United States General Accountin.” Of&e JYP vb GA!!“- Testimony IIIII11111 II 141086 For Release The Social Security Administration's on Delivery Supplemental Security Income Expected at Outreach Activities 10:00 a.m. EDT Thursday April 5, 1990 Statement of Joseph F. Delfico Director, Income Security Issues Human Resources Division Joint Hearing Before the Select Committee on Aging and its Subcommittee on Retirement Income and Employment House of Representatives GAO/T-HRD-90-22 / SUMMARY The Supplemental Security Income (SSI) program provides financial support to aged, blind, and disabled people who have limited income and resources. SSI is administered by the Soc’ia? Security Administration (SSA), Since SSI started in the mid-seventies, there has been concern that many people are eligible for the program, but are not participating. A frequently cited reason for ~this is that many people are not aware of SSI or that they may be eligible. To inform these individuals, SSA uses various outreach approaches such as radio, television, speeches, etc. Ho’wever, more needs to be done to determine which outreach mode is the most cost effective. The Congress has also expressed concern at the size of the SSI “enrollment gap” and has recently taken action to support SSI outreach. The fiscal 1990 budget contains $3 million in earmarked funds for research grants to develop new outreach approaches. GAO’s survey of SSA district office managers shows that most believe there is a continuing need to do outreach and that they ,are currently doing enough to meet this need. An exception however is outreach for the non-English speaking. Only 40 percent believed there was a need to conduct outreach for this group and of those, 43 percent said SSA was doing less than enough. Also, concerning outreach in general, many local agencies and advocacy groups that GAO talked with believed that SSA was not doing enough outreach. The amount of resources devoted to outreach by SSA field offices is problematic. Nearly half of SSA’s districts devote 10 hours or less per month to SSI outreach, according to GAO’s survey of managers. In the last several years, the American Association of Retired People (AARP) initiated 12 SSI outreach demonstration projects. The projects provided much useful information on how to conduct effective outreach and should be helpful to SSA as it prepares to implement its own demonstration program starting later this year. Messrs. Chairmen and Members of your Committees: We are pleased to be here today to testify on the activities carried out by the Social Security Administration (SSA) to inform the pub1.c about Supplemental Security Income (SSI) benefits. SST is the principal means of financial support for aged, blind, and disaoled people who have limited income and resources. Moreover, eligibility.for SSI often automatically qualifies individuals for other benefits, such as Medicaid and food stam9.s. Since its inception in the mid-seventies, the SSI program has been characterized by low participation, particularly among the elderly. A number of studies indicate that about 35 to 50 percent of those eligible for the program are not participating. Frequently cited reasons for nonparticipation are that the elderly are not aware of the program or, if aware, do not realize that they are eligible for benefits. In addition, many potential participants are discouraged from participating because of a perceived social stigma associated with income assistance . programs. Within the last year, the Congress and SSA have both placed a renewed emphasis on SSI outreach activities as an answer to this problem. However, questions about what constitutes an effective outrea&h program and how to sustain it, while critical to any 1 discussion of approach and resource allocation, remain largely unanswered. Both SSA and the ad;tocacy groups serving SSI clients hay12 opinions on the program’s shortfalls and solutions. Advocates of increased outreach have various perceptions of the answer. Some point out that more dedicated SSA resources may be needed, others contend that more effective use of the media is needed, and still others note that an integrated SSA/community group approac’n is critical. However, the objective information needed to assess the effectiveness of these and other approaches is lacking. The Congress has expressed its support for SSI outreach by earmarking $3 million in the fiscal year 1990 budget for research grants to develop new approaches for outreach. SSA has a number of initiatives underway to improve outreach, including developing policy to guide the outreach activities of the regional and district offices. These projects may represent the best opportunity to date for developing the information needed to determine the characteristics of an effective outreach program. Our testimony today will focus on some of the issues surrounding SSA’s general outreach efforts. To gather information for this testimony, we first obtained the views of 146 SSA managers on how they felt about their own outreach efforts. We then solicited 2 the opinions of advocacy groups to determine if they thought SSA was doing enough outreach and what, if any, changes they wguld advocate. We analyzed staffing trends and the time deyrotad to outreach in SSA field offices. We also evaluated the results of j.7arious SSI outreach demonstration projects sponsored by the American Association of Retired Persons (AARP). EFFECTIVENESS OF SSI OUTREACH ACTIVITIES SSA field offices carry out a wide range of outreach activities. Common activities include (1) informing other agencies, advocacy groups I or coalitions about SSI eligibility requirements; (2) speaking before groups of potential SSI recipients; (3) talking with individuals on a one-to-one basis at shelters, soup . kitchens, and senior citizen centers; and (4) using the media-- TV, radio, and newspaper articles--to disseminate SSI infor ‘ma tion. Given the tight budget situation, it is important that the outreach activities undertaken are effective and efficient. It is equally important to design evaluations into any project and collect information on what particular outreach efforts are more effective and why, so that they can be refined and replicated. As part of our nationwide survey, we asked district managers to identify-- from a list of eight SSA outreach activities--which 3 they consider to be the most effective. The