Working Through Barriers:How the WeCARE Program Helps New Yorkers

New York City’s Wellness, Comprehensive Assessment, Rehabilitationand Employment (WeCARE) Program

Working through Barriers:How the WeCARE Program Helps New Yorkers

New York City’s Wellness, Comprehensive Assessment,Rehabilitation and Employment (WeCARE) Program

Table of Contents

To Our Readers 1

Introduction 3

Background and Context 5

The WeCARE Model 7

WeCARE Innovations 11

Program Outcomes 15

Lessons Learned 19

Final Note 21

Endnotes 22

“I try to understand what the people in my classthink of themselves and how they see the world, so Ican help them get past the problems they face. I hadone student who was very resistant to participatingat first. He cursed me out twice! But I got him to dohis resume properly, and after he got a job, he cameback to see me, to apologize and to thank me forhelping him.”

—Lynn, Work Readiness Instructor

To Our ReadersDear Fellow New Yorkers,

Perhaps the most important result of thewelfare reform legislation of 1996 was therealization that public assistance recipientswould go to work and hold on to jobs if theywere only given the right incentives. The trueheroes of welfare reform, before PresidentClinton, the Republican Congress, and thestate agencies that implemented the pro-gram, were the millions of welfare recipientswho proved critics’ worst fears and low ex-pectations wrong.

But that achievement has not been universal.As welfare caseloads have dropped, it ap-pears that a rising portion of clients are pre-vented from joining the workforce byconditions that make day-to-day tasks in theregular workplace difficult: mental healthconditions, physical problems, and substanceabuse. And the brave new world of welfarereform was not designed to respond to theneeds of these clients.

Under the leadership of Mayor MichaelBloomberg, New York City designed We-CARE (the Wellness, Comprehensive Assess-ment, Rehabilitation and Employmentprogram) to address this gap. By providing in-dividualized, holistic services, WeCARE helpsclients with medical or mental health barriersto work move from cash assistance to jobs orfederal disability benefits. Now in its fifthyear, WeCARE has helped thousands of NewYorkers leave cash assistance for greater inde-pendence and self-sufficiency. And as the firstprogram of its size and scope to serve thispopulation of welfare recipients, we hopeWeCARE will serve as a model for othercities and social service agencies.

The continued ambitious goals for work par-ticipation rates for welfare programs highlightthe need to find appropriate jobs for cash as-sistance recipients with clinical barriers to em-ployment. But this is not the only reason, noris it the main reason, why social service agen-cies should devote resources to additional

services for these clients. While some mem-bers of this group are unable to work, otherscan if they have the right support and the rightaccommodations. Until we extend them achance at employment and independencefrom public assistance, the promise of welfarereform remains incomplete.

Robert DoarCommissionerNew York CityHuman Resources Administration/Department of Social Services

1

“I had a thyroid problem and got very sick andcouldn’t work. I wasn’t getting proper health care andlost my job. I came to HRA because my wife, kidsand I needed help. I learned MS Word and theyhelped me put a resume together. I’m applying for a jobas a superintendent of a building. There are good peo-ple at WeCARE who want to help you.”

—AngelAngel has been in WeCARE for two months and isactively looking for a job.

In 2004, nearly a decade after the implemen-tation of work-centered welfare policies inNew York City, hundreds of thousands ofcash assistance recipients, many of them sin-gle mothers, had left welfare for work. But asignificant number of those who remainedon cash assistance had complex clinical bar-riers to employment, including unstablemedical and/or mental health conditions.

