At the invitation of U.S. Rep. Jackie Walorski, ranking member of the Worker and Family Support Subcommittee at the Ways and Means Committee in the U.S. House of Representatives, Jim Sullivan, co-founder of the Wilson Sheehan Lab for Economic Opportunities (LEO) at the University of Notre Dame, testified at a March 10 hearing, “Health Profession Opportunity Grants: Past Successes and Future Uses.”
Health profession opportunity grants, known as HPOGs, are competitive grants awarded to organizations to provide education, training and supportive services to low-income individuals so they can obtain the credentials and skills needed for occupations in the health care field. The intended benefit is twofold: to fill the shortage of health care workers in communities across the country, and to help low-income individuals get out of poverty.
With this hearing, the subcommittee sought to understand how to modify the HPOG evaluation approach to focus evaluations at the community level, so it can truly know which HPOG-funded programs are performing well, what models work best to help low-income adults prepare for and enter stable and sustaining health care careers, and how to direct future investment for maximum impact.
Sullivan, who has presented to Walorski and the Committee Chair Danny Davis before on the work done at LEO, was asked to participate based on his 20 years of experience with researching the impact of domestic anti-poverty programs.
A national evaluation of the HPOG program found no impact on employment or earnings outcomes of recipients. However, this national evaluation approach was flawed. HPOGs themselves are not an intervention or service model; they are a funding source. The evaluation used pooled data from dozens of different HPOG recipients — all with different career pathways, approaches and service partners — making it impossible to identify those programs that might be getting better results.
“I was excited to see that Congress required an evaluation of HPOG. There are some promising things in the evaluation — increasing training completion and credentialing, and overall career connectedness — which is defined as being engaged full-time in some combination of work and school,” Sullivan said. “It’s true that the average income has not reflected a boost, but that was the overall effect. What we really want to know is what the effect of specific neighborhood programs is. It is not fair to use an overall, or aggregate, number because the programs being evaluated are not the same.”
Sullivan, who is also the Gilbert F. Schaefer College Professor of Economics, thinks there is no better way to measure accountability than by measuring impact. “I just like to see evaluations targeted at specific interventions so it’s very clear if there was impact created by a specific effort within a program.”
Concerned about spending taxpayer money on ineffective programs, Rep. Carol Miller asked Sullivan how to ensure that social service and job programs are working as intended. Sullivan stressed that, when developing these programs, it is crucial to consider the needs of individual communities. “What can be quite effective is to do the market analysis first and target the programs to match the needs. Goodwill Excel Center and the Padua program both do this,” he said.
Both of those programs include wrap-around services for their clients, meaning all of their needs, not just immediate crises, are considered by case managers. Both were evaluated by Sullivan and other team members at LEO and they show great promise, with the former resulting in a 35 percent increase in earnings that has persisted over time. The findings of the Padua program evaluation revealed that 25 percent of participants were more likely to have full-time employment than the control group. In addition, monthly earnings were 18 percent higher after two years compared with the control group, and 43 percent of participants reported improved health after two years.
“A lot of issues clients face are extremely personal. These can be very difficult to share with people you don’t have a strong relationship with. All the case managers talk about building strong relationships with clients and that builds trust. When you have trust, you can get down to the real issues,” Sullivan said. “A cookie-cutter approach will not allow for this customized approach.”
Rep. Gwen Moore asked what Sullivan called “the million-dollar question”: How can effective programs be scaled?
Sullivan agreed that the stakes are high due to the substantial amount of money the federal government invests in social service programs and acknowledged that programs like Goodwill Excel Center and Padua are small compared to the number of people in need. However, he underscored that programs that do not address all of their clients’ needs and truly help them walk the path out of poverty are not a wise investment.
“The structure of the safety net at the federal level isn’t designed to build a career ladder,” he said, referencing the nature of HPOG and other programs that offer ongoing services to support continuing education and job skills training. “Padua and similar programs are designed to do just that. I am optimistic that we can scale these with the right investment.”