riverside county bar association lawyer referral service

>> john martinez: good afternoon, everyone.um, the, the first comment i'm going to make is it'd be great if folks could move up, becauseall i see is this sea of faces off in the distance and lots of empty tables so close,so. um, i just wanted to welcome everyone to, uh, the, uh, session on the tanf ssi disabilityproject. it's, uh, very exciting for us up on the podium. we've, uh, been working onthis for a long time. uh, before we actually start with the presentation i wanted to justwelcome everyone here. i also wanted to welcome those that are viewing this via the live streamline. um, and i just wanted to say thanks to a fewfolks. um, i wanted to say thanks to our federal partners. there have been a lot of folks thathave been involved, um, on, on the federal

side, both at hhs and the social securityadministration that have been real partners in helping this project evolve and get tothe point where it is now. but i wanted to especially call out our, our four projectofficers that we've worked most closely with, and at hhs that's matt borus and girley wright,and at social security, scott leverty and, and joyce nicholas. and they've been terrificpartners along with the other, uh, federal team folks. um, i also wanted to recognizethe team at mdrc and mef that aren't here. um, certainly the work that we're presentinghere represents a lot of their hard work. uh, so i wanted to acknowledge them. and ialso wanted to recognize the sites that participated in this.

we have three, uh, representatives from threesites that moved onto the pilot phase, and you're going to hear from them in a littlebit. but in addition to, uh, those folks from los angeles and michigan and ramsey county,minnesota, there were folks that participated in phase 1 of, um, this project, um, thatincluded new york, um, ocala, florida, riverside, california, hennepin, minnesota, and we actuallyhad a couple of sites that, um, really helped contribute to our thinking and, and endedup not moving on in the project, but were really important at critical phases earlyon, and that includes, uh, fulton county, georgia and essex county, new jersey. so, what we're going to do here, um, is, uh,mary farrell, uh, from our team, is going

to, uh, provide an overview of the pr- project,summarize, um, some of the early lessons from the project, and then provide, uh, uh, resultsfrom, uh, our assessment of the three pilots, and again they're represented by these folkshere and i'll introduce them in a couple of minutes, um, when we get to the, uh, discussionphase. um, and then rather than, um, having the discussants present more powerpoints andthings like that, we're actually going to do it more as a, almost like a round tablediscussion. we have a series of questions we're going to ask them to reflect on and,um, they'll provide some of their thoughts. and i think that'll still leave us about 20minutes to, to entertain questions from folks here and from folks that are, are watchingvia the lime, live stream. so, um, we'll try

and moderate that to make sure that we haveplenty of time left. so, um, with that i'm going to let mary introduce herself and, uh,get rolling on the, uh, on the presentation. >> mary farrell: all right. so, um, the tanfdisability transition project, it is examining how tanf agencies and ssa can better servetanf recipients with disabilities. um, i'm going to summarize from start to finish, ihave a lot of, [laughs] a lot of information to provide in, in maybe 20 - 25 minutes, buti think the panelists will be able to expand on anything that i've left off. um, and there's a unique collaboration betweenssa, hhs, and tanf agencies of 36 the participating states and counties, with the involvementof ssa field offices and the state ddss. and

i'm going to use the acronym dds throughoutthe presentation. and for those of you who are less knowledgeable of the, um, the ssaside, this, these, this is the state unit that determines a medical disability, makesthe medical disability determination for ssa. so, there are two phases to this project.um, we used phase 1 which we refer to as knowledge development phase to get the lay of the land.to really understand how tanf recipients with disabilities are currently being served andthe extent to which tanf recipients are moving on to ssi. we conducted field assessments on seven sites,um, riverside in la counties in california, and up in new ramsey which includes st. pauland minneapolis. um, the ocala region in florida,

genesee and mason, oceana counties in michiganand conducted data analysis of tanf data that was reported to the office of family assistance.this is the, um, caseload data that you report to acf. and we limited it to the, um, to the26 states that report full tanf caseload data to acf. this was merged with ssi and administrativedata. um, and then, um, the pilot consists of three pilots and, um, they were, they weredesigned to really improve the services that are delivered to tanf recipients with disabilities.and they took three very different approaches as we'll describe. so, i'm going to touch briefly on phase 1work and then spend more time describing the pilots. um, there is a report coming out in,in the next week or two, um, so, [cross talk]

[laughs] okay, any day now. um, and that'sgoing to provide a lot more information on phase 1. where am i supposed to be targeting?here, i'll let you do this. [laughs] [cross talk] okay, the next one. thanks. um, so fromprior studies, um, we find that there's a high, there are high levels of disabilityamong adult tanf recipients. um, 10% to 44% depending upon the study and the definition,10% really is a very narrow definition. it's, uh, limited to recipients who need help withself-care, routine activities like bathing and getting, getting meal, a meal on the table.while 44% represents the percent of tanf recipients who self-report on the, uh, on the [unintelligible]if they have a physical or mental impairment. so from the field assessments in the sevensites we learned that most tanf programs have

policies to exempt individuals with disabilitiesfrom the work requirements. though most states, um, with the exception of california, do requirethat they develop a plan that addresses their barriers, so they're usually required to dosomething and meet with the case manager regularly. and overall we found that individuals exemptedfrom the requirements, because of the disability are largely overlooked. um, there are very few employment servicesthat target recipients with disabilities. and from our field assessment we found thatthere's really little coordination between tanf and ssa. most of this coordination typicallyoccurs after an award has been made to coordinate the tanf termination date. and staff knowlittle about the, um, ssi application process

but most of them wanted to learn more. theywanted to know who should they be referring to advocates for example, how should theybe helping with the ssi application process? so, from, um, the analysis of the merged data,and again, this is limited to the states, um, we, we found that overlap between thetwo programs isn't as large as we might think. in fiscal year 2007, just 10%, less than 10%of the tanf recipients with, um, who had opened ss, let's see, less than 10% of tanf recipientshad opened ssi applications. um, and looking at this from the perspective of ssa, lessthan 6% of ssi applicants were tanf recipients within a year of the application. so, it'snot really, there isn't a large overlap between the two programs. we found that about one-thirdof the tanf recipients who applied for ssi

were eventually award benefits. um, this isactually similar to non-tanf recipients, although the reasons for the denial was different.um, now recipients are more likely to be denied for technical reasons, you know, they don'tmeet the income and resource limits, while tanf recipients are more likely to be deniedbecause they don't meet the disability criteria. but when they, when mdrc controlled for differencesin characteristics, um, such as age and den- gender, it reduced the differences in thedisability termination outcomes between the two groups. it takes over a year on average to completethe process for recipients, and just under a year for non-recipients. and so if someone'sreceiving tanf and their clock doesn't stop,

and that's one year against their time limit.so, during phase 1 we were also working with the sites that were interested in developing,developing interventions or enhancements to their existing programs. and so questionsemerged from phase 1 that helped the sites hone in on what act- what initiatives mightbe piloted. and these questions include, are there effective was to serve tanf recipientswith disabilities? how can ssa coordinate with tanf to ensure that eligible recipientsare assisted with the application process? and for tanf recipients who aren't eligiblefor ssi or they're not interested in ssi, are there promising strategies to help them[audio gap] self-sufficient? so, three very different questions, three very differentpilots that emerged.

