Phase I development of the SGA Model: Use of administrative data and expert opinion to identify key components of the SGA Model

BACKGROUND: The SGA Model Demonstration tested a coordinated team approach that integrated specific components of vocational rehabilitation services to determine if the model would increase earnings outcomes of Social Security Disability income beneficiaries who sought VR services in Kentucky and Minnesota. OBJECTIVE: This paper provides details on the first phase of development of the SGA intervention. METHODS: Researchers combined a Delphi process, key informant interviews, and administrative data review to identify practices that were high priority for inclusion in the model. RESULTS: Researchers reached a consensus on the high priority components to construct a testable intervention under the control of the vocational rehabilitation system. CONCLUSIONS: The SGA Project team identified three practice domains to guide an intensive case study for Phase II development of the intervention. These included pacing of services, work incentives counseling, and strategies for employment service delivery.

Uncertain Subjects: Shaping Disabled Women’s Lives Through Income Support Policy

This article provides a critical reading of one aspect of the “third mobilization of transinstitutionalization” (Haley & Jones, 2018), focused on how power is exercised through the B.C. government income support program (or the ambiguously-named B.C. Benefits), shaping the embodied lives of women living with chronic physical and mental impairments. I research and write as a woman living with a disabling chronic illness whose explicit focus is power: how it is enacted and what it produces in the everyday lives of women with disabling chronic conditions living on income support. I too have been the recipient of disability income support. Thus, my accounts are ‘interested.’ My writing seeks to create a disruptive reading that destabilizes common-sense notions about disabled women securing provincial income support benefits, in particular in British Columbia (B.C.), interviewed as part of my doctoral research. Despite public claims by the B.C. government to foster the independence, community participation, and citizenship of disabled people in B.C., the intersection of government policy and practices and how they are read and taken up by disabled women discipline them in ways that produce profound uncertainty in their lives, such that these women become uncertain subjects (Kimpson, 2015).

Hepatitis A Outbreaks Associated With the Opioid Epidemic in Kentucky Counties, 2017–2018

Objectives. To describe county-level socioeconomic profiles associated with Kentucky’s 2017–2018 hepatitis A outbreak that predominately affected communities affected by the opioid epidemic. Methods. We linked county-level characteristics on socioeconomic and housing variables to counties’ hepatitis A rates. Principal component analysis identified county profiles of poverty, education, disability, income inequality, grandparent responsibility, residential instability, and marital status. We used Poisson regression to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs). Results. Counties with scores reflecting an extremely disadvantaged profile (RR = 1.21; 95% CI = 0.99, 1.48) and greater percentage of nonmarried men, residential instability, and income inequality (RR = 1.15; 95% CI = 0.94, 1.41) had higher hepatitis A rates. Counties with scores reflecting more married adults, residential stability, and lower income inequality despite disability, poverty, and low education (RR = 0.77; 95% CI = 0.59, 1.00) had lower hepatitis A rates. Counties with a higher percentage of workers in the manufacturing industry had slightly lower rates (RR = 0.97; 95% CI = 0.94, 1.00). Conclusions. As expected, impoverished counties had higher hepatitis A rates. Evaluation across the socioeconomic patterns highlighted community-level factors (e.g., residential instability, income inequality, and social structures) that can be collected to augment hepatitis A data surveillance and used to identify higher-risk communities for targeted immunizations.

The Ontario Disability Support Program Work Exit Process: Parallels to a Hostage Negotiation

There is a lack of empirical data on the experiences of people with mental illness (PMI) who transition from welfare to work, or how policy programs are designed to facilitate this outcome. We explore the factors that facilitate or hinder PMI from exiting disability income support programs in Ontario, Canada. Drawing on a grounded theory approach, we examine the process of exiting the Ontario Disability Support Program (ODSP). Data were collected from semi-structured interviews with current and former recipients with mental illness, service providers who support current and former recipients, and ministry staff. A metaphor for the work exit process emerged with four embedded themes: (a) picking yourself back up, (b) breaking the rules to get ahead, (c) stabilizing illness for employment success, and (d) displaying resiliency and resourcefulness for successful exits. The main finding is that system supports are not the determining factors in a successful transition. Rather, participants describe how recipients exit for employment by leveraging personal resources to successfully transition off income support benefits. A system redesign is needed to address the inherent tension between social and health programs if the policy intent is to promote successful welfare-to-work transitions for PMI.

Peace News and Radical Disability Writing in 1970s Britain: Perceptions of Welfare and the Welfare State

The 1970s were an important decade for disability policy in Britain. The 1970 Chronically Sick and Disabled Persons Act promised services for all disabled people and a series of cash benefits appeared to comprise a national disability income. By the 1980s, however, these measures had failed, and some disabled people had taken radical stances against the perceived failures of capitalism. This article shows that radical views amongst disabled people began earlier and were more common than has been assumed. It examines Peace News, a prominent activist publication, as evidence of this phenomenon. Disabled people in the 1970s became radicalised in response to traditional failures of British welfare and recent failures of the welfare state. They self-identified as a minority group—alongside homosexuals and ethnic minorities—and fought against discrimination. Unlike major disability organisations in the 1970s, disabled people had a militant approach to improving their welfare and their position in the welfare state.

Mental illnesses are not an ‘ideal type’ of disability for disability income support: Perceptions of policymakers in Australia and Canada

Aim: This article aims to explore how policymakers conceptualise a person suitable for disability income support (DIS) and how this compares across two settings – Australia and Canada. Methods: A constructivist grounded theory approach was used; 45 policymakers in Australia and Canada were interviewed between March 2012 and September 2013. All policymakers are or were influential in the design or assessment of DIS. Results: Results found that the policymakers in both jurisdictions define a suitable person as having as an ‘ideal type’ of disability with five features – visibility, diagnostic proof, permanency, recognition as a medical illness and perceived as externally caused. Many of the policymakers described how mental illnesses are not an ‘ideal type’ of disability for DIS by juxtaposing the features of mental illnesses against physical illnesses. As such, mental illnesses were labelled imperfect disabilities and physical illnesses as ‘ideal type’ for DIS. Conclusions: The rise of DIS recipients has divided the once protected ‘deserving’ category of the disabled into more (‘ideal type’ of disability) and less deserving (imperfect disability). Such conceptualisations are important because these categories can influence the allocation of welfare resources.