four most frequently mentioned activities ara ranked as follows: -- Joint participation in special outradch projects with other agencies/advocacy groups (24 percent), -- Training staff from other agencies/advocacy groups to do SSI outreach (16 percent). -- Presentations or speeches before the public and staff of other agencies/advocacy groups (15 percent). -- Visits to shelters, soup kitchens, churches, or other local sites (13 percent). The survey results show that there is no clear consensus on what works best. However, common to the top four approaches is that they involve working with other groups that have an interest in helping the poor. Collectively, these approaches appear to be compatible with SSA’s general outreach strategy to foster a partnership with other agencies and organizations. There was also a strong indication that using the media was an effective way to conduct outreach. NEED FOR AND EXTENT OF OUTREACH Our survey showed that SSA district managers acknowledge the need to conduct outreach for each of the SSI target groups we studied --the elderly, the blind, and the disabled. It also showed a need for outreach to the homeless, the rural ioor, and non-English speaking populations within the SSI target groups. Managers ’ perceptions of the degree of need, however, varied. 4 Eighty-eight percent of managers acknowledged there was a need for outreach efforts directed at the elderly, and 34 percent sa’r~ a need for outre’ach for the blind and disabled. In addition, 7: percent said there w,as a need for special outreach for rural populations: 57 percent, for the homeless; and 48 percent, for the non-English speaking population--a number that is low, largely because of the relatively low non-English speaking . population in some districts. While confirming the need for outreach, most district managers expressed the view that they were doing enough. As can be seen from attachment 1, however, the non-English speaking group stands out as an exception. Among managers who perceived a need for outreach to the non-English speaking, a substantial minority, 43 percent, felt that SSA was not doing enough. Concerning the services provided to the non-English-speaking, a preliminary report of the Department of Health and Human Services (HHS) Office of .Inspector General states that limited communications exist between SSA and community agencies and recommends that SSA do more to recognize and address the needs of the non-English speaking. The report, Serving Non-English Speaking Clients (Dec. 1989), recommends that SSA encourage outreich to community-based agencies. It also points out that most SSA field office managers believe there are not enough 5 bilingual interviewers and that past SSA staff cuts and lack of recruiting are major obstacles to providing good service to ttiese clients. VIEWS OF ADVOCACY GROUPS We solicited the views of some local agencies and advocacy groups to compare with SSA’s. views. We met with representatives of 31 organizations in seven SSA service areas where SSA managers said they were doing more than enough outreach. As might be anticipated, only one individual agreed with the SSA managers, and half felt that SSA was not doing enough outreach. When asked specifically what more SSA should do, most officials pointed to a need for expanded public information activities, including radio and television media spots, and more printed material geared to the elderly and non-English speaking populations. As noted earlier, these mechanisms were also perceived as effective by many SSA managers. RESOURCES DEVOTED TO SSI OUTREACH There are a number of indications from our survey results and our analyses of SSA staffing patterns that the resources SSA devotes to SSI outreach may be impacting effectiveness. For example, among’the district managers who believed that they were not doing enough outreach, the principal reason cited for this was lack of 6 staff. There was also a reported decline,in the amount of time spent on outreach and a shift in who performed it. According to our survey of managers,*nearly half zf the districts spend 10 hours or less on SSI outreach per month. Eighty percent of the district managers estimated that on average, their staffs spend 20 hours or less each month conducting SSI outreach (see attachment . 2). Coupled with the amount of time devoted to outreach is a decline in the number of field representatives, who traditionally have performed outreach in field offices. From fiscal year 1984 to 1989, the number of field representatives declined from 1,081 to 601, or 44 percent. This occurred at a time when total field office staff declined by 15 percent on average (see attachment 3) l With the decline in field representatives, responsibility for outreach has shifted to other field office employees. Sixty-two percent of the district managers we surveyed said that they, their assistants, their operation supervisors, and others--rather than field representatives --were conducting most of the SSI outreach. When this occurs, much less time is spent on outreach. i, A final indicator that the amount of field office resources devoted to SSI outreach may be declining 'is the time devoted to general public information activities. This term encompasses ‘3.1 SSA programs and is not rsstricted to SSI outreach. Howeyier , field offices spent 90 fewer staff-years, or 37 percent 12~s time, on public information activities in fiscal year 1989 than in fiscal year 1985 (see attachment 4). .AARP OUTREACH EFFORTS: SHOWING THE NEED FOR MORE DEMONSTRATIONS AND EVALUATION In 1988 and 1989, the AARP initiated SSI outreach demonstration projects in 12 cities. AARP coordinated the project's activities in cooperation with a local agency serving as cosponsor and a coalition of various participating agencies in each community. Each project concentrated SSI outreach activities during a 3- to S-month period. In analyzing results from nine of these projects, we found varying levels of impact and an absence of *data to explain why some projects were less successful. . Demonstration project workers used a wide variety of outreach methods --including extensive use of media, training, community education, and one-to-one counseling--to reach potential SSI applicants. AARP provided an outreach manual, training, mater:als, data collection, and technical assistance necessary to 8 coordinate the project’s activities-. The