Effects on Service Receipt, Program Participation, and Supported Employment

This section presents the effects of Tier 2 — compared with Tier 1 — on service receipt and program participation, including: (1) contacts between study participants and case managers; (2) assistance with barriers to employment; and (3) participation in program activities and supported employment. Twelve-month follow-up survey data are used to compare these outcomes for the Tier 1 and Tier 2 groups. Box 3 describes how to easily read most tables in this report.

Contacts Between Study Participants and Case Managers

• Individuals in Tier 2 had more frequent contact with their case managers than individuals in Tier 1. However, individuals in both programs reported high levels of contact with case managers.

Table 7 shows that about three-quarters of both the Tier 1 and the Tier 2 group reported at least one contact with program staff in the year following random assignment. It is important to note that these survey data do not allow for distinctions regarding the types of staff that respondents were referring to when they reported contacts. (See Box 4 for more on measuring participation in ERA.) Nonetheless, these high levels of general contact reflect the mandatory nature of both programs. In addition, the high level for Tier 1 set a high standard for Tier 2 to surpass. The likelihood of having at least one contact with program staff did not differ between the two groups; however, the average number of contacts did vary modestly. On average, individuals in Tier 2 had 26.4 contacts with program staff in the year following random assignment, compared with 18.3 for those in Tier 1. Individuals in Tier 2 were especially more likely to have telephone contacts. They had an average of 16.5 telephone contacts, while their Tier 1 counterparts averaged 10.4. 49

About two-thirds of both Tier 1 and Tier 2 participants reported in-person meetings with program staff in the year following random assignment, and there was no difference between the two groups in this regard. The most common locations for in-person meetings were in the case manager’s office or at an educational or training program. Across both groups, relatively few participants indicated that any meetings took place in their homes, workplaces, or other places outside the providing agency.

There was very little contact between the case managers and employers in both Tier 1 and Tier 2 (Table 7). This is not surprising, since developing relationships with employers was not a major goal of either program. Nonetheless, the survey data suggest that Tier 2 case managers were less likely than those in Tier 1 to have never talked with respondents’ employers.

Assistance with Barriers to Employment

• The Tier 2 program did not increase participation in services to address three critical barriers to employment: problems with (1) mental health, (2) substance use, and (3) domestic violence.

As detailed above, in the section on implementation, the Tier 2 program placed great emphasis on in-depth, full-family assessments to identify a range of barriers to employment among clients and members of their families. Although these assessments appear to have been both comprehensive and well implemented, the survey data do not provide evidence that Tier 2 clients or their families were any more likely than Tier 1 clients or their families to receive services to address critical barriers — such as problems with mental health, substance use, or domestic violence. (See Figure 2 and Appendix Table D.6.) This is perhaps a critical juncture where the Tier 2 intervention fell short of its goals. Moreover, Tier 2 did not affect the likelihood — compared with Tier 1 — of individuals’ applying for, or receiving, Social Security disability benefits50 (analysis not shown).

The lack of a significant relationship between the full-family assessments and engagement in services highlights two important issues concerning programs designed to target a hard-to-employ population. First, this finding can be seen as support for the contention that up-front assessments must be linked to strong mechanisms to ensure that clients are referred to and receive services.51 Second, it is also in keeping with the argument that some assessment processes can deter or prolong entry into key program services.52

Nonetheless, a few encouraging observations about addressing the employment barriers of participants in both programs can be made. First, Tier 2 was more effective than Tier 1 in assisting clients to access Medicaid benefits and providing certain kinds of help with job preparation. For example, 35 percent of Tier 2 clients received help finding clothes, tools, or supplies for work, while just 20 percent of Tier 1 clients reported the same (Table 8). Tier 2 clients were also more likely to report getting help with “a personal problem that makes it hard to keep a job” — 13 percent of Tier 2 clients, compared with 8 percent of Tier 1 clients. This suggests that Tier 2 case managers may have provided informal help with barriers that did not result in formal service engagement.53

[D]

Second, considerable proportions of the individuals in both Tier 1 and Tier 2 received mental health services54 in the year after random assignment.55 At least 6 percent received services for substance abuse and domestic violence during that time. Differences between the two groups in the use of these services were small and not statistically significant (Figure 2). Rates of service receipt are, of course, higher when the unit of analysis is the family. For instance, at least one person received mental health services in about a fourth of the families in this sample (Appendix Table D.6). Nonetheless, as discussed in this report’s first section and shown in Table 2, the baseline data show that the need for these services was prevalent enough among Minnesota’s target population to reasonably suggest that neither program was effectively reaching clients who might benefit from them.

Finally, it is useful to mention the increasing awareness of how difficult it is to engage and retain people in treatment for behavioral health problems. For example, most people with mental disorders in the United States remain either untreated or poorly treated.56 Therefore, it is likely that clients may have been unwilling or uninterested in participating in the services Tier 2 staff referred them to. This may have contributed to the observed lower-than-expected participation in services to overcome employment barriers. A deeper understanding of such barriers is essential to the design of more effective programs. Consider, for example, the emerging focus on the particular barriers to treatment for depression among low-income and minority populations.57

Participation in Program Activities and Supported Employment

• Tier 2 had no impact on participation in education or training activities but did lead to small increases in job search activities and participation in supported employment.

The overall rates of participation in program activities were quite high for both the Tier 2 and the Tier 1 group, especially for employment-related activities. Over 80 percent of both groups participated in job search, illustrating the strength of MFIP more generally as a welfare-to-work program (Table 9). Nonetheless, the program did lead to a small impact on participation in job search. Rates of participation in education and training activities were about 40 percent for both groups, but there were also no significant impacts on these outcomes. The Tier 2 program also did not have a significant impact on participation in unpaid or volunteer work, for which overall participation rates were low (although the Tier 2 group did participate in unpaid work for a longer period of time: 1.3 versus 0.5 weeks). Tier 2 clients were more likely to engage in supported employment,58 and the majority of those who participated because of the program did so for more than eight weeks. However, the overall rates of participation in supported work were also low, and the participation rate difference between the groups was not large (10 percent versus 4 percent). Finally, individuals in Tier 2 did have greater involvement than their Tier 1 counterparts in an employment or education activity while working (38 percent versus 31 percent) (Table 9).