Evaluation of the Ticket to Work Program, Implementation ...

Ticket Assignments Are Few and Far Between. Sixty percent of all ENs have takenno Tickets; over 20 percent have taken fewer than four Tickets. EN representatives told usthey devoted considerable effort to answering basic questions from potential clients aboutTTW, educating them about the program’s purpose. These ENs frequently found, however,that many callers were not interested in pursuing employment at a level that would lead tozero cash benefits. And even when they were, ENs sometimes screened them out for otherreasons, such as not matching well with the service model, requiring expensive or long-termservices, or not showing sufficient likelihood of succeeding in the workplace. ENs oftenfound that screening efforts yielded few Ticket assignments—or even none at all. Whilemost ENs remain interested in taking Tickets and are willing to continue participating in theprogram at some level, some have decided against taking any Tickets or want to reduce theirinvolvement. EN representatives in both groups cited financial concerns, among otherfactors, as deterrents to participation.Services Are Not Being Expanded. ENs typically serve Ticket clients much as theyserve other clients; that is, there appears to have been very little service expansion in theinterest of Ticket holders. A few ENs employ Ticket holders themselves. Some have takena relatively hands-off approach, providing a minimum of direct services or assistance, eitherbecause they believe that this is the best way to ensure client success (e.g., they need to dothings for themselves) or because they do not have resources to cover more extensiveservices. Some ENs have consistently referred clients to SVRAs, for example, for high costservices. In addition, ENs typically pay for overhead and direct services out of other existingfunding sources, not with revenues from Ticket payments. Most know little or nothingabout the “capitalization initiative” that was designed to help them find new operatingrevenues.In conclusion, our recent findings on EN participation in TTW echo the findingsdocumented in both the initial evaluation report and the preliminary process evaluationreport. This body of evidence strongly suggests that the program continues to struggle tomeet its goal of giving beneficiaries a greater selection of providers.Conceptually speaking, the notion that underpins the program’s design—that entitiesother than SVRAs will enter the provider market and help beneficiaries move off of thedisability rolls in exchange for a performance-based payment stream—is questionable. Themost significant operational problem seems to be that ENs are finding that they aregenerating revenue streams that are “too little, too late,” given the need to cover the upfrontcosts of overhead and direct services. Absent the funding they need, ENs say they mustscreen out individuals with significant service needs and offer less intensive services to TTWbeneficiaries who can return to work most easily. EN officials continue to call for asubstantial overhaul of the TTW payment systems. Even if the systems are radically revised,however, ENs may still have trouble finding enough suitable Ticket holders—those who willgenerate a funding stream that would sustain their TTW efforts without other resources. 109110 More information on EN costs appears in Chapter VIII.V: EN Participation in Ticket to Work