local agency who served as cosponsor c,oordinated the project at the local level. Our analysis of the results s’howed that in fi.12 of the nine projects, there was a statistically significant increase in SSI awards. Though the percentage increases were significant, the increase in awards is small in comparison to the est’imated size of the overall enrollment gap. Attachment 5 shows the average number of monthly awards during the demonstration projects compared with the monthly average -before the project. The demonstration project conducted in Allegheny County (Pittsburgh), Pennsylvania, is heralded as the most successful project. Extensive use of media, including a telethon, generated 5,000 phone calls during the kick-off event. During the demonstration, Allegheny County processed an average of 77 elderly awards per month, up from 46 awards per month before the demonstration. Why some projects succeeded and others did not is difficult to determine based on the data collected. The Rutland, Vermont, project, for example, was a significant undertaking. During the project, SSA’s Rutland district office contacted over 200 organizations, 40 of which agreed to participate in the project. Indivfdua.ls were trained and ‘sent to visit shelters, people’s homes, and senior centers. The governor declared an SSI 9 Awareness Week in Vermont. Despite these and various other activities, the Rutland project did not have any measurable impact on SSI applications and awards. In addition to analyzing the impact on awards during the project, we also analyzed the post-project period for eight of the nine demonstration projects to gain some measure of their long-term effects. Our analysis showed that, compared to pre-project levels, only two of the eight projects had statistically significant increases after the project. One of the projects-- in El Paso, Texas --also had an increase during the project period. The other project--in Asheville, North Carolina--did not show a statistically significant increase during the outreach project, but did increase later, possibly ‘indicating a delayed . effect. The cost of conducting the AARP demonstration projects is not known. For the most part, the projects were carried out without any additional funding to the many agencies and organizations that participated. Further, records were not kept on the amount of time that participating groups spent on the project. However, according to the SSA managers that participated in the five successful projects, the amount of SSA staff time expended on outreach during the project was characterized as significantly highe; than the time expended during the pre-project period. 10 The first three AARP projects did not record data on SSI applicants during the proj,ect period, It is important to know how the applicants heard about SSI and why they wera applying at that tinne. This information would have indicated which outreach techniques or activities were effective. For the other ?ine projects, information has been collected and forwarded to SSA for analysis, which is expected to be completed by mid-April 1990. SUMMARY OBSERVATIONS The problem of nonparticipation has existed since the inception of the SSI program. Given the size of the SSI enrollment gap and the relatively small gains made through some of the more successful outreach efforts, it may be difficult to make major inroads in reducing the gap. Despite the inherent difficulties in addressing the enrollment gap, there are several matters SSA should address that could lead to increased enrollment. A number of SSA managers felt they were not doing enough outreach and they indicated that the reason for this was the lack of staff. SSA needs to examine its current staffing levels for outreach. In the long run, SSA needs to establish staffing levels consistent with the outreach methods selected as the most appropriate based on information from the upcoming demonstration proje:ts. 11 Our survey of field offices also shows that outreach for the non-English speaking is an area that needs particular attention. Our survey results, plus the shortcomings in service to this group disclosed by the recent HHS Inspector General report, point to the need for SSA to aggressiT]ely follow up on the adequacy of services provided to the non-English speaking. AARP’s demonstration projects provided much useful information on how to conduct effective outreach. The projects also raise a number of issues that SSA should be mindful of as it prepares to implement the $3 million grant program authorized by the Congress. Along these lines, the views of SSA managers and advocacy groups should be considered in developing options for outreach. The issue of how to sustain an effective ongoing outreach program is especially critical. In this regard, we believe that in approving .grant projects, SSA should consider the extent that projects can be replicated and sustained at reasonable cost. . From a management perspective, we believe that program evaluation should be an integral part of program administration and that well-designed evaluations are critical to achieving the objectives of the demonstration projects. We believe that the projedts should have a strong evaluation component designed in from the beginning. Done properly, evaluations imbedded in the 12 I- projects can provide useful information on what works and what doesn’t. Xessrs. Chairmen, that concludes z~y prepared statement. 5Qe will be happy to answer ani questions you or other members of the Committees may have. 13 I E nttachment 2 Amount of staff time per month devoted to SSI outreach1 Amount of time Number of field offices (Hours) (Percent) 10 or less 48 11-20 32 21-30 9 31-40 5 41. or more 6 lThe amount of time includes time expended by branch offices and resident stations within the district service area. l General Decline in Resources Devoted to Public Information Activities Percent change Fiscal year Staff-years from 1985 1985 246 1986 193 -22 1987 188 -24 1988 149 -39 1989 . 156 -37 Esttmated lm$mct of Outreach Demonstratton e 120 AvongoNumeardAuoldapu~ Note:Tfmnunberofawaxtsduringhedemon~omi(s -lhatrroublhavebeJen expected without the delnons~tion.
The Social Security Administration's Supplemental Security Income Outreach Activities
Published by the Government Accountability Office on 1990-04-05.
Below is a raw (and likely hideous) rendition of the original report. (PDF)