so, i'm going to just talk a little bit eachof the pilots and the findings. first, muskegon county, is a county in western michigan andit wanted to improve and expedite the states tanf disability determination process andengage those who were determined to be work-ready with limitations in employment services. lacounty wanted to improve their ssi advocacy program that helps recipients apply for ssiand helps them navigate the whole process. and ramsey county, which includes the cityof st. paul in minnesota, they focused on improving the employment services for tanfrecipients with disabilities. so, first i'm, um, talk a little bit aboutmuskegon county. um, and i should give some background. michigan uses, it's a very uniqueprocess, they use a medical review team to

determine who's eligible for exemption fromtanf requirements based on a disability. so, this is very atypical among the states. um,and the, the team, the mrt uses the same criteria that dds uses to make disability determinations,and they're actually co-located with dds. so, that's their current process. a key componentof the pilot was to use the soar model with recipients who are claiming a disability,and this information could be accessed by the mrt. and so for those who are unfamiliarwith the soar model, it was designed to improve ssi and ssdi access among the homeless andthose who are at risk of becoming homeless. and it involves completing materials neededfor the ssi application, um, using a step-by-step process. um, all of the tanf pilot staff weretrained in the soar process and they collected

the materials from their participants, andthe goal was really to increase staff's understanding of the application process, as well as helpmake the mrt, help the mrt make better disability determinations. so, so the, so the mrt then reviewed the materialand they categorized the cases into three categories. those who were, uh, determinedto be work-ready with limitations were referred to goodwill for special employment services.those who were determined to be eligible or potentially eligible for ssi, i should say,the information collected for the mrt was forwarded to the dds and that could be usedto support their ssi application. and those who were determined to have no disabilitieswere, just referred to the regular welfare-to-work

program. so, it was a way to kind of triageand make an assessment and then make an appropriate referral. um, all staff were trained in motivationalinterviewing, which is a evidence based approach that uses kind of empathic supportive counselingstyle to, to increase motivation. so, some results, and i should say from muskegon,um, the muskegon pilot, they're still analyzing some of the data, so we have limited findingsfrom this pilot. but half of the 145 participants referred to the pilot made it through to thedisability determination step. uh, theirs didn't submit the documentation or soar packet.um, of those who received a determination by the mrt, um, most had a disability or worklimitation. almost two-thirds were determined to be work-ready, so they were referred togoodwill. ten percent were not disabled, and

they were just referred to the regular welfare-to-workprogram, and 27% were potentially eligible for ssi or di. so, that, that informationgot forwarded to the dds to help support the ssi application. overall the soar model receivedmixed reviews from staff. um, management actually thought soar was a valuable addition to tanf.they felt that staff had a better understanding of what was needed, and that the informationsent to the mrt, helped them make better determinations. but it was, um, a real burden on tanf staffin part, in part because they had other responsibilities since you're ask- asking them to do otherthings on top of their already, you know, already burdensome loads. so, so it kind ofgot mixed reviews from the, from the line staff.

so, turning to the la county pilot, and ishould give some background on, on counties in california's program. they've, um, they,they, la actually operates an advocacy program that helps tanf recipients with the ssi applicationprocess. and there are six advocates that serve the entire county. tanf staff can referclients to the program, but most of them actually come from an automatic referral. everyonewho has been exempt for 12 months due to a disability are automatically referred to theprogram, and that's where they get most of their referrals. so, the county wanted toimprove the quality of applications. they focus on one county office in glendale. twoadvocates served in that area and participated in the pilot. they developed ways in whichthe advocates could communicate with ssa and

dds about the applications they were submitting.ssa and dds provided training to the advocates, and maybe most importantly they, they providedthese, they provided feedback on the actual applications. they rated the completenessof the, of the, and the quality of the application, focusing on the, you know, whether all theforms were complete. and they also reported on the coordination that took place betweenthe advocate and dds. they also, um, conducted outreach to tanf eligibility and welfare-to-workstaff, conducted presentations, developed flyer, because there's, there was a real concernthat, um, they weren't reaching all of the eligible tanf clients who could benefit fromthe program. so, um, some results. and the, the researchteam felt that the, uh, the pilot improved

communication and coordination between thecounty, ssa and dds. you know, they could actually, they, they knew which cases werebeing served by the advocate and they had lots of conversations, weekly conversationsabout particular cases. um, well the county was worried that the advocates weren't reachingclients. um, they were contacting about 70% of those referred, so that was pretty good,and this was from a small case file review. but it was also, um, verified with administrativedata. um, it's a little difficult to really assess whether the quality of the applicationsimproved over time, but it doesn't appear that it appear, that the quality improved.um, from a review of 40 feedback reports, um, 10 had inadequate or missing functionreports, 12 of the 40 had inaq- inadequate

or missing work history. so, there's still incomplete forms in theapplications, although dds felt that the application was better than a typical ssi applicationand thought that, um, the real reason, um, some of these cases weren't being approvedhad less to do with the quality of the application and more to do with the disability criteria,they're just not meeting the disability criteria. and ssi advocates themselves didn't thinkthat the quality or applications had, um, improved. they, but they, they thought theywere doing a pretty good job to begin with. but overall, just 14% were awarded benefitsat the initial level, so this sounds really low, but it was actually 7% during the pre-pilotperiod. so, it did increase from 7% to 14%

with the assist, and, um, and in the pre-period,and, and for both of these statistics, this is with the, um, advocates assistance in theglendale area, but, but the sample size is quite small, 50 during the pre-period and60 in the post-period. and there might be difference in the characteristics of the caseload,so we can't really say whether the pilot itself increased, um, the quality. so, um, this pie chart, if you can see it,it, it provides, um, some, some of the outcomes of the cases referred to the out, to the advocates.the blue slices, uh, are those that didn't apply for ssi, and the yellow and green slicesare those who did apply. and as this shows, about 40% of the cases referred to the advocatesapplied for ssi, so just half of these with

