oversight

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)

                    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.