Kornfeld R, Rupp K
Soc Secur Bull. 2000;63(1):12-33.
The Social Security Administration (SSA) initiated Project NetWork in 1991 to test case management as a means of promoting employment among persons with disabilities. The demonstration, which targeted Social Security Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) applicants and recipients, offered intensive outreach, work-incentive waivers, and case management/referral services. Participation in Project NetWork was voluntary. Volunteers were randomly assigned to the "treatment" group or the "control" group. Those assigned to the treatment group met individually with a case or referral manager who arranged for rehabilitation and employment services, helped clients develop an individual employment plan, and provided direct employment counseling services. Volunteers assigned to the control group could not receive services from Project NetWork but remained eligible for any employment assistance already available in their communities. For both treatment and control groups, the demonstration waived specific DI and SSI program rules considered to be work disincentives. The experimental impact study thus measures the incremental effects of case and referral management services. The eight demonstration sites were successful in implementing the experimental design roughly as planned. Project NetWork staff were able to recruit large numbers of participants and to provide rehabilitation and employment services on a substantial scale. Most of the sites easily reached their enrollment targets and were able to attract volunteers with demographic characteristics similar to those of the entire SSI and DI caseload and a broad range of moderate and severe disabilities. However, by many measures, volunteers were generally more "work-ready" than project eligible in the demonstration areas who did not volunteer to receive NetWork services. Project NetWork case management increased average annual earnings by $220 per year over the first 2 years following random assignment. This statistically significant impact, an approximate 11-percent increase in earnings, is based on administrative data on earnings. For about 70 percent of sample members, a third year of followup data was available. For this limited sample, the estimated effect of Project NetWork on annual earnings declined to roughly zero in the third followup year. The findings suggest that the increase in earnings may have been short-lived and may have disappeared by the time Project NetWork services ended. Project NetWork did not reduce reliance on SSI or DI benefits by statistically significant amounts over the 30-42 month followup period. The services provided by Project NetWork thus did not reduce overall SSI and DI caseloads or benefits by substantial amounts, especially given that only about 5 percent of the eligible caseload volunteered to participate in Project NetWork. Project NetWork produced modest net benefits to persons with disabilities and net costs to taxpayers. Persons with disabilities gained mainly because the increases in their earnings easily outweighed the small (if any) reduction in average SSI and DI benefits. For SSA and the federal government as a whole, the costs of Project NetWork were not sufficiently offset by increases in tax receipts resulting from increased earnings or reductions in average SSI and DI benefits. The modest net benefits of Project NetWork to persons with disabilities are encouraging. How such benefits of an experimental intervention should be weighed against costs of taxpayers depends on value judgments of policymakers. Because different case management projects involve different kinds of services, these results cannot be directly generalized to other case management interventions. They are nevertheless instructive for planning new initiatives. Combining case and referral management services with various other interventions, such as longer term financial support for work or altered provider incentives, could produc
社会保障管理局(SSA)于1991年启动了“网络项目”,以测试个案管理作为促进残疾人就业的一种手段。该示范项目针对社会保障残疾保险(DI)受益人以及补充保障收入(SSI)申请人和领取者,提供密集的宣传推广、工作激励豁免以及个案管理/转介服务。参与“网络项目”是自愿的。志愿者被随机分配到“治疗”组或“控制”组。被分配到治疗组的志愿者会与个案或转介经理单独会面,后者会安排康复和就业服务,帮助客户制定个人就业计划,并提供直接的就业咨询服务。被分配到控制组的志愿者无法获得“网络项目”的服务,但仍有资格获得其所在社区已有的任何就业援助。对于治疗组和控制组,该示范项目都豁免了被认为会抑制工作积极性的特定DI和SSI项目规则。因此,这项实验性影响研究衡量了个案和转介管理服务的增量效应。八个示范地点大致按计划成功实施了实验设计。“网络项目”的工作人员能够招募大量参与者,并大规模提供康复和就业服务。大多数地点轻松达到了他们的招募目标,并且能够吸引到在人口统计学特征上与整个SSI和DI案例总量相似、患有各种中度和重度残疾的志愿者。然而,从许多指标来看,志愿者总体上比示范地区有资格参与项目但未自愿接受“网络项目”服务的人更“具备工作能力”。在随机分配后的头两年里,“网络项目”的个案管理使平均年收入每年增加了220美元。这一具有统计学意义的影响,即收入大约增加了11%,是基于收入管理数据得出的。对于大约70%的样本成员,有第三年的随访数据。对于这个有限的样本,在第三次随访年中,“网络项目”对年收入的估计影响降至大致为零。研究结果表明,收入的增加可能是短暂的,可能在“网络项目”服务结束时就已经消失了。在30至42个月的随访期内,“网络项目”并没有使对SSI或DI福利的依赖在统计学上显著减少。因此,“网络项目”提供的服务并没有大量减少总体SSI和DI案例总量或福利,特别是考虑到只有大约5%的符合条件的案例总量自愿参与了“网络项目”。“网络项目”为残疾人带来了适度的净收益,却给纳税人带来了净成本。残疾人获得收益主要是因为他们收入的增加很容易超过平均SSI和DI福利的小幅(如果有的话)减少。对于整个SSA和联邦政府而言,“网络项目”的成本并没有被因收入增加或平均SSI和DI福利减少而导致的税收收入增加充分抵消。“网络项目”给残疾人带来的适度净收益是令人鼓舞的。这种实验性干预的收益应如何与纳税人的成本相权衡,取决于政策制定者的价值判断。由于不同的个案管理项目涉及不同类型的服务,这些结果不能直接推广到其他个案管理干预措施。不过,它们对规划新举措具有指导意义。将个案和转介管理服务与各种其他干预措施相结合,例如对工作的长期财政支持或改变提供者的激励措施,可能会产生……