the assistance of the advocates. um, the otherhalf, they, they largely had applied for ssi on their own by the time they were referredto the advocates, um, but information wasn't available in the tanf system. and this, theremaining 60% just didn't apply because they didn't think they were eligible or they werenot interested. and, and the decision to apply or not is, is solely the decision that theclient makes. um, anyone who's interested can apply and with the assistance of the advocates. so, the third pilot is ramsey county: familiesachieving success today. and to give you some ac- uh, background. uh, minnesota moves alltanf recipients with disabilities to a solely stated funded program called family stabilizationservices. and these individuals don't count

in the federal work participation rate calculation.now, the recipients still need to complete an employment plan that addresses their barriers,but they're not necessarily required to be in work activities. so the fast program focusedon employment using the ips supported employment model and i'll have another slide that talksabout that. and, but it really provided it in this very comprehensive integrated a, manner.they, um, integrated and located staff from four organizations in one location providingemployment, mental health, physical health services, and really the focuses on the wholefamily, not just the adult recipient. goodwill was involved, hire, which is a welfare-to-workcontractor provided case managers. open cities health center provided a part-time nurse practitionerand a part-time community health worker. people

incorporated provided a part-time child andfamily therapist. so, very, very comprehensive. the staff would meet weekly to review casesand conduct joint meetings together with families and make sure that they all understood whatissues other family members might be having, you know? the, the idea is that, you know,it's important to have a child therapist as well, because some of their issues might,might impede on the parents ability to pursue employment. so, um, similar to the michiganpilot, all staff were trained in motivational interviewing. uh, this was evaluated usinga random assignment design. uh, cases were randomly assigned from the fss caseload. asa small sample, 241 treatment cases, 148 control cases. and the control group was requiredto participate in activities, but just not

necessarily meet the federal work participationrequirements. um, the ip, the ips supported employment model was developed to help individualswith severe mental illness achieve steady employment in mainstream competitive jobs.and mainstream is italicized because that's a really important component. um, they don'tbelieve that you should rely on sheltered work activities. it's been found effective,um, found to be effective in numerous, uh, random control trials, and now is being testedwith other populations including individuals with physical health conditions, veterans,um, and in tanf for ramsey and also, and with tanf recipients in los angeles. there are eight core principals of ips. um,focuses on competitive employment. eligibility

is based on client choice. now, this couldbe challenging in a tanf environment that focuses more on mandatory requirements, butin this minnesota fss world, this is avail- this is possible, they have a lot of flexibility.um, it involves integration of rehabilitation and mental health services, attention to clientpreferences, personalized benefits counseling. in the disability world this is typicallyfocused on counseling how employment affects disability benefits. um, they, they changedit so that focus more on how employment affects tanf benefits and support services. it realizesa rapid job search. they don't believe in using lots of assessment and job readinessactivities. systematic job development is, is a key component. um, so basically the jobdevelopers really try to understand the clients'

interests and skills and then develop relationshipswith employers based on what they learn about the client and try to match jobs to, theirinterests. and finally, um, the, the eighth principle is time unlimited and individualizedsupport. this is probably the most challenging to implement in a tanf program that's timelimited, but basically the, the idea is that clients can continue to receive services foras long as they want them. so now results. uh, i'm going to go to thethird bullet, because i just discussed the ips program and the challenges, and in fact,even, despite the challenges, uh, it was, the fast program received a relatively goodscore from a fidelity review, and outsiders come in and review the fidelity and, um, itgave it a score of 98 points, 2 points below

good. it scored a little low on collaborationwith state voc rehab which is no part of the fast model, and again, the time unlimitedfollow along supports which just isn't achievable in tanf. [sniffs] um, only 63% of the treatmentgroup enrolled in fast, and i'm just making that point because all of the impact analysisthat we present includes everyone, regardless of whether they received services or not.so, having a 63%, um, participation rate, it does dilute the impacts. part of that is, you know, families, they're,they're losing their eligibility for ssa, they move to other counties, you know? andwe were dealing with an early cohort. over time they did improve, improve the screeningprocess a little bit. [sniffs] um, when we

look at participation levels they're highfor both groups. um, 87% participated in activities for both the treatment and the controlledcontrol groups. but the mix of activities differed where, um, the fast group was morelikely to participate in job search, and the control group was more likely to participatein education and training activities. so, i don't know whether you're, everyone cansee that table, but, um, it shows that there are some reductions in tanf receipt in thefirst two quarters. this wasn't anticipated. we didn't expect there to be any impacts ontanf, especially initially. um, it is at the 10% level. um, [sniffs] the table also showsthat fast program increased employment in a couple of quarters, in earnings in all fourquarters. and after one year of follow-up

the fast group earned $1,235 more than thecontrol group. and this is a 75% increase relative to the control group. so, these arereally promising findings, especially given that that control group faced similar mandatesand were participating at relatively high levels, so. [clears throat] so, just a few lessons from each of thesepilots. um, from, from the muskegon pilot, we found that they had a hard time implementingthe model within the pilot timeframe. they started a little late and they only had sixmonths. and, um, and so the question came whether there are quicker ways to assess disability.there is also some concern that during the, the six months when they're trying to assesstheir disability, there's a real focus on,

on what they, the clients couldn't do. youknow, they're trying to prove what they couldn't do. and then two-thirds of them do end upbeing referred to the goodwill program and are expected to do something. so, they'rewondering, is there a way to, you know, in- introduce some vocational assessments duringthe, that initial period? from the la pilot, you know, the team justlearned that the application is really complex, it's difficult to take care of the application,especially because it was just one face-to-face meeting. um, and one thing we saw from thec- from the knowledge development phase is that advocacy is provided differently, verydifferently across the sites. and so one question is, are there components that are criticalto operating an effective program? are there

ways to engage participants after the initialmeeting? [sniffs] and then finally from the fast pilot, we learnedthat the ips model is very promising. it's very, but it's within this very comprehensivemodel and do you need all of that, is, are there things that you can, if, if cost isan issue or if you can't, if you can't create, recreate that are there other ways in whichyou can find similar findings? another question is whether it can be replicated in other siteswith larger samples? and finally, um, i know the state was really interested in how, um,this impacts other family well-being measures? and we were really just limited to what'savailable in min- in an administrative data. so, so there, you know, if this were to bestudied further, i'd think you'd want to include

surveys, maybe even a child outcome study.i know that the state would have been interested in that. so, um, here's our contact information, includingthe contact information for our project officers and over the next five, six months, i thinkthere's going to be a series of reports that come out from this project. so, if you areon ndrc or mbrc or opres list serve, i'm sure you'll get an alert. thanks. >> john martinez: [clears throat] thanks,mary and thanks for sticking to your time. so, leaves us plenty of time to hear fromour, uh, [clears throat] from our discussants. and i just wanted to quickly, um, introduce,um, each of them and, um, as i mentioned before,