For a welfare client, a medical or mentalhealth problem that presents a barrier to em-ployment does not need to mean a lifetimeof dependence on public assistance. Withadditional support to stabilize their condi-tions and prepare for, find, and keep jobsthat can provide reasonable accommoda-tions, a number of individuals in this groupcan work. Federal disability benefits can pro-vide a larger, longer-term income source fordisabled clients who cannot work. However,more than 20 million working-age Americanshave health problems that fully or partiallyimpede their ability to work, and a full three-quarters of them do not work at all.i

While New York City had some services inplace for welfare clients with medical andmental health barriers in the early 2000’s,they lacked the strong cohesion needed tokeep clients progressing toward work. TheCity’s Human Resources Administration/De-partment of Social Services (HRA), whichprovides social safety net programs, saw theneed for a program that provided compre-hensive services for welfare clients with clini-cal barriers to employment. In 2005, theAgency implemented WeCARE, the Well-ness, Comprehensive Assessment, Rehabili-tation and Employment program. WeCAREbuilds upon HRA’s earlier services for thisgroup, but integrates medical and social as-sessments; wellness services; vocational reha-bilitation; job training, placement, andretention services; advocacy for federal dis-ability benefits; and case management.

While other districts have designed programsfor cash assistance clients with complexbarriers to employment, many provide a spe-cific service, work with particular sub-

groups, and/or are implemented in districtswith small caseloads. WeCARE differs in therange of services it includes and its scale: itserves approximately 24,000 clients at agiven time, and New York City refers allcash assistance clients with medical or men-tal health conditions that prevent them fromworking to the program. In the four yearssince its initiation, WeCARE has helped tensof thousands of New Yorkers attain greaterindependence and improve their health andstandard of living. The program provides amodel for how other municipalities—particu-larly major cities—can serve this group ofclients effectively and help those with tempo-rary or partial barriers to employment movetoward work. Providing these services has be-come especially important with the passageof the federal Deficit Reduction Act in 2005,which contained stricter work participationrequirements for welfare programs.

Introduction

3

“I hadn’t had a job in three years when I came toWeCARE, but every day, I came in and put my heartinto it. I’ve worked for six months for a private mainte-nance contractor at a WeCARE site, and I earn enoughthat I’m off PA. I try to inspire everyone here, eventhough it’s not my job.”

—SabrinaSabrina works at the building that houses Arbor Educa-tion and Training, LLC’s WeCARE facility in Brooklyn.

In the 1990s, HRA worked with a number oflocal providers and state agencies to refer cashassistance clients with varying degrees of dis-ability to wellness services or vocational reha-bilitation, or help them apply for federaldisability benefits. New York City’s cash assis-tance caseload dropped by half between 1995and 2000, as hundreds of thousands of for-mer clients went to work. But an internal 2002HRA analysis revealed that clients who re-ported they were unable to work due to med-ical or mental health conditions sometimeswaited weeks or months for medical assess-ments or referrals to post-assessment services.Others cycled between medical assessmentsand vocational rehabilitation because they re-vealed unexamined health problems afterbeing referred to the vocational rehabilitationprovider.

The way services were delivered exacerbatedthese problems. An HRA-contracted vendorperformed medical assessments while a stateagency oversaw vocational rehabilitation con-tracts, and as a result, the programs were dis-jointed. Because provider payments were not

linked to outcomes, there was little incentive tomove clients through the program efficiently.Case management services were also weak ornon-existent: clients had to schedule their ownwellness appointments and report regularly tothe medical vendor on their progress, eventhough the conditions that prevented themfrom working could also make it difficult forthem to do these tasks. As a result, manyclients failed to comply with cash assistance re-quirements and a significant number had theirbenefits temporarily reduced or their casesclosed.

HRA saw that clients with clinical barriers toemployment would be better served if theycould participate in a range of services thatwere overseen by a single agency or providerorganization; if they underwent holistic, up-front assessments; and if case managementwere improved and vendor contracts changed.In response, the Agency developed the We-CARE model and contracted with two ven-dors to implement the program.

