Publications
Ticket to Work
 "Evaluation of the Ticket to Work Program. Assessment of Post-Rollout Implementation and Early Impacts." Craig Thornton, Gina Livermore, Thomas Fraker, David Stapleton, Bonnie O’Day, David Wittenburg, Robert Weathers, Nanette Goodman, Tim Silva, Emily Sama Martin, Jesse Gregory, Debra Wright, and Arif Mamun, May 2007. The Ticket to Work (TTW) program was designed to promote employment by enhancing the market for services that help people receiving disability benefits become economically self-sufficient. To date, the Social Security Administration has successfully begun the market enhancement process by putting the core elements of the TTW program in place across the country—mailing a Ticket to more than 11 million disability beneficiaries and inviting them to use it as a way to obtain meaningful employment; implementing new rules that allow beneficiaries to attempt to work without fear of triggering a review of their disability status; and enrolling service providers, or employment networks, that offer beneficiaries new choices for providers and service mixes. Early impacts from this report to Congress suggest that TTW slightly increased beneficiary use of employment services in 2002, the first rollout year. However, the increase did not appear to produce a corresponding increase in beneficiary earnings or a reduction in benefit payments during the first two years. The authors note that impacts for 2004 and later may be larger—participation rates continue to increase, and many nonparticipants say they plan to assign their Tickets. Nevertheless, analysis of trends in TTW payment data suggests that the program would have to induce future shifts in beneficiary behavior that are much larger than what has been observed so far in order to generate the level of exits from the program envisioned by Congress. In particular, meeting the exit goal will require TTW participation to increase substantially and a larger share of participants to earn enough so that they no longer receive cash benefits. Appendices.
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Child Mental Health
 Physician and Patient Characteristics Associated with Discussion of Psychosocial Health During Pediatric Primary Care Visits." Jonathan D. Brown, Lawrence S. Wissow, and Anne W. Riley, Clinical Pediatrics, November 2007. Primary care providers often miss opportunities to address child mental health problems but research has not clarified specific mechanisms for intervention. This article, based on 800 primary care visits to 54 providers in 13 diverse health clinics, examines factors associated with the discussion of children’s behavior, mood, getting along with others, school performance, family stress, and parent stress. The discussion of these topics was more common when the child demonstrated hyperactivity symptoms and when the provider was female or had greater confidence in mental health treatment skills. The presence of moderate physical pain interfered with the discussion of psychosocial health, even when parents were seeking help for their child’s mental health problem and when youth demonstrated mental health impairment according to a standardized assessment. The article notes that primary care providers need clinical skills that can be used to effectively communicate with families about mental health and overcome the competing demands of physical and mental health problems.
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Dual Enrollment
 "The Postsecondary Achievement of Participants in Dual Enrollment: An Analysis of Student Outcomes in Two States." Melinda Mechur Karp, Juan Carlos Calcagno, Katherine L. Hughes, Dong Wook Jeong, and Thomas R. Bailey, October 2007. Dual enrollment programs enable high school students to enroll in college courses and earn college credit. Once limited to high-achieving students, such programs are increasingly seen as a means to support the postsecondary preparation of average-achieving students. Moreover, though dual enrollment programs typically have been reserved for academically focused students, increasing numbers of career and technical education (CTE) programs are providing such opportunities to their students. In this report, the authors examine the impact of dual enrollment participation for students in Florida and New York City, examining postsecondary outcomes for participating CTE students in both locations and outcomes of participation for all students in Florida. The report notes that dual enrollment is a useful strategy for encouraging postsecondary success for all students, including those in CTE programs.
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Cash and Counseling
 "Cash and Counseling: Improving the Lives of Medicaid Beneficiaries Who Need Personal Care or Home- and Community-Based Services." Randall Brown, Barbara Lepidus Carlson, Stacy Dale, Leslie Foster, Barbara Phillips, and Jennifer Schore, August 2007. To address the needs of Medicaid beneficiaries who are elderly or disabled and desire greater control over their personal care, the federal government has encouraged states to offer consumer-directed options. One of the most innovative and flexible consumer-directed-care models is Cash and Counseling, recently tested in a demonstration program in Arkansas, Florida, and New Jersey. The program gives consumers a monthly allowance that they may use to hire workers and to purchase care-related services and goods. This report summarizes findings from five years of research on how each of the three demonstration states implemented its program, and on how the programs have affected consumers who participated, consumers’ paid and unpaid caregivers, and costs to Medicaid. The findings from the randomized trial study design show that the program had overwhelmingly positive effects on consumers of all ages and their caregivers. However, in each state, total Medicaid expenditures were higher under the program than what they would have been in its absence, for different reasons. States interested in offering a Cash and Counseling program or similar consumer-directed options may benefit from the report’s discussion of lessons learned about how to control costs.
Executive summary.
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