what we'll do is, uh, we have a series ofquestions. we'll ask each of them to respond, spend about 3 minutes each and i'll try and,you know, do the time check over here. um, uh, first is boyd brown. he's the area directorof employment and training at goodwill/easter seals minnesota, and he's, uh, representingthe, the ramsey, uh, county, uh, pilot. um, tausha drain is a departmental analyst inthe division of family program policy of michigan department of human services in lansing michigan.[out of breath sounds] [laughs] and, uh, and last but not least is, uh, sherri cheatham,she's the, uh, calworks program director in the county of los angeles, uh, departmentof, uh, public social services. so, the first thing i was wondering each ofyou could do is, is you had any just kind

of broad comments, on, um, the findings thatwere presented for, um, each of your pilots? um, all of you kind of lived and breathedthe experience of the pilot, and we'll dig in a little bit deeper in a minute into someof your experiences. but i was just wondering if you had any, any high-level reactions,um, around the findings and boyd, we can start with you. >> boyd brown: hello. um, i think some broadreactions that i had is to be honest, i want to put this a little bit in context. we wereactually surprised that we had as good of results as we did, especially around the increasedearnings. and the reason for that is, it was the first year of implantation, and mary didtalk about that a little bit, um, first year

of anything, especially with the comprehensivemodel like this, we definitely had growing pains. we definitely learned along the way,um, as we were, we were going through that first year. and so some of the challengesthat are facing first of all, is that, um, just recruiting and getting people into theproject was initially difficult. and one of the things that mary mentioned is that 63%of the folks received fast services, and that was because we received the case and thenlater learned that they were not eligible for the service. they didn't have a disabilityor things like that. and it was basically a documentation issue, [laughs] um, with thosethat we were receiving. so, that was one issue. secondly, um, as mary mentioned, that individualplacement support, which is, uh, evidenced

based practice in the disability arena, uh,we were using that model and, uh, we basically got technical assistance probably about half-waythrough, and we got some really good training from dartmouth college, um, where a lot ofthe research around ips comes out of. and i think our services improved dramaticallyafter that. um, uh, just on a multitude of things, uh, that we were working on, especiallyaround, uh, job development and systematic job development as well, as well as vocationalprofiles, uh, that you do with each person. and then thirdly, the fidelity review, um,we got that after the first year of services. um, and, and as mary mentioned, we receiveda fair rating and obviously that means there's things we could work on to do better. so,i, i do believe that now as we are still continuing

our services, uh, for fast currently and weplan to continue at least for another year, um, through 2014, that the impacts now wouldbe much greater from our perspective, and, and just anecdotally seeing the number offolks that are getting employed that are, uh, going off of tanf and the folks that we'reworking with, we're much better now than we were during this pilot phase. >> john martinez: perfect. thank you. >> tausha drain: okay, for michigan, the factthat they even have any data to look at was a miracle in itself. um, [laughs] there wasa lot of staff changes that went on and when i was the final person to take over the pilot,i had pretty much two months to put it together

before the start date of june. so, go fromjune to december and have something to actually look at and focus on was a miracle. um, marymentioned that, uh, the staff thought that the soar process was a lot more, um, timeconsuming which i'm not very surprised by that, because the normal process that we useis giving a one or two page form to the client and saying, go to your providers and provideit back to me by this due date. but by using the soar model, we put the ownership on theworker to actually work with the client to find out what providers they're seeing, andthen actually reaching out to the providers to get the documentation to create a bettermedical packet. so, although i'm not surprised that it's more work for the local office worker,i do believe that it does make a better, a

better documentation for mrt to look at itand make a decision. >> sherri cheatham: hello. um, well goinginto our pilot, um we had two major questions and the questions were, um, were our outreachefforts reaching the, our target population, and were the high denial rates that were seeingat initial determination, was it due to, um, the lack of quality applications preparedand submitted on, by our staff, or was it due to the disability level of the applicant?and the results of the pilot showed that, well, we were doing a pretty good job. um,that the feedback that we got from dds was that the application submitted was good, andit was really more the disability level of our, uh, applicant. so, to have a better qualityapplication, it seems would not have resulted

in a different outcome. um, the out- our outreachefforts were good, and that, um, although we received excellent training by, uh, thessa staff, our staff felt it was more of a refresher training, because it didn't resultsin, um, new knowledge. so, it seems that, um, our staff were doing, um, a good job withthe things that they had control over. >> john martinez: great. thank you. so, next,um, i was wondering if, if each of you could reflect a little bit on some other successesand challenges you encountered when, um, when implementing the pilots, you know? and anytime you try to implement something new or tweak something you already, all, alreadydoing, you know, some things are going to work, some things aren't, and i think it mightbe helpful for folks to hear some of the experiences

around, um, those successes and challenges.and just a little bit about, um, you know, what, what you learned and what would youchange about, um, each of your respective pilots. >> boyd brown: i guess what i would say aboutfast is that, uh, one of the big successes was, i thought the, the, the vision, the servicemodel vision was well developed. um, prior to even beginning, uh, services, um, and i'dlike to give a little shout out to joan truler who is with the state of minnesota now, butat that time she was with ramsey county, and really the vision for this project was hers.and really what we were trying to do is really, as mary was talking about, is really a co-located,integrated partnership with four organizations.

you know, yesterday i was in the, uh, thetwo generations services, um, uh, presentations, and they, one of the things they were talkingabout was partnership in that arena. talking about early childhood and employment and bringingthose together and talking about what makes a good partnership. and, and i think in this project, our partnershipwent even a step beyond what they were talking about yesterday. and some of those thingsthat we talked about around partnership is the four agencies that came together to provideservices, had a common philosophy yesterday, they called a common mission. we actuallydeveloped a common philosophy as part of the rvp process, we continue to work on that uponimplementation about what is our goal here?

what is our vision for services for the folkswe're serving and we need to come together to do that. and then the other piece to is,we, we truly did integrate services. um, we called it horizontal and vertically integrated,and what that meant is, for the vertical integration, we really had leadership from all of our organizationson an oversight committed, so that decisions could be made quickly when, uh, uh implementationchallenges came up or, you know, things that we wanted to do we can make those decisionsquickly. we had one manager that, uh, provides the day-to-day supervision and day-to-dayoperations that happens to be an employee of goodwill, but they really were overseeingthe, the overall project which was extremely helpful. and then on the horizontal integration,mary mentioned that the, the multidisciplinary

team met weekly. and um, so weekly we weretalking about, um, the participants that we're serving, the families we were serving andhow can we coordinate services better, and making sure that they're getting the neededthings that they, they, they needed. um, and so from that perspective i thoughtwe were very well prepared, um, to making this project work well. um, the other thingi think that was a success is that having a fidelity review of fair, i know fair doesn'tsound [laughs] so great, sounds like a c or something, but in the world of ips fidelityas a first-time program going through a fidelity review, we probably had one of the highestfidelity reviews of any first year program. so, just to put that into some context too,uh, that we did quite well, um, even at fair