Background and Context

Background & Context

5

Similar ProgramsHistorically, most local social service districts haveexempted cash assistance recipients with physicalor mental health barriers fromwork requirements.However, several states and local districts havecreated programs for this population. Programs in-clude:• Adult Rehabilitative Mental Health Services(Ramsey County, MN)

• Department of Workforce Services SocialUnit (Utah)

• Disability Screening Services (Los Angeles, CA)• Diversified Employment Opportunities (DavisCo, UT)

• Partnerships for Family Success (AnokaCounty, MN)

• Promise Jobs Disability Specialist Initiative(Iowa)

WeCARE differs from these programs because ofits integrated nature and its size—the above dis-tricts either have small populations compared toNew York City or provide services for a specificsubgroup. However, WeCARE and these pro-grams share several elements in common thatMathematica Research, Inc. highlights as bestpractices:• Individualized services• Comprehensive assessments• Service plans that combine work andsupport, and allow participants to makeprogressive steps toward employment

• Ongoing support after job placement• Case management• Assistance with the federal disability benefitsapplication process for clients who mayqualifyii

New York City cash assistance clients arereferred to WeCARE if they report thatthey cannot work due to medical or mentalhealth conditions. Each client first com-pletes a comprehensive biopsychosocial(BPS) assessment, which includes a medicalevaluation; an integrated psychological andsocial, or psychosocial, evaluation; any rele-vant medical specialty evaluations; and corelaboratory tests. WeCARE providers alsoreview any clinical documentation fromclients’ own physicians or care providers.Most clients who are recommended forBPS assessments complete them: nearly47,000 assessments (84 percent of referrals)were completed in 2008, and nearly allclients referred for additional specialty eval-uations completed those as well.

After finishing the BPS assessment, a We-CARE physician determines whether theclient falls into one of four “functional ca-pacity” categories: whether he or she isemployable or may be eligible for federaldisability benefits. This determinationguides the services offered during the laterphases of the program:

Clients who are employable withlimitations participate in vocationalrehabilitation (VR), which includesspecialized work experience, educa-tion, training, job search, and/orwork readiness activities. VR beginswith an in-depth vocational evalua-tion that further clarifies clients’functional strengths, limitations,and needs for accommodation.

The WeCARE Model

Employable withLimitations

42%

TemporarilyUnemployable

36%

Unemployable 16%

Fully Employable 6%

WeCARE Clients by BPS OutcomeFebruary 2005-January 2009

7

When clients have unstable medical ormental health condition(s) that renderthem temporarily unemployable, We-CARE develops “Wellness Plans” forthem and links them to community-basedtreatment, provides case managementand clinical support to facilitate treatmentadherence, and monitors clinical progressto help them become healthier.

WeCARE helps clients who are found tobe unemployable for 12 or more monthsapply for federal disability benefits bypreparing and submitting the Social Secu-rity Administration’s disability application.HRA also helps clients appeal their casesif they are denied benefits. Clients who

have already applied receive assistance tostrengthen their applications and to keepclinical conditions stable.

Clients who are fully employable areassigned to one of HRA’s other employ-ment programs, such as the Back-to-Work (BtW) program of job search andwork experience activities or theBEGIN basic instruction program.

Each WeCARE client is assigned a casemanager who specializes in the client’s as-signed program component. The level ofthe case manager’s involvement rangesfrom “supportive” to intensive, depend-ing on the client’s needs. Case managers’

duties include assisting unemployableclients with federal disability applications,facilitating treatment for temporarily unem-ployable clients, helping clients who areemployable with limitations search for jobs,and conducting outreach when clients arenot fully engaged in the program.

Approximately 24,000 client cases are inWeCARE at any one time, which amountsto around 7 percent of New York City’sentire cash assistance caseload. The pro-gram’s annual budget is approximately $70million, and it is funded by federal, state,and city tax dollars.

8

]Psychosocial AssessmentMedical ExamLab TestsSpecialty Medical Appoinments

HRA Job Center

Referred to WeCARE

BPS Assessment

Medical/mental healthbarriers

Referred to BTW, BEGIN, etcFully employable

Temporarily UnemployableWellness Treatment

Employable with LimitationsVocational Rehabilitation

Vocational Rehabilitation

Referred to BTW, BEGIN, etc.Fully employable

Vocational Assessment

Referred to BTW, BEGIN, etc.

