Intensive Case Management to Overcome Barriers to Self-Sufficiency in the United States
- Job seekers
- Urban population
- Adults
- Earnings and income
- Employment
- Coaching and mentoring
- Job counseling
- Monetary incentives
- Psychosocial support
Programs geared toward those living in poverty (such as nutritional or rental assistance) often yield temporary solutions, rather than supporting individuals move closer to economic self-sufficiency. Prior evidence suggests that comprehensive case management programs could provide more support for certain population groups experiencing poverty by addressing a broad range of issues at once. Researchers worked with the City of Rochester—one of the cities in the United States with the highest poverty rates—and local social service providers to evaluate Bridges to Success, a comprehensive case management program. Mentors assigned to program participants aimed to support them in achieving better employment outcomes, increasing earnings, and making progress toward participants’ self-identified personal goals. A year after enrolling in the Bridges to Success program, participants had higher employment rates and were more likely to report progress toward achieving their personal goals than the comparison group.
Policy issue
Each year, through both private and public spending, the United States allocates close to US$1.8 trillion on resources for poverty alleviation.1 However, much of this funding goes toward addressing individuals’ immediate basic needs with one-size-fits-all solutions, rather than tackling the interconnected challenges of poverty in a more holistic way. For example, someone experiencing homelessness may also face health challenges, transportation limitations, or be under or unemployed—factors that compound and reinforce one another.
Comprehensive Case Management (CCM) programs provide a more holistic and individualized approach to social services. In these programs, a case manager supports each client in defining personal goals and provides intensive, flexible support to help them achieve these goals. By addressing multiple issues simultaneously, CCM programs have the potential to remove barriers to self-sufficiency for clients. This study investigated whether CCM programs can support individuals in achieving their personal goals and economic self-sufficiency, in the City of Rochester, New York.
Context of the evaluation
In 2013, the City of Rochester, New York had around 33 percent of the population living under the Federal Poverty Level (FPL), with around 16 percent of the population living in extreme poverty (under half the FPL).2 The city’s economic challenges stem largely from a major decline in manufacturing during the 20th century and an outflow of higher-income families, which together led to fewer economic opportunities and a rise in poverty. To better support Rochester’s residents experiencing poverty, the Rochester-Monroe Anti-Poverty Initiative (RMAPI) set a goal to improve the quality of life in the area by reducing poverty and promoting self-sufficiency. In 2016, RMAPI and the New York Governor’s Anti-Poverty Task Force piloted adult mentoring programs in Rochester, including Bridges to Success (BtS), the focus of this study.
Consistent with other CCM programs, BtS offered holistic support by pairing adults with low-income with mentors. These mentors helped participants move toward economic self-sufficiency by working with them to establish short-term and long-term goals and create action plans tailored to their needs. The individuals served by BtS generally experienced high levels of poverty, facing both long-term economic barriers and particular crises around the time of enrollment. Only half of them were employed one year prior to entering the program. Compared to others in urban communities, BtS participants were 26 percentage points less likely to have a high school degree, 77 percentage points more likely to be female, and 64 percentage points more likely to be Black.
Details of the intervention
Researchers conducted a randomized evaluation of the BtS program to measure its impact on employment, earnings, and progress toward individualized goals. After actively promoting the program through advertising, word-of-mouth, and intra-agency referrals, BtS staff conducted a standardized intake process with prospective participants. The study enrolled US citizens of working age who were able to work and whose household income fell below 200 percent of the FPL, and each eligible participant completed a baseline survey. Using a case management software, program staff randomly assigned 237 participants to the intervention group and 193 to the comparison group. The intervention group received BtS services while the comparison group participants were directly handed off to other programs that would meet their immediate needs.
Since BtS is a multidimensional program, participants worked toward different “life pillars”—such as housing, family support, health, social networks, education, or financial management—based on the areas they personally prioritized, beyond employment. Mentors then worked with participants to set long-term goals, identify actionable steps, and connect them to resources and partner organizations aligned with their priorities. Mentors met with participants for up to two years, aiming for at least monthly interactions, though in practice, meetings occurred more frequently. To support participants’ progress, BtS offered financial incentives for meeting participants’ established goals.
One year after conducting the baseline survey, researchers invited participants to complete an in-person follow-up survey to assess changes over time. The researchers also collected administrative data from multiple sources, including unemployment insurance records from the New York Department of Labor, benefits data from federal assistance programs, and consumer credit and housing mobility data from Experian.
Results and policy lessons
The intervention group participating in Bridges to Success had higher employment rates and self-reported improvements in their primary goal compared to non-participants in the comparison group.
Employment and earnings:
One year after the program, individuals assigned to BtS were 10 percentage points more likely to be employed than the comparison group (a 15 percent increase from a baseline of 64 percent). By the three-year mark, BtS participants continued to show higher employment rates, but the difference was no longer statistically significant. Lastly, the study did not find differences between participants and non-participants’ earnings.
Progress toward individualized goals:
Participants in the BtS program were more likely to report progress toward the personal goals they had identified at the start of the program, compared to those referred to other services. BtS participants were 19 percentage points more likely to report progress on their personal goals relative to the comparison group (a 28 percent relative increase from a baseline of 39 percent). However, when researchers used objective indicators to measure progress, such as changes in net assets to measure financial management, they did not find any significant improvements across the different life pillars.
The difference between participants’ self-reported improvement in life pillars and the objective indicators might have represented a shift in mindset rather than in circumstances. An index of hopefulness between 0 and 1 increased by 0.13 for BtS participants relative to an initial base index of 0, which may have influenced their perception of progress.
Cost-effectiveness:
Researchers estimated the program’s cost-effectiveness and found that the increase in participants’ after-tax earnings would need to continue for roughly seven years in order to outweigh the net cost of delivering the program. On average, the program cost about US$6,875 per participant per year in 2020, and participants engaged in services for approximately 1.65 years, for a total average cost of US$10,386 per participant. While earning gains from BtS are substantial, their long-term impact depends on whether the positive employment effects are sustained over time, beyond the time horizon of this study.
Overall, the findings suggest that Bridges to Success, a comprehensive case management program, has the potential to improve participants’ employment and self-reported progress toward primary goals in the short term.
Espinosa, Javier, Evans, William, Phillips, David, and Tim Spilde. "How Do Holistic Wrap-Around Anti-Poverty Programs Affect Employment and Individualized Outcomes?," NBER Working Paper #32911, September 2024
Tanner, Michael D. 2022. "Poverty and Welfare." Cato Handbook for Policymakers. https://www.cato.org/cato-handbook-policymakers/cato-handbook-policymakers-9th-edition-2022/poverty-welfare.
Rochester Area Community Foundation and ACT Rochester. 2019. "Benchmarking Rochester’s Poverty: A 2015 Update and Deeper Analysis of Poverty in the City of Rochester." https://www.racf.org/wp-content/uploads/2019/10/RACF-Poverty-Report-Update-2015.pdf.