on that fidelity for the ips model, so we'revery proud of that. um, and i know, and we're going to have another fidelity review, comingup in this fall, and i know we would be at least in the good category at this point,just based on changes we made based on the first fidelity review. so, some of the challenges,i need probably half-hour or more to talk about those, but… >> john martinez: you have two minutes. >> boyd brown: …i have two minutes. um,i think one of the biggest ones and it's, it's probably the main purpose of this wholething, was that tanf and disability, um, systems, um, and, and thinking about those, becauseips or individuals placement support, is born

out of the disability community. and to giveyou a little context, in a disability community, first of all, employment rates are abysmal.um, 70%, sometimes you hear of unemployment rate of people with disabilities. and alsoit's a system that really was born out of, we want to protect people with disabilities,protection and risk a- avoidance. um, uh, you know, deinstitutionalization didn't happenthat long ago, uh, where people are integrating and, you know, to people with disabilitiesare integrating into their communities. so, when you think of, when you hear ips talkingabout competitive employment is the goal. people have choices, they have a voice, theywant, you know, to be in their communities and be integrated. perhaps in the tanf world,talking about employment, competitive employment

being a goal is not such a big deal, but inthe disability community, that's, that's a major shift in what's happened in the lastdecade or so in, in that community um, so talking about some of the challenges, i thinksome of the key challenges was, when, in talking about amfab, i can't, or amfab, i'm sorry,that's our name for tanf, uh, but tanf is that the paperwork requirements are just unbelievable.and when you're trying to work with folks, uh, to help them improve their chances foremployment, to get them employed, and it's also about engaging with people when you havea lot of paperwork, and, and, i differentiate documentation from verification, and it'sreally the verification requirements that were really problematic, because it just,initially, you, you have an inherent distrust,

because you're verifying everything they dofrom job logs to are they still disabled, they had medical documentation re- reviewsevery six months or so. all of those things really puts this kindof barrier to really being able to engage folks well. um, i think we managed that well,obviously we have some good results, but that was definitely a challenge of just gettingover that barrier of the documentation and verification of what folks were doing. youknow, the other piece related to that, is that, um, in the [unintelligible] team meetings,i would say the first three to six months, unfortunately, a lot of time was talked aboutdocumentation. so, we'd have the case manager come in, all right, uh, bobbisue doesn't haveher medical documentation. do you have it?

you know, uh, mental therapist, do you haveit? where we can get it? and we, at, by three to six months we decided, we can't be talkingabout those things in these meetings, we need to be talking about f- these folks, how arewe coordinating services? how are we moving them forward and not talking uh, uh, mostlyabout documentation. so, that was one of the key problems. >> john martinez: and i was going to say,boyd, i'm, i'm going to cut you off there and we can move on. >> boyd brown: okay. sure. >> tausha drain: okay. in michigan, i wassurprised that we weren't really ready to

start. um, as i said, we had a lot of staffingchanges internally on the higher level, and so i'm thinking i'm the last person to comein and just, let's get ready to go. and when we initially met with the mdrc staff, andwe met with the pilot county, they said they were ready, and then the start date, i waslike, oh, we're not really ready, we thought we were, but we still need more time. so,that kind of, uh, delay that was unexpected. um, but some of the successes, um, motivationalinterviewing is something that we've never done in the state of michigan before. andme coming in, you know, i've been a worker and sometimes the mindset is, they're notgoing to want to go work, and how, what do we do?

and in muskegon, the director wanted all ofher staff that dealt with the tanf, uh, clients to come in and participate in the motivationalinterviewing training, not just the staff that was assigned to the pilot, which i thoughtwas very good because the feedback was tremendous. i mean, they, i got, um, feedback that theywish they would have gotten this training when they first started, and some people havebeen working for the state of michigan for over 20 years. and just giving them some ideasof not putting it on themselves of what to get the client engaged in, but finding outwhat it is that they enjoy doing and kind of working from that to get them engaged insomething else. so, that was a very good success. um, we also collaborated with the workforcedevelopment agency with this pilot, and um,

we did what we called a one transfer betweenthe client meeting with their tanf worker, and them having to go over to the workforcedevelopment agency for orientation. we actually had our goodwill person come over the datethat they were meeting with their tanf caseworker to talk to them about the pilot and let themknow this is not the same as it used to be if you've been through workforce before. um,this is really different and we want to meet your face-to-face so you'll know who to lookfor when you go over to orientation, so they wouldn't get lost in the cracks or just getdiscouraged thinking that it's the same thing that they've been through before. um, thatactually worked out pretty well. we met a lot like boyd said, having the communicationwith all the partners made a big difference.

so, if there were issues, we were findingthose things out right away instead of two, three, four weeks or a month going by andwe not know what's happening with, with the clients and tracking what's been going onon a weekly basis. >> sherri cheatham: okay. in la, um, well,let's talk about the challenges first. um, one of the, the clearest challenges are therules that we have to operate under. um, applying for ssi for our aged disabled, um, populationisn't mandatory. our ssi advocacy program is strictly voluntary. anyone who wants, um,assistance with completing the ssi application are those, those are the ones that we help.so, as it's not mandatory, we're not seeing, um a great number of people, uh, knockingon our door for assistance. um, another is

the differing definition of disability. um,physc- physicians, uh, may label someone permanently disabled, but ssa a different definition meaningthat although you may be disabled you're not disabled enough to qualify. um, so althoughour staff are knowledgeable enough they, some of them have been doing this for over 15 years.although they are knowledgeable enough, when someone presents, asking for assistance tocomplete an application, they pretty know, pretty well know that they probably won'tqualify, but they're going to complete and submit the application anyway on their behalf. another is, another that we faced is thatwe are unable or were unable to obtain work histories. in la we, um, utilized the freeservice by, offered by the work number to

obtain employment records and work histories.and the free service provides if you know the employer name and code, you're able toaccess that history. um, good news is, is in late june, early july, the state of californiaexpects, expects to have a contract with work number that will allow us to search by socialsecurity number so our applications will be enhanced have work histories. another is thatstaff, um, are not able to complete the functional reports needed to support the application.those documents are completed by a third party. and as mary mentioned, we only meet with theapplicant once, and that's at our initial interview to get the information to completethe application for an hour, hour-and-half, and after that it's just support if dds contactsus asking for additional information, we may

contact the client on their behalf. otherthan that, we pretty much have no further contact, um, with the client. one of the successes is, is that through thispilot and the flagging of the cases, we had enhanced, um, communication with the dds staff.uh, they were able to communicate with us what was needed or what was lacking, and wewere able to contact them to ask for statuses of the applications. now, if, um, we wereable to keep that going, um, and have our cases funneled directly to a dds office incalifornia and not routed to offices all over the, the, the united states, that would helpus. but, uh, through this pilot we were able to get direct contact and communication so,and we believe that contact will continue.