Employable with Limitations

Unemployable

Unemployable: Complete or Supplement Federal

Disability Bene!ts Application

If necessary, HRA willassist with appeal

Job Training/Readiness Services

Job Placement/Retention Services

The WeCARE Process

9

Several components of WeCARE directly ad-dress shortcomings in HRA’s previous effortsto serve clients with clinical barriers to work,and help WeCARE serve clients more effec-tively. These characteristics also distinguishWeCARE from other districts’ efforts to servethe same or similar populations.

First, each client undergoes a compre-hensive clinical assessment upon enter-ing the program, rather than a medicalevaluation focused on specific problemsthe client reports. This approach helpsavoid unnecessary repeat assessments,allows WeCARE providers to addressclients’ conditions and the interactionsbetween them holistically, and some-times reveals serious medical problemsof which clients were previously un-aware, such as hypertension, diabetesand irregular heartbeats.

A client who returns to the programafter being disenrolled—because he or

she did not comply with cash assistancerequirements, contested the outcome of aBPS assessment through New York State’sfair hearing process, or left cash assistancefor personal reasons—does not need torepeat the BPS assessment if he or she hascompleted one within the last year. To helpthese clients reenter the program quickly,WeCARE developed “Clinical ReviewTeams” (CRTs) to determine if there hasbeen a change in their health/mental healthconditions.

Second, WeCARE integrates servicesfrom assessment to job placement oradvocacy for disability benefits intoone program, whereas in the past,different services were overseen by dif-ferent providers. WeCARE servicesare provided by two vendors, ArborEducation and Training, LLC andFEGS Health and Human ServicesSystem, Inc., which HRA selectedthrough a competitive bidding process.Each vendor is responsible for allWeCARE components within theNew York City boroughs it covers,although some services, such as med-ical assessments and some VR serv-ices, are sub-contracted to other or-ganizations. Combined with strongercase management, this structure helpsmake clients’ transitions between dif-ferent program componentssmoother.

WeCARE Innovations

11

“WeCARE does not give in to theidea that people with medical ormental health barriers cannot work.We help clients understand theirstrengths, not just their limitations.”

—Dr. Frank Lipton, HRA Executive DeputyCommissioner, Customized Assistance Services

Third, a WeCARE case manager supports eachclient and monitors his or her progressthroughout participation in the program, pro-viding a level of support tailored to the client’sneeds at that time. Insufficient case manage-ment weakened New York City’s previous ef-forts to serve this population. Althoughintensive case management is a key componentof some specialized and smaller programs forwelfare clients with barriers to employment, notall WeCARE participants need such a high levelof engagement, and with 24,000 clients in theprogram, providing case management on a“continuum” is more practical and cost-effec-tive.

Fourth, HRA created performance-based con-tracts for vendors. Few clinically-oriented pro-grams that work with individuals withfunctional limitations have been able to success-fully adopt a payment structure that rewards re-sults for clients rather than the amount ofservices provided. Vendors are paid based oncompleted BPS assessments, wellness plans,and vocational evaluations; federal disabilityawards for clients; and job retention after 30,90, and 180 days. Vendors are not paid for as-sessing the same client more than once per cal-endar year, nor are they paid for services that

are provided outside contractual timeframes.These milestone payments fund two-thirdsof the WeCARE vendors’ contracts; the re-maining one-third of funding is providedthrough line-item reimbursements for casemanagement services.

Finally, HRA and the vendors use automatedsystems to record case information and scanclient documents for storage. Vendors usetheir own systems to record detailed case in-formation and BPS assessment notes; theyalso enter data into HRA’s cash assistanceclient tracking system, which contains built-in checks to preserve data integrity and accu-racy. This makes it easier for WeCARE staffto track clients’ progress and to aggregateand analyze data, and ensures that clients’case information will be available if theymove from WeCARE to HRA’s regular cashassistance program.

