Effectiveness of the Ticket to Work Program for Beneficiaries Who Are Blind or Have Low Vision: Comparisons with Other Beneficiaries.

The Ticket to Work (TTW) program began in 13 states in February 2002, and nationwide implementation was completed in fall 2004. This federally funded program is meant to assist persons who receive disability benefits from the Social Security Administration (SSA) in obtaining employment, with the ultimate goal of terminating SSA benefits and thereby providing a cost savings for the government (Livermore et al., 2003). Other goals of the program are to increase beneficiaries' choice of providers of rehabilitation services and to improve the quality of rehabilitation services by providing for competition among service providers. With its focus on employment, the TTW program would seem to be an excellent opportunity for beneficiaries who are blind or have low vision, since lower levels of employment are a well-known problem for them compared to persons without disabilities and persons with most other types of disabilities (Houtenville, 2003; Kirchner, Schmeidler, & Todorov, 1999). However, the manner in which the program has been implemented has caused professionals in the field of blindness rehabilitation to voice concerns about whether the program is effective with beneficiaries who are blind or have low vision. This concern stems primarily from the fact that the program has not provided incentives to serve beneficiaries who are more severely disabled (that is, those who may require more time and assistance to become employed). How THE PROGRAM WORKS Under the Ticket to Work program, eligible social security beneficiaries with disabilities--those who are receiving either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)--are given a ticket that can be used to obtain rehabilitation services from an employment network. Employment networks is the term used by the SSA to describe the organizations that provide services to beneficiaries in the TTW program. Employment networks can be nonprofit private, for-profit private, or public organizations, and all state vocational rehabilitation agencies are considered employment networks under the TTW program. The goal of the rehabilitation services that employment networks provide to beneficiaries must be employment. A beneficiary selects the employment network that he or she wants to work with and assigns the ticket to it. After the ticket is assigned, an individual work plan is developed, which specifies what each party will do to help the beneficiary obtain employment. After the beneficiary agrees with the work plan, he or she begins to receive rehabilitation services. If the beneficiary is dissatisfied with the services received, he or she has the option of "unassigning" a ticket and reassigning it to another employment network or vocational rehabilitation agency. Progress toward employment is monitored under the program 24 months after a ticket is assigned and every 12 months thereafter (see Capella-McDonnall, 2005, for a more detailed overview of the program). EMPLOYMENT NETWORKS' CHOICE OF PROVIDING SERVICES One concern of professionals in the field of visual impairment and blindness about the TTW program is that employment networks have the option of refusing services to beneficiaries for any reason. Therefore, employment networks could choose not to serve persons who are blind or have low vision. (Note that state vocational rehabilitation agencies are required to provide services to all eligible beneficiaries.) Some reasons why employment networks may choose not to serve beneficiaries who are blind or have low vision are that these beneficiaries may require a higher level of earnings to terminate benefits, may be more likely to need expensive services and assistive technology, may be perceived as difficult to place, and require assistance from persons with specialized training in blindness rehabilitation (Cavenaugh, 1999, 2000; Gallagher, 1988; Spungin, 1997). Survey research on the attitudes of employment networks in the first 13 states toward serving beneficiaries who are blind or have low vision found that employment networks do have these concerns, although such concerns did not prevent some of them from accepting tickets from beneficiaries (Capella-McDonnall, 2005). …