>> john martinez: great. thanks. um, so, uh,one more question and this should take us through and, and still leave 15 minutes, um,for questions from audience, so if you all could try and limit your comments to two orthree minutes. um, you know, one of the things with this that i think is really importantto keep in mind, is these were pilots. um, so for example, in, in minnesota, uh, theyuse ip, a, a version of this ips model, supported employment, but it was a test of this modelin minnesota similar in, in michigan, they use soar, but it was a test of soar in michigangiven michigan's context. it wasn't a test of soar across all tanf agencies. so, thesewere pilots. um, but i, i was really curious to hear from,from each of your perspectives if you could

reflect on some of the implications from thesepilot, um, results, um, just in terms of the policies and practices in, in each of your,um, each of your respective agencies. and in, in thinking about this you can reflecton either your pilot experience, um, you know, the results from your particular pilot, fromthe study overall, but just thinking a little bit about how that might inform, uh, policyand practice for you all. >> boyd brown: i think the key piece for uson how, and, and i'm going to make it a little broader than just our agency and how policiesand, uh, procedures for us or implications for us, but just in general. you know, oneof the things that mary talked about is that many state agencies, uh, take the disabledyou know, tanf families with disabilities

and then put them over there, parking lot,uh, and, and don't provide services thinking they can't work, they're too difficult toserve or et cetera. and i, and i think that this project, our project proved that's notnecessarily the case. that we serve very challenging families and in the disability arena whenyou work with vocational rehabilitation et cetera, we believe everyone can work, there'sa possibility that everybody can work, it's just providing the right services at the righttime to help them make that happen. and i think this project definitely proved that,that you can and hopefully there is more studies on that and, and really looking at, uh, tanffamilies with disabilities and, and working with them.

um, i think the other thing i would suggestis that there are possibilities to replicate this in a much cheaper way i'm guessing, becauseyou can leverage lots of different resources. so, it's looking at, what can vocational rehabilitationbring to the table? what can tanf bring to the table? and the other big piece that wehaven't talked about is medicaid. i mean, a lot of the services that we were providingthrough this project were medicaid reimburse, which is all the mental health treatment,all the children's mental health treatment, um, a lot of the, you know, obviously thephysical disability, uh, sources. um, the really the cost to provide those services,we, we had a few dollars to help with the coordination efforts, but otherwise, all ofthat was reimbursed, um, all those health

services were reimbursed through medical assistance. um, and actually we do have another projectside-by-side with this one where we're serving tanf individuals or tanf individuals who arenow on social security because of efforts like ssi advocacy where we are providing ipsfor those folks and we're, we're showing, i mean, it hasn't been rigorously studied,but definitely have very positive outcomes. and it's, it's a traditional ips model. itdoesn't have all of those other, uh, pieces to it that our model had. so, i think thereare opportunities to do this and to replicate this and make it scalable. >> tausha drain: um, for michigan, you know,for years we struggled with this, um, group

of clients and what to do. and, um, the newadministration that's coming, we got a new governor and everything has changed prettymuch with the program, and they finally have taken a better look, that the clients thatwe serve do have barriers and not everyone can just go right off and look for a job.and with that being, the orientation process has changed and we're currently in talks with,um, the michigan rehabilitation services and they have now come under our umbrella of dhsand there's talk of getting them to work with this group of, uh, participants. uh, we'vedone this before, but i think that the results that will come from this pilot will actually,um, help us be more focused of what we need to really do to, to serve this populationvery well. um, and that may include us not

using mrs, i'm not really sure how that'sgoing to work, but i think that this pilot ending is very timely and once we get theresults it's really going to help move michigan in a direction to really serve this populationbetter and then from there. >> sherri cheatham: okay. um, in la we havea very large, uh, tanf population. uh, we serve over 175,000 tanf cases, calworks aswe call it in los angeles, in california, and that equals to over 425,000 individuals.and so it's not a wonder that ssi advocacy is not in the forefront of our line staff'smind. we have six ssi advocates as mary mentioned, um, that serve that entire population, andtwo were included in this pilot. and we went into the pilot thinking that we want to knowhow to do a better job for that targeted population.

and the pilot showed that our staff were knowledgeable,they were able to do and were doing the best job that they could with things that had thecontrol over. and that although moving large numbers of calworks, um participants in, ontossi isn't, um, our total focus, um, we've done a good job with those that we have outreachedto and we're successful in submitting applications on behalf of. um, and i, i think as boyd had mentioned thatwith this population that are unable to fully participate in welfare-to-work, you know,we tend to set them aside, label them disabled exempt, and leave them alone, and it wouldbe, i think, helpful in los angeles, if were to find, able to find something that wouldthem to do something, uh, something like with

mic- michigan and minnesota have found. >> john martinez: great. thank you. and withthat we actually have about 20 minutes for questions which is terrific. um, so, uh, idon't know if anyone has any questions. >> audience question: chiquita crawford: hi.good afternoon. um, i have two questions. i was wondering in your research, in our pilotprograms, if you all found that, especially through the advocacy, did you find that therewas any, um, resistance as far as through cultural implications, and through the stigmaof mental illness, um, in regards to trying to locate the people that had special needsand they didn't want to be identified, um, that way, um, in regards to getting the ssichecks and so forth, um, even though they

had the tanf, and did they not want to beidentified in that way? and in that regards, do you have the issues with having to reapplyor did the advocacies have issues of having to, having the people reapply two and threeand times, because we have that issue and it's a known issue that usually the firsttime they're not going to get accepted. and the second part of that question is, um,see if i can read my notes. oh, do you also have concerns especially with the advocacydid they have concerns with the people thinking that their checks their ssi checks would bereduced if they start working because the ssi checks, i know in maryland will be reducedwith the ssdi checks if you're on ssdi versus tanf with ssi would be reduced?