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“When I had my back operation, I couldn’t workand didn’t know if I would walk again. I was in awheelchair when I came to HRA. They sent me toWeCARE and I was given therapy at a hospital.Within months, I was walking again. My jobdeveloper helped me get an interview with a graphicscompany. They hired me and I have been employedfor almost one year.”

—Aldo, former WeCARE client

Stacey, Aldo’s former Case Manager, says Aldo wasvery motivated to look for employment, which helpedhim succeed. “He always has a smile on his face and is willingto put a smile on someone else’s face,” she said.

WeCARE’s impact is measured by its ability to help clients find and keepjobs, complete wellness plans, and obtain federal disability benefits. Bythese standards, the program has improved throughout the past fouryears. HRA and the vendors strive to continue improving the qualityof services provided and clients’ quality of life.

JJoobb PPllaacceemmeenntt aanndd RReetteennttiioonnIn total, WeCARE has placed more than 9,000 clients in jobs. TheWeCARE vendors’ success at making job placements, the most diffi-cult component of the program, has improved markedly throughoutthe past four years: from Program Year 1 to Year 4, the number ofclients who obtained jobs more than tripled and the rate at whichclients who completed a vocational assessment were placed in jobsnearly doubled. The number of clients obtaining employment in-creased the most from Year 1 to Year 2, by 2.5 times—an increasethat could be due in part to growth in referrals to the program andthe buildup of WeCARE’s operations. However, the placement rategrew most rapidly in Years 3 and 4, and despite the current economiccrisis, in Year 4, there was a small increase in the number of job place-ments and the placement rate grew by almost 25 percent.

WeCARE tracks clients’ job retention at three and six months afterplacement. Nearly all clients who retain jobs for at least three monthskeep them for the full six, a pattern found throughout HRA’s employ-

Outcomes

Total Placements: 9,12330%

20%

10%

0%

5,000

4,000

3,000

2,000

1,000

0Program Year 1 Program Year 2 Program Year 3 Program Year 4

Feb 05-Jan 06 Feb 06-Jan 07 Feb 07-Jan 08 Feb 08-Jan 09

14%15%

21%

26%

Job Placement: Yearly Totals and Rates, February 2005-January 2009

Number of Job Placements

Percent of Clients Referred who are Placed in Jobs

2,324

2,873 3,021

905

Total Placements: 9,12330%

20%

10%

0%

5,000

4,000

3,000

2,000

1,000

0Program Year 1 Program Year 2 Program Year 3 Program Year 4

Feb 05-Jan 06 Feb 06-Jan 07 Feb 07-Jan 08 Feb 08-Jan 09

14%15%

21%

26%

Job Placement: Yearly Totals and Rates, February 2005-January 2009

Number of Job Placements

Percent of Clients Referred who are Placed in Jobs

2,324

2,873 3,021

905

ment programs. 82 percent of WeCARE clients placed in jobs retain them forat least three months, and 74 percent for the full six months; overall, 86 percentof HRA clients placed in jobs retain them for at least three months and 80 per-cent retain them for six months.iii

