership, Virginia Beach; she may be reached at 757/412-2342 or soevans@erols.com. David Brewer and Carol Blessing are on the faculty with the Program on Employment and Disability at Cornell University, and can also be reached at 607/255-7727 (voice) or 607/255-2891 (TTY). Golden, O’Mara, Brewer & Blessing Ticket to Work and Self-Sufficiency Program © 2002 Institute on Community Integration. Used with permission. 8 © 2002 Institute on Community Integration. Used with permission. 1