>> sherri cheatham: well, in los angeles,uh, when you mention, um, mental health issues and was there a stigma. we have found overthe years, we've been operating this calworks ssi advocacy program since 2003. and overthe course of time, um, we've heard over and over again, um, individuals with mental healthbarriers are afraid if they move onto ssi or if someone found out that they had mentalhealth issues that the department of children and family services would come and take awaytheir children. so, we've run into that wall and although we've tried to, although we haven'thad the motivational interview, um, experience or techniques, we've tried to motivate themand try and dispel that myth. um, but we aren't very successful there. um, as far as the reapplication,in 2007 we contracted with, uh, health advocates

llc and they take on, um, um, reconsiderationdenials, they take that on. and since they've been in place we've had a 70% award rate ofthose that they have represented, uh, during that time. >> tausha drain: i will say for michigan,um, for the ssi advocate to get involved, that means that our medical review team hasdeemed that they are disabled, so they will meet a social security listing. so, when thessi advocate get involved, um, i don't, or i have not heard that any of our clients areresistant to that. the only thing is if they already have legal representation, then ourssi advocates don't s- overstep those bounds. so, it's mostly for people who haven't gonethat extra step to appeal or, um, maybe they've

applied years and they've come back and nowthey're deemed as disabled, and then our ssi advocates get involved to help them throughthat process. because if you are dealing with any types of issues and just going throughit, it's a lot of documentation, paperwork and it can be overwhelming, um, for peoplewho don't have any barriers. so, that's how we do it in michigan. i haven't heard of,um, what you mentioned about people feeling, you know, a stigma if they do have issues,but i'm no expert. >> audience question: chiquita crawford: dothey, are they concerned about their checks being reduced once they start working? >> tausha drain: um, if they're receivingssi, it's not going, in michigan it's not

going to affect their tanf. but, um, if itis for the ssdi then it would, but i guess just looking from the outside in, you're talkingabout someone who has no income or very, very limited income from the tanf grant, comparedto what they can get from the social security grant, or amount, it, it's a lot more incomefor them. >> audience question: chiquita crawford: okay.thank you. >> audience question: donna: i have two questionsand they're different but i'm going to go ahead and ask both of them. one, mary, yousort of mentioned that, um, motivational interviewing is an evidence base practice, and then doesshe, i can't, i'm sorry, i got your name, um, you talked about how much it impactedyour staff. i'm just curious on what, what

kind of evidence there is and just a littlebit more about what it is and whether it is something that is both affordable, um, andworth doing more of. um, and then, boyd, i have a question for you, which is that eventhough there's significant impacts which is not often, which is often what we see, thereare a lot of people who are still not employed and what do you know about those families?uh, was that you tried and couldn't get them employed or what happened? >> john martinez: do, do you, do you wantto start boyd? >> boyd brown: i knew donna would ask thatquestion, um, but i don't have a very good answer. so, what do we know about those families?uh, one of the things i didn't get to in,

when i was, uh, presenting the comments wasabout engagement. engagement, you know, because some of the folks that were, that we haveon this project are folks that work with dis- folks with disabilities or in the traditionaldisability system with voc rehab, and one of the things we found is engagement is muchmore difficult, and maybe it's not a s surprise to this room, but much more difficult thanthe tanf population than it is in the disability community. and i, i think part of that isjust the mandatory nature of the program. um, i think, because a lot of folks with disabilities,they, when they come to voc rehab they want to work. i mean, it's, it's something thathasn't been a part of their life and they want to work. in tanf, there's a lot of ambivalenceabout work and what does work mean, uh, to

them. and so, it's a lot of, and this is actuallyrelated to motivational interviewing, um, we just, a segue to motivational interviewing.um, we have been doing motivational interviewing for the past three or four years as part ofour agency. we've, we've really, uh, adopted it as our culture of how we work with participants.um, the, the evidence actually or where the practice started is in chemical dependency.um, and it, and it is like a, it's a series, i'm not an expert on motivational interviewing,but what i know about it, it's a series of techniques, counseling techniques and strategieson helping people really, uh, change and, and helping them find that motivation and,and really enhancing and accelerating that

motivation to get them to change whateverit is. and how we use it in the employment context, it's really come, becoming from annon-working person or, to a working person. and what does that mean for that person? whatchanges will happen when you do that? and when people, they talk a lot about ambivalenceand you, you'll hear, uh, ambivalence about work and what does work really mean for me,and it's really helping them explore that. and then once you start hearing what theycall, change talk, which is, maybe i do want to try employment, it's really encouragingthat and accelerating that process to get them to change. we have found in our agency that motivationalinterviewing is extremely helpful. um, it's,

uh, very helpful around a special initialengagement. you get a lot more information faster about that person. um, they trust youmore easily and faster. um, and then as you're moving along your, your services with themyou'll see far greater results from that. um, for the evidence, i would go to motivationalinterviewing.org,um, and the, one of the, i can't think of both names, but one is art rolnick is oneof the founders of motivational interviewing, the one, uh, and then there's one other gentleman,but i'm forgetting his name right now. but if you go that website you'll have all theinformation about motivational interviewing. >> mary farrell: and i did look at one [unintelligible]analysis, it looked at like 120 different quasi and experimental evaluations. and basicallywhen they compared it to a uh, treatment control

group or comparison group, but there werestatically significant findings when they compared it to really active treatment groupslike, let's say, uh, the control for say, cognitive behavioral therapy, that's a verylong and, you know, um, active treatment, there weren't any differences. but the factthat motivational interviewing is shorter term, it's, less costly, um, it seemed tobe very promising. >> tausha drain: and i'll say from michigan,you know, when workers are new, learning how to be an eligibility specialist, it's moreon process of how to determine if someone is eligible for benefits, not necessarilytalking with the client and engaging them of if they do have issues. so, it was justanother tool for them to be able to use that

had never been explored with the state before.and like i said, the feedback was more positive than i thought it was going to be. and, um,we are looking at implementing it throughout the state. so, um, and any tool to help engageour clients is going to be a benefit. >> sherri cheatham: we will be looking intomotivational techniques. [laughter] i'll be going on the plane ride home, i'll be lookingat the website. [laughter] >> john martinez: any more questions? seematt going up to the, uh, microphone. >> audience question: matt: uh, yeah, thoughi'm a project officer there's actually a question i don't know the answer to, so, uh, uh, andi've been trained in motivational interviewing and putting an actual what is it is a trickything. um, but, uh, my question was primarily

for boyd, maybe some for tausha as well. um,in knowing the data we have that boyd mentioned about the levels of unemployment in, um, thedisability community and, you know, and some of the, you now, the flat, you know, sometimesblatant, sometimes, you know adverse, uh, responses that, um, that one gets from employers,i wanted to ask for those who did seek employment, i mean, you did have in a couple quartersstatistically significant employment gains, i was curious just what the, um, if you hada sense of who those employers were, were there particular, um, particular companiesthat you worked with or sectors or anything like that or, you know, where was that comingfrom and why do you think that that got past some of the barriers that are often therefor people with disabilities? and i guess,

tausha, that would also go for folks who managedto get through the program in michigan if there are many that you can comment on. >> boyd brown: you know what i, i can sayabout that is, no, it's not related to just particular employers. job development in theips model is very different than what you might consider in you know, in traditionaljob development. and it's really based on that individual's preferences and what theywant to do and choices that they want to make. and then we go out and pursue that for themon their behalf, and with them, looking for employers that fit those particular individualpreferences and, and wants. but one thing i want to say, because you just brought upa point, when i was talking to the staff of,