15

Job Placement: Yearly Totals and Rates, February 2005-January 2009

1,980

7,641

9,43610,034

Number of Wellness Plan Completed

Percent of Clients Referred who Complete Plans

Program Year 1

Feb 05-Jan 06

Program Year 2

Feb 06-Jan 07

Program Year 3

Feb 07-Jan 08

Program Year 4

Feb 08-Jan 09

0%

10%

20%

30%

40%

50%15,000

10,000

5,000

0

24%

40%

36%

40%

Total Plans Completed: 29, 091

Wellness Plan Completion: Yearly Totals and Rates, February 2005-January 2009

WWeell llnnee ssss SSeerr vvii cc ee ss ffoorr tthhee TTeemmppoorraarr ii llyy UUnneemmppllooyyaabbll eeMore than 29,000 clients have successfully completed wellnessplans, stabilizing the underlying clinical conditions that affect theirhealth and ability to work. The number of clients who completedwellness plans increased almost four times from the first to thesecond year of WeCARE, and continued to improve at a slowerrate after that. The percentage of clients assigned to this programcomponent who completed it rose from 24 percent in ProgramYear 1 to 40 percent in Year 2, and while it fluctuated downwardin Year 3, it h as remained essentially stable around 40 percentsince the second year.

FFeeddee rraall DDiissaabbii ll ii ttyy BBeenneeff ii tt ssOver 12,500 WeCARE clients have been awarded federal disabilitybenefits through the program, and the number of clients who re-ceive benefits has grown significantly each year. In Year 2, eighttimes as many clients received benefits as in Year 1; the number ofawards doubled from Year 2 to Year 3 and grew by an additional30 percent from Year 3 to Year 4. Another 9,300 initial federal dis-ability benefit applications from WeCARE clients are currentlypending with the Social Security Administration, and almost 6,000more are in the appeal process and have yet to be decided.

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Clients Awarded Federal Disability Benefits and DisabilityApplications Filed, February 2005-January 2009

Wellness Plan Completion: Yearly Totals and Rates, February 2005-January 2009

1,862

7,625

11,71312,858

0

4,000

8,000

12,000

16,000

Awards on Initial Application Awards on AppealApplications Filed

ProgramYear 1

Feb 05-Jan 06

ProgramYear 2

Feb 06-Jan 07

ProgramYear 3

Feb 07-Jan 08

ProgramYear 4

Feb 08-Jan 09

Total Awards: 12,536

277*

2,173*

4,371*

5,760*

*The number of total awards, oninitial application and appeal, isgiven for each year.

Awaiting DeterminationAwards on Appeal

Awards on Initial ApplicationBeneÞts Not Awarded

Percent of Applications Awarded BeneÞts, Denied BeneÞts, andAwaiting Determination: WeCARE February 2005-January 2009

All Applications33,998 Total

Applications with a Determination24,681 Total

Award on Appeal1,593 clients

(6.5%)

AwaitingDetermination

9,317 clients(27%)

DeterminationReceived

24,681 clients(73%)

Awards onInitial Application

10,943 clients(44%)

BeneÞts Not Awarded12,145 clients

(49%)

Percent of Applicants Awarded Benefits, Denied Benefits, andAwaiting Determination: February 2005-January 2009

WeCARE has a demonstrable impact on its clients’ ability to obtain thesebenefits. Approximately half of clients who apply for benefits throughWeCARE receive them upon either their initial application or their firstappeal. Because the application process takes many months, it oftenspans multiple program years, so WeCARE’s cumulative award rate istracked. For first-time applicants, WeCARE’s award rate, 44 percent, issignificantly higher than the national award rate for first-time applicants,which is approximately 30 percent.iv Approximately 70 percent of We-CARE clients who are denied benefits and appeal the decision receivethem.

WeCARE is ambitious in its scope and its mis-sion to serve all New York City cash welfareclients with medical/mental health barriers towork. While praised for their work, HRA and thevendors have also learned from challenges andcriticism in the past four years.

MMoovviinngg ffrroomm DDeessiiggnn ttoo IImmpplleemmeennttaattiioonnFrom the beginning, WeCARE has had toevolve in response to unexpected circumstances.In the program’s first two years, many moreclients than expected were referred for BPS as-sessments. HRA and the vendors adjusted tothe increased client volume over time, but HRAalso reduced the number of repeat referrals byimplementing the Clinical Review Teams(CRTs) in January 2007. Since then, more than55,000 clients have reentered WeCARE throughthe CRTs. For clients who did not respond tomail or phone calls, HRA had planned for We-CARE case managers to make home visits, butdue to staffing constraints, home visits are onlyused in special circumstances. Finally, HRA hadplanned for the cash assistance program toserve WeCARE clients through cash assistanceoffices, or Job Centers, customized for them.But as the result of a lawsuit, HRA changed itsplans and serves WeCARE clients at Job Cen-ters throughout the City.

QQuuaalliittyy CCoonnttrrooll aanndd CCuussttoommeerr SSeerrvvii cceeProviding high-quality services is a priority forWeCARE. HRA has monitored the vendors’performance since 2005, but the Agency wasdelayed for two years in hiring an independentquality assurance reviewer. A 2008 audit by NewYork City’s Comptroller recognized several ofHRA’s effective monitoring techniques but alsoidentified some weaknesses in HRA’s vendoroversight procedures and noted the delay in hir-ing the independent reviewer.v HRA has imple-mented many of the audit’s recommendationsto address these gaps.

In 2007, a local advocacy group put out a reportthat praised WeCARE’s design but criticized itsimplementation.vi Though the report’s findingswere not statistically significant, HRA re-sponded to several of its recommendations anddirected the vendors to implement client forumsand suggestion hotlines, emphasized the impor-tance of individualizing VR plans, and created amechanism to ensure that vendors review client-provided medical documentation.

PPeerrssppeeccttiivveess oonn CClliieennttss’’ CCoonnddii ttiioonnssIntegrating medical, wellness, and disability serv-ices with VR sets WeCARE apart. These disci-plines often view clients differently: doctors are

trained to diagnose and treat illnesses and dis-abilities, while VR providers evaluate clients’strengths and the accommodations they need towork. As a consequence, it has taken time forWeCARE providers to ensure their medical stafftake an employment-centered approach, and We-CARE physicians sometimes draw different con-clusions than clients’ own care providers aboutwhether or not clients are employable.

WeCARE’s VR component has faced challengesin finding the best way to serve clients who areassessed as being able to work with reasonableaccommodations, but who think of themselvesas unable to work. WeCARE work readiness in-structors and case managers try to help theseclients gain the confidence they need to succeedin the workplace, in addition to specific skills. Ithas also been harder for WeCARE to engageclients in VR than in the other program compo-nents. Around 40 percent of case managers’outreach efforts succeed for clients assigned toVR, 60 percent for wellness services, and 80 per-cent for clients receiving help with federal dis-ability benefit applications.vii While this is anongoing issue for WeCARE, it may become lessof one as work requirements for clients withbarriers to employment become more accepted.

Lessons Learned

19

WeCARE has shown that social serviceagencies can give clients with clinical barriersto employment opportunities to move fromwelfare to work, and that they can do so on alarge scale. Using a holistic approach that in-tegrates multiple disciplines, an innovativeperformance-based payment structure, andsophisticated tracking systems, WeCARE hashelped tens of thousands of cash assistanceclients find and keep jobs, improve theirhealth, and/or obtain federal disability bene-fits, improving their standard of living andself-sufficiency.

This report highlights several aspects of We-CARE that can be summarized as two con-cepts: comprehensiveness and customization.WeCARE is designed to serve all cash assis-tance clients with clinical barriers to employ-ment, not just a subset with specific issues; allservices for these clients are integrated intoone program; assessments look holistically atclients’ health and try to identify all potentialbarriers to employment; and case managers

who follow clients throughout the programprovide continuity. These characteristics laythe foundation for WeCARE to customizeservices. Comprehensive assessments helpWeCARE identify clients’ strengths and needsup front and design service plans to meetthem. Integrated services make it easier tocarry out that plan, and case managers trackclients’ progress and changes in their needs.Finally, performance-based contracts and theefficient use of technology have helped We-CARE run smoothly.