when i was getting ready for this. when iwas talking to the staff about what was the difference from their perspective and workingwith these folks and looking at employment, and one of the counselors said, well, if,if you go to any of our job logs for any, or tanf person, um, what you're going to seeon that job log is retail and customer service. that's it. very narrow. and one of the key pieces of ips, is thatyou are opening up their minds to what employment is and what that means for them. and one specificexample that came up just so you can put it in some context. we had a person that reallyenjoyed their, they, they have a dog and they love dogs, they love animals, they want towork with animals. and so they explored lots

of different opportunities but what came,came to them that they really wanted to do was be a pet groomer. and so that employmentcoun- uh, employment support consultant, took them out to learn about what is it to, [laughs]you know, what, what's dog groom about? what does that mean? how do you get into that position?and, and eventually they did a job in that. and so that's i think one of the key pieces. >> audience question: matt: yeah. and i wouldjust say, i wonder, you know, if that opens the mind not just of the client, but alsoof the workers who are often used to doing the same thing over and over again. [crosstalk] pigeon hole their clients. [cross talk] >> john martinez: so we actually have a questionfrom the live stream.

>> john martinez: this is a question fromjohn, in d.c. given your experiences over the course of this project, are you now moreor less optimistic regarding the feasibility of substantially improving tanf ssi coordinationand helping tanf recipients with a disability sustain employment? >> tausha drain: i'll say that i'm, i'm stillvery optimistic. um, it was just nice to have, um, the research, um, mrdc come to us andallow us to be able to focus on this. um, and like i said, as a state, we had been strugglingfor a long time of what to do. and like i was mentioning before, the timing couldn'thave been better because now this is becoming a focus of, you know, our clients that dohave barriers and how to help them overcome

some of those to get them engaged. so, i'mvery optimistic. i will say that this has been, although it was very challenging experience,um, i would not have changed it because it's helped open my eyes to other things, and tobe able to see the changes be implemented in the state is going to be great. >>sherri cheatham: well, um, we're optimisticin that, you know, we've found, the pilot results have shown that we've done, we'redoing a good job, our staff is doing a good job. and they've always been willing and ableto help those that do accept their assistance. and we just hope that we keep doing a goodjob, um, for them. >>john martinez: and, and i would just sayfrom the perspective of, um, having directed

this uh, this project for the last severalyears, um, i think there's a lot of promise here. i'm really excited. you'll, uh, youknow, you'll see a lot of things coming out, a lot of deliverables coming out of this projectover the next few months, but, um, but i do think that, um, you know, there, there's somepotential here and, and that's why it's exciting to have projects like this, so you can dosome early exploration and, and kind of figure out what, what direction to head in. i thinkwe have time for one more question. >> audience question: chiquita crawford: i,i don't have a question, i have a comment on, uh, what this gentleman here, um, hassaid earlier. it's so important because it's something that i have been advocating aboutin maryland for years on the disability or

the special need side. uh, where young peopleleave school and try to, um, incorporate in the community for the types of jobs that theyare interested in in the special needs community, and they are typecast as not being able toincorporate themselves in a community, when that's really not the case. the case is, thatthey are put in cookie cutter positions such as, janitorial positions and restaurant positionsinstood of, instead of the positions that they had asked for such as, working with animalsor things that really take thinking that they actually could do. and when you mentioned,um, the type of positions that they had reserved for people in the tanf community, you're soright, and it's so important that we try to open up the minds of the people who are helping,um, our, um, people in the society get back

into society whatever area that they're inand whatever their handicap might be or whatever their situation might be, that they look atthe broader aspect and ask them what they want and really take that into account whateverthe situation is. >> john martinez: right. >> audience question: chiquita crawford: thankyou. >> john martinez: thank you. that was a greatcomment. so, we have two minutes left. i wanted to give the, uh, the panelists an opportunity,anyone to, to chime in the last two minutes if they had anything to say before we closedout. >> boyd brown: i just, i really quickly, idon't know if i answered donna's question.

i'm not sure if there is good answer about,you know, the 50% that are not working. you know, wherever you, whatever the study is,you know, when there's significant impacts there's always a big sizeable group that'snot working. um, what i, what i want to say about that, it's, i'm worried about messagesthat we give people. um, and i know in this con- this bubble of research and context,it, we, i just want to caution, we don't want to say to people, we're going to put you overhere because you can't work. i mean, i think we can learn from the disability communityfrom that, just that message. i just know if that was said in a disability conferencethere'd be protestors outside [laughs] right now, uh, uh protesting that kind of message.

and so, i guess the question for me is, it'sturning that question around to, so if we had, you know, if there's 50% or whateverthat sizable portion is that's not working, i feel we've done something wrong. what isit that we're not able to engage? what is the messaging? because if you think aboutit, this is a huge challenge for us. these folks have gotten messages their whole lifethat work is not viable option for them. you now, i hear a lot about, talk about motivationhere, you know, throughout the conference. people have been talking about motivationand people lacking motivation. everyone is motivated. the question is, what are theymotivated to do and what's influencing those motivations? and for us as a system, as peopleworking with them, um, if we want to change

that motivation or change those incentivesor whatever it is that's, that's keeping them from becoming more self-sufficient, i mean,that's our job and that's our challenge. um, so that's, that's what i want to input. >> sherri cheatham: well, what i'd like tosay is, thank you, very much. thank you to mdrc and emf, mike fishman, mary, brett andto, uh, acf for approving this. and to ssa and dds for partnering with us. it was anexperience and we hope that from here forward we, um, will do more and can do more, um,for our targeted population and thank you to my, uh, inviting me here and thank youto my fellow panelists. i've enjoyed talking to you over the course of a year and the relationshipswe've built.

>> tausha drain: um, i'd also say thank youto all of the above that were mentioned. um, one question that i'm hoping to learn fromthe research that's being done is at least for michigan, for the people that were deemednot disabled by our mrt and yet, they were approved by the social security side, andto see, you know, what the disconnect was or what the differences were. that's justa question that i had, you know, wondering how that can happen and why that happens,um, if that could be further looked into that would be something i would be very much interestedto hear about. but other than that, this was a great experience. we all have learned alot and there's more work to do, but we're all here to continue to fight on to help thepeople who need it the most.

>> john martinez: great. thank you. so, iwanted to thank all of you that stuck it, stuck it out to the bitter end and hopefullythis was, uh, interesting and you learned something. thanks to the folks that participated,un, via the live stream and thank you to our great panel. we really appreciate it.