Other districts can draw on WeCARE’s modeland New York City’s experiences translatingthe program from theory to practice. Some al-ready do: WeCARE has received visitors fromU.S. and foreign social service agencies whohoped to learn about the program. HRA willcontinue to improve WeCARE in years tocome, and New York City hopes that otherdistricts will be able to learn from its experi-ences to benefit their own residents.

Final Note

21

i U.S. Census Bureau (2008). Disability Data from the Current Population Survey (CPS) ASEC, Table 2. Retrieved from:http://www.census.gov/hhes/www/disability/disabcps.html.

ii Derr, M. (2008). Providing Specialized Personal and Work Support; Derr, M. & Pavetti, L. (2008). Creating Work Opportunities; Martin, E.S., Pavetti, L. & Kauff, J.(2008). Creating TANF and Vocational Rehabilitation Agency Partnerships; Pavetti, L., Derr, M. & Martin, E.S. (2008). Conducting In-Depth Assessments. All publishedin Washington, D.C.: Mathematica Policy Research, Inc.

iii Information on WeCARE and HRA program outcomes comes from HRA administrative data as of February 2009.

iv A combined award rate of 30 percent on initial application is given for the Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) programsin: U.S. General Accounting Office (1997). Social Security Disability: SSA Actions to Reduce Backlogs and Achieve More Consistent Decisions Deserve High Priority(GAO publication T-HEHS-97-118). Testimony before the Subcommittee on Social Security, Committee on Ways and Means, House of Representatives, 6.

More recent data was obtained from the Social Security Administration’s annual reports on the SSI and SSDI programs for 2007. The percentage of SSDI applicantsawarded benefits upon their initial application averaged 31 percent from 1996 to 2006; while a similar figure was not available for the SSI program, total award rates—forinitial claims and appeals— for applicants ages 18 to 64 was 25 percent for 2006. Citations: Social Security Administration (2008). Annual Statistical Report on the SocialSecurity Disability Insurance Program, 2007 (SSA Publication No. 13-11826), 139. Washington, D.C.: U.S. Government Printing Office. Social Security Administration(2008). SSI Annual Statistical Report, 2007 (SSA Publication No. 13-11827), 132. Washington, D.C.: U.S. Government Printing Office.

v City of New York, Office of the Comptroller, Bureau of Management Audit (2008). Audit Report on the Oversight of the WeCARE Program Contractors by theHuman Resources Administration (Comptroller’s Report MG08-083A). New York, NY: City of New York.

vi Kasdan, A. and Youdelman, S. (2007). Failure to Comply: The Disconnect between Design and Implementation in HRA’s WeCARE Program. New York, N.Y.:Community Voices Heard.

vii Sample outreach data provided by a WeCARE vendor for October-December 2007.

Endnotes

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Other References

Berry, C., Smith, D., Kuhlman, J., Margulies, R., Oakley, L. & Wilbur, K. (2008). WeCARE Process Evaluation: Final Report. New York, NY: New York Univer-sity Robert F. Wagner Graduate School of Public Service.

City of New York, Human Resources Administration/Department of Social Services (2002). New York City’s Welfare Population: A Case for Fully/PartiallyUnengageable Cases.

City of New York, Human Resources Administration/Department of Social Services (2006). Welfare Reform in Motion. New York, NY: Author.

Doar, R. (2007). Testimony before the General Welfare Committee, New York City Council on the Wellness, Comprehensive Assessment, Rehabilitation andEmployment Program (WeCARE).

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AcknowledgementsThis report was based in part on interviews with HRA and WeCARE vendor staff and clients, and many others provided input or helped createthe final product. Thanks to all of the contributors from Arbor Education and Training, LLC, FEGS Health and Human Services System,Inc., and the Human Resources Administration, and to the WeCARE clients who agreed to be featured.

Copyright 2009, The City of New YorkHuman Resources Administration/Department of Social Services.For permission to reproduce all or part of this material contact the New York City Human Resources Administration.